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PRACTICAL SKILL DEVELOPMENT IN PREPARATION OF PROTOTYPE PLAN ON HEALTH PROMOTION IN SPORT CENTERS
- 1. i PRACTICAL SKILL DEVELOPMENTIN DEVELOPMENT OF INTERPERSONAL HEALTH COMMUNICATION MEDIA AND ITS APPLICATION FOR COUNSELING ON MATERNAL, INFANT AND YOUNG CHILD NUTRITION PSD submitted to fulfill the partial requirements of Masters in Public Health (MPH) Third semester (Applied Health Communication, PSD 624) Submitted by: Mohammad Aslam Shaeikh Sarmila Baral Submitted to: Master of Public Health Program School of Health and Allied Science Faculty of Health Sciences Pokhara University, Kaski, Nepal November, 2019
- 2. ii DEVELOPMENT OF INTERPERSONALHEALTH COMMUNICATION MEDIA AND ITS APPLICATION FOR COUNSELING ON MATERNAL, INFANT AND YOUNG CHILD NUTRITION Submitted by: Mohammad Aslam Shaiekh, 1870003 Sarmila Baral, 18700006 PSD report submitted to fulfill the partial requirements of Masters in Public Health (MPH) Third semester (Applied Health Communication, PSD 624) Submitted to: Master of Public Health Program School of Health and Allied Science Faculty of Health Sciences Pokhara University, Kaski, Nepal November 2019
- 3. iii Approval Mr Mohhamad AslamShaeikh and Ms Sarmila Baral have prepared the project report entitled “Development of interpersonal health communication media and it’s application for counseling counseling on maternal, infant and young child nutrition The project report has been prepared and presented for the partial fulfillment of the requirement for the degree of Master of Public Health (MPH) and forwarded for final evaluation. …………………………………….. Dr. Dipendra Kumar Yadav Associate Professor, School of Health & Allied Sciences Date: Master of Public Health (MPH) Program, School of Health and Allied Sciences, Faculty of Health Sciences, Pokhara University, Pokhara Metropolitan-30, Kaski, Nepal. This report/proposal has been reviewed and accepted Accepted with condition Not accepted Not accepted External Examiners 1. Name: _____________________ Signature: _____________ Date: _________ 2. Name: _____________________ Signature: ______________ Date: __________ __________________ ______________________________ Chiranjivi Adhikari Dr. Damaru Parsad Paneru Program Coordinator, MPH Director School of Health & Allied Sciences School of Health & Allied Sciences
- 4. iv Declaration To the bestof our knowledge and belief we declare that this project entitled “Development of interpersonal health communication media and its application for counseling on Maternal, Infant and young child nutrition. “Is the result of our own project and contains no material previously published by any other person except where due acknowledgement has been made. This project report contains no material, which has been accepted for the award of any other degree or diploma in any university. Signature Name Mohammad Aslam Shaiekh Sarmila Baral Roll No 18700003 18700006 PU Regd No 2018-4-70 2018-4-70- Date 2019 Novemeber 2019 November
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- 6. vi ACKNOWLEDGEMENT Our heartiest gratitudegoes to our subject teacher, Associate Professor, Dr. Dipendra Kumar Yadav for his continuous inspiration, valuable guidance and suggestion. We express our hearty thanks to, Mr. Chiranjeevi Adhikari, MPH coordinator and Associate Professor Dr. Damaru Prasad Paneru, Director of School of Health and Allied Sciences for providing me the opportunity to conduct Practical Skill Development (PSD) for enhancing skills in practical setting. We would like to thank our entire MPH team who kindly helped us by providing feedbacks and comments throughout the study and during presentation. We would like to utilize this opportunity with great pleasure to thank all those who were participated on our PSD work. Mohammad Aslam Shaeikh, Sarmila Baral MPH 3rd semester
- 7. vii TABLE OF CONTENTS Approval................................................................................................................................................iii Declaration.............................................................................................................................................iv ACKNOWLEDGEMENT .....................................................................................................................vi TABLE OF CONTENTS......................................................................................................................vii CHAPTER I: INTRODUCTION............................................................................................................2 Background.........................................................................................................................................2 Rationale .............................................................................................................................................3 Objective.............................................................................................................................................4 General objective ................................................................................................................................4 Specific