PROFORMA FOR REGESTRATION OF SUBJECT FOR DISSERTATION

MR. MATHEW ISSAC

1ST YEAR M.Sc NURSING

COMMUNITY HEALTH NURSINGYEAR 2011-2013

PADMASHREE COLLEGE OF NURSINGGURUKRUPA LAYOUT, NAGARBHAVI

BANGALORE-560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS

Mr. Mathew Issac1st year M. Sc. NursingPadmashree College Of NursingNo. 23, 80 Feet RoadGurukrupa Layout, NagarbhaviBangalore - 560072

2 NAME OF THE INSTITUTION Padmashree College of Nursing

Bangalore

3 COURSE OF THE STUDY AND

SUBJECT

1st year M.Sc Nursing

Community Health Nursing

4 DATE OF ADMISSION 28-10-11

5 TITLE OF THE STUDY A study to assess the effectiveness of structured teaching program on knowledge and practices among mothers of preschool children on prevention of vitamin A deficiency diseases in a selected rural area, Bangalore.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Under five children are one among vulnerable population”

Health care of under five children has been markedly changed in developed

countries. There is a change in the view of children from, “Miniature adults” to

“Unique individual” with special needs and qualities, the under five children has

prime importance, as the mortality and morbidity are higher in this group, due to

vitamin deficiency disorders. Under five children focus on important segment of the

Indian population. They contribute to the vital human potential and impart strength to

the national economy and development.1

The word “vitamin” means life. Vitamins are substances essential for the

maintenance of normal metabolic functions they are required for the metabolism of

carbohydrates, fats and proteins. Vitamins are widely used as dietary supplements.

Even though vitamin supplements are of no demonstrated value for healthy infants,

child adolescents or adults who is consuming an adequate and varied diet.2

According to 2009 statistical report by WHO more than 254 million children

suffer from vitamin deficiency world wide in each year, 20-40 million children suffer

from mild vitamin-A deficiency and three million children from severe deficiency.

World health organization estimates that 100 to 140 million children under the age of

five may be living with dangerously low vitamin-stores. More than four million

children are world wide exhibit sign of severe deficiency. In Karnataka 0.3% of

children are suffering from vitamin deficiency.3

Vitamin A is essential for eye health and the proper functioning of the immune

system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm

oil and green leafy vegetables, although the amount of vitamin A readily available to

the body from these sources varies widely. In developing areas of the world, where

vitamin A is largely consumed in the form of fruits and vegetables, daily per capita

intake is often insufficient to meet dietary requirements. Inadequate intakes are further

compromised by increased requirements for the vitamin as children grow or during

periods of illness, as well as increased losses during common childhood infections. As

a result, vitamin A deficiency is quite prevalent in the developing world and

particularly in countries with the highest burden of under-five deaths.4

Vitamin A deficiency (VAD) is a major nutritional concern in poor societies,

especially in lower income countries. Its presence as a public health problem is

assessed by measuring the prevalence of deficiency in a population, represented by

specific biochemical and clinical indicators of status. The main underlying cause of

VAD as a public health problem is a diet that is chronically insufficient in vitamin A

that can lead to lower body stores and fail to meet physiologic needs. Deficiency of

sufficient duration or severity can lead to disorders that are common in vitamin A

deficient populations such as xerophthalmia, the leading cause of preventable

childhood blindness, anaemia, and weakened host resistance to infection, which can

increase the severity of infectious diseases and risk of death.5

Vitamin-A deficiency is seen more commonly in under five children (1-5 yrs).

Vitamin-A deficiency affect the eyes. It causes “xeropthalmia” which is characterized

by series of clinical signs. These are include- Night blindness, Conjuctival xerosis,

Bitot-spot, Corneal ulceration, Karatomalacia and Corneal scar. Dietary deficiency of

vitamin-A most commonly and importantly affects the eyes, and it can lead to

blindness. Xerophthalmia, meaning drying of eyes (from the Greek word Xerox,

meaning dry) is the term now used to cover the eye manifestations resulting from

vitamin-A deficiency.6

A poor diet and infection frequently coexist and interact in populations where

VAD is widespread. In such settings, VAD can increase the severity of infection

which, in turn, can reduce intake and accelerate body losses of vitamin A to

exacerbate deficiency. The prevalence and severity of xerophthalmia, anaemia and the

