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In Phase 2 the Methodology followed to record, evaluate, counsel and monitor the

Nutritional Intake was designed by implementing the following Schedules:

a. Food preferences Survey:

Research has shown that children‘s food preference predict their food

consumption patterns (Pilgrim 1961, Birch, 1979, Calfas et al., 1991, Domel. et

al., 1993, Domel et al., 1996, Resnicow et al., 1997, Ricketts1997, Drewnowski,

1997, Birch 1998,).A Child‘s preference for a food or flavor has been shown to

increase with repeated exposure. (Birch, 1979,; Birch and Marlin, 1982,; Pliner

and Pelchat, 1986,; Sullivan and Birch, 1990,; Domel, et.al., 1993,; Sullivan and

Birch, 1994,; Mennella, et al., 2001,; Gerrish and Mennella 2001,).

The parents of children from preschool and 1st to 4

th standard /children from 5

th to

9th

standard reported their food likes and dislikes. The evaluation of these

criterions in parents made it possible to understand and modify the diet during the

nutrition counseling and education sessions of the Nutrition Intervention. This

questionnaire (Table 2.4) was adapted from the data collection schedule

implemented by Skinner, et al., (2002).

In order to improve dietary intake, to prevent anemia in adolescent girls through

community kitchens in a urban population of Lima, Peru, Creed-Kanashiro et al.,

(2000) considered diet as a ―natural‖ treatment, which was perceived to be

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―better‖ than the clinical treatments such as use of vitamins or tonics. The foods

were selected for promotion on the basis of availability, accessibility,

acceptability, and cost-nutritional benefit. The ―best buys‖ for iron included

blood, spleen, beans and liver. For vitamin C, the ―best buys‖ included oranges,

papaya, cabbage, mandarin orange and lemon. As a result of a behavioral

analysis, in which each behavior was evaluated for potential nutritional effect and

feasibility of adoption, the primary dietary recommendations selected for the

intervention were intended to increase heme iron food sources in stews prepared

in the Community Kitchen and increase consumption of vitamin C–rich salads

and/or drinks with meals containing nonheme iron sources (mostly beans).

Table 2.4 The Food Preferences Survey Form:

The Food preferences Survey Form

Name of Child ____________Class ________Code No. ___________

Please select your most appropriate answer

(Select only one choice, A – E) for the following

A Likes and willingly eats

B Hates but eats when forced

C Hates and refuses to eat

D You have never heard off & never tasted

E You have Heard off but never tasted

Liver_____ A B C _D___E_

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Brain____ _A B C _D___E_

Kidney____ A B C _D___E_

Mutton_____A B C _D___E_

Beef___ __A B C _D___E_

Chicken __ _A B C _D___E_

Fish __ ___A B C _D___E_

Prawns _____A B C _D___E_

Egg _____A B C _D___E_

Milk A B C _D___E_

Curds _____A B C _D___E_

Panner _____A B C _D___E_

Lassi/Buttermilk____ _A B C _D___E_

Cheese_____A B C _D___E_

Chappati/ Roti ___ __A B C _D___E_

Ragi (Nachni) ____ _A B C _D___E_

Rice Flakes (Poha) _____A B C _D___E_

Rice Puffed (Kurmura) _A B C _D___E_

Bajra___ _ _A B C _D___E_

Jowar____ _A B C _D___E_

Cornflakes_____A B C _D___E_

Museli_____ A B C _D___E_

Glucose Biscuits___ _ _A B C _D___E_

Cream Biscuits___ __A B C _D___E_

Chocolate Biscuits____ _A B C _D___E_

Toast__ __ _A B C _D___E_

Khari__ ___A B C _D___E_

Bread___ __A B C _D___E_

Spinach (Palak) ___ __A B C _D___E_

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Corriander Leaves(Kotmir) ___ __A B C _D___E_