objective:...............................................................................................................................4 CHAPTER II: LITERATURE REVIEW ...............................................................................................5 CHAPTER III: METHODOLOGY ........................................................................................................7 3 ..........................................................................................................................................................7 CHAPTER IV: ACTIVITIES.................................................................................................................8 CHAPTER IV: CONCLUSIONS, RECOMMENDATIONS AND SKILL DEVELOPMENT ..........25 Conclusions.......................................................................................................................................25 Recommendations.............................................................................................................................25 REFERENCES .....................................................................................................................................26 ANNEXES............................................................................................................................................26
- 8. 2 CHAPTER I: INTRODUCTION Background Goodnutrition is the bedrock of child survival, health and development. Well-nourished children are better able to grow and learn, to participate in and contribute to their communities Nutrition education and counselling is a widely used strategy to improve the nutritional status of women during pregnancy. The strategy focuses primarily on: promoting a healthy diet by increasing the diversity and amount of foods consumed promoting adequate weight gain through sufficient and balanced protein and energy intake Promoting consistent and continued use of micronutrient supplements, food supplements or fortified foods. The period between conception and the age of two years that, with good health and nutrition i.e. MIYCN practices can mitigate the risks of malnutrition that hamper a child’s long-term physical and cognitive development. Infant and young child feeding practices have a direct effect on the nutritional status of under two children which ultimately impact child survival.(WHO 2015). The optimal feeding practices are poor with complementary feeding practices among 6 to 23 months of age.(Basnet D, 2016). Good nutrition and dietary behaviors in childhood are important to achieve full growth potential and appropriate body composition, to promote health and well- being, and to reduce the risk of chronic diseases in adulthood. Growth continues at a steady rate during childhood, then accelerates during adolescence, creating increases in nutrient needs to support the rapid growth rate and increase in body weight. In addition to the impact on growth and development, children’s diets are important to ensure overall health and wellbeing. (Adhikari 2008) Problem Statement More than one-third (36%) of children under five in Nepal are stunted, or too short for their age. Stunting is more common in rural children (40%), compared to urban children (32%). Overall, 10% of children are wasted (too thin for height), a sign of acute malnutrition. In
- 9. 3 addition, 27% ofchildren are underweight, or too thin for their age. Similarly 36% of children’s are stunted. Stunting is more common in the mountain and hilly areas while wasting and underweight are more common in Terai areas. Overall, 53% of children are suffered from some degree of anemia, 26% mildly anemic and less than 1% severely anemic. The prevalence of anemia decreases with age, ranging from high of 74% among children age 12-17 months to a low of 36% among children age 48-59 months. About 24% of newborns are born with low birth weight. Only 66% of infants get exclusive breastfeeding in the first six months of life. Only 47 per cent children aged 6-23 months are receiving diversified diets and 36 per cent of them receive a minimum acceptable diet. Four in ten women age 15-49 in Nepal are anemic. The proportion of women (BMI less than 18.5, which indicates under nutrition) is 17% and the prevalence of anemia among pregnant women is 46%. NDHS 2016 Skills needed to address the Problem Rationale The first 1,000 days from the start of a woman’s pregnancy to a child’s second birthday offer an extraordinary window of opportunity for preventing undernutrition and its consequences. About 80% of mental development occurs within 2 years of age We need to target our actions to this critical period, using widely accepted and evidence-based interventions, including support for breastfeeding, appropriate complementary foods for infants over six months, and micronutrient supplementation for women and children to address deficiencies. These investments in nutrition – particularly in the earliest years of life – can yield dramatic results for children, their families, and communities. Among various professional skills of Health promotion and education/ Public health professionals, different media designing, developing, producing, using and evaluating is one of the most important competency/ skill.
