NIP PILOT PROJECT ON Nutrition & Parenting
Item
- Title
-
NIP PILOT
PROJECT ON
Nutrition & Parenting - extracted text
-
c.
NIP PILOT
PROJECT ON
Nutrition & Parenting
Sponsored
by
UNICEF
( DRAFT FOR LIMITED CIRCULATION ONLY )
PREFACE
fO THE CONCERNED PEOPLE AND ORGANISATIONS ,
WORKING IN THE AREA OF CHILD SURVIVAL , GROWTH &
DEVELOPMENT.
ABOUT N.I.P
The Network for information on Parenting is a
voluntarily federated democratic body with a
membership of approximately thirty organisations
working with infants and children.
This Network is committed to supporting efforts to
strengthen capacities of parents and communities
to create a positive, nurturing environment for all
children and especially those from the deprived
and unreached communities in rural and urban
areas . in Tamil
---- Nadu
-- the Network?s
.
. . . mandate is to
support and promote positive child rearing
practices for children below 5 years whichi would
ensure
the child’s physical well being
O
o
o
psycho-social development ( emotional security,
socialisation and affection )
the child’s mental development- interaction,
stimulation and play
as also good and healthy nutrition and food
habi ts
ACTION STUDY PROJECT
This Network undertook to do.a study cum
intervention project on Nutrition and child care
practices among a cross-section of select
copulations in seven districts of Tamil nadu.
It was titled
Communication of Best Practices for
chan9e "in Nutrition and Documentation of
Child Care practices in conditions and contexts of
deprivation.
A f0U/->nA?p0n^^a?ti9n study was conducted for one
year (2001-2002) in four sites of Tamil nadu under
the stewardship of four Institutions as listed
below-:
i)Tamil Nadu voluntary Health Association
Project Holder : saulina Arnold
area of operation was in the five districts
of Nagapattinam, Erode, Tiruvanamalai, Virudhanaqar
and Sivagangai among the backward community in each
district. Select NGOs and voluntary groups worked
in co-ordination with the women’s self help groups
now a part of the community structure in tne rural’
areas.
tnvha’s
ii) RUHSA Department, Christian Medical college
Project Holder : Dr Rajaratnam Abel
RUHSA , yellore worked in five panchayats in k.v
kuppam Block in hilly area of Vellore district with
community self help groups already formed in the
area consisting mainly of non-lettered populatios
Madhuram Narayanan Centre for Exceptional
children ; Project Holder : Jaya Krishnaswamy
MNC,s Action study on Nutrition and child care
practices in institutions, was conducted in both
rural and urban sites and included children and
infnnts with disability and without disability. It
'ocussed on child care practices in the
different communities of the Christian, Muslim and
districtUSeh°ldS ’ 1n select ham1ets in the Ramnad
iv) Sahishnatha vijaya Institute of child Health
Project Holder : Dr s. Jayam
svich
worked with the Health Professionals
of the Dharmapuri district i.e, Doctors, staff
nurses, and Annis of the district, in a series of
Refresher training workshops in essential
protocols of Early childhood care and psycho
social dimensions of Parenting. The trainings were
tailored as per the level and duty functions of the
participants.
This one year project was sponsored by UNICEF from their corporate donor
funds. NIP Secretariat based at the Balamandir Research Foundation after a
due selection process chose the above four organisations to conduct this
Nutrition and Parenting Intervention Programme in their project areas.
Description of target population, details of the intervention programme i.e
Background of Project area, Rationnale, Content of messages that were
disseminated , Methodology of Training , Main Findings and
Recommendations are all provided in the summaries of the four Action
Studies that follow.
We have focussed more on packing in as much relevant data and
information into these summaries, so any inadequacies by way of an easier
reading style and narrative, needs the readers 'patience andforgiveness. As
can be seen from a careful reading of these summaries, apartfrom
parenting messages reaching the target groups, this programme has also
benefited a large number of extended populations, going well beyond the
numbers cited as target population. It must be said here that all the
Network members involved in this complex project realised that when a
Networkfunctions with team spirit and in tune with its commitment a lot of
strengths can be generated and consolidated.
The full and unabridged documentation of this UNICEF -NIP Pilot Project
is available with UNICEF ( Health Division ) as well as with Balamandir
Research Foundation.
THIS DRAFT IS FOR DISCUSSION AND LIMITED
CIRCULATION ONLY
For NIP Secretariat
ry
&
NJ I’- SVB
PARENxfe" .' i ’' ■ • ‘' k-...\ M M E
Nutrition and Child Care Practices
Process Documentation on
Interventions conducted
In
Dharmapuri District
2001-2002
PROJECT HOLDER : Dr SJayam
Sahishnatha Vijaya Institute
Of Child Health
Vijaya Health Centre
N.S.K.Salai
Chennai
SUMMARY REPORT:
see below-:
2
An over view of the workshops conducted
Group
composition
Objectives
Rationale
Doctors from
the district of
Dharmapuri
especially
those in
Government
service.
-To
disseminate
information
and
knowledge
on parenting
- Doctors,
especially
Pediatricians
play an
important
role as care
enhancers
hence the
need to be
informed on
Parenting.
Content
Comment
s
Vital findings
-Appropriate -The
-The
doctors
medical
participants agreed
to
knowledge
were
introduce the
was
involved
topic ini the
integrated
during the
school 1health
with
sessions
programmes.
information
and a few
-Doctor
’s
- To identify
on parenting volunteered handbook
resource
to sustain
to be
evolved after
persons on
their
resource
the workshop.
the subject
interest.
persons.
-Doctors found
to carry
the subject of
forward the
- Doctors
-The four
-For many
child
message.
deal with the vital points - doctors it
development
new born
* Planning
was a
quite practical
first, they
for
refresher
and rewarding.
have to be
Parenthood, course.
-Doctors agreed
refreshed
-Welcoming
to include it in
and
the Baby,
-The Patient their
clinical
motivated to -safe
is to be
practice.
provide
motherhood looked at
-Doctors
appropriate
-Nurturing
holistically admitted that
and essential the child
as a person they
were
new born
This was
rather than
involved
in
care.
covered
only as a
curative
care
using
patient
but would shift
clinical
which
to Preventive
photographs confines the and promotive
and practical Doctor’s
care
and
sessions
role only to counseling,
including
treatment of (sensitization
ward rounds. the disease
and
-Adolescent and not the personalized
health was
cause of it.
communication
also covered
with children
and
parents/care
givers)
was
new
to
Government
doctors.
Nurses from
-To impart
-Nurses are
-The content -This was
-Subsequent to the f
the District of knowledge
involved in
was much
their first
workshop there was a
Dharmapuri
and skill on out patient
simplified
ever
significant
change in 1
especially
Parenting to and inpatient when
refresher
their
attitude.!
those serving
this group
care so they
compared to course after Example: Three off
in
who are the often
the Doctors’ joining
the staff nurses saved (
Government
vital care
communicate training but service,
three female babies
Hospitals
givers to
with patients. the vital
hence felt it hy talking to the 1
mother and -Secondly in points were
was very
mothers who were 1
children.
the case of
covered.
useful.
about to abandon i
I the Medical
-The flip
them soon after birth.
community,
-Adolescent chart was
Economic and social
nurses play
health was
an effective help to these babies 1
an important discussed at tool and
was provided through I
role as care
length by
they
their own family ;
givers and
sharing
suggested
members.
hence there is certain
that they
(Dharmapuri
HQ
need to be
specific
use it in
Hospital).
informed
cases.
their Out
about
patient
-Few of them are
parenting.
-Nurses
counter to
taking classes on
were
educate the Parenting in the Post
familiar
mothers.
natal and general
with many
medical wards at
cases
of
their place of posting.
I
neo-natal
deaths and
-The tool (FLASH
welcomed
CARD \ Flip chart)
the
was found effective.
knowledge
The nurses responded
of
new
enthusiastically to
techniques
these tools, which
of neo-natal
were colorful and real
resuscitation
life representations. It
and
was used to e,xplain
emergen C)7
the POSITIVE
new -born
EMOTIONALITY much i
care.
needed by women
and children
especially during
pregnancy and
adolescence and early ;
childhood years.
|
4
Village health
Nurses and
Auxiliary
Nurse
Midwives
serving under
the
Government.
-To share
information
on parenting
to this
specific
group as
they form
the
backbone of
our health
system.
-To impart
updated
knowledge
on essential
new born
care as they
deal with
the
community
directly.
-VHNs &
AN Ms are
groups
having direct
contact with
the
community.
-The vital
-The
-They were quite
points to be participants knowledgeable
delivered
found the regarding
the
were
“learning
advantages of breast
simplified to through
feeding but they were
colloquial
Play’ itool unaware of exclusive
language by very
breast-feeding for the
the trainers
effective
first six months.
-They visit
and were
and useful.
regularly the presented in They used -The management of
mothers and
Tamil so
the tool in the newborn was a
children and
that the
the OPs.
new area of learning.
their status
message
Using the techniques
will be in
reaches
-Eight
of warming
and
their finger
them.
ANM
kangaroo care they
tips. They do - Many case workshops
felt that more babies
ante natal
discussions
were
could be saved.
visits and
were shared conducted
-They felt that rural
immunization from their
locally
practitioners
and
at the village. experiences using
medical
personnel
Hence
in the
resource
have to be educated
educating
villages they persons
NOT to prescribe
this group is
visit.
identified
Tinned Baby foods.
very
through the
important as
-Clinical
previous
they have a
rounds were workshops.
direct link
done as part
with every
of practical
family.______ sessions.
5
Background
The Sahishnatha Vi jaya Institute of Child Health (SVICH) selected
Dharmapuri district for intervention under the Parenting program
because of its socio-economic profile. (Refer Annexure I)
Dharmapuri district also has a high infant and female mortality rate.
(Details in Annexure I). The contributing factors have been identified
as low birth rate, birth asphyxia, neo natal infection, diarrhea and
respiratory problems. The social causes include female infanticide.
Major efforts have been made to educate the public and anganwadi
workers to increase the knowledge on nutrition and childcare.
1 he blip chart has been introduced to the Anganwadi workers through
Social welfare department’s network.
In the rural health sector PHC Medical officers, VHNs and the nurse’s
closely work with the Anganwadi workers to do the antenatal care and
child care.
Unless health professionals are also informed and oriented with
relevant skills and vital information and referrals on child rearing
practices and parenting, current trends in health are not likely to
change positively. Also presently the medical professionals are only
locusing on curative care and on treatment of disease as their primary
task. 1 herefore there is a need for making the professionals look
beyond the disease and introduce this approach of parenting as a tool
for change. Medical professionals are the leaders and if they absorb
and practice the others will soon follow ,including nurses, ANMs and
VHNs. 1 HE C0MM11'MENT of the resource team is also necessary
to make this work.Therefore there arises a need for making the
professionals look beyond the disease and approach the patient with a
parenting attitude thereby forging a new relationship between
themselves and the patients.
Medical professionals are the leaders in health care and if they
develop this practical approach in their clinical practices, then the
other professionals- nurses, ANMs and VHNs, will soon follow suit.
1 he commitment of the resource team to this mission, of bringing
about a positive change in the attitude among the medical fraternity, is
considered absolutely necessary. 1 he project in charge appointed only
6
such members to conduct the workshops so that the overall tenor is
consistently maintained.
Based on the needs in the selected district, the SV1CH chalked out a
holistic, participatory learning programme to reach out to medical
professionals, staff nurses, VHNs and the ANMs.
7
Executive Summary
There have been significant changes in child care which in the last few
decades have had far reaching implications for the future. There has been
a major shift of approach in programmes to include developmental
perspectives. We recognize that every child who is born has the right to
first breath (life), survival and nurture without any discrimination.
Parents have got to carry out the major responsibility but the medical
professionals :
the doctors and the nurses can give a lot of quality
support to achieve proper development of the child.
Nutrition and
nutritional supplementation will improve the cognitive development and
adolescent growth. This knowledge of nutrition and a systems approach to
early childhood care needs to be
stressed so as to ensure a healthy
next generation of adults. The Network for Information on parenting
(NIP) evolved as an off shoot of such ideas among professionals
interested in child health and development comprising of both the
government and the non-government involvement with an aim to target all
parents and would -be parents.
NIP encompasses the following broad areas of child care:
Roles and responsibilities of parenting, identifying common problems in
parenting, creating awareness of positive and negative parenting practices,
promotion of good parenting practices, propagating gender equality in
child rearing and also emphasizing the role and value
of the family
setting in psychosocial development of the child.
The Sahishnatha Vijaya Institute of Child Health (SVICH) selected
Dharmapuri district for intervention under the Parenting program because of its
socio-economic profile. (Refer Annexure I)
Dharmapuri district also has a high infant and female mortality rate. (Details in
Annexure 1). The contributing factors have been identified as low birth rate, birth
asphyxia, neo natal infection, diarrhea and respiratory problems. The social
causes include female infanticide. Major efforts have been made to educate the
public and anganwadi workers to increase the knowledge on nutrition and
childcare.
The interventions planned were multifaceted and the basic thrust was in bringing
about an attitudinal change among the medical professionals regarding parenting
practices. An effort was made to sensitise everyone responsible for child
development on the psychosocial aspects of child rearing. This was done by
conducting workshops and training programmes for dissemination of such
knowledge at four levels. The first level concentrated on training of resource
person/facilitators and preparation of basic material on parenting aspects. The
second level was training of the doctors who are the professionals who are in
charge of the child’s health. The third level was the training of the nurses in the
government sector and the fourth the VHNs and the ANMs. The fourth level was
the most vital link in the transmission of parenting ideas as they are the persons
who are in continuous contact with the people and are aware of their problems at
the grass-root level. This programme was conducted for the Dharmapuri district
but has potential to be replicated at the state level throughout the districts so that
the overall morbidity and mortality rates of women and children can be brought
down.
The major findings that emerged from the doctors’ workshop was that this area of
psychosocial development in child care was a relatively new concept. It was
realized that preventive and promotive care were much more crucial than curative
care and it was their role to look into both the aspects. The holistic treatment of a
patient was clearly understood and the need to focus on such aspects as counseling
and sensititization emerged.
The findings from the nurses’ workshop was fthat though they were working in
close proximity to the population, their knowledge
_ J was not regularly updated and
this workshop was an (eye opener on many vital issues on parenting. Though they
had come face to face with neo -natal deaths and morbidity, they were not aware of
such things could be prevented at the early stage itself. Promoting positive
emotionality, gender sensitivity and humanizing the labour room were all new
aspects that they were eager to implement.
The finding from the
I ANMs and VHN workshop was that the new exposure they
gained on management of new born children was a relativelyy new concept. They
were aware of the importance of breast feeding but not of exclusive breast feeding.
The start of complementary feeding utilizing local resources was appreciated.
1 hey made a point to stress that the need to sensitise medical practitioners asking
them to refrain from prescribing breast milk substitutes. The learning through play
method was found very useful.
