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ACKNOWLEDGEMENT
Before proceeding further I, Shreya Roy Chowdhury
(Student of Clinical nutrition and Dietetics, Bsc.V Part-
III) would like to extend my cordial gratitude to all the people
without whom and whose help and support my internship would
not have been possible.
I would like to express my cordial sense of gratitude andsincere indebtness to :-
Miss. Ujjyani Dasgupta , Head of the department ofClinical nutrition and Dietetics of GOKHALE MEMORIAL
GIRLS COLLEGE.
Mrs. Paramita Chatterjee , Lecturer of thedepartment of Clinical nutrition and Dietetics of
GOKHALE MEMORIAL GIRLS COLLEGE.
Mrs. Nirmala Kochar , Teacher-in-charge of GOKHALE
MEMORIAL GIRLS COLLEGE for sending me to train myselfin Child In Need Institute (CINI) & continuing my source
of encouragement and inspiration.
Last but not the least I would like to thank all the
staff members, Course co-ordinators, guest lecturers
of CINI who have helped me during my training.
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INTRODUCTIONGood health is a vital part of the great experience of living.
The World Health Organisation (WHO) defines Health as a
state of physical, mental and social well-being and not merely
the absence of disease or infirmity.
FOODS, SHELTER AND CLOTHING are the basic needs of thehuman being. Among them food is the most important for
survival.
Food may be defined as anything solid or liquid which when
swallowed, digested and assimilated in the body keeps it well.
NUTRITION is the science of foods, the nutrients and othersubstances therein ; their action, interaction and balance inrelationship to health and disease.
The word Nutrition is derived from Nutricus which means to
suckle at the best.
The term Nutrition can be defined as the process by which
the organism ingests, digests, absorbs, transports and utilises
nutrients and disposes of their end products.
Nutrients are the constituents in food that must be supplied
to the body in suitable amounts. These are proteins,
carbohydrate, fats, vitamins, minerals and roughage.
The study about the effect of different food on human
body,what they should eat and what not is the dietetics and
those dealing with these are the Dietitians and Nutritionist.
CLINICAL NUTRITION AND DIETETICS is the subject whichis offered by Calcutta University. The object of this course is to
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produce people with knowledge and skill for creative role in
society. Hence a practical work is necessary to become an
expert in this field and that is why this Internship has been
included in our subject.
WHAT IS
INTERNSHIP ?
Internship is a work including special learning objectives.Itis used to describe a variety of experience. My internship
programme was in highly structured corporate environment.
A good internship is an educational opportunity where one
can gain career related experience. Internship can be
found any time in the year and are available in every
field. Internship is usually performed under the guidance ofsupervisor.
The internship has helped me of a various aspects. The internship has given me the knowledge of the work
of a Dietitian.
I was intern to the NGOs working environment. I got the chance of interacting with the patients about their
likes.
I have learnt how to make diet charts for a patientaccording to situational needs.
I got good knowledge about the different disease conditionand their Dietary Modification.
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I , being the student of Food & Nutrition , Major in the
department of Clinical Nutrition & Dietetics. Calcutta
University has taken up my Internship in Child In Need
Institute (CINI).
I, the student of Gokhale Memorial Girls College, have spent 15
days (From 13th February to 29th February, 2012) for my
internship session at CINI.
My training
schedule is as
follows :-
Name of the NGO :- Child In Need Institute(CINI)
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Location :-CINI, Village : Daulatpur,
P.O.: Poilan, via Joka,
Pin 700104,
West Bengal, India
Duration :- 13th feb to 29th feb ,2012
Timing :- 10 A.M. to 4:30 P.M.
DATE :- 13.02.2012
In the first half (, the lecture was given about CINI
which are as follows :-
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CHILD IN NEED INSTITUTE
GENERAL INFORMATION ABOUT CINI
:-
Recognized as a national NGO, Child In Need Institute (CINI) is
guided by its mission of Sustainable Development in
Health, Nutrition and Education for the child, adolescent
and women in need. From a humble beginning in 1975, the
institute now reaches about 8,00,000 people in both rural andurbans in India. This includes 13,000 street children and 16,000
young people (10-24 years). Besides West Bengal, the institute
has spread its operations to operations to Jharkhand, Orissa,
Bihar, Madhya Pradesh and Chattisgarh. CINI is also the
Regional Resource Centre (under the RCH programme of the
Government Of India) for West Bengal, Orissa, Jharkhand and
Andaman and Nicobar Islands.
CINI has the unique honour of receiving the National Award for
Child Welfare twice. Presented by the Government of India, CINI
received this award for 2003-2004 and earlier in 1985.
CINI has received several other prestigious national and
International awards including :-
Parliament prize for infants given by Parliament Commissionfor Infants, Italy in November 2005.
The Allen Shawn Feinstone Hunger Award, Brown University,USA, 1993.