- 10. 4 Objective General objective: To developinterpersonal health communication medias and apply for counseling on Maternal, Infant and young child feeding (MIYCF) practice Specific objective: To develop interpersonal health communication Medias on Maternal, infant and young child nutrition To conduct counseling on Maternal, infant and young child nutrition
- 11. 5 CHAPTER II: LITERATUREREVIEW A cross-sectional study was conducted in Rupandehi district of Western Nepal to assess complementary feeding practices, and associated factors. Face-to-face interviews were conducted among 178 mothers of young children aged 6–23 months using a structured questionnaire and data on complementary feeding practices, only 57 % of mothers initiated complementary feeding at the age of 6 months. While the proportion of young children receiving minimum meal frequency was reasonably high (84 %), meal diversity (35 %) and minimum acceptable diet (33 %) remained low. Maternal education and having had their children’s growth monitored were independently associated with receiving minimum acceptable diet. Study concluded that This study reported only one-third of infants met the recommended meal diversity and acceptable diet showing a major gap in infant and young child feeding practices in Western Nepal. Study recommended that the health promotion programs that educate and enhance the skills of mothers should be a priority for future nutrition interventions.(Gautam et al., 2016) For assessing the nutritional status of under-five children and factors associated a cross- sectional study was conducted in Kapilvastu district, Nepal. Total 450 children i.e. 15 children from each VDC were chosen conveniently. Study showed that the Better socio- economic status, mother’s age 20-35 years, birth order up to second, gap more than two year between two pregnancies, recommended exclusive breast feeding, early recommended supplementary foods, complete immunization and timely care seeking had positive effect on children health, which were also statistically significant. More than 60% of children’s were found with malnutrition(Bhandari, 2013) A quasi-experimental design was employed in three rural villages of 3 districts in Nepal to assess the impact of peer facilitators for improving maternal, infant and young children’s nutritional status. Differences over time between comparison (C) and intervention (I) groups show that the PF approach had a significant positive impact on several indicators of mothers’ knowledge and practices relating to maternal and child nutrition: (i) knowing that fruits and vegetables are good for children 6–23·9 months (ii) child dietary diversity (iii) child minimum dietary diversity (iv) maternal dietary diversity and (v) maternal minimum dietary diversity Additionally, exposure to a PF three or more times in the past 6 months was positively associated with a small improvement in maternal and child dietary diversity scores(Singh A et all, 2018)
- 12. 6 Nutrient requirements arehigh during pregnancy and lactation because of the need to support fetal growth and production of breast milk. In regions such as South Asia, meeting nutrient needs during the first 1000 days is a major challenge. Pregnant and lactating women and their young children need diets with high micronutrient density, but in low-income populations, intakes are usually well below recommended amounts for several key nutrients because diets are dominated by staple foods with low nutrient density and poor mineral bioavailability. Several options for improving diets of pregnant and lactating women and their infants exist, including dietary diversification and increased intake of nutrient-rich foods, improved complementary feeding practices, micronutrient supplements and fortified foods or products specifically designed for these target groups. In South Asia women’s are poorly nourished with poor hygiene and sanitation.(Dewey, 2016) Poverty is the most important determinant for poor nutrition in Nepal. Nepal ranks at 157th position out of 187 countries in Human Development Index with 54 percent of total population living on US$ 1.25 per day (NPC & CBS, 2013). Infant and young child feeding practices have a direct effect on the nutritional status of under two children which ultimately impact child survival.(WHO 2015). The optimal feeding practices are poor with complementary feeding practices among 6 to 23 months of age.(Basnet D, 2016). A cross-sectional study was conducted in in Lamjung, Gorkha and Tanahun to find the nutritional status of 6 to 59 months of children and its associated factors. Results showed that the significant numbers of under-five children were malnourished. The prevalence of wasting, stunting and underweight among the children were 10.6%. 53.9% and 20.8% respectively. Boys were more likely to be wasted, stunted and underweight compared to girls.(Dhungana GP,2017) Poor nutritional status is an alarming public health problem in Nepal. Malnutrition, iron deficiency anemia and other micronutrient deficiency disorders among the children, adolescents and women are some major nutritional health problems prevailing in Nepal (WHO, 2008).