I he programme on the whole has been an effective one with the medical
professionals being able to relate positively and internalise some of the inputs for
piactice in their daily routine. It is hoped that this process of sensitization and
internalization of parenting practices that have come forth as a value addition to
the medical practitioners diagnostic routines can be replicated throughout the
slate.
rft)
An overview of the Health Department
Govei nincnt of Tamil Nadu
Administrative Set up:
Hi <
i“--i G«=! 1 'fci i--
I
Reproductive &Child Health (RCH) Commissioner
Director, Rural &
Medical health services Public health service preventive health
▼
(Co-ordinates
With JD & DD)
E>ist. Hospitals
I Ta i ofc HftspitaJm
v
V
PHCs
Deputy Director
Sub Centre(only rural)
Hospitals
8
◄
Deputy Director-1
jHea[th.Seryices)
District t Public Health Nurse
Sector Health Nurse
Village administrative Health
answerable to JD & DD
Sub center (VHNS)
(For every five villages)
/
centres
&
medical
officers
9
Rationale behind the workshops
1
■
’
Target group:
Doctors, nurses, VHNs & Alms working in
Dharmapuri District.
Why this group:
During their professional training, which is, hospital based, the health
personnel are exposed to the treatment of many diseases and poor
health conditions among persons of all age groups. Currently the
problems faced by this vital group are as follows:
A. The professional knowledge imparted to them earlier in during
their gaining professional degrees has either become obsolete
or needs a fresh orientation.
B. The professional skills taught to them in the course of their
training also need constant up-gradation.
C. The basic attitude of the medical professionals, that of
prescribing a particular course of treatment for a disease needs
to be refreshed with what is current.
D. Many professionals have not had opportunities to benefit from
refresher courses.
Yet, it is the three target groups specified earlier who form the
main channel for implementation of any health initiative or scheme
put forth by the Government.
If an attitudinal change can be brought about in these groups of
professionals, through workshops on training in knowledge on
positive child care practices and on the appropriate skills required
by them to use the information so gained, it can be optimistically
hoped that parenting messages can be reached to almost every
10
household in every village in the district. If networked with the
programmes of the anganwadi workers, the volunteering services
of the self help groups and that of the VHNs who are so familiar
with every household, this programme can soon be converted as a
model programme for implementation in all the districts of Tamil
Nadu.
This is the rationale behind choosing the specified target groups.
How the target group was reached.
A. Collaboration with the Directorate of Reproductive Child Health
to get the required information on the groups to be reached.
B. Planning the methodology.
Finalizing on the necessary
formalities for the selected professionals to attend the workshops.
C. Designing a separate workshop for each category of professionals
to make the communication processes on parenting effective and
appropriate.
D. Co-coordinating with the RCH
The Reproductive Child Health (RCH) Department:
• Has a specific scheme that is concerned with the health status of
women and child.
• Takes care of the concerns of the mother to be durin g her
pregnancy, during delivery and of the newborn. This programme
reaches out to all sectors of the society in every location.
• Is authorized to depute doctors, nurses, the VHNs & ANMs to
attend training programmes and workshops. The RCH is the
department, which gives permission for the using their venues for
training.
I 1
The project co-ordinator of RCH was met with initially to discuss on
the choice of the district, the geographical location of the blocks the
venue for the workshops and to decide on the selection of the
participants.
It was planned that every workshop was attended to by a fresh set of
participants so that the programmes circumscribed a wide spread.
12
The Workshop Plan
Level 1: TRAINING OF FACILITATORS
Level 2: Nodal workshop for doctors
Level 3
i
Staff Nurses' Training
(4 workshops)
Level 4: VHN and ANM Training
(12 workshops)
The training schedule involved four levels. The first level was the
preparatory phase with training being imparted to the facilitators, It
also involved the preparation of material for dissemination at the
workshops to be held subsequently. In the second level, doctors were
trained. The third level was the training of Staff nurses and level four
the training of the VHNs and the ANMs.
13
Level one: Preparatory PhaseThis level comprises of two phases - training the facilitators and
preparing the material for the workshops at the different levels.
a. Training Facilitators
As
a
pieliminary
step
Dr.Kumutha,
Dr.Mangayarkarasi.
Dr.Mammegalai, Deepa (Counselor), Vidya (Child Development
assessment consultant), Dr.Viswanathan, and Dr.Priya went in for an
intensive training on parenting skills and practices organized by the
Network on information in Parenting (NIP).
This Master Trainers workshop gave them the required background
knowledge on the subject and the communication skills to disseminate
the information to the select audience.
The facilitators as a group were committed and had a positive attitude
with respect to the purpose of the programme.
b.Preparation - Learning Material:
Alter a series of discussions the team then planned the sessions and
worked out the modules needed for the workshops for the doctors and
nurses.
Dr.Jayam, the Project holder coordinated these sessions.
four in-depth discussions were also held in working out the
methodology for imparting the subject matter.
Dr.Jayam with her Held experience suggested that the methodology
should be: —
• Field appropriate,
• Relevant to the cultural scenario of the selected district and also
incorporated with practical interactive sessions.
14
FOUR major topics related to parenting were chosen for the
preparation of the workshop material from the NIP resources. They
were:
•
•
•
•
Parental readiness, with major emphasis on health of the girl.
Planning for parenthood,
Welcoming the baby
Nurturing the child, particularly the girl child.
In the preparation of the learning capsules emphasis was laid on the:
• Health of the adolescent girl child.
• Information on:
- Advances made in the medical practices on the management
of pregnancy and new born care
- Special skills required to examine the newborn baby
- Neonatal resuscitation procedure with practicals.
- The art of exclusive breast feeding and young infant feeding
- Case scenarios were included to ensure the caring for and
humanizing, mother and childcare.
The required tools such as flash cards, slides, posters etc were also
selected and the strategies to reach out the message, such as case
studies, simulations, hands on training in clinical situations in
hospitals were also identified by this group.
Level two
A nodal workshop was planned specifically for the doctors.
Ihis workshop was designed in such a way that the doctors would be
motivated to form a core team to become effective trainers on the
subject in the district.
The icsouice team met the day prior tc the workshop at the venue
(Dhaimapu! i) and gave the final touches to the arrangements for the
workshop.
15
Level three
As a consecutive step four workshops were planned to include all the
staff nurses in the Dharmapuri district.
Nurses play an important and dominant role in parenting and
influencing parents and parents to-be in the nurturing of the new born
babies and infants. In many of the training workshops nurses are not
included.
Doctors in general only implicitly acknowledge the considerable help
that the ANMs and VHNs provide as Health functionaries. The series
of workshops were intended to take a big leap forward in bringing
hierarchical levels within the Health dept on a single platform and
putting developmental perspectives at the forefront.
Hence members of the doctor's resource team were of the strong
opinion that nurses being key personnel in hospitals must be
included in the programme.
Level four
Among the members of the health community, the VHNs and ANMs
foim a major group that work in close co-ordination with the people.
Unless they are made aware of the latest advancements achieved in
the medical field in relation to patient care and provided with the
necessary information on its practices this group of service providers
cannot show any attitudinal change in the way they relate to persons
in their care.
et, in all trainings provided to the medical community, this group
has always been ignored.
Hence it was planned to conduct twelve workshops to
include the large population of VHNs and ANMs in the
district.
16
Workshop 1. - Doctors
Some outcomes
• The
FLIP CHART session enlightened the doctors on
psychosocial aspects of child development, an area new to many
of them.
• Having been trained only in disease-oriented medicine this subject
was a welcome change to them.
• Identification of developmental delays and helping the mothers
with early stimulation was also a new area of learning.
• Usually disabilities, particularly mental disability is identified in
children only at a late stage and medical professionals are at a loss
then as to how to help the parents.
They feel, desperate because of.their lack of knowledge in the area
of .disabihtms^ Very few institutions are available for medical
interventions, particularly in the rural areas for children with
severe disabilities.
Therefore the doctors felt using the Flip chart, as an effective tool
will help them in identifying problems early and also in giving
early stimulation
* The girl child and trauma of rejection were discussed in keeping
with the prevalence of a high incidence of female infanticide in the
area. The medical community initially expressed that it was a
social issue. Their experiences in the clinical rounds however made
the doctors think differently, that there could also be a medical
aspect to it and therefore there is a role for the medical
professionals in preventing female infanticide. The humane aspect
of this issue was emphasized. It was stressed that clinical scans
should not be promotedfor sex- determination alone.
17
I* EED BACK on—the Flash card tool
It was a good tool to disseminate messages on parenting to the
masses especially those who cannot read.
*
It was pointed out that the flash card did not bring out the
importance of hospital delivery as also the immunisation schedule.
• The doctors expressed that the flash <
caids would be effective
information sheets for patients waiting at the
.J out patient
department.
The following maxims to be propagated widely by doctors ;
• Minimum age for marriage for girls should be 21 yrs.
Minimum weight gain during pregnancy should be I Okgs
Regular antenatal checkups essential, especially during the last
ti imester since many complications occur then.
NURSES ORIENTATION & WORKSHOP
The strategies and outcomes
Role play: The power of play was demonstrated through a role play, in
which all the paiticipants brought out the importance of play in a
child's life.
PEAY IS WORK for the CHILD.
1 his aspect of the parenting programme
was a concept entirely new to
everyone.
One of the participants being a new i
.
mother herself could relate very
enthusiastically to the many discussions that
were held. One of the
dimensions of nurturing a child iis to
' surround it with POSITIVE
emotionality.
lhe participants came up with real life incidents on t_,
teenage
pregnancy, sex abuse and female infanticide and the steps that
needed to be taken to prevent them.
Al lhe end of the session they were looking forward to pul to
practtee ,n then- heldwork what they had learnt during the day
18
They discussed at length about the need for better newborn
equipments and were willing to give more importance to simple ideas
like the use of a warmer, hand washing and continuing breast- feeds.
[
Outcomes of the sessions
First session outcomes:
r
As carry home messages on planning for parenthood
participants contributed the following:
□
the
• Planning for parenthood starts from the conception stage and
continues till the birth of child.
• All children are to be welcomed, irrespective of gender,
appearance, colour and ordinal position.
• Paternal readiness, acceptance of parenting role that is as
important as that of the mother.
• Special children need special care.
The psychosocial aspects of child development, planning for birth of
child from the stage of conception, and the role of the father in
parenting, though new concepts, were well received.
A satisfying conclusion was drawn that the messages on parenting had
reached them.
Second session outcomes:
Regarding welcoming the baby, the participants concluded that
• Clean and hygienic delivery environment was essential in
preventing infections to new-born.
• Immediate breast feeding is very important in providing natural
immunization and nutrition to the new born and in giving the
required body warmth and the sense of security that the child
needs most.
19
• Positive child rearing practices should be encouraged and the
negative ones to be avoided.
• Female infanticide must end.
Third session outcomes:
On Parental readiness the participants were of the opinion that
• Adolescent counseling was of utmost importance in today's
context of urbanized family life.
• Practicing safe sex was necessary in preventing sexually
transmitted infections.
Treatment facilities for sexually transmitted diseases need to be
improved.
e
1 he need foi economic planning by young couples, important.
Female literacy to be encouraged.
©
ANM’s /VHN Workshop: Strategies and Outcomes
Methodology:
• The language used was predominantly
]
Tamil especially for the
discussions and demonstrations.
®
Role-play and songs were the most popular and effective
methods that this cadre of medical workers responded to.
Feedback from the VHNs on the FLIP CHART tool.
® 1 he i elationships of the child, in the extended arena of activity,
with other family members, care givers; other well-wishers
weie depicted clearly through the colorful pictures of the Flip
chart.
• This tool had a very positive impact on them.
e
They felt very much at home, and comfortable in using this tool
as it helped them identify with the village settings they were
familiar with.
20
• They expressed that the pictures were “ our own village women
and families (the facial expressions of the people depicted in the
narrations, their dress, the family settings, the utensils, and the
environment.)
• Not even one picture had struck a false note.
• They felt that they could spread effectively the message of
“Warm welcome “ to the baby and mother in their villages.
• They were <quite knowledgeable regarding the advantages of
breast-feeding but they were unaware of exclusive breast
feeding for the first six months.
• They felt that there is a need for rural practitioners and medical
personnel to be educated NOT to prescribe tinned baby
foods.
•
1 hey asked a lot of questions regarding insufficient milk and
understood the needed lactation process to help the mothers.
• They were an eager batch to learn as they all realized the
impoitance to be trained to combat the high IMR in the region.
Feedback from the ANMs:
• Health education should be given on a continuous basis in the
I HC itself by inteiacting with mothers of every teenager and all
the teenagers who visit the PHC.
• Importance to be stressed on small family norm and the various
family planning options available in the PHC.
• Counseling by the ANMs to remove any fear or misconception
in this area.
• Counseling was also needed to improve the nutrition of the
adolescent girl so as to break the chain of low birth weight
babies born to under nourished mothers.
• The importance of antenatal visits to prevent unforeseen
emergencies was to be communicated to all pregnant women.
21
• Need to introduce Rubella vaccination and the need to have the
TT dose
• All the above help in demystifying pregnancy for the teenager
and removing any fear or misconception at the pre marital stage
itself.
• The participants agreed that this was a very important topic, as
most parents do not prepare themselves properly to receive the
new born. And hence not in a position to handle any emergency
emotionally or financially.
• On discussion, the need to be financially prepared came out
veiy stiongly and this should be done so that the pregnancy is
planned well in advance.
This can be achieved by proper pre-pregnancy counseling at the
adolescent period.
I his will also to insure a healthy pre pregnancy weight.
G
I he family should constantly monitor the pregnant woman’s
personal hygiene and nutritional intake to insure the birth of a
healthy child.
e
The need for pregnant women to make antenatal visits to the
ANMs wheie they would also receive counseling on the
importance of breast-feeding.
o
this should be not just for the pregnant woman but also for all
the members ol the family especially the elder woman, as they
will be taking most of the decisions for the mother.
o
1 he importance of essential newborn care .
22
Major Findings
Doctor’s Workshop
1) The doctors found the topic new and appropriate.
2) The importance accorded to the psycho-social treatment of
medical and physiological issues was a new area.
3) The doctors found that involving the father as active partners
in parenting is a new concept and would be worth
implementing.
4) Many of the participants recalled their own childhood and
parenting roles and could envision how this input can be, and
could have been incorporated in their lives.
5) A few doctors were motivated enough to have volunteered to
be resource persons on this subject.
6) One doctor has initiated her own school health programme for
the adolescent age group.
7) The doctors agreed to introduce the topic in the school
health programmes.
8) A Doctors Manual has been evolved after the workshop.
9) The doctors finding this specialty subject of child development
quite practical and rewarding agreed to extend it to their
clinical practice.
10) They also admitted that they were basically involved in
curative care and now they would think along the lines of
preventive and promotive care and counseling.
11) This aspect of counseling (sensitization and
]personalized
communication with children and parents/care givers)) was
unfamiliar terrain to Government doctors.
23
12) In an over crowded out-patient service they were unable to
transact these skills and felt that suitable training of other
health workers will prevent overload in PHCs.