Colocasia Leaves(Alu Pata) ___ __A B C _D___E_

Shepu Leaves (Sova) ___ A B C _D___E_

Red Amaranth Leaves___ A B C _D___E_

Betal leaf (Pan) ___ __A B C _D___E_

Mustard Leaves( Sarson ka sag) ___ _A B C _D___E_

Radish Leaves (Mula ka pata) ___ __A B C _D___E_

Drumstick ___ _A B C _D___E_

Cabbage___ __A B C _D___E_

Carrots___ _A B C _D___E_

Ladies finger___ __A B C _D___E_

Chavli vegetable__ __A B C _D___E_

Cauliflower _ __A B C _D___E_

Chana Atta (Besan) _ __A B C _D___E_

Mutki ___ __A B C _D___E_

Chavli ___ __A B C _D___E_

Dried Peas (Green) __ __A B C _D___E_

Masoor (Whole) ___ A B C _D___E_

Toovar Dal___ _A B C _D___E_

Rajma___ __A B C _D___E_

Soya bean (whole) ___ __A B C _D___E_

Soyabean Atta___ __A B C _D___E_

Soya bean(Chunks/ Granules) __A B C _D___E_

Til___ __A B C _D___E_

Banana ___ A B C _D___E_

Chikkoo___ __A B C _D___E_

Apple___ A B C _D___E_

Orange___ __A B C _D___E_

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Guava___ A B C _D___E_

Pear ___ _A B C _D___E_

Papaya___ _A B C _D___E_

Pineapple___ A B C _D___E_

Bora___ A B C _D___E_

Amla___ A B C _D___E_

Mango Raw ___ _A B C _D___E_

Mango Ripe ___ _A B C _D___E_

Dates Dried (Kajhur) ___A B C _D___E_

Figs Dried ___ A B C _D___E_

Apricots(dry) ____A B C _D___E_

Sweet Lime ___ A B C _D___E_

Jackfruit (Phanas) A B C _D___E_

b. Attitude and Practices Questionnaire of the Children and Parents (AP):

Parents play an important role in the development of their child's eating

behaviors. Sherry, et al., (2004) conducted, 12 focus groups (three white, three

African-American, and three Hispanic-American low-income groups; three white

middle-income groups) of mothers (N=101) of 2- to less than 5-year-old children

to explore maternal attitudes, concerns, and practices related to child feeding and

perceptions about child‘s weight. The researchers identified, the following major

themes from responses to our standardized focus group guide: 12 groups wanted

to provide good nutrition, and most wanted children to avoid eating too many

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sweets and processed foods; 12 groups prepared foods their children liked,

accommodated specific requests, and used bribes and rewards to accomplish their

feeding goals (sweets were commonly used as bribes, rewards, or pacifiers); and

11 of 12 groups believed their children were prevaricating when they said they

were full and mothers encouraged them to eat more. Thus the researchers felt that

the common use of strategies that may not promote healthful weight suggests,

work is needed to develop culturally and socioeconomically effective overweight

prevention programs. Further study is needed to verify racial/ethnic or income

differences in attitudes, practices, and concerns about child feeding and

perceptions of child weight.

Questions with regard to good nutrition, eating and personal hygiene were also

included in the questionnaire. This information was collected before and after the

Nutrition Intervention Program. This schedule was labeled as a Nutrition and

Health Questionnaire in the Phase 1 and the same questions were included as a

final feedback form in Phase 3.The questions were as described in Table 2.5.

