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Effectiveness of Computer-assisted Teaching Program on Malnutrition and its Prevention in Under-five Children among Adolescents Studying in Selected Pre-university College, Bengaluru

How to cite this article: Parry IA, Siraj SS, Arifa S. Effectiveness of Computerassisted Teaching Program on Malnutrition and its Prevention in Under-five Children among Adolescents Studying in Selected Pre-university College, Bengaluru. Int J Nur Res. 2019; 5(2): 50-55. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution Noncommercial Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Introduction


Introduction
Malnutrition in pre-school children is a significant problem and has been identified by the World Health Organization as the most lethal form of disease which indirectly causes an annual death of at least 5 million children worldwide. [1] Malnutrition is widely recognized as a major health problem in developing countries. It is widespread in rural, tribal, and urban slum areas. Growing children are most vulnerable to its consequences. Anthropometry is a simple field technique for evaluating physical growth and nutritional status of the children. [2] © 2019 IJNR | Published by Innovational Publishers The United Nations Food and Agriculture Organization estimates that nearly 870 million people of the 7.1 billion people in the world, or one in eight, were suffering from chronic undernourishment in 2010 to 2012. Almost all the hungry people, 852 million live in developing countries, representing 15% of the population of developing counties. At present, two-third of the deaths of the children around the world are directly or indirectly associated with nutritional deficiencies. Nearly half of India's children -approximately 60 million -are underweight, 45% have stunted growth (too short for their age), 20% are wasted (too thin for their height, indicating acute malnutrition), 75% are anemic, and 57% are deficient in Vitamin A. [3] The findings of the third National Family Health Survey-3 revealed an unacceptable prevalence of malnutrition in our children: 42.5% of our children under the age of 5 years are underweight (low weight for age), 48% of our children are stunted (low height for age -chronically malnourished), 19.8% of our children are wasted (low weight for heightacutely malnourished), and in poorer states, the situation is even worse with over 50% of children underweight. [4] Malnutrition is both a cause and consequence of disease and illness and there can be many contributing factors. While some causes of malnutrition might be the result of underlying ill health, disease, or the body's inability to absorb nutrients, malnutrition can also be linked to other experiences or factors in a person's life. [5] The costs of malnutrition run into billions of pounds in spite of proven interventions that can prevent identify and manage the problem and risks promptly and thereby reduce the human suffering and the astronomical associated costs. [5] Studies have revealed that severe degree of malnutrition can be reduced by practice of exclusive breastfeeding, introduction of timely complementary feeding, education for maintaining personal hygiene, proper implementation of Universal Immunization Program immunization, periodic deworming, standard case management of diarrhea, and acute respiratory infection as well as continuation of feeding during illness among under-five children. With reference to the above studies, malnutrition is quite prevalent in our state and the major cause is lack of knowledge among caretakers which needs to be addressed. Hence, the study was aimed to evaluate the effectiveness of computer-assisted teaching program (CATP) on malnutrition and its prevention in under-five children among adolescents studying in selected Pre-university College (PUC), Bengaluru.

Methodology
Fifty students for the academic year 2014-2015 at selected PUC, Bengaluru, were enrolled through simple randomization method in this quasi-experimental study. The students were included in the study if present during the study, for the academic year 2014-2015, were the part of the selected college, and ready for consent to participate in the study. The students were excluded if on leave, vacation, on sick leave, absent for study or on vacation, and did not provide consent for participation.

Data collection tool
A structured knowledge questionnaire was developed through extensive study of literature and discussion with experts. Content validity of the tool was confirmed through nine experts. The tool consisted of two sections and had a total of 36 questions.
• Section I contained questions related to demographic variables of the study population. Demographic variables include age, sex, religion, income of family (father), educational status of parents (father and mother), occupation of parents (father and mother), student's status, previous knowledge and its source, and source of information • Section II contained items related to knowledge regarding malnutrition and its prevention.

Scoring procedure
For knowledge items, each correct answer was given a score of "one" and incorrect answer a score of "zero." The knowledge questionnaire has 36 items regarding malnutrition and its prevention for the correct answer given score of "one." Hence, the total score was 36 for the knowledge questionnaire.