The International prize Linguria, Genoa, Italy, 1991
The mission and the process of continuous learning from field
realities has lead to the adoption of the Life Cycle Approach
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(LCA) as the key organizing principle in CINIs
interventions.The approach address issues like low birth
weight, malnutrition and various reproductive and sexual
health issues. The LCA intervention aims to break the
intergenerations cycle of poverty, malnutrition and ill health,
targeting critical stages of the lifecycle, i.e. pregnancy and
lactation period, 0-2 years, and adolescent. Implementing LCA
based interventions would result in lowered maternal and infant
deaths, reduced incidence of low birth babies and improved
awareness regarding nutrition and reproductive and sexual
health issues among adolescents.
The experiences and learnings of various thematic divisions(focussing on child health, adolescent health, womens health,
HIV/AIDS, urban health, education and child protection,
training, communication) and geographical units (state units
and also several district units in West Bengal) enrich the LCA
and thus the interventions involved. These divisions and units
focus on key areas (thematic/geographic) and are developing
as unique resources. Beside this, CINI is also involved in
running various institutional services that provide clinical andcounselling support to women, children and adolescents.
Partnership with the government, CBOs, other civil society
representatives, NGOs, International bodies and donor agencies
constitute a focus area for the institute. Recognizing that it is
this collective strength that makes change possible, CINI has
involved various stakeholders in all its endeavours.
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MILESTONES :-
1975-1985 Under 5 clinic started at Balananda hospital,and St. Vincent school, Thakurpukur, Kolkata
by Dr. S.N. Chaudhuri, sister Pauline Prince
and Rev.Fr.Hendricks SJ.
CINI registered as a society Nutrition Rehabilitation Center opened Relief operation in flood hit Moyna block of
Midnapore
Relief measures undertaken in cyclone hitareas of Andhra Pradesh
Projects of MCH initiated in Moyna (midnapur)and Baikunthapur (south 24 parganas), West
Bengal.
Relief operationin Kampuchea, Cambodia Sishu kalian sahayika and child sponsorship
program started.
Training of anganwadi workers initiated Research undertaken in collaboration with
Nutrition Foundation of India on women and
child health
Relief operation in cyclone affectedSunderban in South 24 Parganas district.
1985-1995 Health intervention initiated in Tollygungeslums
CINI received first National Award in 1985 for
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child welfare
Awareness programme on girl child initiated. CINI ASHA unit set up to look after urban
programs with key focus on street children
Adopt a Mother programme on girl childinitiated
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In the 2nd half, we were given a case study ( situational
analysis ). We had solved it by poster presentation.
The case study was based on NRHM and ASHA, which are
related to women and child care specially in rural areas.
CASE STUDY :-
CAUSES OF NEW-BORNS DEATH :-
1) Poverty
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2) Illiteracy ( family planning )
3) Malnutrition
4) Lack of hygiene
5) Lack of proper sanitation
6) Excessive physical work
7) Poor health of mother
8) Improper medical treatment
9) Inadequate dietary needs during pregnancy
10) Unscientific delivery technique
11) Superstition and prejudice
12) Delayed delivery
13) Poor gestational development
14) Low birth weight
15) Lack of awareness
16) Early pregnancy with low parity
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DATE :- 14.02.2012
1st half (10:00 a.m. to 11:00 a.m.) :-
NRHMThe National Rural Health Mission (2005-2012) seeks toprovide effective healthcare to rural population throughout the
country with general focus on 18 states, which have weak
public health indicators and/or weak infrastructure. They are
Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal
Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Meghalaya,
Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura,
Uttaranchal and Uttar Pradesh.
The goal of the Mission is to improve the availability of
and access to quality health care by people especially
for those residing in rural areas, the poor, women and
children.
NRHM - VISION :- It has its key components of decentralizing the health
facilities and prioritise the demands of the beneficiaries.
It also includes the major government departments besides
health like Panchayat, Department of Social Welfare, ULBs
It seeks to revitalize the local health traditions and
mainstream AYUSH into the public health system.
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It seeks to address the inter-state and inter-district
disparities, especially among the 18 high focus states, including
unmet needs for public health infrastructure.
It shall define time-bound goals and report publicly on theirprogress.
It seeks to improve access of rural people, especially poor
women and children, to equitable, affordable, accountable and
effective primary health care.
GOAL OF NRHM :-
Reduction in Infant Mortality Rate (IMR) and Maternal
Mortality Ratio (MMR).
Universal access to public health services such as womens
health, water, sanitation and hygiene, immunization and
nutrition.
Prevention and control of communicable and non-
communicable diseases, including locally endemic diseases.
Population stabilization, gender and demographic balance.
Revitalize local health traditions and mainstream AYUSH.
Promotion of healthy lifestyles.
STRATEGIES AND COMPONENTS :- Accredited Social Health Activists (ASHA)
Stengthening Primary health centres.
District health plan
Public-Private partnership for health goals, including
regulation of private sector.
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Reorienting health/medical education to support rural health
issues.
NRHMState
government
Panchay
at
NGOs ICDS
State action
plans
Prioritize
funding
Public health
budget
Manage
all public
health
institutions.