(less-measurable) “vicious cycle” between VAD and infection in vulnerable groups

represent the most compelling consequences of VAD and underlie its significance as a

public health problem around the world.5

6.2 NEED FOR STUDY:

During the first year after birth, breast milk from a well nourished mother

provide all vitamins that an infants needs, since 12% of the children (1-5yrs)

constitutes a valuable and much neglected population of our country education and

health status of children of a nation is a highly reliable index of health of its

population, under five children suffer from major health problem of them is vitamin

deficiency disorders and the reason are overcrowding, unhygienic products, poor

environmental health, poor education or lack of knowledge in mothers and poor

nutrition.7

Vitamin-A deficiency is a major public health problem those most deficiency

countries. In children, Vitamin-A deficiency disorder is the leading cause of

preventable visual impairment and blindness. Vitamin-A was estimated to affect

between 75 and 254 million preschool children each year. In a recent meta-analysis

conducted by West 127.2 million preschool-aged children were vitamin A–deficient;

this figure represents 25% of preschool-aged children in developing countries and in

one developed country experiencing social conflict. Estimated 250,000–500,000

vitamin- A deficient children become blind every year, and about half of them die

within a year of becoming blind vitamin-A deficiency significantly increases the risk

of severe illness and death from common childhood infections, particularly diarrhoeal

diseases and measles. It was estimated that worldwide, vitamin-A deficiency may be

responsible for as many as 1.3–2.5 million deaths annually.8

A survey of blind school students in Nine Indian states revealed that 18.6% of

the blindness was due to vitamin-A deficiency and another 3.2% due to measles

which precipitates vitamin-A deficiency. On the other hand, vitamin-A deficiency

contributed to only 5.5% of the childhood blindness in a population-based survey in

West Godavari district of Andhra Pradesh. The magnitude of childhood blindness due

to vitamin-A deficiency probably varies considerably in different parts of India. This

may be related to variations in socioeconomic status. Vitamin-A deficiency also

contributes to child mortality, which can be reduced with vitamin-A

supplementation.9

In Karnataka (2007) the stages of xerophthalmia in Rural areas are, Night-

blindness 2.9%,Conjuctival-xerosis 25.1%,Bitot-spot 8.8% in Urban areas, Night-

blindness 1.1%,Conjuctival-xerosis 18.9% and Bitot-spot 5.2%.10

Eyes are windows for the human being through which they are able to utilize

the entire glory of the nature. This vision can be affected by many factors such as-

faulty practices malnutrition, infection and refractive errors. The vitamin-A deficiency

is the major cause of disturbances in vision during preschool age. Vitamin-A is

essential nutrient that play an important role in vision. Inadequate dietary intake of

vitamin-A is the primary cause of vitamin-A deficiency. Low fat content of diet is

also an important contributory factor. The consumption of animal foods that contain

performed vitamin-A is very low because of cost.11

The Researcher during his experience has also found that mothers had lack of

knowledge regarding prevention of selected vitamin A deficiency disorders. So

investigator felt the need to assess the mother’s knowledge regarding prevention of

selected vitamin A deficiency disorders in preschool children and to impart structured

teaching programme to improve the mothers knowledge.

6.3 STATEMENT OF PROBLEM

A study to assess the effectiveness of structured teaching program on knowledge and

practices among mothers of preschool children on prevention of vitamin A deficiency

diseases in a selected rural area, Bangalore.

6.4 OBJECTIVES

1. To explore the knowledge and practices among mothers of pre-school children

regarding prevention of vitamin A deficiency diseases.

2. To assess the effectiveness of structured teaching program on knowledge and

practices on prevention of vitamin A deficiency diseases.

3. To correlate the knowledge and practices on prevention of vitamin A deficiency

diseases among mothers of preschool children.

4. To associate the pre-test knowledge and practices on prevention of vitamin A

deficiency diseases among mothers of preschool children with their selected

demographic variables.

6.5 OPERATIONAL DEFINITIONS

1. Assess: It is the activity to estimate the outcome of teaching program on

prevention of vitamin A deficiency diseases.

2. Effectiveness: It refers to significant increase in the level of knowledge and

practices among mothers of preschool children regarding prevention of vitamin

A deficiency diseases.

3. Structured Teaching Program: It refers to systematically developed instruction

with teaching aids designed for mothers of preschool children regarding

prevention of vitamin A deficiency diseases by using A.V aids such as charts,

video of vitamin A deficiency diseases, flash cards and posters.

4. Knowledge: It refers to number of correct responds received from the mothers of

preschool children regarding prevention of vitamin A deficiency.