Table 2.5 Attitude and Practices Questions. (+ Positive /- Negative Statement)

2. Is your child willing to try new foods? (+)

3. Does your child eat foods he loves to eat? (-)

4. Do you try to give your child variety of foods? (+)

5. Do you force your child to eat certain foods because you think it is healthy? (-)

6. Does your child eat only when hungry? (+)

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7. Does your child eat sweets/chocolates? (-)

8. Does your child eat with rest of the family?(+)

9. Do you feel your child is too rushed in the morning so it is difficult to eat? (-)

10. Do you give the same food as a packed lunch that has been eaten for breakfast? (-)

11 Does your child love to eat green leafy vegetables (+)

12. Does your child loves eat one item like curd, paneer? (+)

13. Does your child love to eat fruits? (+)

14. Does your child drink buttermilk (chaas) (+)

15. Does your child eats from the road side hawkers? (-)

16. Does your child eat at least one of the following items- mutton, chicken, fish and

eggs? (+)

18 Do you insist your child should wash hands before/after using the toilet? (+)

19. Does your child wash hands before/after using toilet? (+)

20. Do you insist your child brush teeth twice a day? (+)

21. Does your child eat split food from the floor? (-)

22. Does your child eat food if flies are seen over that food? (-)

23. Does your child washes hands after eating sticky foods? (+)

24. Does your child wash mouth after eating sticky foods? (+)

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Computing the total score on attitudes and practice was as follows:

For Positive Practice/Attitude Statements e.g. Is your child willing to try new

foods?

Always=5 Sometimes=3 Rarely=1 Never=0

For Negative Practice/Attitude Statements e.g. Does your child love to eat outside

foods?

Always=0 Sometimes=2 Rarely=4 Never=5

For Positive Practice/Attitude Statements e.g. Does your child love to eat fruits?

Once a day=5 Twice a day=5 Once a week=4 Twice a week =2 Thrice a

week=3

Four times a week=3 Sometimes=2 Rarely=1 Never=0

For Negative Practice/Attitude Statements e.g. Does your child eats from the road

side hawkers?

Once a day=0 Twice a day=0 Once a week=1 Twice a week =3 Thrice a

week=2 Four times a week=2 Sometimes=3 Rarely=4 Never=5

For ‗Yes/No‘Questions it will be 5 & 0 for positive questions and 0 & 5 for

Negative questions e.g. does your child love to eat green leafy vegetables?

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c. Individual Counseling:

Three Personalized nutrition-counseling sessions based on the 24-hr. dietary recall

with regard to healthy eating habit and monthly follow-up was conducted as well

as dietary modifications of students were conducted over a period of four months.

Nutrition counseling is the sinequanon for bringing a permanent and favorable

solution to the problem of malnutrition. It is an effective tool of changing the food

habits of the people without affecting their sentiments. It is a process by which

knowledge, attitudes and beliefs about food and health are channelized into actual

practices which are sound and consistent with the individual needs, purchasing

power, food availability, health and socio-cultural background (Orstead, et al.,

1985).

Impact of Nutrition Counseling on Anthropometric and Biochemical Parameters

of School Girls (7-9 Years) has been reported by Sharma and Chawla, (2005). In a

study on sixty girls of 7-9 years belonging to lower socio economic group in

Ludhiana who were divided equally in control (C) and Experimental (E) groups.

The Experimental group comprising of 30 girls and their mothers was imparted

Nutrition Counseling (N.C.) twice a month for a period of four months.

Assessment of nutritional status was done before and after imparting nutrition

counseling. In case of anthropometric measurements: the mean height of subjects

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in C and E group was 116.1 and 117.1 cm at baseline and 116.2 and 117.9 cm

after experimentation. Also, a significant increase in weight and Mean Upper Arm

Circumference was observed in E group after N.C. However all the

anthropometric indices were lower than the standards. In case of biochemical

parameters: the hemoglobin level of school girls was 9.47 and 9.6 g/dl in C and E

group at baseline which significantly increased to 10.5g/dl in E group after N.C.

All the haemopoetic indices revealed the occurrence of iron deficiency anemia in

both the groups before and after N.C. But the status of respondents in E group

was comparatively better after N.C. when compared to before N.C. Thus it was

recommended by the researchers that nutrition counseling should be imparted for

a longer duration and should be included in school curriculum.

Dietary intake has been widely used as an indicator of nutritional Status before

and after the Nutritional Intervention Program where, a detailed food

consumption pattern was recorded in the form of a questionnaire format and the

dietary information thus collected was used to reflect on ―low‖ or ―excessive‖ or

―adequate‖ intake of nutrients as compared to the recommended dietary intake.