Permission from concerned authority
Formal written permission was obtained from selected educational institutes, Bangalore, before the data collection from respondents to assess the effectiveness of CATP on malnutrition and its prevention. After the formal written permission was obtained from the concerned authority and the study was conducted during the month of January from January 28, 2015, to February 5, 2015, at Acharya PUC, Bangalore. Respondents were selected in accordance with laid down criteria. Consent was obtained from each respondent after giving assurance of confidentiality.

Statistical analysis
Data were presented as frequency, percentage, mean, and standard deviation. Categorical variables were compared using Chi-square test. Paired t-test was used to compare pretest and post-test knowledge score. P < 0.05 was considered statistically significant. Statistical analysis was performed using the SPSS v21.

© 2019 IJNR | Published by Innovational Publishers
had completed profession, middle school certificate, and primary school certificates, respectively. All of the subjects were Hindu. About 90% were day scholar, 6.0% were hosteller, and 4% were paying guest. About 74% of the subjects were not exposed to knowledge on malnutrition and its prevention and 26% of the subjects were exposed to knowledge on malnutrition and its prevention. About 64% of subjects had information from TV/Radio/ Internet, 32% had information from magazines/books/ posters, and 4% of subjects had information from friends/ neighbors/health personnel.

Comparison of knowledge level
We classified knowledge level on the basis of total score. Subjects who scored ≥65% were considered to have adequate knowledge. Scores with 41-65% were considered moderate knowledge and scoring <40% was considered inadequate knowledge. We observed that 90% of the subjects had inadequate knowledge in pre-test. While only 8% and 2% subjects had moderate and adequate level of knowledge respectively. After administration of teaching program, 92% of subjects had adequate knowledge and 8% had moderate knowledge. None of the subjects had inadequate level of knowledge showing effectiveness of teaching program [ Figure 1].

Comparison of knowledge score
We also evaluated effectiveness of total knowledge score following administration of teaching program. We observed that post-test overall knowledge score was significantly higher in comparison to pre-test overall knowledge score (32.20 ± 8.77 vs. 8.14 ± 10.99; P = 0.01).
We also evaluated knowledge of individual aspects on knowledge scores related to malnutrition and its prevention. We observed that all the aspects of the knowledge were significantly higher following administration of the teaching program [ Table 2].

Association of demographic variables with knowledge level
We also evaluated relation of the demographic variables with post-test knowledge level. We observed that age, gender, nationality, family income, fathers' occupation, mothers' education, religion, students' status, previous knowledge, and source of information were significantly associated with the post-test level of knowledge on malnutrition and its prevention (P < 0.05) [ Table 3].

Discussion
The links between nutrition and health are well known, with good nutrition accepted as one of the primary determinants of optimal growth, good health, and well-being. [6] Accordingly, an unhealthy diet has been identified as a major risk factor for the global increase in chronic non-communicable diseases such as coronary artery disease, cardiovascular disease, cancer, diabetes, and obesity. [7,8] A large proportion of these diseases can be avoided as they are either initiated or accelerated by unhealthy nutrition in addition to other etiologies. In recent years, there has been a growing worldwide concern about the dietary and nutritional needs of children. [9] Our study observed that CATP was significantly effective in increasing knowledge on malnutrition and its prevention. Similar findings have also been reported in the previous studies. Betagiri and Tata [10] compared the effectiveness of structures teaching program on knowledge regarding Integrated Child Development Services (ICDS) program among mothers of under-five children. They concluded that structured teaching program regarding ICDS program was an effective method for providing adequate knowledge and helped mothers to enhance their knowledge and utilization of services provided under ICDS program.
Similarly, Isarannavar et al. [11] showed that effectiveness of structured teaching program helps to gain the knowledge score on malnutrition and the preparation of Hydrabadi and Davanagere mix recipe. It is essential for community health nurse to develop knowledge regarding malnutrition, its management and prevention to avoid life-threatening complications among under-five children.

Conclusion
CATP is effective in increasing knowledge of adolescent regarding malnutrition and its prevention in under-five children.