5. Practices: It refers to the practices that are followed by mothers of preschool

children to prevent vitamin A deficiency among pre-school children such as eye

care, dietary management, vitamin A prophylaxis, cooking habits.

6. Mothers: This refers to women who are having their own children in the age

group of three to five years and are residing in selected rural area.

7. Preschool children: This refers to children in the age group of three to five

years who are residing in selected rural area.

8. Prevention: It refers to the promotion of constructive lifestyle and norms that

discourage the vitamin A deficiency diseases among preschool children.

9. Vitamin A deficiency: It refers to the blood serum vitamins A that are below a

defined range (30 - 95 µg/dL) due to failure in intake of sufficient amount of

vitamin A or beta carotene.

6.6 ASSUMPTIONS

The mothers may have inadequate knowledge regarding prevention of vitamin

A deficiency diseases.

The adequate knowledge and healthy practices of mothers regarding

prevention of vitamin A deficiency diseases may lead to good vision.

The selected variables have influence on mothers knowledge and practices

regarding prevention of vitamin A deficiency diseases.

6.7 HYPOTHESIS

H1:- There will be significant differences between pre and post test of mothers of

preschool children regarding prevention of vitamin A deficiency diseases.

H2:- There will be a significant relationship between pre and post test knowledge of

mothers of preschool children on prevention of vitamin A deficiency diseases.

H3:- There will be significant association between pre knowledge and practices of

mothers of preschool children regarding prevention of vitamin A deficiency

diseases.

6.8 REVIEW OF LITURATURE:

The term literature review refers to the activities involved in identifying and

searching information on a topic and developing an understanding of the state of

knowledge on topic. Also review of literature is a written summery of the state and

the art of a research problem. Literature review is an essential step in the whole

process of research. Therefore the researcher has reviewed literature with regard to

the problem by referring books, journals, thesis, etc.

In this study the relevant literature reviewed has been organized and presented

under the following headings.

1. Studies related to etiology & risk factors on vitamin-A deficiencies.

2. Studies related to manifestation, Treatment and Prevention of vitamin-A

deficiencies.

3. Studies related to Lack of knowledge and the effectiveness of structured

teaching programme on selected vitamin-A deficiencies.

1. Studies related to etiology & risk factors on vitamin-A deficiencies.

A cross sectional study was conducted to determine the risk factors of

xeropthalmia among preschool children at primary centre (Bihar), in rural India. 4,205

preschool children were samples of the study. The outcomes were risk factors of

xerophthalmia, nearly socioeconomic status and a history of repeated diarrhoea,

measles, passing worm in stool and respiratory tract infection. The result indicate that

the socio economic status of families, a history of passing round worm in stool and

diarrhoea were important antecedent risk factors in vitamin-A deficient in preschool

children.12

A study was conducted on Drumstical leaves as a source of vitamin-A in

ICDS-SEP, An integrated approach was adopted in this study. This included

comprehensive training sessions for the staff of the ICDS and non government

organization (NGO) involved in the SF preparations. Prior to the acceptability trails,

the data were elicited on the socioeconomic profile and knowledge about vitamin-A,

of 60 children of 1-5 years of age attending two aganwadi centers of the ICDS. The

results indicates that integration of nutrition communication along with the

introduction of unconventional Dehydrated Drumstick leaves (DDL), into the ICDS-

SF, was feasible and can be endeavored for a longer duration in the existing national

programme.13

A study was conducted among under five children on dietary xerophthalmia in

Jimma town, south west Ethiopia to assess patients knowledge about children need for

plants sources of vitamin-A intake. The objective of the study was to estimate the

prevalence of xerophthalmia and to forward appropriate recommendations. Eight

hundred and thirty one children between the ages of six to 59 months were sample of

the study. The result of study showed that only eighty percent of the children were

getting green vegetables, fruits and carrots once a weekly or more. The major reasons

given for not including green vegetables, fruits and carrots in the diet were “can not

afford” (39%) ”not available” (33%) and child too young (16). Thus it was

recommended that periodic vitamin-A supplementation, preferably combined with

immunization, should be a priority action and parents need to be educated about

vitamin-A deficiency and its prevention.14

A study was conducted to investigate risk for sub clinical vitamin-A

deficiency among under six years of age in urban slums of Nagpur, India. The current

study recognized a significant association between female gender, ill-literate mother,

lower socio economic status, more than two children of under five years of age at

home, under nutrition, history of Diarrhoea, Measles, Acute respiratory tract infection

and sub clinical vitamin-A deficiency on univariate analysis.15

2. Studies related to manifestation, Treatment and Prevention of vitamin-A

deficiencies.