The counseling initiated ―Be wise about your diet, cost & life‖ campaign, which

was be aimed to assist children & parents in make healthier food choices that

promote healthy body weights and reduce health risks. As is well established

healthier lifestyle decreases the risk for many of the diseases associated with poor

nutrition and physical inactivity. Such counseling is expected to help

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parents/students to take the first steps toward healthy eating, including learning to

select portions that meet their nutritional needs without providing excess calories.

This counseling was aimed at the parents of children studying in nursery to fourth

standard, where as for those children studying in 5th

– 9th

standard there was one

counseling session with the parent and the remaining two sessions were

conducted with the child.

24 hour Dietary Recall –The parent /child is asked to report the food consumed

the previous day which is recorded in standard volumetric measures and is later

converted to raw weight of cooked foods in grams and the nutritive value is

calculated using food values as published by Gopalan, et al., (1989).

Methodology for 24 hrs Dietary Recall

(Reference source: www.ibms.sinica.edu.tw/~pan/class2004/epi0929a.ppt;

riskfactor.cancer.gov/diet/.../thompson_subar_dietary_assessment_methodology.p

df)

24-Hour dietary recall and food record was taken based on foods and amounts

actually consumed by the student on one specific day. Diet histories were taken

based on students perceptions of usual intake over a less precisely defined period

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of time. An in-depth interview conducted by a trained nutritionist Interviewees—

students, parent, caretaker.

A dietary recall is a retrospective method of dietary assessment where an

individual is interviewed about their food and beverage consumption during a

defined period of time, typically the previous day or the preceding 24 hours.

Recall of intake over a longer time period is problematic due to the limitations of

memory. Several national surveys use the 24-hour recall method because of its

high response rate and its ability to obtain detailed information. The interview

can be carried out in person, by telephone or increasingly via the Internet. In the

Norwegian arm of the EPIC study no significant differences in the dietary data

obtained were found when face-to-face 24-hour recalls were compared to

telephone 24-hour recalls (Brustad, et al., 2003).

A single 24-hour recall is not considered to be representative of habitual diet at an

individual level but is adequate for surveying intake in a large group and

estimating group mean intakes. In a preliminary study to decide the method for

the UK Low Income Diet and Nutrition Survey (LIDNS), four repeat 24-hour

recalls were recommended as the most appropriate method of dietary assessment

in this group (Holmes et al., 2008). Repeat 24-hour recalls can be employed to

assess a typical diet at an individual level; these are also known as multiple

recalls. In a recent Australian study in adults, eight repeat 24-hour recalls were

recommended to capture the variation in macronutrient intake (Jackson et al.,

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2008); The nutritionist gather detailed information about everything the subject

ate and drank from morning to night of the previous day or over the 24-hour

period, either backward or forward depending on short term memory and

cooperation from the interviewer

Food preparation methods, recipe ingredients, brand name of commercial

products, use of dietary supplements were asked by using open-ended questions in

nonjudgmental manner in a neutral attitude & by avoiding, asking questions in a

manner that might influence the subject‘s responses

To get an accurate quantification of amounts of foods amount estimation tool,

food containers, geometric shapes & number were used.

Strengths and limitations of the 24-hour dietary recall.

The strengths are based on actual intake to estimate absolute amount rather than

relative amount of nutrients Open ended—high level of specificity Interviews

could be sensitive to the cultural difference

The Limitations include day to day variation in dietary intake. Therefore to reduce

the error from dietary recall interviewers were given considerable training and

practice.The interviews were conducted by nutritionist and dietitians. During the

interviews there was a relaxed and unhurried atmosphere.

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A 24-hour Dietary recall was elicited in the beginning and consequently followed

for 2 sessions, (1 + 2 = 3) over a period of four months. Dietary intake was

recorded during the individual session, followed by a counseling of Parents of

children Nursery to 4th

standard and children themselves from 5th

to 9th

standard

and modifications in their diet were suggested using the formats ( Table 2.6) have

been given below.