ASHAs
would be
selected
Prepare
the village
health plan
Jointoperation of
untied fund
PRI
involvement
in Rogi
Kalyan
Samitis
Provision
for training
of PRI
members
Making
available
healthrelated
Included in
institutional
arrangement
at National,
state and
district levels
including
standing
mentoring
group for
ASHA.
Member oftask groups
Provisions of
training, BCC
and technical
support for
ASHAs/DHM
Healthresource
organizations
Service
delivery for
identified
population
groups onselected
Hold
nutrition day
weekly
immunizatio
n day.
Provide
referral
services
Exclusive
breast
feeding
promotion
Awareness
to pregnant
lactating
mothers and
nursing
mothers
Taking
birth weight
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databases. themes
For
monitoring,
evaluationand social
credit
ICDS
ICDS ( Integrated Child Development Service ) was
started in 1975.
ICDS Beneficiaries :-
1) Children below 6 years
2) Expectant and nursing mother
3) Adolescent girls
4) Women in the age group 15-45 years
Services under ICDS :-
1) ICDS provides a package of integrated services in a
comprehensive and cost effective manner to meet the multi-
dimensional and inter-related needs of children.
2) ICDS beneficiaries receive health, nutrition and early
childhood care and education related services. In addition,
there is coverage of other important supportive services like
safe drinking water, environmental sanitation, womens
development and education programmes.
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3) All services in ICDS are expected to converge at the same
set of beneficiaries i.e. group of children and their family to
create an appreciable impact.
Integrated Package of services under ICDS :-
Nutrition :-
1) Supplementary Nutrition
2) Growth monitoring
3) Nutrition and health education
Health :-
1) Health check-up
2) Immunization
3) Identification and treatment of common childhood illness
and minor ailments
4) Referral services
THE ANGANWADICENTRE :-
1) An anganwadi centre a courtyard play centre located
within village or a slum, is the local point for delivery of all the
services under ICDS programme in an integrated manner tochildren and women.
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2) An anganwadi is a centre for convergence of services for
children and women.
3) An anganwadi is a meeting ground, where women/mothers
group can come together with other frontline workers to shareviews and promote action for development of children and
women.
4) An anganwadi is run by an anganwadi worker who is
supported by a helper in service delivery.
ICDS TEAM, THEIR ROLEAND JOB RESPONSIBILITIES
:-
1) A CDPO ( Child Development Project Officer ) is an overallincharge and is responsible for planning and implementation of
the project.
2) A CDPO is supported by a team of 4-5 supervisors who
guide and supervise Anganwadi Workers (AWWs).
3) In large ICDS project, where there are more than 150
Anganwadi centres in a project, an Assistant Child Development
Project O fficer is also a part of the team.
4) A supervisor has the responsibility of supervising 20,25 and
17 AWWs in rural, urban and tribal project respectively.
5) A supervisor guides an AWW in planning and organising
delivery of ICDS services at anganwadi centres and also gives
on the spot guidance and training as and when required.
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6) An anganwadi workeris a community based frontline
voluntary worker, selected from within the local community.
The selection is made by a committee at the project level.
7) An AWW is mainly responsible for effective delivery of ICDSservices to children and women in the community.
8) An AWW is an honorary worker who gets a monthly
honorarium.
9) At each anganwadi centre, a helper is appointed to assist an
AWW.
10) Helper is an honorary worker and is paid monthly
honorarium.
11) Health services in ICDS are given by a team of Health
Functionaries comprising Medical officer, Lady health officer,
ANM and Female health worker from primary health centre and
sub-centre in the project. At the community level ASHA will be
the first part of call for any health related demands and
deprived sections of the populations especially women and
children.
1st half (11:00 a.m. 1:00 p.m.) :-
Introduction to
Ante-natal care
Intra-natal care
Post-natal care
ANTE-NATAL CARE :-
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DATE 15.02.2012
The first half (10 a.m. to 4:30 p.m.) comprises the
discussion on child and neo-natal care, care for children upto 2
years of age, signs and symptoms of an ill or unhealthy baby
and jigsaw puzzle making.
CARE OF A NEWBORN :-Newborn babies need special care and attention.
Newborn care helps the baby to :-
Adjust to the new environment
Establish cardio-respiratory function
Maintain body temperature
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Avoid infections
Promote establishment of lactation
Helps in early detection and treatment of congenital
disorders.
CARE OF LOW BIRTH WEIGHT BABIES :-
If a is less than 2.5 kg, he/she is low birth weight baby and
needs special care.
Provide extra warmth by wrapping the baby well and
covering his head to prevent heat loss.
Keep the baby close to the mother and she should
breastfeed him/her frequenly.
Too many people should not be allowed to handle the baby.
People who have infection should be kept away from thebaby atleast during the first month.
DANGER SIGNS AMONG NEWBORNS :-
Baby doesnot suck or refuses to breastfeed.