13) Doctors felt the use of the flip chart to Identify disability and
applying it for early stimulation is a new area and their
knowledge is limited. Also latest and updated Information on
neo-natal health and the networking and plasticity of the brain,
which can be enhanced by good nutrition was an important
capsule of information which could be shared among their peer
groups.
1 he visuals on ward delivery and immunization schedule need
to be incorporated with the other visuals showing a breast feeding woman subsequent to a pregnant woman so as to add
continuity.
Ilf)5) The presentation using flash cards was; received positively by
the participants and there were some :suggestions to suitably
modify it so that both the rural and urban sections can both
benefit from it.
They clearly stated that there was lacuna in the area of medical
tiansaction. i.e., Looking at the mother and child only in terms of
disease.
Nurse’s workshop:
1) For the nurses this was the first refresher workshop during their
service span of over 11 years.
2) Since the participant mix included nurses from the HQ hospitals
and sector health nurses from the field, practical and field issues
and problems as regards to the girl child, teenage issues, young
mother difficulties, transport issues were raised and they also
had ideas on solving them. They had practical suggestions on
reducing maternal morbidity and mortality.
24
3) Involving SHGs in the villages for many of these messages of
NIP was emphasized.
4) They were quite familiar with the many cases of neo-natal
deaths and welcomed the new knowledge of learning neo-natal
resuscitation and emergency new -born care.
<1
5) After the workshop there has been significant changes in their
attitude. Example: Three of the staff nurses saved three babies
by talking to the mothers who were about to abandon their
female babies soon after birth. They arranged economic and
social help to these babies throughfheir own family members.
(Dharmapuri HQ Hospital).
6) Few of them are taking classes on Parenting in the Post natal
and general medical ward wherever they are posted.
7) The tool (FLASH CARD \ Flip chart) was found very
effective. The nurses responded with lots of spontaneous
enthusiasm for these tools, which were both colorful,
picturesque and real life representations. They interpreted the
FLIP Chart to explain the POSITIVE EMOTIONALITY much
needed by women and children especially during pregnancy and
adolescence and early childhood years. The TOOL seemed to
have crystallized very systematically something that they
already knew in their field experience but were unable to
articulate in such a clear manner.
8) A nurses Manual has been evolved after the workshops.
9) "Humanizing the Labor room “ when the woman
was the need they felt.
is in pain,
10) The nurses felt that they were the "UNREACHED PERSONS
even within the Health care system’ and expressed a desire to
have regular updates.
ANM’s /VHN Workshop: MAJOR FINDINGS
25
Eight ANM workshops were conducted locally with the help of
the lesouice peisons identified from the previous workshops.
A manual for ANMs & VHNs has also been evolved for further
use.
1) The ANM S and the VHNs were quite knowledgeable on the
importance of breast-feeding but unaware of the need for
exclusive breast-feeding for the first six months.
2) I he exposure to the situations on the management of the
newborn was a new area of learning to many of them. They
recognized that when infants were provided with the required
physical warmth and given the closeness, "the kangaroo care"
many more babies could be saved.
3) The participants strongly expressed that the rural
practitioners and medical personnel should be made to
understand that they should not "prescribe" processed baby
foods but should promote exclusive breast feeding and home
made weaning foods.
4) The participants asked a lot of questions regarding some
mothers complaining about insufficient milk to meet the infant's
requirements, but when explained, understood the lactation
process. They were optimistic that they were equipped enough
to convey the information to the mothers.
5) The participants found the “learning through Play’ tool very
effective and useful. They were enthusiastic to use the tool in
the OP Waiting Rooms.
26
EXECUTIVE SUMMARY
AND
MAIN FINDINGS
MNC -NIP- UNICEF Project on POSITIVE
PARENTING & NUTRITION PRACTICES
PROJECT HOLDER : Jay« KRISHNASWAMY, MNC
Executive Summary :
Project title: ACTIVITY-ORIENTED INTERVENTIONS IN NUTRITION & CHILD
CARE PRACTICES
I. TARGET GROUPThe target group of this study comprised a universe of 240 children,
of whom 200 were under three years, and the rest under six years of age.
These children (120 each) were chosen from Urban Chennai and Rural Ramnad and
grouped under four variables
a. Destitute ( abandoned) and orphaned children in
Institutions with some family suppport I
b. . Children in urban slums and rural backward areas
c. - Children within families ,with disability
d. Children within institutions with disability
Distribution of Populations: ( see next page)
Urban Sites: 4
1. 30 children without any observable
disability- under Bala Mandir Creche Care,
from Gangaikarai puram, Giriappa Colony,
S.S. Puram and colonies near Bala
Mandir,T.Nagar.
Rural Sites: 4
1. 30 children without any observable
disability- 15 from Thirupullani from
different communities availing of Bal
wadis, and 15 from 2 creches in
Singarathoppu,Ramnad.
2. 30 children with disabilities- under the 2. 30 Children with disabilities (many with
early intervention programme at Madhuram multiple disabilities), with no intervention
Narayanan Centre, T.Nagar.
till the Chennai Camp 2001- from the
hamlets in and around Thirupullani, from
different communities.
3. 30 children with disabilities- under 3.
30 children with disabilities-under
Shishu Bhavan Care, Missionaries of institutional care, physically handicapped,
Charity, Royapuram.
hearing impaired.
4. 30 Children without any observable
disability- under Bala Mandir Care,
Infant and Young Children Block,
T.Nagar, Chennai.
4. 30 children without any observable
disability- under institutional care.
Total: 120
Total: 120
Though the focus was on the holistic development of children , the interventions were
made through the training given to and
the
active
participation of Parents
/elders/caregivers— in families,
special educators/ therapists/medieal professionals, caretakers— in institutions.
MNC trained both the technical staff and the community in the psycho-social
dimension of positive parenting using these tools : - Flip Chart on the Joy of Parenting,
U PAN AYAN , Early intervention programme, and the Flash Cards.
Families:
Parents:
Elders
Institutions:
Special Educators
Therapists/Caretakers
Total:
Urban:
Rural:
120
180
120
450
011
012
015
015
323
590
Trained population-Total- Urban: 323 ; Rural: 590
2?
Extended population
(This group was drawn into the programme because of the awareness that was created,
.
curiosity and
int,er.eSt t.h.at WaS &enerated- Thls was observed in the responses received and
i
'
- J in the participation
exhibited by the population at large.) As can Ibe seen below this was not the envisaged target group.
But nevertheless this group we feel is an influential
------ 1 entity that can have a positive impact on the
targeted group. They are the opinion makers.
Urban:
Interdisciplinary
Team of Experts:
21
Administrative Staff
07
Primary Schools:
Correspondents/Supervisors/Heads: 07
Teachers:
12
Children :
160
Govt., Officials/ DPEP personnel:
09
Dist Rehab Office Staff:
01
Temple/Mosque/Church Heads and other staff:
Staff in Corporation/Municipality
03
Slum/Village Leaders:
03
Anganwadi workers:
03
Supervisory staff
05
Self Help Groups (Women):
03
Medical professionals in;
Government Hospitals:
09
Public Health Centres:
01
Hotel/Restaurant Staff:
00
Wayside Tea Stall Staff:
02
Public Distribution System Staff
03
Auto rickshaw Drivers/Bus Drivers
07
Conductors:
Theatre Group Participants:
01
General Population in the Slums
2000
Villages.
Total
2,360
Rural:
At sites:
04
Made affordable at Chennai 21
11
17
80
2800
07
03
03
10
110
47
11
07
14
03
06
15
II
21
14
12,000
15,212
NB. lt does seem to indicate that the extended population in rural Ra nnad has expressed a
■felt need for.’more accessibility to vital nformation and resources, in nutrition , and
medical support in child-care.
♦
.■
‘
-
............
.
.
II. SPECIFIC AIM & OBJECTIVES :
Globa! Aim:
Io identify the lacunae in nutrition and child practices, among children in socially and I
economically deprived communities and among children with disabilities in the same communities !
all under three years +, both from urban and rural populations.
’ I
Specific Objectives:
fo collect information on current and traditional nutrition and childcare practices, the support
cvctp.mc
nvnilnhlp family
fnmilv anH
systems available,
and institution.
Identify, lacunae/ needed critical input.
Document listing, reinforcing the positive, and modifying for relevance and meaning.
I
Disseminate information- parents, care givers, childcare workers, the adolescent population |
management at institutions and anyone caring for the child.
: Prepare, Best Practices Guide for Behaviour Change in Nutrition and Child Care.
Flip Chart with messages on nutrition practices and on care & management of the child with i
disabilities.
III. ACTIVITIES SPECIFIC TO EACH SITE
Phase I: June-September 2001
Phase II: Oct-Dec 2001.
Phase III: Jan -March 2002
URBAN SITES
l.BalaM Colonies ( Hutments in the vicinity of Bala Mandir)
Gangaikarai puram /S.S.Puram /Giriappa
Main Aim:
To sensitise parents to positive practices in nutrition and childcare.
Specific objective:
Creating awareness on :
Cooking wholesome meals, using optimum time and resources.
Utilising the daily routine to just talk and listen to their children.
Activity- Oriented Interventions:
Phase 1.
Visits to the households, interacting with the members, collecting
Information through a pre-planned schedule
Interventions were conducted through parent meetings , camps and workshops.
( Workshop I )
Phase 2.
Interventions were made through medical check Up- Health and Hygiene messagesWorkshop 2 was on
(Medical care and prevention of medical crises, attention to
Water management; garbage disposal, and toilet training for adult and child.
Assessing developmental progress in children.
-Workshop 3 was conducted on reinforcement of the Flip Chart - enforcement
I 30
Cooking Demonstrations were done at site.
Phase 3.
Dissemination
Parents’ Get Together - Workshop 4.
Encouraging social interactions of family members beyond home environs
(with creche caregivers, teachers and those concerned with the education of the child.)
Wrap Up Camp - Interactions with media celebrity
Phase 4.
Process Documentation
IL Madhuram Narayanan Centre for Exceptional Children, Chennai
Main Aim: To sensitise parents in positive practices in nutrition and childcare (disabilities) /
early intervention.
Specific objective:
To assist parents in :
• Assessing nutritional requirements
• Management of disabilities in children -Correct feeding postures
• Planning play activities -for learning and relaxation
Activity-Oriented Interventions:
Phase I
Administering the Schedule
Interventions: Parent meetings - Workshop 1
Phase 2.
Cooking Demonstration
Interventions: Medical Check Up-Workshop2
Assessing developmental progress
Flip Chart Recap -Workshop 3
Child care Practices within the Family , in celebrations of developmental milestones
Reached by the child, birthdays , festivals etc .
Observations of both current and traditional practices of inclusion of children , especially
those with disabilities.
Meeting Ramnad parents and children.
Phase 3.
Time and Work Management- Workshop 4. Conducted for the MNC parents.
Phase 4.
Process Documentation
III. Missionaries of Charity, Shishti Bhavan, Royapuram.
Main Aim: Nutrition Care and Child Care Practices - Training of children in Self Help.
8 3i
|\IUT-1C
r
09717 /
e
r.^
K !
Specific Objectives:
Assisting supervisors (Sisters in charge) to:
■ plan nutritional requirements
■ follow feeding postures in the care and management of children, individualised
programme plan for building self help skills - physical strengths-age appropriate.
Activity-Oriented Interventions:
Phase 1.
Visits to Shishu Bhavan, administering the schedule to collect information, planning
nutrition and diet chart and daily routine.
Interactions with volunteers, sisters in charge and physiotherapist.
Observations were made on the daily routine of the sisters in charge
Orientation to Sisters on handling of children with cerebral palsy : Workshop 1.
Phase 2.
Revisit to Shishu Bhavan
Conducted Physiotherapy-Assessment of the children
Routine Medical Check up done
Phase 3.
Counselling given to the sisters in charge in promoting self help skills.
Optimum use of human and material resources suggested
Phase 4.
Process Documentation
4.Bala Mandir Infant and Young Children Block
Main Aim:
To sensitise wardens on:
■ Early detection of disabilities, observations and interventions
■ Joy of Parenting — planning play activities
Specific Objectives:
To assist wardens in:
■ Assessing children on their developmental progress
■ Planning group activities based on the Joy of Parenting
Activity-Oriented Interventions:
Phase 1.
Visits-to the children block for Observations
Administering Schedule to collect detailed information
Phase 2.
- Workshop 1. On Recap of Joy of Parenting and assesssing using UPANAYAN.
<
41
V>
Early Intervention Programme
Dissemination of messages- Exhibition of notes on observations made by the matrons of
children ‘s developmental progress.
Phase 3.
Planning Group Activities -Learning through play
Phase 4.
Process Documentation
B. RURAL SITES -Ramnad
ThiruppuIIani
Target Group: Children without disabilities and with parents, selected from different
cultural communities.
Main Aim: To sensitise parents on the importance on nutrition care, self prepared foods, and
early childhood education.
Specific Objectives:
To teach through demonstrations, nutrition care <and’ grooming. Also, the importance of early
childhood care and education through group interaction and the flip chart methodology.
Activity-Oriented Interventions:
Phase 1.
Visits to households creche care centres, orphanages and institutions.
Administration of Schedule,
Interactions with the parents , care givers/ Medical Check Up for targetchildren
Workshop 1. - cooking and grooming routines ( demonstrations)
Phase 2.
Revisiting Tirupullani Block
Cooking - Grooming
routines -Workshop2
Q p-CLiQ./ Q C
Phase 3.
Dissemination of Messages
V KJC L l ('
{• v
"
Phase 4:
Wrap up Camp
Process Documentation
ThiruppuIIani
Main Aim:
Educating parents on:
•
•
Nature and cause of disability,
Prevention of disability due to nutritional deficiency
Comprehensive early intervention for care and management of disability
T 3^
v
I
Specific Objectives:
Creating awareness on:
• The importance of medical intervention and seeking facilities for medical
intervention, and the required orthotics.
• The need for developmental assessments and interventions.
This is to be done through visits, by administering the schedule, and interactions usin« the
Upanayan Early Intervention Programme and the Flip chart.
°
Activity-Oriented Interventions :
Phase 1.
General medical checkup-Workshop 1
Phase 2.
Cooking - Grooming - Workshop 2.
Chennai Camp: a five-day comprehensive camp at Chennai
From 29th October to 2,,d November, 2001.
Selection/Transportation: children -multiple disabilities
Comprehensive Interventions -medical and developmental
Interfacing :MNC Parents.
Phase 3.
Dissemination of messages
Phase 4:
Wrap Up Camp
Process Documentation
Institutions: Children under Creche care
1. Brother Angelo’s Orphanage for Physically Handicapped:
Children with physical handicaps -17
2. Government Institution for Deaf and Dumb Children
Children with hearing impairment -13
(Orphans under residential care and day boarders)
3. Government orphanage for girls(up to 18 years) and boys(upto 10 years only)
Children without disabilities.
(Orphans under residential care)
4. Creche Care : Children with parents
Main Aim:
Introduction of the wardens to the concept of parenting along with teaching/ caretaking.