Table 2.6 A 24 – Hour. Dietary Recall and a Diet Suggestions and Counseling

Format

24 – HR. DIETARY RECALL

Name of the Child_____________Class___________ Code No________

TIME MEAL QTY ITEMS

BREAKFAST

MIDDAY

LUNCH

EVENING

DINNER

LATENIGHT

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DIET SUGGESTIONS & COUNSELING FORMAT

Name of the child_____________ Class________________ Code No___________

TIME MEAL QTY MENU

BREAKFAST Almonds/ Walnuts/ Khajur /Figs

Raisins/ Kharik

Herbal Tea

Milk

Oats/ Museli /Cornflakes/ Wheatflakes

/ Rice flakes

Chappati / Roti / Fulka / Parathas

Bhakris / Multi grain Bread /Thepla

Idlis / Dosa/ Uttapam/ Dhoklas/

Muthias / Thalipeeth

Besanomlet/Pudlas/Chilas/rava

pancakes

Egg any Variety, Veg/ non veg cutlets

& kababs (shallow fried),

Poha / Upma / Dalia/ Vermicelli

Fruits

MIDAY SNACK Herbal Tea

Boiled masala whole pulses/ sprouts

(usal) /dal

Chappati / Roti / Fulka / Parathas

/Bhakris /Multi grain Bread /Thepla

with green leafy vegetables eaten with

various types of chutneys, all types of

khakras

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Khichadis, Veg / Nonveg pulav,

Biryani/ Fried Rice

Idlis ,Dosa, medu vadas, besan tomato

omlets, Dhokla, upma or poha with

roasted channa dal

All types of Sabjis with rotis,

Any non veg, egg, paneer, cheese

sandwiches (multi grain bread) No

mayonnaise

Lassi, buttermilk, limbu pani

Chikki of all types,

Ladoos of Besan, Rawa, Rajgira,

Garden cress seeds (Halim)

Mixed Roasted Chivda all varieties

LUNCH Veg / Non Veg Soup Home made

All Varieties of cooked Vegetables

Chappatis, Rotlas, Bhakri, Phulka,

Thalipeeth

Rice, Khichidi ,Pulav , Biryanis, ,

Dals , Whole Pulses , Sprouts

Homemade Paneer,

Buttermilk, Lassi, Curd,

Variety of Raw Salads with lemon

juice

Non Veg Items

Fruits

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EVENING

SNACK

Herbal Tea

All types of khakras,

Idlis , medu vadas, besan tomato

omlets

upma or poha with roasted channa

dal,

Any non veg, egg, paneer, cheese

sandwiches (multi grain bread, no

mayonnaise)

Milk, Lassi, buttermilk, Fruit Juice,

limbu pani, Fruitbased Milkshake

Chicki of all types, Ladoos of besan,

Rawa, Rajgira, Garden cress seeds

(Halim)

Roasted poha, kurmura, channa dal ,

moong dal

Mixed Roasted Chivda all varieties

Veg/ Non Veg Soup(Homemade)

Fruits

DINNER Veg / Non Veg Soup Home made

All Varieties of cooked Vegetables

Chappatis, Rotlas, Bhakri, Phulka,

Thalipeeth

Rice, Khichidi ,Pulav , Biryanis,

Dals , Whole Pulses , Sprouts

Paneer,

Buttermilk, Lassi, Curd,

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Variety of Raw Salads with lemon

juice

Non Veg Items

Fruits

A HEALTHY START TO A WEALTHY LIFE Food Groups

Cereals –Wheat flour, Broken wheat (Dalia), Rava, Bajra flour, Jowar flour , Rice flour, Corn

flour, Ragi flour. Rice products like Poha, Kurmura, Also included are ready made products made

from Maida – Breads, Naans, Biscuits, Khari, Toast, Butters, Noodles ,Pastas, Macroni, Spagetti,

Lasagne, Sponge Cakes etc.