Baby doesnot cry/difficulty in breathing
Baby is cold or hot to touch
Baby develops yellowness in palm and soles
Baby has convulsions
Baby is drowsy or cries continuously
Baby does not pass stool within 24hours or urine within 48hours
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Baby has any birth defect
In the 2nd
half (10 a.m. to 4:30 p.m), the session startedwith the topic of immunization and its importance, CD
demonstration.
IMMUNIZATION CHART :-
AGE IMMUNIZATION
At birth BCG, Polio, Hepatitis-B
1 and half months
2 and half months
3 and half months
DPT, Hepatitis-B
8 months completes in 9
months
Measles, Vitamin-A oil
16-24 months DPT, Polio
5 years DT
CD DEMONSTRATION :-
NANHI SI JAANThis CD demonstation is about the care of pregnant women
and child.
The messages conveyed through this CD
demonstration were :-
The mother should not hide the news of pregnancy.
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The mother should take atleast 3 full meals a day as the poornutritional status of the mother may lead to weakness,
anaemia etc. leading to spontaneous abortion, still birth etc.
As the child totally depends on mother for nutrition, themother should take food from all food groups like rice, dal,
wheat, green leafy vegetables, curd, milk, chana, matar, fish,
ghee, meat, egg, germinated grams etc.
Regular health check up is necessary for the mother. Weightand haemoglobin level should be monitored. Folic acid and
iron tablets should be consumed.
BREAST CRAWL
After the delivery of the baby, the mother should start breast
feeding her baby as early as half an hour after normal
pregnancy. Breast crawl technique of breast feeding the infant.
In this technique, the baby crawl on the mothers body and
finds her breast and start suckling. It may take about 1 hour.
This is very useful technique because it increases the milk
secretion of the mother and also creates a strong bond
between the mother and baby.
DA
TE :- 16.02.2012
In the 1st half (10:00 a.m. to 1 p.m.) :-
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VISIT TO CINI 1
The Child in Need Institute phase I has three main
activity centres NRC (Nutrition Rehabilitation Centre),
Thursday clinic, Emergency ward. At first the mother gets the
babys name registered at the centre.
The weight of the baby is measured and if he/she is
malnourished, then he/she is referred to NRC for admission and
treatment.
The baby receives 7 meals a day and mother receives 5 meals
a day. The RCH clinic deals with Reproductive and Child Health
Services.
RCH deals with HIV AIDS and other sexually transmitted
diseases. The Thursday clinic of RCH is a special clinic for
screening AIDS, its treatment and rehabilitation.
At the NRC clinic, both mother and baby are admitted.
FOOD MENU provided at nrc :-
DAY AT 6
A.M.
AT 9
A.M.
AT
12:00
A.M.
AT
2:3
0
P.M
.
AT
4:30
P.M.
AT
7:3
0
P.M
.
AT
10
P.
M.
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Monday Nutrimix
payesh/ha
lwa
Soojis
upma,
boiled egg
Rice, dal,
sabji,
Egg, lemon
Fruit Nutrim
ix
payes
h,puff
ed rice
with
badam
/chola,
cheera
Rice,
dal
sabji/
dal,ro
ti
Sooji
s
paye
sh/h
alwa
Tuesda
y
Nutrimix
payesh/ha
lwa
Nutrimix
laddoo,
boiled egg
Rice,dal,sabji
,nutrella,lem
on
Fruit Nutrim
ix
payes
h, gola
roti
prepared
with
ata+s
ooji+b
esan+
sabji+j
aggery
Rice,
dal
sabji/
dal,ro
ti
Sooji
s
paye
sh/h
alwa
Wednes
day
Nutrimix
payesh/ha
lwa
Puffed
rice,alook
abli andegg
Rice,dal,sabji
,chicken,lem
on
Fruit Nutrim
ix
payesh and
nutrim
ix barfi
Rice,
dal
sabji/dal,ro
ti
Sooji
s
payesh/h
alwa
Thursda
y
Nutrimix
payesh/ha
lwa
Cheeras
upma and
egg
Khichdi
pepared with
dal, green
leafy
vegetables
and othervegetables,
bhaji,
chutney,
salad
Fruit Nutrim
ix
payes
h,
puffed
ricewith
potato
,chola,
onion
Rice,
dal
sabji/
dal,ro
ti
Sooji
s
paye
sh/h
alwa
Friday Nutrimix
payesh/ha
lwa
Soft rice
boiled
with
gourd, dal
Rice, dal,
sabji,fish,
lemon
Fruit Soojis
barfi,
payes
h
Rice,
dal
sabji/
dal,ro
ti
Sooji
s
paye
sh/h
alwa
Saturda Nutrimix Soojis Rice,dal, fruit Nutrim Rice, Sooji
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y payesh/ha
lwa
upma and
egg
sabji,chutney ix
payes
h and
laddoo
dal
sabji/
dal,ro
ti
s
paye
sh/h
alwa
Sunday Nutrimixpayesh/ha
lwa
Payeshprepared
with
cheera,
dal,
jaggery
Khichdi withleafy
vegetables
and other
vegetables,
bhaji,
chutney/sala
d
fruit Payesh, gola
roti
with
besan,
jiggery
,ataa
Rice,dal
sabji/
dal,
roti
Soojis
paye
sh/h
alwa
In the 2nd half (1:30 p.m. to 4:30 p.m.) :-
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Firdausi bibi is a 23 years old housewife. She got married at the
age of 17 years and conceived her first baby within 3 months of
marriage. She lives in a joint family with more than 6 members.