Sensitisation ol wardens on positive nutrition practices.
Specific Objectives: Orientation to the matrons on Positive Parentin"
Practices through FLIP CHART transaction.
Activity-Oriented Interventions:
Phase I
Visits to institutions and administering questionnaire . Interactions
K 3^
With the management staff.
Phase 2
Medical intervention- in preventing illnesses and maintaining good health.
Developmental Intervention -in early detection of disabilities and interventions.
Introducing Joy of Parenting.
Phase 3
Sensitising the larger community, beyond the family.
(through dissemination of messages with community involvement,
on-the-spot contests).
Phase 4.
Process Documentation
Vision: The “healthy” child - with positive nutrition and childcare practices
Mission. Dissemination of information on the importance of:
The holistic development of child (with and without disability)
At home, creche and institution.
IV. Activity-Oriented InterventionsInformation Collected :
From observations made during visits, through informal interactions and interviews
From meetings.
Through administration of schedule, and questionnaire.
Interventions conducted through group activities, workshops, cooking demonstrations
camps, theme songs , street plays and hands on training in care and management of children
A. Urban:
l.Bala Mandir Colonies:
Identified Nutrition Practices: Findings
The nutritional practices within the colony were based on the availability of food items /
money to purchase/ adult male needs / available time in the daily routine / and community
practices.
General Information:
I. Number of meals a day:
Basically, only one meal is cooked at home.
.
•
nu drCn
°ne ?ieal 3 day frOm the cr6che on days of attendance at the creche
Other meals in the home are morning tiffin (idlis bought from vendors), evening
snacks (sweets savouries) bought from roadside vendors, and the night dinner of left
overs of the earlier meal cooked during the day for the adult members
No special meal is prepared for child.
0 3^
<)
2. 1 ypc of meals: Items / Nutrition
Items:
Rice (usually par boiled rice),Sambliar (with the commonly used tuvar dal tomatoes
onions, juice ol tamarind, and with some vegetables like brinjals etc.,
Leafy vegetables, keerai variety- most often.
■ Other "special" vegetables- very rare.
Non vegetarian dishes once a month/ fortnightly/on festive occasions, depending on
the availability of money in hand. Beef is cheaper, therefore preferred - no religious
constraints. Fish items prepared more often.
■ Tea.
■ No milk /curds/buttermilk.
Specific Nutrition practices: Findings
■
Only one meal was cooked at home, with importance given to quantity, taste (with oil
and masala base), most often suited to the requirements of the adult man of the
household.
Cooking was never time bound. It was done leisurely, in the afternoons or in the early
part of evenings, while watching TV shows or while conversing with neighbours
when they dropped in.
Water was drained off while cooking rice and vegetables, as a matter of habit
Leafy vegetables ( keerai) were often used as a side dish.
WoIcSe'^168 ' POlat°eS’ O'liOnS °r tomatoes’ were “sed only when the prices were
Other vegetable items that were not a daily fare were cauliflower and cabbage which
were used on special occasions.
5 ’
Non-vegetanan items, a special but rare delicacy was not a common fare. Cost was
the prohibitive factor, though beef has now been found a convenient substitute for
mutton (especially on festive occasions, even in "non beef eating" communities)
Snacks were bought from vendors to save the bother of cooking at home, to appease
children and often as a compulsive habit.
The morning “tiffin” of idlis with sambhar and chutney (to feed the children before
they were sent to the creche or to the school) was usually bought from outside
vendors and not prepared at home.
Colony parents stated that they were not purchasing rations from the PDS
Except for kerosene, and some few items only if they in were in sood condition
Reasons:
Due to compulsory late nights, awaiting water supply and filling up the pots the
women were too tired in the mornings to get up early.
On an average the family spent 4 hours a day on water procurement. The women
therefore felt there was no time in the morning for such preparations, before they
reported to work at the “bunglows”.
Cliddren relished the additional dishes of sambhar and chutney that are supplied with
the idlis, which the parents at home are not in a position to prepare because they either
lack time, or the required items are not easily available, or affordable
■ Many households have grinders at home but most were not used or under repair
® O Co
{
!
I
Food fads
■ The members in the households have strong beliefs that some foods cause colds, some
make the body get “over heated” and so on.
■ The following items are not included in their diet, especially on "ccold
‘ ‘ days
'
and "rainy
’’days - banana, buttermilk, ragi ■kanjee’. Some vegetables are tabo^Tec^ o‘f the
water content in them, like the pumpkin varieties, plantain stem and
marrow(Bangalore brinjal).
Women working as domestic help, get one meal (a mixture of sorts) from the place of
work.
Processed foods, in spite of the cost, are used as supplements in some "affordable"
households while weaning infants.
■ Meals are taken only to appease hunger.
There is a preferred indifference to matters relating to nutrition and good health.
Need to create a Safe Environment
Kerosene is the cooking fuel used, and very rarely firewood. Kerosene stoves are commonly
used. A few households use gas stoves in addition. Safety precautions are not adhered to.
Accidents are common, since children are not warned strictly to keep away from fire or plu<*
points.
&
Messages disseminated by MNC from information collected through activity - oriented
interventions:
. Nutritious and tasty meals can be prepared with available resources.
Steam cooking is easy to be set up; it saves time, fuel, conserves nutrition and there is
more intake of nutrients.
Keerai and green leafy vegetables are easily available, inexpensive, help in digestion
and easy to prepare. Keerai gives strength.
Sundal is easily prepared and with a variety of easily available pulses. Sundal helps
the growth of strong muscles.
■ Any seasonal affordable vegetable can be used in daily cooking to add taste and
nutrition to a meal.
■ All seasonal vegetables are nutritious, provided they are fresh, taken in right amounts
and along with other food items.
Kanji prepared from parboiled rice contains nutrition; it also appeases hunger
It is not costlier than cups of tea.
Preparing special food when celebrating your child’s birthday, or any important
celebration in your family gives joy.
■ Using ginger, coriander, pudina, curry leaves in daily cooking destroys germs inside
the body and help in the digestion of food.
Turmeric has medicinal qualities - it cleans and cures, and using it in powder form in
daily cooking will help in maintaining good health, or as a paste for bath for a clean
skin.
■ Well-prepared nutritious food builds strength to fight illnesses.
Safety is important in your living and work area. Handle stoves with care - fire can
cause danger to life.
B 3^
Identified Childcare Practices: Findings
Creche Care
General Information:
Parents felt that it was convenient to leave children in the creche while at work, one full meal
was taken care of, charges were minimal, and the child was protected, sheltered and safe.
Specific Childcare Practices: Findings
At home:
Parenting, in the normal course, is not part of their daily life.
■ Only routine time was spent with child - getting child ready for creche , feeding
bathing, attending to toilet needs.
There was no awareness on need to utilize the routine activities for interactions.
■
All matters pertaining to family problems were exploded in the presence of the childparticularly with demonstrations of verbal and physical violence.
Priority was not for planning and spending money usefully on child - but only
whimsical and compulsive spending.
■
No long-term goal was set for child’s education - no job preparation.
Schooling was only as a "time pass" till child either got dropped out or under family
compulsions took up any job that came by. Schooling not yet taken seriously.
The girl child dropped off earlier in school life to take up a job, supplement income
and reduce the financial burden to get married soon after.
The woman juggled between her endeavours to behave like the lady employer
"bunglow amma” in dressing, bringing up children, saving money, and, facing the
reality of life, a drunken husband, uncertain income, frequent ill health of children and
lack of basic amenities in the colony.
The women were very much aware of the facilities available: the creche to leave their
while going for work, school nearby for grown up children, medical consultation al
the Bala Mandir premises and at the Gurdwara.
Yet, they displayed a deep apathy and lethargy to seek these benefits.
■
They were cynical of the services, at times expressing their displeasure in a
demanding, aggressive manner.
Alcoholism led to family feuds, and lacking proper counseling and guidance, many
young girls in sheer desperation, unable to face these pressures resorted to suicide,
usually by douching with kerosene and setting fire to themselves.
Lack of closeness amongst in the family, and inability to take deliberate decisions
have led many young adolescents even in middle school level or as school dropouts to
" run away " from homes and choose partners in marriage.
These "love marriages" have broken religious bars in quite a few cases, but caste bars
in many.
With daily crises daunting them, endeavoring to acquire knowledge to better
themselves docs not become a priority.
The women in the households (on becoming familiar with the team members)
expressed their keenness on getting tips on how to look better, eat better, bring up
their child better-particularly about leading a better life.
Messages disseminated by MNC from information collected through activity-oriented
interventions.
■ Creche is a blessing for working mothers
■ Sending your child regularly to the creche and on time every day will make your child
a disciplined person.
KT 3 'S
I ractice with child at home, what is taught at the creche.
Train your child to help herself/himself- bathe on her/his own; dress independently
and eat without help and without spilling.
■ Listen to what your child wants to tell you. He/She may need your help.
■ Tell stories to your child. Grandmother’s tales help the child learn a lot.
■ Always tell child why you cannot spend on a particular item he/she wants.
Compensate at the right time.
- Keep telling your child how important it is that he/she does well at school.
■ Encourage child to have dreams of what he/she would want to be in future.
Talk to child of good qualities, citing examples from the lives of persons familiar to
child.
Quarrelling in the presence of the child means helping child to become violent in later
years (disseminated through role play by children of the colony).
Through interventions, an awareness was created in the population at Bala Mandir
Colonies on the importance of.
Optimal use of time and material resources 1. saving time and, money on fuel.,
2. optimal use of available resources,
3. improvisation in cooking and thereby
4. making available relaxation time to be spent with the children.
Nurturing as the psychosocial dimension in Parenting
1. With positive parenting practices
2. Seeking clarifications in childcare in their own life situations.
3. Developing a positive relationship with other family members (mother-in
law, father-in-law, aunts, etc) to get their help in raising the children.
4. Interacting with the creche
..j care givers, and participating in the total
development of their children.
Maintaining personal hygiene and environmental cleanliness.
1. Practicing personal hygiene and maintaining cleanliness in the
environment, which is directly related to fall in rate of occurrence of
infective illnesses.
2. A nutritious diet to enhance and maintain health of child.
3. Averting and managing medical crises.
4. Reducing medical expenditure by preventive actions and using facilities
afforded by government.
The optimal use of resources and time, nurturing the child, and maintaining personal
hygtene and envtronmental cleanliness, will lead to uninterrupted growth and development
children
Pare,ltS selfesteeni ail(lPride aild build a happy home with healthy
Recommendations:
While working with the parent community in the urban slum colonies it was seen that
awareness programmes must be organized for the prevention of disease, and on giving first
aid. There is also the need to plan and conduct play activities to reflect the teaching strategies
at the creche. School children have to be involved in drawing, painting, singing and
dramatisation on the themes of Nutrition and Childcare and displayed at parent teacher
meetings.
The parent community has to be motivated to open small savings schemes like bank
accounts, Post Office deposits and insurance policies." Educative" interactions have to be
periodically conducted for the people in the colony with those from the media and those in
public service to get them interested in schemes in health care, money and time management
and planning recreations. Useful "demonstrations" have to be conducted in cookery, health
care, personal grooming, traditional crafts and life skills. Interactive "enlightenment lectures"
tor parent groups need to be planned to instill the value of literacy by teaching them how to
read posters, newspaper headlines, letters, small accounts etc. Dialogues have to be held
between teachers and parents on the progress made by the children under creche care. Parents
have to be trained on how to listen attentively to radio programmes on basics of health,
hygiene, civics etc and on discerning TV viewing.
Parents need to be motivated to help by contributing time or resources to the creche, by
taking turns in creche care for specific activities, and training children in self help skills, in
the creche care programmes or celebration of festivals and other occasions.
Maintenance of personal hygiene and environmental cleanliness
General Information: Findings
■
■
■
■
■
H
"
On an average the family spends between 300 and 400 rupees every month on
medical bills.
There is little or no awareness on prevention of illnesses, health care, routine
checkups and taking timely action before a crisis sets in.
Many of the illnesses are stomach related, diarrhea, jaundice and so on, or of
respirator}' causes resulting in chronic colds, breathing problems.
Many of them suffer from worm infestation.
Malaria is also common because of the environment, with open garbage and stagnant
and open water.
Members have no idea on relating personal hygiene care or environmental cleanliness,
to prevention of diseases.
They are unaware of the importance of positive nutrition practices as a correlation to
good health and its maintenance.
Specific health care practices: Findings
Medical care: Crises management in emergencies
“ Free medical facilities are available only for specified hours.
■ When there is an emergency, the parents have to rush their children to the “private
doctor” or to the government hospitals.
- Maintenance of good health is not a priority, health-seeking behaviour is not present.
a They trust private medical practitioners more, and are disdainful of government health
care.
1?
■
■
■
Faith in instant cure, like injections or tonics is more.
Expenditure on treatment is a major chunk in the income, but there is no worry on that
count. Borrowing, lending and pawning precious items is a daily affair.
There is no awareness on any home remedies / indigenous systems of medicine.
Specific personal hygiene care and maintenance of environmental care practices
Findings:
Personal hygiene- A daily bath for children and adults is not in the routine due to water
problem. It is also not a cultivated habit.
Clean maintenance of skin, nails, hair, teeth is not in the routine.
Toilet habits are not part of any training.
Clothes are washed not as a daily routine job, but only when there is easily available
water (like pilfered water from water tankers in connivance with tanker drivers/cleaners).
Washed /dried clothes are not folded, but bundled into any space available.
Shampoo sachets are commonly used, besides talcum powder.
Messages disseminated by MNC from information collected through activity
oriented interventions.
•
A child fed with nutritious meals grows into a healthy person.
•
A healthy child is a happy child and a well-developed child.
•
Prevention is better than cure.
•
Personal cleanliness prevents diseases.
•
A family that takes care of cleanliness and eating of proper food saves on routine
medical expenses.
•
Brushing teeth every day is essential. Clean teeth prevent illnesses.
•
Rinsing the mouth after every meal keeps germs away.
•
Well-kept nails do not lodge dirt.
•
Washing feet before entering the house has been our cultural practice. It keeps the
house clean and keeps away germs.
•
Washing feet after using toilet has been our cultural practice. It keeps you free from
germs.
•
Washing hands clean after toileting is essential, even after urinating.
•
Washing hands before every meal will prevent you swallowing germs along with
food.
•
Wearing clean clothes makes you look respectable. It does not matter even if they are
old clothes.
•
Decorating your doorstep with kolam or any other decoration, makes your household
look welcome.
•
A pot or two with a flowering shrub or with a medicinal plant always come in handy.
L:A
SPECIAL MESSAGE FOR MEDICAL PROFESSIONALS
A graded fee structure should be worked out for different types of consultations - for
routine check up, maintenance of health, preventive health and curative health.
Family patterns and influences: Findings
•
A nuclear family is the usual set up, with husband, wife and children living as one
unit.
•
A partitioning wall - in most cases- separates this area from an adjoining one in which
live the main parent family unit, consisting usually of the grandparents, unmarried
daughters and sons.