A study was conducted to compare vitamin-A supplementation status of

children age 6-60 months to the prevalence of vitamin deficiency disease, mal-

nutrition, diarrhea and acute respiratory tract infections with the help of trained

female community health worker. They interviewed mothers about child health status

by using a standardized questionnaire. The nutritional status of children were

estimated using mid upper arm circumference measurements. The results indicated

that compared to children who did not receive supplements, children who received

vitamin-A supplements regularly had less malnutrition, diarrhea and acute respiratory

tract infections regardless of the number of children per house hold, age, sex or

fathers occupation.16

A study was performed as a research project to evaluate the effectiveness of a

wide spread vitamin-A supplementation programme and to describe indicators of

compliance with the programme in Indonesia. The design used was prospective cohort

study and the samples were children aged 1-5yrs. It was that vitamin-A

supplementation programme marginally decreased the portion of vitamin-A

deficiency and had a marginal effect on the nutritional status of the recipients. Thus it

was recommended that more than one micronutrient intervention is needed to increase

the effectiveness of the supplementation programme. To increase compliance and

coverage in the supplementation programme, nutrition communication and private

health care practices are needed to be included in the programme. 17

A community based interventional study was conducted to determine the

impact of vitamin-A supplementation on child morbidity and nutritional status. The

pre and post intervention data on xerophthalmia, morbidity, nutritional status and

serum retinol levels were compared. The results indicates that vitamin-A capsule

coverage of 87 percent in all village were as and a statistically significant (p<0.05)

reduction in the prevalence of Bitots-spot, Measles, conjunctivis and Diarrhoea. It was

concluded that the significant improvement in morbidity and nutritional status with

nutritional educations.18

A study was conducted to assess effect of vitamin-A supplementation on

childhood morbidity and mortality. In a double blind design, 1520 children aged <10

years were individually randomized in vitamin-A and placebo group in slums of

Chandigarh. The results revealed that prevalence of vitamin-A deficiency was

significantly reduce in vitamin-A compared to placebo group during the follow up

period. Finally it was concluded that promotion of vitamin-A rich diet or

supplementation with synthetic vitamin-A at 4-6 month interval should be a priority in

populations where risk of vitamin-A deficiency is high. 19

A study was performed on assessment of progress in prevention and control of

vitamin deficiency disorders in department of international health, Emory University,

Atlanta, USA. They found that key recommendations for specific interventions were

to double the existing dose of prophylactic Vitamin-A supplementation to 50,000 IU

at three expanded programme on Immunization contact for young infants and two

doses of 2,00,000 IU each for women with in six-week after delivery and to include

promoting breast feeding and consuming animal product they concluded that the 21 st

century and called for successful implementation of integrated approaches that will

eliminate vitamin-A deficiency disorders.20

A study was conducted on the coverage of vitamin-A supplements among

under five children in block I.A. of Gulshan-e-Sikanderabad, Karachi. The objective

of the study was to assess the incidence of symptoms related to Hypervitaminosis.

The results revealed that data was obtained in 489 children. The coverage of polio and

vitamin-A supplementation was 88% and 74.8%. They found that vitamin-A

supplementation can save lives. It is only a short term measures, what is needed is a

multistrategy approach including short and long term strategies.21

A study carried out on administration of 25,000 IU vitamin-A doses at routine

immunization among under five children at diarrhea treatment centre, Dhaka,

Bangladesh. Infants were randomly assigned to receive either 25,000 IU vitamin-A or

placebo. The results revealed that 101 infants received vitamin-A and 98 received

placebos. Irritability, Diarrhoea and Vomiting were comparable between two groups

they concluded that the results suggested that administration of 25,000 IU of Vitamin-

A in under five children along with routine immunizations through associated with

increased incidence of transient bulging fontanalle without any associated adverse

sign and symptoms, may still be inadequate to prevent deficiency population.22

3. Studies related to Lack of knowledge and the effectiveness of structured

teaching programme on selected vitamin-A deficiencies.