The cereal - pulse combination gives a superior quality protein.

Pulses – Whole Legumes, Dals & Flours of Toovar ,Moong, Massoor, Matki, All types of

Channa, Chick peas,Urad, Kulith, All types of Vatana, Soya bean & its products like Soya chunks,

Granules, Tofu, & Milk, All types of Rajma, etc.

Green leafy and Stem Vegetable –Palak, Methi Cabbage, Colacasia leaves, Spring onions,

Corriander leaves. Mint Leaves, Suva Bhaji, Mayalu, Amaranth Leaves, Radish leaves, Curry

Leaves, Drumstick Leaves Cauliflower Greens, Lettuce, Celery, Parsley, Garlic greens Asparagus,

Lotus stem Leek etc.

Cook leafy vegetables in their own moisture is advised. Take green leafy vegetables daily.

Roots & Tubers - Potato, Sweet potato, Turnip, Cassava, Yam, Ginger, Carrot, Raddish

Beetroot, Arbi, Onions, Garlic. Bamboo Shoots,Artichoke, Water Chestnuts.Parsnip etc.

Cook vegetables without peeling.

Other Vegetables –. Tendli, brinjal, Carrots, Chavli, Capsicum, Bhendi ,Tindola, Yellow Pumkin,

French Beans, Karela, Lauki, Cauliflower, Ash Gourd, Snake Gourd, Cucumber, Green Tomatoes,

Brocoli, Green peas, Walor, Mushrooms Sweet Corn ,All varieties of green chillies , Zuckini, etc.

Eat raw vegetables as salads daily.

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Milk / milk products - Cow‘s, Buffalow, paneer, cheese, Buttermilk, Lassi, Curd, Skimmed

Milk, Chenna, Khoa, Butter , Ghee.

Non veg - Chicken, Mutton, Egg, Fish,

Fats & Oils - Butter, Ghee, Hydrogerated fat, cooking oils like Groundnut, Mustard, Safflower,

Sun flower, Rice Bran Canola, Coconut.

Nuts & Oily Seed – Almonds, cashew nuts, walnuts, Pista, Flax seeds, Garden cress seeds etc.

Sugar: Jaggery, Table Sugar, Brown Sugar, Honey.

Fruits –Banana, Apple, Chickoo, Mango, Guava, Tomato, Papaya, Orange, Sweet lime

Watermelon. Grapes, Pear, Pineapple, Pomegranate, dates fresh & dry etc.

Always try to eat fruits in season.

Water – 10 – 12 glasses /day.

The dietary intake was calculated using food values as published by Gopalan, et

al., 1989 for the following nutrients:-Total Calories, Protein, Carbohydrate, Fat,

Calcium, Total Iron, Heme and Non Heme

d. Small Group Sessions:

Among the rapid assessment procedures (RAP), the focus group discussions

(FGD) are the most appropriate when quick assessment of the community beliefs,

their points of resistance and insights into facilitating points are needed Since

growth (nutrition) and development are interlinked, caring practices for one may

also be relevant to the other. Therefore, positive deviance in the growth and

development of children depends on caregiver‘s behavior and the positive

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interaction even in the face of multiple socio-economic deprivations. Such

mothers are, therefore, different from mothers who fail to cope positively with

child rearing under similar conditions. (ICMR Bulletin, 2003).

The methodology adopted for the small group discussions was an interactive form

of education, where the parents (learners) addressed a specific topic, shared their

knowledge and experience with other group members. The nutritionist facilitated

and encouraged this discussion by also sharing meaningful nutrition information,

encouraged and motivated those parents who gave positive approaches and

solutions to problems which arose in the course of discussion, any misinformation

was also clarified. The parents were encouraged to take down notes. At the end of

each discussion written information was distributed, which was again summarized

and reinforced and by the nutritionist before the session ended. For each session

which lasted for 1 hour, a group of 15-20 parents were invited to participate

according to the standard their children were in. These sessions were organized in

a relaxed and comfortable atmosphere, where the parents freely communicated

with one another.