•
Borrowing and lending is a common practice between the two households.
•
Elders are feared more than respected and influence major decisions. Yet they
advance amounts from their meagre resources, when sudden or even planned
spending is incurred by the younger generation.
•
Community participation is obligatory, in times of celebrations or in sorrow. The loss
of working days and related earnings are not considered.
•
Collecting items, especially used ones, and not necessarily related to need, is a
compulsive habit- TVs, mixies, transistors and so on.
•
Repair work when needed is not undertaken, for want of cash. Instead, a “new”
second hand one is acquired.
•
Clothing is accumulated. Some given by employers on festive days, and others bought
by the women on a “ wear now, pay later” basis.
Messages disseminated by MNC from information collected through activityoriented interventions.
•
Childcare is a shared joy — with every family member participating.
•
Saving is more important than borrowing or lending.
•
Welfare includes your family’s as well as that of the neighbourhood.
•
Buying new clothes only at festival time helps in planning the expenditure; many
varieties are available then and there is also concession on price.
•
Buying now and paying later helps in getting the item for use straightaway; but
returning the loan becomes tedious.
•
Listening to radio programmes helps in getting a lot of useful information. Listen and
learn, enjoy while doing your work.
•
Watching I V should also include other useful programmes, not just serials.
•
Playing with friends is more important for your child, than just always watching TV.
Reinforcement of disseminated messages to a larger community in the colonies:
•
Door to door dissemination of messages through school children in the Governement
Primary School under Bala Mandir Management,from the 5th standard
•
Role-play: Devised and enacted by the school children for the parents in the
community.
•
Get-together: (A feedback on messages on Nutrition and Childcare Practicesdisseminated since July,2001 ).
•
Reaching out to the larger community in the colonies.
•
Wrap up Session with all the parents and caregivers in the populations
The feedback revealed that the community was keen on more such interactions
2. Madhuram Narayanan Centre for Exceptional Children
Identified Nutrition care practices -MNC Parents: Findings.
Parents interacted with the visiting professionals, medical and non medical, very
freely clarifying all doubts.
Meals are painstakingly prepared, cereals mashed with vegetables.
Quantity is more than sufficient, with parents taking advantage of the relaxed meal
time available at the centre to feed the child with the quantity planned. This type of
time is not available at home.
As the meals are prepared for easy intake, in a semi solid condition, the child has no
scope for developing taste for different types of food, mixing food items according to
taste, or using different processes in eating food- swallowing is normally the way
most often used. Chewing, biting, sipping, sucking, licking used very rarely.
Postures observed at feeding time are based more on those convenient to the feeding
person, than to the person fed.
Mothers were under stress that they should somehow feed their child with the
quantity brought from home.
There was wholehearted participation by MNC parents in demonstrating to the
Ramnad parents on how to care and manage their children with disabilities.
MNC parents recognized the virtues of sharing resources and ideas, and planned
activities together in managing a common problem with a community approach.
Mothers formed support groups.
Messages disseminated by MNC from information collected through activityoriented interventions:
Make feeding time a learning time for the children - developing self help skills.
Make feeding time an enjoyable time interacting with the child -talking softlv and
singing when needed.
Correct feeding postures when observed will help a child to swallow easily, and
prevent suffocation.
Recommendations:
Since parents were keen on self-improvement,
•
guest lectures have to be conducted on different topics pertaining to the development
of children with disability and on self-empowerment for the mothers.
•
reinforcement has to be periodically given on the importance of nutritious diet, in
quality and quantity.
awareness has to be created on the need for regular health checkup for mothers
recognising the fact that mother’s health is as important as that of child’s.
there is a need for stress management courses for parents
A "Talent Search" is required for utilization of parenting skills for self improvement
and seeking self employment opportunities.
•
3. Missionaries of Charity, Shishu Bhavan , Royapuram.
Child Care practices infrastructure -Environment /General Appearance of
Children
Findings:
The premises were very well maintained, the environment inside and outside as clean.
All utensils used were clean.
The children were all with disabilities, including developmental delays and mental
retardation, and many with associated conditions and disorders.
All were well groomed, clean and their ailments attended to.
One child was infected with ringworm. Another had gross malnutrition -she was three
years old, but weighed only 5 kgs.
No child had been trained in toileting indicating by sign or sound. Some of them
had no bowel or bladder control.
Intensive physiotherapy had not been scheduled.
Individualised programme plan for developmental training was not scheduled.
No importance was given to self help skills, most importance given to caring and
attending
Messages disseminated by MNC from information collected through activityoriented interventions:
Nutrition practices
•
A child will relish and eat the food when given a different item at each meal, in small
quantities and with shorter intervals between meals
•
When different types of food items are provided, your child will learn the different
ways of taking food: sucking, swallowing, chewing, biting, masticating and allowing
food to slip down the food pipe. Gulping alone is not a sufficient eating movement.
•
When you give all opportunities to your child to practice proper eating, a child will
have no problem with regard to bowel movements.
Childcare Practices:
Findings: Positive Parenting Points
•
When your child is trained in sell-help skills, your child's self esteem is enhanced and
self-confidence built up.
•
With the child trained in self help skills, as care-givers you will have more time with
the child, in observing, playing-joyful parenting.
•
Your child needs your affection and attention, but let not compassion overcome the
importance of making the child self-dependant.
Recommendations:
A streamlining of activities concerning the care and management of children with
disabilities in institutionalized settings is needed for the following a
•
Optimal use of time and human resources.
•
Training each child to become as self sufficient as possible
( Note: In spite of genuine interest shown by the management of the organization for
dialogues and discussions on evolving a system of management, the activity did not
take off because of swift transfers of personnel that happened. Practically every Sister,
was a new incumbent (o the area and none in a position to take on any responsibility.)
4. Bala Mandir: Infants and Young Children Block :
Findings
The children occupy the first floor of the hospital block.
The place was airy and spacious.
On the particular day of the visit, the children were occupying the corridor space, as there
was a power failure and the rooms were stuffy.
There were a lot of play items (toys) for the children all neatly placed and easily
accessible for use. All of them were washable, and they were well maintained.
Children s clothes were folded and stacked neatly in airy plastic containers.
Babies’ soiled clothes were washed separately in a washing machine.
Developmental
Matrons were not tuned to observations on child developmental processes,
Attending to the sickness of child was an overwhelming priority.
As medical emergencies were frequent, specialized medical therapeutic care was availed
of only in government hospitals. This entails travel and time for the matrons attending to
routine childcare every day.
Nutrition Practices:
The children were in three groups
Fhe younger children were led first, while the other children waited without fuss or
disturbance.
The food was well-prepared, appetizing iin appearance, neatly served and the children
were fed by the attending care-givers.
The older children were served next and they fed themselves except for two children who
required assistance.
42 ^5"
There was hardly any spilling and no wastage.
The children placed the used plates at the appropriate places and washed their hands at
the assigned place.
Areas of strengths:
•
Clean environment
•
Enough room space.
•
Rooms well ventilated, floors well swept, clean
•
Toilets clean
•
Children(infants) well clothed
•
Sufficient toys provided
•
All items well arranged- clothes, toys and so on
•
Meal services well organized ,orderly, and children trained to wait for
Meals served :hot and with appealing fragrance
•
Children trained not to waste food.
•
Skin ailments, scabies in particular attended to at onset.
•
Hair clean and without any infection
turn.
Areas of challenge
•
Matrons tense while visitors are around; on the defensive even while answering direct
queries — What did the child have for lunch today? Do you take the child to the
playground to play?...... ”
•
Children were given only mixed foods and in fixed quantities.
•
Children were not aware of different food tastes.
•
Items that could be used as interim tidbits between meals were given along with meals
- vadai etc. Feeding children with nutritious tidbits may help add weight for child.
•
The area was well maintained, food well cooked and nutritious. However, it offered
very little scope for children to experience different tastes in food.
•
Matrons were anxious on time management, not relaxed for playful interaction with
children.
Childcare practices:
Matrons were assisted by ayahs perform all grooming activities for children.
Training children in self help skills, which necessarily requires patience and also involves
lime initially, was not thought of as priority.
Completing tasks and getting on to the next is the pattern followed.
Toilet training is not the priority.
& LiAo
Between the matrons and the ayahs, the duty of cleaning up the child is taken on as part
of the routine.
There is very little verbal communication between the child and matron.
Matrons were not aware that every activity with the child - feeding, grooming, preparing
for bed time, are all play activities for child.
Concern for the child is the worry - that he/she gets what is due and right on time.
Special points noted:
Weight for age is in acceptable parameter, but limbs (upper and lower) are thin, wiry and
skinny.
For children with disability, participating in a naturally evolved manner and " inclusive
situations " are not being created. Perhaps some special situations need to be created for
their well -being.
Development in the area of cognition is veiy/ good, but they are weak in self-help
communication areas.
and
Recommendations :
a. Matrons should be made aware that they have the entire Balamandir Institutional
backing with them to do their duties and that there is no one on a fault -finding mission.
b. Using the older girls to help in the younger children's routine of feeding, playing, story
telling, dressing, grooming etc. Some incentives can be offered to those who add value
and joy to child development.
c. Trying to avoid crisis situations in the care and management of infants.
That is to have on call, a doctor with all emergency medical facilities or a tie up
arrangement with nearby medical facility.
d. May look for matrons among retired nurse community.( for eg
from Defence sectors, Red Cross etc.
e. To provide infant stimulation the suggestion is to arrange for
Placement of Montessori trainees at the infant block for children between the ages of I
year and two and a half years. Timing : 2 hours.
For 2 /i to 5 years, primary school teacher trainees who are oriented to Flip Chart
Parenting programme are needed. Timing : 2 hours.
f. To give a "family touch ' by celebrating individual child's birthdays( by naming the day
on the notice board, one small present to the child), welcoming new entrants etc
h. Have a NIP member as a catalyst to interface between matrons and the administration
. This would involve
*being at the Bala Mandir at least twice a week and familiarizing with the routines
^interfacing with the teacher trainees ( Montessori and Primary )
^interfacing with the medical doctor for health concerns..
ST 4-T
B. RURAL -Ramnad
Observations:
Appearance: Kuruvikara Hamlets
With clothes that were tattered and mended, and they exuded a peculiar stale smell
in the semvaters
intereSt gr°Oming themselves’ with tIieir every day life spent
Other aspects:
1 he families do not seem to believe in family planning.
dlildren"1 H 7 marr'ed °ff eariy 6Ven before they reach adulthood and they give birth to
children, m the nnmediate post pubertal stage, in ‘keeping with nature’ No family
planning methods are practiced.
5
The young girls looked tired and unenthusiastic about anything new being introduced to
them, but were curious to know the purpose of our visit.
General Information: Identified Nutrition Practices
Findings:
The young mothers look tired and emaciated in appearance. Not so the older women
T m'rL‘V < T d° '10t '“’'y StarVe f°r f0°d- They reguIarly take birds' meat or pork
fhey however do not consume any green vegetable, particularly keerai
Their daily staple diet consists of rice gruel with any seasonal root vegetable
Greens and vegetables are not part of the daily diet.
Whatever is available is given as meals for child.
XdrXaces milk’both for the weaning and the weaned child’and is a reguiar drink f°r
Messages given by MNC.
Meat diet is good, but an additional dish of a leafy vegetablef drumstick leaves) as many
Rice gmeHs fill'die‘PS
t0 assimilate the nutrition
the meat diet.
lIX8 J H f
g yd ■?1VeS energy; gruel made out of the available millets ( Ram
kanjee and other types) will build your muscles and strengthen your bones.
Identified Childcare practices:
Findings in the psychosocial context
me'alTrel^H?118 ~ 8r0U|PS Offamllles llvln8 together in hutments in clusters of hamlets
‘ah
°ne another throug|1 kinship within a closely knit community
All available resources are shared.
othe^sXs'ye‘derS in 1116 gr°UP Wh‘le the ni°therS and fathers are 0,1 work or
Orphaned children are cared tor by elders and other members in the family.
Children rare nurtured in the open environment.
Education facilities are not availed by the parents for their children.
No child is a burden to flamiiy; child starts earning even as an infant- used for begging,
4- year-olds trained in salvaging offerings from the; sea.
4c S'
Messages given by MNC
•
Make use of all the facilities given by
I the
' government.
.
Send children to Balwadis
and Anganwadis . Avail of the facilides there.
•
Educate all children- girl children too.
•
Educating children will help them learn more skills and earn more.
•
Begging is not respectable. Children with good education can earn more money.
Family patterns and influences:
Findings
•
Early marriages are usually consanguineous and families are large Mother of
married daughter is also in the child-bearing age.
•
Close kinship is demonstrated by sharing all resources.
•
Alcoholism is a life style, men and women.
•
They are well informed, articulate and aware about political situations,
governmental doles.
•
Remarriage is common, and there are no widowhood practices.
•
Adultery is severely condemned, with public denouncements and punishments to
the offender.
•
Group leader is usually an elder in a more "feared" position than elders in
families.
•
Women are loud voiced and aggressive. Men more restrained and yet forceful in
their arguments.
Messages: given by MNC
•
Sharing a resource is a happy practice.
•
Alcohol ruins your purse, and your health.
•
Use governmental welfare measures that are meant for children.
Recommendations:
There is a need to create awareness on:
•
school education for the children,
•
women becoming literate and being taught job-oriented skills
•
giving up alcohol drinking
•
grooming and personal hygiene practices
All these factors will help the community get out of their current ‘ghetto’ status and
become socially accepted within the mainstream.
H'"dus “nsi!“"g
Findings- A brief ethnographic study
Brahmins:
Education is a big priority.
Growth of child is considered important, not necessarily health.
Processed foods are popular, in spite of prohibitive cost.
Men in the households carried on the conversation with the visiting team, not the women
lough educated. They acted as prompters positioning themselves at doorways
Girl child is still not given the No: I position, but not considered a "burden"
Hardly any sign of prosperity in the life style.
All members, male, female and children looked emaciated.
Strict adherence to rituals of fasting, preparation of special items on festival days bathiim
several times a day during death ceremonies, celebrations of religious functions’ - all of
greater significance than personal comfort, hygiene and health.
Thevars/ Chettiars/ Konars/
Malc child is the pride ol the community.
Education of male child is a priority, that of female child generally upto age of maturity
Nutrit on is only related to weight increase; not as a health builder
Growth of child is related to physical growth, not to total development
Women are socially visible. Man's decision in all social and business matters final Women
the elders, control "purse strings" on family expenditure.
The 1 hevar households are status conscious and " well-to-do" in appearance.
Processed foods are popular.
All are into business for their livelihood.
Both men and women are inquisitive and somewhat suspicious
on the nature and purpose of
the project.
All male members are politically involved
in small and big ways. Political leanings influence
decisions in public welfare undertakings.
A child with disability is a concern, not a social shame.
Men, as head of families, are not committed to the need for special education for the child
with disability.
The family looks more ttowards wonder drugs and instant cure, than any training
Children with disabilities are from scattered hamlets
Keczhakkarai Muslims:
Findings
Information gathered on the children in Keczhakkarai - with disabilities.