A cross-sectional survey was conducted on nutrition education efforts for

mothers of under five children to prevent vitamin-A deficiency. Samples of the study

were mothers (N-15) from rural/ peri-urban villages’ provinces to assess vitamin-A

knowledge regarding vitamin-A was low in all villages regardless of difference in

socioeconomic status and level of education. The study concluded that educational

interventions should focus on basic vitamin-A Knowledge regarding sources as well

as symptom of deficiency. Education should also emphasize increasing the variety of

food rich in pro-vitamin-A carotetnoids grown in home garden.23

A study carried out to evaluate the long term effect of a horticultural and

nutrition education intervention. A quasi-experimental post term design was used. The

research was carried out in 10 villages in Singida region, Tanzania. Mothers and their

children aged 6-71 months (n-236) from experimental (Ilongero) and control (Ihanja)

were interviewed regarding knowledge and practices were more favorable to vitamin-

A intake in of green leaves was associated with higher serum retinol values. Thus it

was concluded that food based vitamin-A programmes can make sustainable

improvements in knowledge and dietary practices. 24

A study was conducted to assess the effectiveness of training programme on

the knowledge of vitamin-A deficiency among Anganwadi workers in a rural area of

North India. Training of 95 Anganwadi workers was done in two groups’

i.e.expremental and control groups in a rural block of Hyrayana state, India to impart

knowledge on vitamin-A deficiency through lecture, demonstration and discussion

methods. This study revealed the need for in-services training of Anganwadi workers

using appropriate teaching methods incorporating audio-visual aids like film slide

shown for control of vitamin-A deficiency.25

7. MATERIALS AND METHOD

7.1 SOURCES OF DATA

The data will be collected from the mothers of preschool children in the selected

rural area, Bangalore.

7.2 METHODS OF DATA COLLECTION

i. Research Design

One group pre and post test.

ii. Research variables

Independent variables

Structured teaching program on prevention of vitamin A deficiency

diseases.

Dependent variables

knowledge and practice level among mothers of preschool children on

prevention of vitamin A deficiency diseases.

iii. Settings

The study will be conducted in a selected rural area, Bangalore.

iv. Population

The population will be the mothers of preschool children in selected

rural area, Bangalore.

v. Sample

A sample of 50 mothers of preschool children

vi. Criteria for sample selection

Inclusion criteria

Mothers of preschool children:-

Who are willing to participate in study

Who are having their own children

Who are residing in rural area

Who are able to read and write Kannada.

vii. Sample technique

Probability sampling - simple random sampling – lottery method will

be adopted for selecting the sample.

viii. Tools for data collection

Section A

Interview schedule will be used to assess the demographic variables

such as age of mother, age of child, sex of child, religion, parents education,

parents occupation, parents income, type of family, immunization status, past

history of eye diseases and sources of information.

Section B

Structured knowledge questionnaire will be used to assess the

knowledge of mothers of preschool children on prevention of vitamin A

deficiency diseases.

Section C

A check list will be used to assess the practices of mothers having

preschool children.

ix. Method of data collection

Phase 1

Formal permission will be obtained from the concerned authorities and

participants, after explaining the purpose of study by the investigator.

Phase 2

Prior to data collection, the pre-test will be conducted by administering

structured knowledge questionnaire on assessment of mothers of preschool

children.

Phase 3

Structured teaching program will be conducted approximately for 45 -

50 minutes by using AV aids such as poster, chart and pictures of Vitamin A

deficiency diseases.

Phase 4

After seven days the post-test will be conducted by administering the

same knowledge and practice questionnaire which was used for the pre-test.

x. Plan for data analysis.

The data will be analyzed by means of descriptive and inferential

statistics.

Descriptive statistics

Frequency and percentage distribution will be used to study

demographic variables of the mothers regarding prevention of vitamin

A deficiency diseases among preschool children.

Mean and standard deviation will be used to determine the level of

knowledge and practice of mothers regarding prevention of vitamin A

diseases.

Inferential statistics

Spearman’s correlation will be used to correlate the knowledge and

practices of mothers regarding prevention of vitamin A deficiency.

Chi-square test will be used to find out the association between

knowledge and practices of mothers of under five children with

selected demographic variables.

xi. Project outcome

After the study, the researcher will come to know the level of the

knowledge and practices of the mothers of preschool children regarding

prevention of vitamin A deficiency diseases.

7.3 Does the study require any investigations or interventions to the patients or

other human beings or animals?

No, the study requires only assessment of knowledge and practice of mothers

of preschool children. The investigator is planning only for structured teaching

programme and no active manipulation is involved in the study.

7.4 Has ethical clearance obtained from your institution?

Yes, the permission will be obtained from institution and concerned

authorities of the selected setting. Consent will be obtained from the sample and

privacy and confidentiality will be maintained. Ethical clearance certificate will be

enclosed.