Three Interactive small group sessions were organized with power point

presentations. Various topics were discussed such as:Basic functions of food, food

hygiene, how to preserve nutrients while cooking, anemia and other nutrient

deficiencies, worm infestations, and dental hygiene. It was an interactive session

with feedback from the audience.(Several Topics dealt with in large group

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sessions were repeated in small group sessions this enabled the participants to

express their views and further clarify their doubts)

Cooking Demonstration with nutrition education was conducted for 50 parents at

one time for all parents; Care was taken to elaborate on the nutritive value of

every ingredient used and variations of recipes. A variety of recipes were

demonstrated and samples were given for tasting. Some of the recipes includedin

this programme were: – green rice, vegetable potli, handwa, palak whistle,

thalipeeth, vegetable kachori, recotta cheese sandwich, til ladoo, harabhara

kababs, morning delight ,curry leaves chutney, kurmura chivda, dates and banana

pressure cooker cake ,tomato dip two different salad dressing, stuffed puris to

name a few.

Mid day meal planning for preschool children: – Parents of each child had to take

turns in providing the class of their child a mid day snack. This was planned and

implemented under the guidance of the nutritionist on a monthly basis.

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e. Three Large Group Sessions:

Talks(lecture method) with power point presentations was organized for parents

as well as children during the intervention months followed by Question Answer

session It was an interactive session with feedback from the audience. These

sessions were conducted by doctors, child psychologist and nutritionist. Parents,

grandparents, teachers were invited. Approximately 300 participants attended

each session, which lasted atleast 3 hours.

Topics for Large Group Sessions were:

Diabetes and nutrition, Bone Health, Vitamin and Mineral deficiencies, Worm

infestations, Dental hygiene, Out of box approach to dealing with a fussy eater.

f. Learning through fun activities:

One fun activity like Nutrition game or Nutri - Quiz, was conducted for children

every month for three months.

A Nutri Taste Game for children, which was a modified version of memory

games, was conducted, where the benefits and ill effects of good and bad nutrition

were reinforced. This Game of Sensory Evaluation was organized 1st to 9

th

standard. It was an Interactive session with the students, in this activity students

were paired in two, one child was blind folded, and then he was made to taste and

102

guess the food item. The other partner was handed placard that read points about

that food item, memorize them and present them in front of the class. Students

who won the game were given prizes. Example: If the blind-folded partner is

made to taste orange then the other partner will read and memorize the points that

describe the nutritive qualities of the same. ―The focus of the game conducted was

to create awareness for vitamin A, vitamin C, calcium, fiber and protein rich

foods and also to reinforce the overall theme of ―Excellence Begins with

Breakfast‖. By consuming a good breakfast each morning students can become

their own super hero. The message sent across was very apt and straight forward

―Eat right and be bright‖.

‗

A Nutri Memory Game was conducted for the students of 1st- 9

th standard

.

Students were shown 25 food products and then they were asked to record the

names, which would test their memory. Ill effects of junk foods were also

explained.

A Nutrition Exhibition was organized by the teachers and Parents of the Preschool

section Nursery, Lower KG & Higher KG were the children were taught a small

song and action dance of good food habits and Parents and teachers prepared

charts and posters on good food habits exhibition was open to all the Parents and

students of the school as well as all the members of Bohra Community

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Fun activity for parents - A nutritious recipe competition was organized as well as

a Slogan competition was conducted as a part of large group sessions

A Nutri Quiz, the ―nutri - edu‖ fun activity was also conducted for all children as

well as for parents

g. Tiffin Box Checking:

Random Tiffin box checking, once every 15 days was done by the nutritionist

during the short break time, to ensure the children did not bring any products like

biscuits, khari (puff pastry), toast, wafers, chocolates, cakes etc. If any child was

found carrying it, the parents were immediately called telephonically and

persuaded to give a more nutritious snack or lunch for the child. The child was

also motivated and encouraged to carry a healthier option.

h. Interactive Sessions with Management:

Interactive sessions were held with the canteen man intentionally to enhance the

type of products he sold in the school. Recommendations given were with regard

to modifications in the existing menu which was batata wada pau, samosa, or

bread bhajia. Emphasis was placed on reducing the bread / pav to twice a week

and inclusion of kheema pau ,idlis, meduvadas, veg.cutlets chanabatata chat,

mince kebabs, addition of vegetables to noodles in their menu.

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An Oral Feed Back was taken after each session - Large or small group. During

this session parent‘s point of views regarding the session and ongoing nutrition

program were discussed also, barriers in attitudinal and environmental factors,

such as conflicts with of mother- in law in child‘s dietary habit, role of

grandparents, junk foods in school canteen, school water facility hygiene,

handling a fussy eater, were all dealt with in subsequent sessions and making

necessary revisions in program strategies to address the parents and children in a

more effective manner.

As the program matured the behavioral changes did begin as it was reflected in

the hematological, biochemical and dietary parameters.

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8. Academic Performance (Marks) Assessment.

Hallberg, (1989) reported, a one of the confounding factors that may influence

brain function in poor diet is iron deficiency, which might be part of the general

protein-energy-malnutrition syndrome or be combined with other nutritional

deficiencies.

Academic performance during the present research was obtained by recording the

data from school records and registers. Marks given by teachers for tests and

terminal examinations were recorded.

Phase 1 was all tests from JULY‘08-OCTOBER‘08 and

Phase 3 was considered from NOVEMBER‘08-FEBUARY‘09.

Subjects for whom the marks were recorded are listed below; these marks were

converted into percentages and taken for analysis.

Subjects were as follows: -Art / Environmental Studies / Mathematics/ English /

Hindi for 1st Standard.

-Art / Mathematics / English / Hindi /History-Geography /Science / Marathi for

2nd

to 9th

Standard.

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9. Attendance Assessment.

According to Gopaldas and Seshadri, (1987), a higher attendance, as a percentage

of enrollments, would no doubt, reflect high priority given by parents to education

of their children, but it would also indirectly reflect the nutritional health status of

the school going child. This is so because a common reason for not attending

school is illness of the child. (Kanani, 1984)

Attendance was recorded and percentages were derived. For Nursery to 9th

Standard. Phase 1 was considered from 1 JULY‘08-OCTOBER‘08 & Phase 3

from NOVEMBER‘08-FEBUARY‘09,

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10. Stool Examination.

The parents were encouraged to get the stool of child tested. These were arranged

at the end of Intervention Phase 2 for all pre-primary students at Saifee

Ambulance, Medical and Diagnostic Center. Reports were collected & explained

to the respective parents with a power point presentation on types of worms and

infections in man.

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11. Good Will Sessions.

As the program drew to an end the parents were very motivated and suggested

that they wanted to learn more on health and fitness. Therefore on parent‘s

demand two sessions of Yoga were organized, where breathing techniques and

stretches were demonstrated. One session on Acupressure was also organized.

Such a gesture created immense good will and a desire to improve their own

health, and this was an excellent way to end the nutrition intervention program.

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12. Statistical Methods.

Statistical analysis carried out using SPSS 12.0 FOR Windows.msi and

submission of the report to the School authorities with regard to the improvement

in the nutritional and Health Profile of each child was accomplished.

It was both descriptive and inferential statistics.

Descriptive statistics for each parameter was represented as a Mean Value ±

Standard Deviation.

Inferential statistics involved correlations; paired T test and ANOVA (Analysis of

Variance) were also used. A p value was used to stat the significance

Positive/Negative Correlations between parameters were statistically reported.

The interpretation of results and discussion as well as suggestions for further

research are detailed in the next chapter.