Her husband is a daily wage earner, who earns Rs. 200/day.
During her pregnancy, she weighed 36 kg and suffered from
abdominal pain and anorexia. When She reported this to healthworker, she got an USG done which revealed that uterus was
small. Soon after she delivered her first baby boy who was
healthy.
She again conceived for the 2nd times, when her first baby was
2 year old. At the 8th month of her pregnancy due to water
breakage, she gave birth to premature baby boy weighing just
2 kg. Just after the birth, the baby started gasping for breath
and was turning blue. Then the baby was wrapped in the cloth
and held under the sun, so he recovered.
Both the time, her delivery was done at home by dai-ma.
Her 2nd baby named Farooqh Seikh is 2 years old and is
admitted to NRC unit of CINI 1 with a problem in walking. He
has completed all the immunization, he was exclusively breast
fed for 1 year. Their sanitation and personal hygiene is also
good.
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Communication is a two way process of sharing and
transmitting ideas, information and messages between
two or more individuals.
ELEMENTS OF COMMUNICATION :-
1) Communicator
2) Message
3) Medium
4) Receiver
5) Impact
COMMUNICATION IS AN INTERACTIVE
PROCESS OF 5 ELEMENTS WHICH
ENSURES :-
1) Who?
2) Says what?
3) In what channel?
4) To whom?
5) With what effect?
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FUNCTIONS OF COMMUNICATION :-
1) Sharing of information and ideas
2) Increasing knowledge
3) Influencing people for change in attitudes and beliefs
4) Bringing about behavioural change
5) Persuasion and negotiation
6) Motivation
7) Counseling
8) Giving instructions
9) Reaching a decision
10) Building human relationship
11) Entertainment
COMMUNICATION BARRIER :-
Communication becomes ineffective due to many hurdles
called Barriers of Communication. A good communicator
should be aware of the following communication barriers and
should try to overcome them to avoid problems :-
Poor planning Inadequate knowledge Too much or too less information Unaware of knowledge, attitude and practices of community Failure to understand cultural differences Poor communication skills of communicator
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Poor presentation Selection of inappropriate channels and medium,
Selection of messages contradicting existing beliefs andpractices
Inadequate communication material Inappropriate language Various forms of external noise Insufficient feedback Technical errors.
COMMUNICATION CHANNELS, MEDIA AND
TECHNIQUES :-
MASSCOMMUNICATION
GROUPCOMMUNICATI
ON
INTERPERSONAL
COMMUNICATIO
N
1) Electronic Media :-
Films; Film Quickies;
Radio programmes; Radio
spots; Audio tapes; TV
programmes; TV
quickies/Spot, slides.
2) Print Media :-
Books, booklets,
foldersand leaflets,
handbills, letters,
newspapers,
1) Lecture
2) Group
meetings
3)
Demonstration
4) Camps
5) Field visit
6) Role play
7) Flip book
1)Home visits
2)Counseling
3)Negotiation
4)Motivation and
persuation
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advertisements, press
release, posters,
photographs, hoardings,
magazines, newsletters,
journals.
3) Folk and Traditional
media :-
Song,dance,drama,kiortan
/bhajan,puppet show, wall
writing etc.
4) Alternate Media :-
Street play, nautanki etc.
5) Multi-media
campaigns :-
Publicity
campaigns/awareness
campaigns; exhibition
8) Flash cards
Etc............
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DATE :- 17.02.2012
In the first half (10 a.m. to 4 p.m.) :-
COUGH, COLD AND ACUTE
RESPIRATORY INFECTIONS (ARI)
ARI is the major cause of death among children. On anaverage children below 5 years of age suffer about 5
episodes of Acute Respiratory Infections (ARI) per year.
Cold, cough, sore throat and running nose are commonrespiratory infections and are of no cause of alarm. In some
cases, cough and cold are danger signs of more serious
respiratory as tuberculosis and pneumonia.
COUGH AND COLD :-
Cough and common cold is the most frequent problem inchildhood and is usually due to infection of the upper
respiratory tract.
Cough is a sign of some other sickness affecting the throat,lungs or air passage in the chest.
SYMPTOMS TREATMENT HOME TREATMENT
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AND CARE
Running nose,
sneezing,
sore throatand cough.
Children with
cough, cold,
running nose orsore throat who
are breathing
normally can be
treated at home
and will recover
without
medicine.
A child with
harsh cough
requires
immediate
referral.
Keep the child warm
and let him rest.
Encourage the child to
eat normally
Increase the amount of
fluids including
breastfeeding
Soothe the throat and
relieve the cough
remedy i.e. Ginger tea
with honey; lemon
drink; drink with tulsi
leaves, saunf and
elaichi; hot soups etc.