- 13. 7 CHAPTER III: METHODOLOGY 3.1Project method 3.2 Project Area The study was conducted on Pokhara-30 Khudi targeting Pregnant and mothers of under 2 year children. Total 10 mothers were counselled. 3.3 Ethical consideration: Approval was taken from subject teacher and coordinator to conduct the program Identification of the major nutrition problem through literature review Title selection through group discussion with group members and teachers Media selection: Poster and flipchart for interpersonal communication Development of media: poster, and flip chart and development of counseling script Conduction of counseling with application of media in the community
- 14. 8 CHAPTER IV: ACTIVITIES Atfirst group division was done and the major types of communication was aligned to each group .As one of the method of interpersonal health communication counseling was selected. Situation analysis was done and maternal and child nutrition as one of the leading issue of Nepal was chosen. Through various literatures and the activities of nutritional organizations flip chart was chosen and counselling done. Flip chart Flip chart comprised of the following components Importance of nutrition Maternal nutrition Role of husband and family members in maternal nutrition Importance of breastfeeding Correct Positions and attachment for breastfeeding Complementary feeding, Active feeding Nutritious food preparation method Care of sick children Essential hygiene action Growth monitoring Farm to plate Counselling script Counselling script based on developed flip chart
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- 31. 25 CHAPTER IV: CONCLUSIONS,RECOMMENDATIONS AND SKILL DEVELOPMENT Conclusions PSD is quite good for skill development. Many professional as well as non-professionals skills were developed like literature searching strategies, development of detail framework of program, designing, developing, producing, using and judging of health communication material/ media and also provided counselling using developed media. The language used in the poster as well as in flipchart was understandable. Key message and pictures in the poster and flipchart was good .Counselling provided on MIYCN was taken beneficial by clients to improve and maintain nutritional status. Recommendations Community based nutrition programs should be strengthened Details of skills development Group work skill was developed. Coordination skill was developed while coordinating with local community people. Ability to select the appropriate messages and media for appropriate group. Ability to develop, design the material i.e flipchart Developed counselling skills about MIYCN following GALLIDRA approach
- 32. 26 REFERENCES Bhandari, T.R., 2013.Nutritional Status of Under Five Year Children and Factors Associated in Kapilvastu District, Nepal. J. Nutr. Health Food Sci. 1. https://doi.org/10.15226/jnhfs.2013.00106 Dewey, K.G., 2016. Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: evidence, challenges and opportunities. Matern. Child. Nutr. 12, 27–38. https://doi.org/10.1111/mcn.12282 Gautam, K.P., Adhikari, M., Khatri, R.B., Devkota, M.D., 2016. Determinants of infant and young child feeding practices in Rupandehi, Nepal. BMC Res. Notes 9, 135. https://doi.org/10.1186/s13104-016-1956-z Singh, A., Klemm, R., Mundy, G., Pandey Rana, P., Pun, B., & Cunningham, K. (2018). Improving maternal, infant and young child nutrition in Nepal via peer mobilization. Public Health Nutrition, 21(4), 796-806. doi:10.1017/S1368980017002993 NPC, & CBS. (2013). Nepal thematic report on food security and nutrition 2013. Kathmandu, Nepal: National Planning Commission (NPC) and Central Bureau of Statistics (CBS). ANNEXES PSD Action Plan PSD Topics Objectives PSD activiti es Approache s/ Methods Setting Logistics Estimated time Indicator s Means of verifica tions
- 33. 27 Develop ment of Interper sonal Health Commu nication Media on Materna l, Infant and Young Child Feeding Practice s (MIYCF )for counsell ing mother. 1. To review the literature on Maternal, Infant and Young Child Feeding Practices (MIYCF) in Nepal and Asian Countries 1.1 Literat ure review 1.2 Design an action plan 1.3 Proble m identifi cation from literatu re review Desk review Consultatio n Literature review Classroo m/Home Setting Laptop Dairy Pen 6 hrs 4 hrs 6 hrs No. of literature review Action Plan developed Soft copies of literatur e Develop ed action plan 2. To develop the Interpersonal communication media on promotion of MIYCF practices for Mother and Young child 2.1Gat her inform ation on selecte d theme (MIYC F) 2.2 Develo pment of media (Poster s, Flip Charts, Nutriti on & WASH Corne) for Interpe rsonal commu nicatio n Desk review Consultatio n Literature review Media Developme nt Classroo m/Home Setting Laptop Dairy Pen 6hrs 8hrs No. of literatures reviewed Media Develope d Soft copies of literatur e Develop ed media
- 34. 28 3. To providehealth education about MIYCF practices to Mothers through Interpersonal communication 3.1 Selecti on of mother for health educati on 3.2 Take approv al and plan for Interpe rsonal commu nicatio n 3.3 Provide health educati on Field visit Interperson al HE approach Commu nity setting Laptop Newsprint Projector Marker Masking Tape 2hrs 2 hrs 6 hrs No. of Mother Particpate d/attendin g the session Logboo k Approva l letter Photos Attenda nce sheet 4. Present ation Universi ty 4hrs PPT prepared Soft copy of ppt 5. Report Writing Classroo m/Home Setting 4hrs Report prepared Final Copy of report