8. LIST OF REFERENCE

1) http://www.scribd.com/doc/49187895/Encyclopedia-of-Children-and-Childhood-in-History-and-Society-Volume-1-A-E

2) Garg P, Zaloga. Nutrition in critical care. New York: Mosby publishers, 1994: 177-90.

3) Underwood B.A. Vitamin-A deficiency disorders, international efforts to control a preventable pox. Journal of nutrition 2004. Jan; 134 (1): 231-6.

4) http://www.childinfo.org/vitamina.html

5) WHO. Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO Global Database on Vitamin A Deficiency. 2009: 1-10.

6) Gulani K.K. Principle and practice community health nursing. 1st ed. Delhi: Kumar publication, 2005; 412-4.

7) Colin D. Rudolph, Abraham M. Rudolph’s pediatrics. 21st edition, McGraw hil: Medical publishing division, 2001: 1321-5.

8) www.who.com. (World health organizations micronutrient information, 2008).

9) Busie B, Maziya-dixon, Isaac O. Akinyele, Rasaki A, Sanusi, Tunde E.Oguntona et al. Vitamin-A deficiency is prevalent in children less then five years of age in Nigeria. Nigeria :International institute of tropical Agricultural.

10) Kulkarni, M.L. Prevalence of vitamin-A deficiency among preschool children in rural area. Newsletter-sight and life, 2007: 31.

11) Venkateswaran C. Vitamin-A role in newborn and children. Indian Journal of pediatric practice. 2001; 3(4): 81-2.

12) Pal R, Sagar V. Antecedent risk factors of xeropthalmia among rural preschool children. 2008 Mar; 34 (2): 106-8.

13) Nambiar, V.S. Drumstick leaves as source of vitamin-A in ICDS-SEP. Indian Journal of Pediatric. 2003; 70(5): 383-7.

14) Getaneh, T. Dietary practices and Xeropthalmia in under five children. Jimma town: Southwest Ethiopia.

15) Khandait, D.W. Risk factors for sub clinical vitamin-A deficiency in children under the age of six year. Journal of Tropical Pediatrics 2002; 46 (4): 239-41.

16) Grubesic R.B. Vitamin-A supplementation and health out comes for children in Nepal. Journal of nursing scholarship 2003; 35(1): 15-20.

17) Pangaribuan, R.Vitamin-A capsule distribution to control vitamin-A deficiency in Indonesia.Public health Nutrition 2003; 6 (2): 209-16.

18) Tsegage, D.Impact of vitamin-A supplementation child morbidity and nutritional status. American Journal of Nutrition 2003; 16: 1295-303.

19) Chowdhury, D. Effect of vitamin-A supplementation on childhood morbidity and mortality, Indian Jouranal of Medical Science 2002; 56 (6): 259-64.

20) Ramakrishnan U, Darnton-Hill I, Assessment and control of vitamin-A deficiency disorders. Nutritional Journal 2002; 132 (9): 2947-53.

21) Bharmal FY, Omair A. Evalution of vitamin-A supplementation in Gulshan-e-Sikandarabad. 2001.Jul; 51 (7): 248-20.

22) Rahman MM, Mahalanabis D, Wahed MA, Islam. MA, Habte D. Administration of 25,000 IU vitamin-A doses at routine immunization in young infants. 1995.Jan; 49(6): 439-45

23) Mills J.P, Mills TA, Reicks M. Caregiver knowledge, attitudes and practice regarding vitamin-A Intake by Domician children. 2007 Jan; 3 (1): 58-68.

24) Kidala D. Five year follow up a food based vitamin-A interventation in Nepal Indian Journal of pediatric. 2000; 65: 547-55.

25) Singh M.M. Effectiveness of training of the knowledge of vitamin-A deficiency among Anaganwadi workers in a rural area of North India. Indian Journal of public health.1999; 43 (2):79-81.

9. Signature of the candidate :

10. Remark of the guide : This study is essential to create an awareness among mother of preschool children to prevent vitamin A deficiency diseases.

11. Name and designation :

11.1 Guide : Mrs. Suseela J. R

H.O.D, Community Health Nursing

11.2 Signature :

11.3 co-guide (if any) : Nil

11.4 Signature :

11.5 Head of the department : Mrs. Suseela J. R

H.O.D, Community Health Nursing

11.6 Signature :

12.1 Remark of the principal : The study is relevant and appropriate for the specialty chosen.

12.2 Signature :