Sponge/bathe with cool
but not cold water if
child has fever
Clean the nose by
putting in nose drops
(boiled and cooled
water mixed with salt)
or by cleaning the nose
with a soft cotton wick.
A moist atmosphere canmake breathing easier.
Medication should be
used only if prescribed
by a doctor.
PNEUMONIA :-
SYMPTOMS ASSESSMENT TREATMENT
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A child with cough
and cold and fast
breathing haspneumonia
To assess
whether the child
has fastbreathing or not
count the
breathing rate for
one minute.
Breathing rate of
a child is as per
his age. As the
child grows older,
breathing rate
slows down
A child have
pneumonia is
treated withcontrimoxazole.
Contrimoxazole is
not provided in
the medicine of
AWW. She may
contact ANM
immediately, who
can prescribe the
medicine and has
it in her stock.
PREVENTION :-
Million of child deaths from pneumonia can be prevented if :-
Parents and caregivers know that rapid and difficultbreathing are danger signs requiring urgent medical help.
Parents and caregivers know where to get medical help. Medical help and low cost antibiotics are readily available. Babies are exclusively breastfed for 6 months and are fully
immunized.
Children and pregnant women are particularly at risk ifexposed to smoke from tobacco or cooking fires.
SEVERE PNEUMONIA :-
SYMPTOMS ASSESSMENT TREATMENT
If a child with
cold and cough
has chest
chewing, he has
To assess severe
pneumonia, look
for chest
indrawing at the
Refer the child
with chest
indrawing to
PHC/hospital
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severe
pneumonia.
Normally, the
lower chest wallcomes out when
the child
breathes in. In
case of severe
pneumonia, the
whole of lower
chest wall goes
in as the childbreathes in. This
is called chest
indrawing.
lower chest wall
when the child
breathes in.
Make sure thatthe childs lower
chest is fully
exposed, child is
not crying and
childs nose is
not blocked.
immediately, as
this is a specific
danger sign.
DIARRHOEA :-
A child has diarrhoea if he/she passes three or more watery
stools per day.
Diarrhoea is more common among under-nourished children
than in normal children.
Diarrhoea kills children by draining liquid from the body thus
dehydrating the child.
If diarrhoea continues for more than two weeks, it is
persistent diarrhoea. In this case, the child needs
immediate attention and should be referred to PHC/hospital.
If a child has blood in stools, he/she has dysentery and
should be referred to PHC/Hospital.
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Mild Diarrhoea/No dehydration Child drinks normally.
Moderate Diarrhoea/Some Dehydration Child is thirsty
and drinks eagerly
Severe Diarrhoea/Severe Dehydration Child drinks
poorly or is not able to
TREATMENT :-
Diarrhoea usually cures itself in a few days.
Do not give a child with diarrhoea any tablets, antibiotics or
other medicines unless prescribed by a doctor.
A child with persistence diarrhoea or dysentery or severe
diarrhoea should be referred to PHC/hospital.
Home treatment of diarrhoea includes :-
a) Intake of Home available fluids :-
A child with diarrhoea should be given extra fluids availableat home like soups, rice water, coconut water, weak teawith a little sugar, clean water from safe sources, diluted dal,
butter milk and breastmilk (if child is breastfed).
Fluids should not be diluted. If the fluid is heavy for the child,plain clean water can be given to the child after giving fluid.
If the child vomits, wait for 10 minutes, then continue givingfluids, but more slowly.
b)Continued feeding :-
A child with diarrhoea needs to be fed continuously While recovering from diarrhoea, the child needs atleast one
extra meal every day for atleast 2 weeks.
Mother should not stop feeding the child.c) Continued Breastfeeding :-
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Breast milk is the best source of liquid and food for a younginfant with diarrhoea. It can reduce the severity and
frequency of diarrhoea.
Breast feed the baby frequently and for longer time thanusual.
In the 2nd half (1:30 p.m. to 4:30 p.m.) :-
HANDS ON PRACTISE :-We did the hands on practise. We were divided into three
groups. One was given poster presentation on New born care,
the second one was given puppet show on PNC and the third
one was given street drama on ANC.
Our group was allotted for puppet show and so we did the
hands on practise in the second half.
DATE :- 20.02.2012
In the 1st half, we were taught about the growth chart .
This chart is used to monitor the growth of the children
according to their age and weight.
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GROWTH
MONITORINGWhat is Growth Monitoring ? Growth Monitoring means keeping a regular track of the
growth of the child through key indicators like weight,
height according to age etc. at regular intervals.
Growth Monitoring is a way to detect growth failure inchildren at an early stage and take immediate and effective
action.
Growth Monitoring must start right from the birth of the
child.
In ICDS, Growth Monitoring is done with the help of growth
chart.
Growth Chart :- Growth chart is a tool for assessing the growth of the child
using weight-for-age as indicator. It is a visual record of the
growth pattern of a child.