Consanguinity is a usual practice.
Si1-" sys'e'” in pr’c,i“' We‘lded piris
Children are identified with disability by the elders in the household
Elders in the family were in a position to give all the required information on the child with
3- 50
disability.
Disability is a concern, not a social stigma.
Community help is unstinted and available.
2;et™„mgerS
£i?"sw'sxis
'“ki"8 ” "me<fcal
"Kre
» >1“ need
”ard'y
on <iu”,i'y- ,m q”iiiy
X".doz
(A? 'eoXmSj.’"
™'t' °"ly f°r
n,0,lKre ■«
q—ito
Vegetables, seasonal, and inexpensive ones, (barring tabooed
ones among the Brahmin
communities) included in one meal in a day.(All communities)
n“’nev"s'aSSC"’
<li‘yS "“'ebra‘ions' F“
special preparations included, when
oney is available (barring non meat eating communities).
cNo°mnwnCifa)fO°d
"'ea"i"e a"<l "'ea"ed Chi'd- ""'Ud"’g child
“soS.y S“Z.™Xsr ,S “"Sidered d'r0Sa“ry
‘I'SdWily.lAII
“"'"'“"'‘iewieially
Proeessed food the preferred choice, particularly as a status symbol
even if really not
aliordable.
Children and women (old women and widows barred) fed with cooked rice from the previous
■ yS PreParatI0n> soal<ed in water and mixed with buttermilk in the mornings as a pre lunch
veaet h1'5
t0 “ "Ppazhayadu"
32'13^11" or old
old rice, whose usual accompaniment is a
vegetable preparation of edible leaf bunches.(Brahmin families).
Eating prepared food sold in the market preferred to preparing meals at home
Children indulged in the same practice.(Keezhakkarai families)
Nutrition no! give,, any though, i„ the daily diet, only taste md su,np,„o„s„ess (Keeol.akk.ra,
Messages spread by MNC:
A chHd with disability requires as much nutrition as your child without disability
Koozh and Kanjee are right foods for weaning child.
Any available millet or parboiled rice is ideal for preparing kanjee powder
costn uch
'H' SUbSt'tUte With kanjee’ 3 tllling and llea,t,iy drink>
^es not
All „asoMl vegcables .re rr.trto and inexpensive. Use seasonal vegaables in yonr daily
Suiidal made wulr pulses, and paanagam made witli clmkkti (dried ■mmerl and iarmerv
strengthens your muscles and nourishes your blood
~ &
Jagi=er)
Introduce different foods at different stages in your child’s development.
Childcare practices:
Findings
All members of the family, particularly the elders, are involved in raisin- child
ild .s exposed to all family and social activities of the family as well tTs the community.
------
09717
AS- <?>'
7^/
cW
A
& SI
Child is exposed to different opportunities to develop self-dependency even from early
childhood.
Child is introduced to family meals and eating along with family members, even from
infancy.
Child is provided ample space for exploratory activities.
Child is ambulator}' very early.
Child is provided with many activities in self-learning, particularly in communicating needs.
Immunisation schedule is adhered to.
Medical treatment with private practitioners is resorted to even under difficult financial
circumstances.
Education is not an obsession-only a routine, taken only as far as the child can go.
Making the child earn, is a more urgent priority (both boy and girl children). Studies do not
matter.
Family pattenis and nifiuenees:
Findings
Single parent families in the households, where the male members are away in the Gulf
earning money.
Education of girl child of no real importance.
Rigid family hierarchy - in-laws set the rules, younger members follow.
Female members inherit property (Keezhakkarai Muslim families). The husband away
earning and only an occasional visitor. Women have right to ulset aside “an unwanted
husband and marry again.
Importance in investments in gold ornaments, not on education.
Women very articulate and assertive (all communities).
Messages given by MNC
Your child is lucky, when every member of the family has helped in making the child grow
healthy and happy.
Your child is learning with joy, every time there is a celebration in the family or a family
outing.
Feeding your child alongside siblings and adult family members helps your child enjoy the
meal.
A happy child is a healthy child.
Avail of all the facilities for the child to be educated. Send your child to the nearest balwadi
and Anganwadi.
Education will make the child a respected person.
Celebrate your child’s developmental milestones in the first year as your parents did for you
as a child.
Observe your child’s development, detect any disability early, and intervene fast.
Dissemination of Messages Through Street plays , Parades by primary students,
distrubution of hand -bills and posters to individual households.
Observations: During dissemination of messages
In some villages the women sat together in the shadows of huts and trees away from the
groups of men. In others there was no such segregation.
There were no overt religious demarcations. The communities mixed freely with each other.
1’he parents in the population, familiar with the project members extended all hospitality to
the team, the drama troupe and the DEEP staff preparing food, providing drinking water( a
scarce commodity in the region).
They freely introduced the other members of their family, talked of family matters, of the
harvest that was just over, of the untimely rains that had spoilt the crop that was just coming
up.
They were all in a happy communicative mood.
The drama invariably got over beyond 10 pm at night and the villagers stayed on.
The people were excited that they were in the limelight (video and photographs).
They interacted freely with the members of the drama troupe, exchanging repartees.
Recom mendations:
Thiruppulanni Block:
There is an urgent need for setting up of resource centres, one in each block for
comprehensive and inevitable interventions.
Accessibility to general health counseling at Primary Health Centres has to be ensured for all
communities.
Facilities have to be made available for medical investigations for prevention and early
detection of disabilities.
Kuruvikkaras have to be integrated with mainstream communities through awareness
workshops on parenting education and thrift schemes.
Involving parents and encouraging their participation in display of talents on theme "Joyful
Parenting" at Balwadis and Anganwadis.
Ramnad: Institutions:
1. Malathi Crcchc
}
2. Sunganthi Crcchc }
At Ramnad
Observations
The creches at Ramnad were a contrast to the creche to which the children from the Bala
Mandir Colonies went to.
Both do serve a need of parents wanting to leave their children under supervised care while
they were at work.
While the Chennai creche charged a very nominal amount (more for parents to "register"
their interest for the service provided) but gave a lot more in terms of care, the ones at
Ramnad were run as a business, charging Rs 250/ per month per child.
The Ramnad creche catered to the needs of the "office" going types of parents while the one
in Chennai catered to the need of parents from the slums, working as domestic helps.
Mothers in the slums arc working mothers; in Ramnad the women who were domestic
helpers had their family members to look after their children in their absence. They did not in
need any creche for their children.
The "nuclear" family concept has not yet trickled down to this socio economic group.
General Details:
fhe location was a convenient and safe place for parents to "leave" their children during the
day.
The place was fairly clean, with a "home" environment.
The matrons were running the facility as an income generating enterprise, in their own
homes.
Older children were helping out the ayah with younger children.
Parents have chosen the location of the creche as a convenient factor.
Parents not concerned with lack of amenities, also ignorant on safety factors.
Parents unenlightened on "parenting" needs.
Very happy with matrons (the full time available person) flattering remarks on how well
their child "behaved" during the day.
No accountability by the creche in charge, the wards; no maintenance of address, or any
detail on child.
Environment very bare; no stimulating materials
Matrons friendly with the visiting team members and cheerful in disposition; were free in
giving all details on child. No detail seemed a matter of confidentiality to the matrons.
Nutrition and Child Care Practices
Findings
Food was brought from homes, and no other meal was prepared for child.
Parents were particularly encouraged to give processed foods to children.
The matrons had each employed a full time "ayah", a caretaker who took care of all the jobs
concerning the child.
The jobs included, feeding, grooming, assisting in toileting and getting the children to
take a nap in the afternoons and also working as "help" in the households.
7he matron in one of the two centres was available at all times, except when she was away on
personal work. During that time the ayah supervised, attended to telephone calls and other
sundry' jobs.
The matron in the other centre was a full time teacher in a nearby school. The children in her
centre were entirely in the care of the ayah.
77iere were very few play materials available for children.
There was no planned play activity for the children.
There were no "educational " inputs either.
Matrons only care-takers, not care-givers.
"Older" children, 4 and 5 year old children were "told" by the ayahs to give a hand now and
then when handling the little ones need a lot more attention than otherwise.
No training on any self-help skills for children.
1 he parents were at work for long hours during the day, were in a hurry to take their children
home and were not tuned to answer any question peacefully.
Very often the matron had not communicated to the parents- the reasons
the
reasons cited
cited were
were, the
telephones did not work; they say they can’t come, they are sick and so on.
Nutrition practices:
Findings
Parents had only a general idea on the importance of nutrition.
Parents "captive" to advertised processed foods.
Eatmg out and buying food outside, not a common indulgence either for themselves or for
their children.
Satisfied that at least one main feeding schedule is being looked after by the matron at the
creche.
Worried that their child iis not putting on weight in spite of "everything: that is being given to
child.
Content that they are ggood parents - having found a "good" English medium nursery school
for child and giving everything theyj can afford to make child happy and study well.
22 SZc
Recommendations:
•
Parenting information for matrons and wardens through periodic workshops
•
Social auditing of privately run creches.
Government Aided Institutions:
Government Institution for Deaf Children : Ramnad
Bro Angelo's Orphanage for Physically Handicapped Boys
Annai Sathya's Government Orphanage for Girls
To be Noted:
It IS to be noted that in all the institution/orphanages located in Ramnad , including the
ones selected, those for children with disabilities and the other for children without
disabilities, it is mandatory that the age at entry is not less than 5 s ears for the child
The children are admitted at that age so that their entry to primary school is taken care
of. It is a common practice to upgrade date of birth to facilitate easy admission.
When the team members asked for children in the age group 4 years and under in these
institutions they were informed the rules but also told that many of the children could
be actually younger in age than was indicated in the records.
"Orphans", as understood in the district of Ramnad refers to children without liviim
parents, with living parents but those unable to take care of their children, and does not
denote abandoned destitute children.
All ’’orphans” have homes to go to during the summer vacation, or after completion of
schooling. They all have families.
Observations and findings
Bro Angelo's Orphanage is run by the Brothers of St. Michael's Mission. The
orphanage is located in private grounds with plenty of open space
Fhc team members visited the primary school (for both boys’ and girls) housed in
thatched rooms.
By the end of the project term a new building had been constructed for the primary
school and the children had moved in.
The new building with airy rooms has also been well equipped with storage space for
books, and teaching and learning materials, all donated by well wishers.
The teachers were happy and enthusiastic at all times to meet the team members.
I he Curator is a Brother, the head of religious as well as secular matters. There is a
Brother in charge of the hostel and the school.
Lay teachers are iin charge of teaching at the primary school.
I , he older children
(physically handicapped), all boys
i the secondary and vocational
,
v - in
streams, are taken by bus to a close by premises donated bv a philanthropist
I hose in charge of the institutions said that the resources available from the
government were utilised judiciously.
The Father in charge of Bro Angelous Orphanage expressed that though the governemnt
giant fm food Mas tar below the required amount, yet they managed well with
donations they received for food and also with offerings of food by individuals.
The kitchens were open and the team members were allowed to observe the children at
meals.
A cheerful environment prevailed in the classrooms and the children looked happy.
There was no hesitation in the children answering any question posed to them even in
the presence of their teacher or the Brother in Charge.
So too with the teachers, but they did not take any decision on their own.
Every schedule for the day was strictly adhered to, education a priority.
Outdoor activity was restricted to children playing on their own.
Aids and appliances for mobility though supplied by the government were stacked in a
corner, not utilized at all (except by one or two older children). They did not feel the
need for its use.
Young children in the selected list for the project, preferred crawling on their fours to
move from one place to another.
Annai Sathya Orphanage for Girls- Government Aided
Observations and Findings:
Ample moving space in the compound as well in the rooms in spite of the crowd of
school going children and the younger ones.
Heaps of clothes were bundled in corners of rooms along with their steel trunks
containing their belongings.
A few children were taking their afternoon naps,(‘They were not well’ ,said the matron)
curling themselves on the heaps of clothes strewn around.
Older girls were seen helping the little ones in grooming activities and in play.
Kitchen was open for entry by visitors.
The matron was quick to recount the day’s activities and the menu for the day.
The matron was also maintaining, with the help of the older girls, a small patch for a
plant nursery.
There was evidence of a lot of freedom, for the older girls especially, to chat with the
matron and the other helpers as also with the teachers there. It was like a family
atmosphere.
The matron expressed that though the government grant for food was far below the
required amount, yet they managed well with donations they received for food and also
with offerings of food from well-wishers.
The children walked across to the government school nearby for their schooling.
Again as in Bro Angelo's orphanage, the team members noticed, during their visits, that
a lot of interactions were happening between the seniors and the little ones in grooming,
playing, caring activities.
Older children also helped with the homework too. It was observed that the older
children were chatting freely with the juniors.
The team members therefore felt that the older children would have positive influences
on the younger ones if given an exposure for such expressions.
The response was very good, with the management staff, teachers and students
participating enthusiastically.
rhe members of the staff sought ciarifkations on the rules and regulations, followed
the correctly and submitted the entries on time.
Institution for Deaf and Dumb Children
Children with extended families but without living parents
31) 5^.
Special Note:
The special educator with the help of her artist husband had prepared several
educational charts.
She was a highly motivated person and had devised several teaching aids usin<»
indigenous materials available around.
She gave speech learning through attention on the facial movements of the teacher a
priority and discouraged communication through gestures.
She used appropriate teaching strategics.
Observations and Findings
Children were all from very poor families, belonging to all communities.
Children mixed freely with each other and interacted with the teacher and the members
of the visiting team.
The children were comfortable with the hearing aids provided to them.
Like the other government-aided institutions in Ramnad, available resources were well
utilized to make up for the shortage in the funds given by government.
Recommendations:
Dissemination of parenting information for parents.
Special workshops on parenting for adolescent girls and boys
Resource facilities for periodic medical and developmental checkup and intervention for
early detection of disabilities and interventions
***************************************************************************
33 S3
F
MADHURAM NARAYANAN CENTRE
FOR
EXCEPTIONAL CHILDREN
126, G N Chetty Road
T Nagar, Chennai - 600 017
32 b-'S'
€
RUHSA DEPARTMENT, CHRISTIAN MEDICAL COLLEGE
RUHSA -NIP -UNICEF project on Positive Parenting Practices
And Nutriiton
EXECUTIVE SUMMARY
This is a summary report of the parenting programme carried out by RUHSA
Department during the year 2001-2002, in collaboration with the Network for
Information on Parenting(N.I.P). The programme was restricted to few isolated
villages of K.V.Kuppam block numbering 5 panchayats with 40 Self Help Groups
functioning in the area covering a population of about 20,000. With senior trainers of
N.l.P conducting initial capacity building of select RUHSA staff through a Master
trainers Programme in Chennai and providing orientation to all senior staff of
RUHSA, at Vellore, this programme got off to a start. A total of 45 staff and trainees
were taken through the Parenting Programme in preparation for the subsequent
implementation.