Growth chart also determines the grades of malnutrition of a
child, identifies beneficiaries for supplementary feeding, and
is used for imparting nutrition and health education to
mothers.
Four growth curves on the growth chart depict the growth of
the child and help in assessing his/her nutritional status.
Growth chart has two axis :-
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a) The horizontal axis is for recording the age of the child
and is being referred as month axis.
b) The vertical axis is for recording the weight of the child
and is being referred as weight axis.
Weight of the child as per the the age is plotted on the
growth chart.
When should an Anganwadi workers weigh thechild ?
Weigh all children upto 3 years of age per month.
Weigh children 3-6 years old every three months.
Severely malnourished children and child who have not
gained weight consecutively for three months should be
weighed every month (irrespective of the age)
How to monitor growth of children ?Steps in Growth Monitoring :-
1. Determine correct age of child.
2. Determine correct weight of child.
3. Plot weight accurately on the growth chart.
4. Interpret the direction of the growth curve and recognize
growth failure, if any.
5. Discuss childs growth with mother and the follow-up
STEP 1 : Determine the correct age of
the child :-
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Knowing the correct age of the child is necessary for
accurate growth monitoring.
Assess the childs age by :
a)Asking mother/older members of the family.
b)Checking birth register/home visit, resister/hospital records
for the age of the child.
c) Using local events calendar while talking to the mother about
childs age. A local events calendar indicates all the dates on
which important events took place during the past five years
like name of months, important events in the agriculturalseason of the area, local festivals, national festivals, phases
of moon etc.
STEP 2 : Determine the correct weight of
the child :-
Anganwadi workers are provided salter/bar weighing scalefor taking the weight of a child.
Steps involved in weighing the child are :-
a)Setting the scale -
o Hang the scale securely from a beam or branch of a tree.
o Keep the dial at eye level so that the weight can be easily
read.
o Place the cradle or infant sling on the cradle hook.
o Adjust the pointer to zero by turning the screw on the top of
the scale.
b)Weighing the infant or child -
o
Ask the mother to remove childs heavy clothing.
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o Place the child in the cradle.
o Childs feet should not touch the ground.
c) Reading the scale -
o Scale is graduated from 0 to 25 kg. Each kilogram is divided
by a 500 gm or a 100 gm marking. Read the pointer on the
scale to nearest 100 gms.
o Ask the mother to stand near the child and talk to him/her so
that he/she does not cry.
o Read the weight while standing exactly opposite the scale.
Do not read the scale from the side.
STEP 3 : Plot weight accurately on
growth chart :-
Plotting the weight on the growth chart reveals whether the
child is growing normally or not.
Growth chart should be filled-up systematically as givenbelow :-
a)Fill-up all the necessary information about the child in the
index box on the growth chart register.
b)Fill-up the information box on the growth chart which gives
the childs name, fathers name, mothers name and family
registration number.
c) On the month axis, in the first box write the name of month
and year during which the child was born and then fill-up the
remaining months and year columns for all the five months.
d)On the month axis identify the month box which indicate
the present age of the child.
e)Write the weight taken below the month box.
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f) On the weight axis, identify the line which indicates the
present weight of the child.
g)Plot the weight in the appropriate square above the
identified month box.
h)Draw a circle around the dot so as to know its position.
i) Now connect this dot with the dot made on the previous
month with a line. This forms the growth curve.
STEP 4 : Interpret the direction of growth
curve :-
Direction of growth curve of the child can be upward, flat or
downward.
Direction of growth curve is more important than the actual
weight of the child at any point. It can be interpreted as :-
a)Upward growth curve indicates that the child is gaining
weight and is growing.
b)Flat growth curve indicates that the child is not growing
adequately.
c) Downward growth curve indicates that the child is in danger
and needs immediate health care.
Weight of all normal healthy children fall above the top
curve.
Corrective action on the first sign of growth faltering can
help in restoring health.
STEP 5 : Discuss childs growth with
mother and follow up :-
Priortise children who are malnourished and whose mother
need counselling.
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Show the growth chart to the mother and explain the
direction of the growth curve.
Discuss and ask the parents the reasons for no or poor
weight gain
Advise parents about nutrition care, frequency of feeding
and blending with family food patterns.
Monitor the growth of malnourished child regularly
Convince mothers to bring the children regularly to
anganwadi workers for weighing.
Refer the children whose growth is faltering consecutively for
2-3 months or who are severely malnourished to PHC
hospital.
In the 2nd half, we were told about BMI (Body Mass Index
) and its calculation. Again we were divided into groups
and told to determine our own groups.
BODY MASS INDEX
Body Mass Index (BMI) is a simple index of weight-for-heightthat is commonly used to classify underweight, overweight and
obesity in adults.
BMI is defined as the weight in kilogram divided by the square
of the weight in metres (kg/m2).
CLASSIFICATION :-
Classification Principle cut off
points
Additional cut
off
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Underweight < 18.5 < 18.50
Severe thinness < 16.00 < 16.00
Moderate
thinness
16.00 16.99
Mild thinness 17.00 18.49
Classification Principle cut off
points
Additional cut
off
Normal range18.50 24.99 23.00 24.99
Overweight 25.00 25.00
Pre-obese 30.00 30.00
Obese class I 30.00 34.99 30.00 32.49
32.50 34.99
Obese class II 35.00 39.99 37.50 39.99
Obese class III 40.00 40.00
Calculation of my own BMI are
given below :-
[My weight = 56 kg
My height = 5 ft 2 inches
= 152 + (2.54 x 2)
= 152 + 5.08
= 157.08 cm
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= (157.08)2
= 24674.1264 cm2]
Height in m2 = 2.46 m2
BMI is equals to weight in Kg divided by Height in m2
i.e 56 Kg / 2.46 m2
= 23.15 ( Normal range)
Therefore my BMI is 23.15, which is of normal value.
After this we were given the layout the layout of the diet survey
and it was explained to us. The day ended with hands on
practise.
HANDS ON
PRACTISE :-We did the hands on practise. We were divided into three
groups. One was given poster presentation on New born care,
the second one was given puppet show on PNC and the third
one was given street drama on ANC.
Our group was allotted for puppet show and so we did thehands on practise in the second half.
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It was an informative day which we thoroughly enjoyed.
DEMOGRAPHIC DATA OF DIET SURVEY :-
NAME OF RESPONDENT :- Mrs. Channda Chatterjee
FAMILY SIZE :- Nuclear
TOTAL FAMILY MEMBERS :- 3
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MALE FEMALE
ADULT 1 2
CHILDREN - -
FAMILY HISTORY :-
SL
N
O.
NA
ME
AGE SE
X
EDUCAT
ION
OCCUPA
TI-ON
INCO
ME
PHYSIO-
LOGICA
L
STATUS
PHYSI
CAL
STATU
S
A.C.
U.
1 Ch
ann
da
DATE :- 21.02.2012
MENU :-
EARLY MORNING (6A.M.)
Tea, 2 biscuits
BREAKFAST (8:30 A.M.) 2 Roti (2 pcs. for each
member), sabji
LUNCH (12 P.M.) Rice , dal, sabji, fish curry
(charapona)
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EVENING SNACKS (4
P.M.)
Puffed rice, tea, biscuits
DINNER (9-9:30 P.M.) 3 roti (for each member), dal,
sabji
DATE :- 23.02.2012
MENU :-
EARLY MORNING (6
A.M.)
Tea, biscuits (2 pcs.)
BREAKFAST (8:30
P.M.)
Roti (2 pcs. for each member),
sabji
LUNCH (12:00 P.M.) Rice, mixed veg curry (ladys
finger, broad beans, brinjal,
cabbage, tomato), brinjal fry,
ladys finger,poppy seeds, egg
curry
EVENING SNACKS (4
P.M.)
Puffed rice, tea
Dinner (9-9:30 P.M.) Roti (3 pcs. for each member),
Mixed veg curry
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DATE :- 23.02.2012
MENU :-
EARLY MORNING (6
A.M.)
Tea, biscuits (2 pcs.)
BREAKFAST (8:30 A.M.) Roti (2 pcs. for each member),
sabji
LUNCH (12:00 P.M.) Rice, masoor dal, mixed veg
(broad beans, brinjal, tomato,
onion), cabbage with macher
muro.
EVENING SNACKS Puffed rice, tea
DINNER (9-9:30 P.M.) Roti (3 pcs. for each member),
mixed veg.
CALCULATION :-
SERIA
L
NUMB
FOOD
STUFF
DA
Y 1
DA
Y
2
DA
Y 3
AVERAGE
CONSUMPT
ION
PERHEAD
CONSUMPT
ION
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ER
1 Rice 25
0
gm
2 Atta 27
0
gm
3 Dal
(masoor)
70
gm
4 Fish 25
0gm
5 Egg -
6 Mix veg
(a)ladys
finger
(b)broadbeans,
(c)brinjal
, (d)
cabbage,
(e)
tomato
-
7 Milk
8 Poppy
seeds
9 Biscuits
10 Oil
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11 Puffed
rice
12 Onion
Serial
numb
er
Food
stuffs
Stand
ard
intake
Field
values
Exces
s
value
Defici
ency
value
1 Cereals 460 gm. 227.35
gm
- 232.65
gm
2 Pulse 40 gm. 14.28
gm.
- 25.72
gm.
3 Green
leafy
vegetabl
es
60 gm. 95.23
gm.
35.23
gm.
-
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4 Other
vegetabl
es
50 gm. 164.27
gm.
114.27
gm.
-
5 Rootsand
tubers
50 gm. 45.23gm.
- 4.77 gm.
6 Milk 150 ml. 89.28
ml.
- 60.72 gm
7 Flesh
food
40 gm. 84.51
gm.
44.51
gm.
-
8 Fats andoils
40 gm. 25.59gm.
- 14.41gm
9 Sugar
and
jaggery
30 gm. - - 30 gm.
10 Fruits 30 gm. - - 30 gm.