Around the same time a baseline survey was carried out on parenting
behaviour and nutritional status. This baseline looked at the knowledge, attitude and
practices and the behaviour of parent towards parenting, nutrition and health care was
obtained. Additionally the nutritional status of children for both the target areas and
a comparable group from and non target areas for 332 boys and 296 girls were
obtained.
While many parents had good knowledge on current methods of parenting,
there were many who still followed age old practices. The involvement of fathers Tn
parenting was limited. The knowledge on nutrition among mothers was reasonably
good and breast feeding practices and supplementary feeding and child immunization
were also good. The nutritional status showed that over 65% of the boys and girls
were normal in their height and severe stunting was observed only among
approximately 8% of both boys and girls. Over 80% were normal without any
wasting. Little less than half the boys and girls were under weight.
Subsequently Animators of SHGs were trained on parenting using flash cards
prepared for the Network by RUHSA and printed by UNICEF. At the community
level the Animators along with RUHSA staff trained all the members in a one day
programme. The animators were also trained on the FLIP CHART messages to
highlight the Pyscho -social dimension of good parenting. Subsequently there were
street plays and a one day special programme in 40 villages so as to cover the entire
area.
While in the initial rounds there was passive learning by the participants, the
street play enlivened the process. However the special one day programme organised
and conducted by the Sell Help Group members involving the entire community was
the major high light and learning as a result of this programme.
One Day Campaign on Parenting
This was one of the major training provided at the community level. The
programmes were planned and implemented by the Self Help Groups in and around
the villages were the programmes were conducted. The activities that were included
in this programme were; briefing on key messages to SHG Members, hand bills with
printed messages on parenting were distributed, flash cards were introduced, cooking
demonstrations on low cost nutritious food for under 3 children were also carried out
Additionally group members also prepared and brought some of the food items
commonly used in the villages and exhibited in the group. Group discussion among
members on the issues around parenting followed.
Street Play
Street play was organised exclusively for initial 10 villages. Additionally
street play was also organised as part of SHG members training in another 10 villages
making a total of 20 programmes. It was ensured that the places that were selected for
the street play programme were not repeated in the same villages where the earlier
Street Play and Orientation Programme were organised. Thus the Street Play covered
all the 40 villages. The Street Play was the same programme that was carried as part
of the one day campaign.
SIIG Organised One Day Programme
This was the final programme of the parenting project during the year. Each
of the 40 SHGs selected were provided some funds to organise a one. day programme
m their own respective areas. In some of the villages, while each group organised
individually, in some villages where there were more groups coordinated activities
were carried out.
by J..
,
ind women,
vi i
a®
©1
A story by a small girl indicated the importance of parenting.
_________ ____
Pilot Project on Parenting and Nutrition
"Give me the child until he is seven and I shall give you the man" (Proverb)
Introduction
'Parenting of under three (U/3) children was a one year project funded by
United Nations International Children's Emergency Fund (UNICEF) through Bala
Mandir Research Foundation (BMRF) to be implemented in selected villages located
at the foot hills of the K.V.Kuppam Block. An average of 2 - 5 Self Help Groups
(SHGs) operated the scheme over a period of 1 - 3 years. It was planned to use the
women of the SHGs to educate the community for behavioural change on 'Parenting’.
On the 2011' of November 1989 the general assembly of the United Nations
adopted "The convention on the rights of the child". India ratified the convention in
1992 and became one of the 191 signatories.
This made India both morally and
legally bound by the various principles laid down by the convention.
In the years since these events, changes in attitudes and practices have led to
an improvement in children's welfare worldwide.
However, in many developing
countries millions of children remain beyond the reach of even a minimum of
essential services in the fields of nutrition, health and education.
Parenting is one of the most important roles in the life of an adult.
The
children of today will be the parents of tomorrow and therefore the attitudes and
wellbeing of children are inseparably linked to the peace and prosperity of tomorrow.
In developing countries, there is much which can be done even though people
are poor. There is no cost involved in improving children's lives by offering praise
and encouragement, gaining experience and learning through play, educating to
prevent accidents, killing insect pests, using food wisely, safely, hygienically and
learning about suitable and safe ways of treating illness.
The role of parenting can be done by many people in addition to the father^
mother® siblings, grandparents, neighbours, the community, health organisations,
J.
teachers and any other person who has a shaping influence in a child's life can also
perform this valuable role.
Children need support and guidance in all areas of their life to develop fully.
Physical, mental, spiritual, emotional and intellectual wellbeing in all areas of their
lives need to be nurtured and perfected to enhance a child's holistic development.
1
<
i
From birth all human beings have within them the potential from which to
grow. Parenting is a crucial factor in this growth and unfortunately the cost of poor
parenting is failed human potential. That is a price that no child should have to pay.
With the above background, the Rural Unit for Health and Social Affairs
"f
i
(RUHSA) Department of Christian Medical College, Vellore began a parenting
project also funded by UNICEF through the BMRF. The objectives of this project
were as follows:
Objectives
1.
To identify the current nutritional status and practices relating to the
nutrition of children under three years old in K.V.Kuppam block. §
2. To design a curriculum to educate mothers on
appropriate nutritional growth of their children.
3. To utilise the health volunteer
parenting in the community.
the changes necessary for
women in the SHGs as educators on
4. To promote growth monitoring of children in the community through
ammators/health volunteers
5. To evaluate the changes in nutritional behaviour among mothers.
6.
gemmate experiences to wider audiences covering the entire Vellore
Id.
To achieve the above objectives the following strategies were adopted.
1. Using Health Volunteers of SHG
2. Use of a curriculum designed for health education
3. Communication and education to create behavioural change
This project was implemented in K.V.Kuppam, a rural block comprising of 39
rural panchayats.
A state highway runs through this block from east to west
connecting Katpadi and Gudiyatham and passing through Latheri, Vaduganthangal,
K.V.Kuppam, RUHSA campus and Keelalathur. Hills run along the northern side of
this block and the southern boundary is marked by the Palar river. South of the River
Palar and running parallel to it is a national highway connecting Chennai and
Bangalore.
2
To ensure that isolated pockets of the population were reached by this project,
the northern foothills were included within the block. This area is isolated and access
to health services are not easy and worse than in those areas along main highway or
along the southern Palar River basin. 20 SHGs were selected to carry out this project
in the hilly region.
Literature Review
For almost half a century children's rights have been promoted and have
enhanced public awareness of children's specific needs and of the equity to which
they are entitled. 1959 was the year of the 'Declaration of the rights of the child'.
Followed in 1979 by the 'International year of the child' (Aarons, Hawes, & Gayton,
1979).
The United Nations Commission on Human Rights (UNCHR) drafted a
document intended to promote and protect the wellbeing of children and on the 20th of
November 1989 the general assembly of the UN adopted 'The convention on the
rights of the child', to which India is a signatory (Murickan 2001).
Murickan describes one response to this as, 'The National Initiative for Child
Protection' (NICP). The NICP state four rights that all children are entitled to,
•
•
•
•
The right to survival
The right to protection
The right to development
The right to participation
Parents are the first point of contact for asserting these rights for their children.
It is essential therefore that parents are aware of the effect of their actions upon their
offsprings and that they are able to enhance the lives of their children and help them
to reach their full potential.
Henry (1978) states that the capacity to love is not inherent but must be taught
to a child. Hence children raised without adequate love, tolerance and good example
may find themselves in positions of parenthood for which they have been either not
prepared or at best ill prepared. Henry goes on to suggest that as a result parents may
resort to aggressive and violent means of child rearing and presume that this is correct
because it does not conflict with their own personal experience.
Babcock (1962) stresses that parents need to be good role models as this is the
way that children learn how to behave. A child's personality is affected by how their
family feels about him or her and the family expectations of them. Where female
3
children are devalued, it is important to make parents aware of the needs of all of their
children and not just the male family members.
Malnutrition is the commonest disease in the world. It inflicts damage on the
developing brain and reduces the size and number of cells within the brain
I
(Illingworth, 1987).
Nutrition is therefore a fundamental part of a parenting
programme. The diet of the pregnant and lactating mother as well as the nourishment
that the child receives are essential to give the child a good start in life.
Bhauna and Mukhopadhyay (1998) promote exclusive breast-feeding for six
months and argue that colostrum (the initial thick yellowish milk) is rich in disease
preventing substances and should never be discarded. Any other food, even water, is
cited as being not only unnecessary but also dangerous. In a leaflet circulated by the
Breast Feeding Promotion Network of India (2001) during the World Breast feeding
week, 1-7 August 2001, it was suggested that breast-feeding is a human right. They
also suggest that six months exclusive breast-feeding provides adequate nourishment
for a baby.
After nourishment, parents need to be aware of milestones in a child's
development. Should there be a developmental delay, early intervention would then
be of great value. Morley and Woodland (1979) stress the importance of weight
curve charts being of great value as a continuous record of health. Malnutrition is
much easier to identify this way before the more obvious signs appear.
Babcock
(1962) states that although individuals develop at a different rate, all humans develop
in a head to tail direction.
Although the stages in children's development are universal, the time period in
which the child masters these skills varies. (Bhauna & Mukhopadhyay, 1998).
All of the following suggestions made by Illingworth (1987) can be positive
parenting measures that can be practiced in all homes regardless of poverty or lack of
material possessions.
•
Love and security and comforting a child as soon as it shows signs of distress.
•
Avoidance of nagging, criticism, belittling, degradation, favouritism and long
separation from the parents.
•
Acceptance and praise for effort rather than for achievement alone.
•
Firm loving discipline with a minimum of punishment.
4
•
Opportunity to practice new skills and develop special interests.
•
Provision of play materials that enable learning by discovery instead of rote
learning.
The emotional development of a child is an intrinsic part of parenting.
Babcock (1962) places much emphasis on the role of the family in a child's emotional
development. He suggests that a child grows as a person as well as a collection of
body systems. A child thrives best when his or her rhythms of nature are respected.
E.g. eating and sleeping habits.
A warm and loving family provides the best
development. Morley and Woodland (1979) discuss the impact of continuous and
consistent love and state how reassuring the physical contact with their parents is. If
young babies are held in their mother's arms then they are less affected by loud noise
or illness. This close contact has enormous rewards for the child and costs nothing. It
is a process that can be described to mothers in developing countries to enhance the
lives of their children.
Morley and Woodland (1979) cite a study in Cali, Columbia where children
were divided into three groups.
•
Group 1 were given full curative care and immunisation
•
Group 2 were given the above plus a balanced diet
•
Group 3 were given both of the above plus a stimulating environment
The groups were compared to children who received none of the above and
the results were:
•
Group 1 showed no change in intellect or growth
•
Group 2 showed good physical growth but no change in intellect
•
Group 3 showed both physical and intellectual growth
Learning through daily routines is a way that any parent can assist their child
to develop, suggest Meier and Malone (1979). Holding the baby close whilst feeding
helps the child to feel secure. Parents can talk about colours and textures, smell and
taste. Items can be placed just out of reach to encourage movement and grasping.
During bathing, body parts can be named and topics such as wet, dry, hot and cold
can be taught.
5
Kuppuswamy (1994) cities Harlow (1985) when they state that contact
comfort is more important than food giving.
Once again emotional needs are
highlighted and are quoted as being something that any parent can give no matter how
rich they are or which country they live in. Kuppuswamy (1994) lists activities that
I
stimulate children at different ages.
Young babies learn through touch, enjoy
different sounds and like to be talked to and smiled at. Having items placed out of
reach stimulates crawling babies. They also enjoy noisy play, for instance hitting
pans with sticks. Walking children are ready to catch, to throw and to push and pull.
V
They like to talk about what they see and to climb and hide. Toddlers and pre school
children benefit from active play. Stimulating play does not have to be expensive.
Water, sand and mud are always children’s favourites.
Tins containing seedpods
make lots of noise, wood can be used for boat-s and hollow reeds and soap make great
bubbles. Games with shadows, skipping or hopscotch are universal and available.
Painting can be done from ink dyes or local plants and brushes from chewed sticks.
Out of interest, people are encouraged to make their own toys or at least someone in
the village. A stuffed elephant would not be hard or expensive to make filled with
tailoring waste. The list is endless and can be as stimulating as the imagination will
allow.
Education is not only for the literate. Songs and stories have been used for
millennia.
Silva (2001) suggests that illiterate people keep knowledge this way
therefore making it easy to store and transport. Dance, drama, music, games and
visual art integrate into the fabric of village life. This assumption promotes the use of
street theatre to achieve a mass education project. In the developing world it is a
natural way to educate. Projects can be shaped around lifestyle and tradition and
locals can become involved making use of valuable resources with limited funds.
Silva continues to promote education in this manner by stating that a parable allows
people to discover truth of themselves, and that internalised truth is the motivating
force needed for change in practices. Songs and stories avoid confrontation about
inadequacies.
Participation, entertainment, cultural relevance, credibility and
empowerment stimulate fresh thought.
A child’s needs change with age but children always need love, nutrition,
safety, guidance, stimulation, praise and encouragement. It is hard work changing
attitudes but for the sake of children worldwide and a healthy future for all, good
parenting practices are essential.
It is not effective however to change good old
6
practices for bad modem ones. For example, stopping breast-feeding or replacing
useful herbal medicines with expensive shop bought ones. The most effective way to
train parents is to recognise what is a useful practice and should be kept. Decide
which practices are harmless and may be kept and emphasise the practices which are
harmful and which must slowly and gently be changed (Aarons et al 1979).
The approach followed in behaviour modification (Abel, 2002) is illustrated
in the diagram below:
Behaviour Modification Process
Sensitise policy makers, stake holders, and planners
Plan with all senior staff of implementing organisations
Prepare acceptable messages for the required behaviour change
Train staff/personnel who will be involved in implementation
Train staff or personnel who will be the key trainers
Staff should train community volunteers to train the community
Volunteers should educate the community according to a curriculum
Facilitate the community to plan and implement activities
Monitor effectively to ensure that activities have taken place at each level
Enable the community to organise an evaluation programme.
Implementation
The programme started with a baseline survey of the project area with another
control group. This survey is briefly described below:
Sample Design
A total of 32 villages from 8 Panchayats at the foothills where the 'Parenting’
programme is being implemented were the villages selected for the survey.
An
average subsample of 10 mothers with U/3 children from each panchayat were the
subjects for the Knowledge, Attitude, and Practice (KAP) survey. All U/3 children in
these villages were the subjects for the nutritional survey. These 32 villages selected
were ones in which at least one SHG is functioning.
7
From the remaining panohayats of K.V.Kuppam block an unbiased
representative sample of 8 villages were selected from 8 panohayats for the non
project area All U/3 children and a subsample of mothers were the subjects chosen
for the nutritional and KAP surveys respectively.
The base line survey consisted of a KAT survey on Antenatal Care (ANC),
r
childhood immunization, dietary habits of mothers and parenting beh.v.our,
A
schedule was designed and modified based on the experts comments from the
network on information parenting-.
Along with this, the nutritional status of U/3
children was also assessed using anthropometric measurements; height, werght and
circumference. The schedule was pretested with mothers of U/3 chtldren and
arm
necessary modifications were made to obtain the reasonably correct parental
behaviour. This survey was carried out in May 2001. Four data collectors, wrth
either bachelor or masters degrees were trained to administer this schedule. As they
were involved in other surveys conducted by RUHSA, their experience was broadly
utilised. They were supervised by two RUHSA staff.
The data was edited daily. A coding key was prepared to code all the data.
The Foxplus software package was used to enter the coded data. The KAP survey
data was analysed using SPSS Windows Version 7. The anthropometric Z scores for
height and weight were calculated using an Anthro software package and further
analysis was done using the SPSS software package.
8
Table A. Sampled panchayats and villages in the project and non project area
S.No
Panchayats
Project Area
SHG
Villages
_______ Non Project Area
Panchayats
Villages
1.
Thondanthulasi
3
1. Thondanthulasi
2. Old Thondanthulasi
Keelalathur
K.A.Mottur
2.
Senji
9
1. Senji Main village
2. Senji HC
3. Ramapuram
4. MotturHC*
5. Krishnapuram
6. Senj AC
7. Ayakulam
8. Mailar Thoppu HC
Pasumathur
Pasumatliur colony
3.
Panamadangi
4
1. Panamadangi MV
2. Panamadangi HC
3. Pallathur *
4. Kesavapuram
D.R.Kuppain
Gemmanguppain
4.
Maliyapattu
3
1. Maliyapattu MV *
2. Maliyapattu HC
3. Maliyapattu New col.
Maclianur
Machanur
5.
Kalampattu
4
1. Kalampattu HC
2. Gengasanikuppam HC*
3. Melachukattu
Veppaneri
Veppaneri AC
6.
Melmoil
9
1. Mailadumalai MV
2. Melmanguppam MV
3. Moolakanguppam MV
4. Dhuruvam MV *
5. Dliarmavaram MV*
6. Kattu Kalampattu MV
7. Kallapadiyanpatti MV
8. Semmankuttai MV
Latheri
Kanagasainudram
7.
Kanguppam
6
1. Thuraimoolai MV
2. BCP.Kuppam MV *
3. Poorijanamoolai MV *
Thiruinani
Thinmiani
8.
Ammananguppam
2
1. Vanniyarpatti MV *
Kavanur
Kavanur old colony
All
40
Note: * Villages selected for mothers’ interviews
9
FINDINGS
1
As part of the project a baseline report was prepared and documented
separately. However in this report only nutritional and psycho-social stimulation data
are presented.
J
A. NUTRITIONAL STATUS
Altogether 630 childrens anthropometric measurements were obtained, of
■>
which 2 were less than 2.5 kg. weight even after one month of their birth and the Z
score values were not obtained and so excluded from the analysis.
A total of 628 U/3 years old children were available for analysis. Of these 296
were females and 332 were males. Height for age Z scores (HAZ) weight for age
Scores (WAZ) weight for height Scores (WHZ), Body Mass Index (BMI) and
Waterlow Cross Classification(WCC) was the method of nutritional analysis carried
out. Initially the data is analysed for the entire population and then subsequently
classified into those inside project and outside the project area.
Height for Age Z Scores by Sex
HAZ
N=
<-4
-3.99 to 3.0
-2.99 to 2.01
-2.00 to 9.98
PROJECT ARE
Male
Female
235
219
2.1
2,3
6.4
5.9
23.8
23,3
67.7
68.8
OUTSIDE P A
Male
Female
97
77
1.0
3.9
8.2
9.1
15.5
15.6
75.3
71.4
TOTAL
Male
Female
296
332
2.7
1.8
6.8
6.9
21.3
21.4
69.3
69.9
’Normal’ height was seen in 68.8% of girls and 67.7% of boys in the project
area. Mild stunting among girls was 23.3% and among boys it was 23.8%. Severe
stunting was observed among 8.2% of girls and 8.5% of boys in the project area.
Outside the project area, 71.4% of girls and 75.3% of boys respectively were normal.
Although there were
more stunted girls than boys, there were no significant
differences between inside and outside the project area or between boys and girls. In
the whole block approximately 70% of boys and girls were normal, a little over 21%
of the same category were mildly stunted and less than one tenth were severely
stunted.
10
Weight for age Z scores by sex
Underweight
Z Scores
N=________
<-4.0
-3.99 to 3.00
-2.99 to 2.01
-2.00 to 9.98
Project Area
Female
219
1.8
9.1
30.6
58.4
Outside Project
_____ Area
Male
Female
Male
235
I. 3
II. 1
32.3
55.3
0
10.4
31.2
58.4
2,1
5.2
33.0
59.8
Total
Female
296
1.4
9.5
30.7
58.4
Male
332
1.5
9.3
32.5
56.6
In the project area 58.4% of boys and 55.3% of girls were normal in weight,
while outside the project area the figures were 58.4% for girls and 59.8% for boys. A
little less than one third of girls and boys in the project area, outside the project area
Approximately a tenth in all categories
and over all were mildly underweight.
respectively were severely underweight the differences were not significant.
Weight for height Z scores by sex
Wasting Z Scores
N=_________
<-4.0
- 3.99 to-3.0
-2.99 to-2.01
>2.0 to 9.98
Outside roj.Area
Female
Male
77
97
1.3
0
1.3
1.0
14.3
12.4
83.1
86.6
Project Area
Female
Male
235
219
0.9
0.9
1.8
2.1
14.6
14.9
82.1
82.6
Total____
Female
Male
296
332
1.0
0,6
1.7
1.8
14.5
14,2
82.8
83.4
In all three categories over 80% were normal with no wasting. Mild wasting
was observed in a little less than 1.5% among all categories. For males outside the
project area, the figure was 12.4%.
Severe wasting was about 2% over all three
categories combined.
The following set of five tables show the response of mothers and fathers
towards their children on various categories. Both tables compare the stated response
of mothers with that of the fathers. The first table refers to the study area and the
second to those outside the study area.
The response referred to three levels of
frequency; often, rarely or never. A total of fifteen broad parameters were measured.
11
Body Mass Index by sex
BMI
N=_______
0.01 - 15.99
16.0 - 16.99
17.0- 18.49
18.5 - 19.99
20.0-24.99
Project Area
Male
Female
235
219
72.8
78.1
15,7
9.6
9.4
8,7
0.9.
2,7
1.3
0
Outside >roj« Area
Male
Female
97
77
71.1
83.1
12.4
9.1
3.9
0
3.9
12.4
4.1
0
Total____
Female
Male
332
72.3
14,8
10,2
1.8
0.9
296
79.4
9.5
7.4
2.0
1.0
Waterlow Cross Classification by -sex
Nutritional Status
Normal_________
Stunted________
Wasted_________
Stunted & Wasted
Outside roj. Area
Male
Female
Project Area
Male
Female
55.3
57.5
25.1
25.1
11.9
9,6
7.8
7.7
58.4
64.9
24.7
21.6
10.3
3.1
ir.7
5.2
Total____
Female
57.8
25.0
10.1
7.1
Male
58.1
24.1
11.4
6.3
B. PSYCHO-SOCIAL ASPECTS OF PARENTING
1. Calling children by own or pet name
Almost every mother called their child by their own or pet name (56.4%) or
rarely (41.5%). The results were often similar with the fathers. 2.1% of mothers and
3.2% of fathers never called their children by their own or pet names.
Cuddling
2. More mothers (71.3%) than fathers (52.1%) cuddled and held their baby close
often. 1.1% mothers and 4.3% fathers never cuddled their child.
3. Among mothers, 60.6% often spent a lot of time with their baby as against 29.8%
of fathers. Those who never spent a long time with their child were 4.3% of
mothers and 7.4% of fathers.
Allowing children/the child to strain for objects
4. Of the mothers, 22.3% never and 70.2% rarely allowed their child to strain for an
object. The mother gave it to the child instead. The figure was 29.8% and 62.8%
respectively for fathers. Only 4.3% of mothers gave the object to the child. It was
29.8% and 62.8% respectively for fathers. Only 4.3% of mothers and 7.4% of
fathers allowed the child to strain for objects.
12
Reassurance
5. When a Child was frightened 10.6% of mothers and 6.4% of fathers reassured and
held their child often. Among those who practiced it rarely, there were 74.5%
mothers and 72.3% fathers. Interestingly 14.9% mothers and 21.3% fathers never
reassured their children.
6. Response while disturbing
When a child disturbed parents while talking to others, 43.0% of mothers often
and 50.5% rarely responded to the child. Among fathers the response was 30.1%
often and 57.0% rarely.
There was no response from 6.5% mothers and 12.9%
fathers.
7. Hiding objects to find
Only 7.4% mothers often hid objects for the child to find, as against 43.6%
rarely. It was an equal 7.4% fathers who often hid objects, while 40.4% fathers
practiced it rarely. Surprisingly 48.9% mothers and 52.1% mothers never hid objects
for their child to find.
8. Encouraging imitation of action.
A very small proportion of mothers (19.1%) often encouraged their child to
imitate actions while 35.1% mothers rarely did it. An even lesser proportion of fathers
o
practiced this often (14.9%), with 38.3% rarely encouraging this.
Again a large
proportion of mothers (45.7%) and fathers (46.8%) never encouraged their child to
initiate their actions.
9. Teaching parts of the body
This was practiced by 36.2% mothers often, 56.4% rarely and 7.4% rarely.
Among fathers, 26.6.% often taught their children body parts while 64.9% rarely and
8.5% never did this.
10. Repeating stories in the same sequence
Only 9.6% of mothers and 7.5% of fathers repeated stories in the same
sequence. Nearly 61.7% of mothers and 67.7% of fathers never repeated the stories in
the same sequence and 28.7% of mothers and 24.7% of fathers rarely practiced this.
13
11. Encouraging to play with other children
I
In this activity 30.9% of mothers often encouraged their children to play with
other children while 58.5% rarely did this. Among fathers 23.4% often and 60.6%
rarely practiced this.
Interestingly only 10.6% mothers and 16.0 fathers never
encouraged their child to play with other children.
12. Screaming at children for pulling household things
Only 8.5% of mothers and 6.4% of fathers stated that they often screamed at
their children for pulling household things. Most parents with 69.1% of mothers and
68.1% of fathers, screamed rarely at their children. Screaming for this reason was
never practiced by 22.3% of mothers and 25.5% of fathers.
13. Play pretending/guessing games
Only 6.4/o of mothers and fathers often played pretending or guessing games
with their child, with 47.9% of mothers and 46.8% of fathers rarely doing this.
Pretending/guessing games were never played by 45.7% of mothers and 46.8% of
fathers.
14a. Allowing to do things independently
About 23.4% mothers and 22.3% of fathers respectively often allowed their
child to do things independently, with 70.2% of mothers and 68.1% of fathers rarely
allowing their child. Only 6.4% mothers and 9.6% of fathers never allowed their
child to do things independently.
14b. Eating independently
Allowing a child to eat independently was practiced often by 25.5% of
mothers and 21.3% of fathers, rarely by 64.9% of mothers and 61.9% of fathers and
never by 9.6% of mothers and 17.0% of fathers.
15. Setting a safe limit to play
Surprisingly only 7.4 % of mothers and fathers respectively often set safe
limits for the child to play with 2.1% of mothers and fathers rarely practicing this.
This was never practiced by 90.4% mothers and fathers or no safe limits to play were
set by 90.4% of mothers and fathers.
14
16. Calling by slang names
Surprisingly, 3% of mothers and 19.1 of fathers called their children by slang
names often, with 63.8% mothers and 56.4% father using slang names rarely. Among
mothers 14.5% never used slang names and the figure was almost double for fathers
(24.5%).
TRAINING OF SHG REPRESENTATIVES
The animators training programmes were conducted at RUHSA Campus
during August, September and October 2001. Ten programmes were conducted and
236 animators participated.
After forming the MET, the two-day programme started with a needs
assessment and pre evaluation quiz programme. In this quiz session the participants
(about 30-50) were divided into 5 groups and the questions were asked.
Each
question carried 5 marks.
TWO DAY TRAINING PROGRAMME FOR THE SHG
ANIMATORS/REPRESENTATIVES
SYSTEMS APPRAOCH I'
I
INTRODUCTION
Children need lots of love and affection. Parents should give lots of cuddles
and tell them that they love them many times a day. Children are eager to learn and
need lots of things to do. When they are very young their parents are their best
playmates. They like to be danced with, to be talked to, to be sung to, and to be taken
for walks and for the parents to pretend and crawl play. Parenting involves both
ather and mother taking total care of their own children for their positive growth and
development. The goal of this workshop is to enable the participants to encourage the
development of quality, responsible parents in the community.
NEEDS ASSESSMENT
a. Basic needs of this training programme were identified from materials
on
parenting provided by UNICEF/NIP and discussions with the RUHSA faculty.
b. Desires and needs of the participants are to be identified through a discussion at
the beginning of the training session.
c. Entry level of the participants will be assessed through a pre-test (quiz).
GENERAL OBJECTIVES
1. To discuss the concepts of parenting
2. To discuss the importance of breast feeding
15
£
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3.
4.
5.
6.
To describe supplementary feeding and weaning process
To differentiate each stage of a childs growth and development
To provide stimuli for child development
To demonstrate parents role in childcare.
METHODOLOGY
Lecture, Group discussion, Role-Play, Flash Cards, Demonstration.
RESOURCE PERSONS:
Mr. Stalin Mrs. Jayalakshmi, Mr. Sekar & Rural
Community Officers
IMPLEMENTATION:
Date/Duration
Medium
Process
Coordinator
2 Days
Tamil
Workshop
Mr. Stalin/ Mr. Sekar
EVALUATION:
MET, Process Evaluation, Post Evaluation (Quiz), Group Presentation
The following list indicates the list of SHG representatives trained and the
dates of their training programme.
Batch No
Dates
1.
23.08.2001
24.08.2001
30.10.2001
31.10.2001
06.11.2001
07.11.2001
08.11.2001
09.11.2001
19.11.2001
20.11.2001
22.11.2001
24.11.2001
26.11.2001
27.11.2001
06.12.2001
08.12.2001
10.12.2001
11.12.2001
03.12.2001
04.12.2001
Total
2.
3.
4.
5.
6.
7.
8.
9.
10.
No. of members
Attended
29
29
29
28
17
18
21
21
28
28
18
18
36
36
20
20
22
22
16
16
236
16
This training programme covered the SHG representatives of all the villages
in the K.V.Kuppam Block including forty SHGs where parenting programmes are
intensively implemented. It is felt that it would be a useful opportunity for preparing
all the volunteers throughout the block so that the messages on parenting are shared in
all the villages. However, the subsequent parenting programmes were carried out in
only forty SHG areas. No additional inputs were provided in the rest of the area.
Orientation on using "Flip Charts" on parenting
was conducted on 2.3.2002
for the representatives of the forty selected Self Help Groups. This was conducted by
the trainers from 'Network' Mrs. Lakshmi Gopal and Ms. Chitra.
The quiz questions were:
1. Who is responsible for parenting?
2. What support can the husband extend to his pregnant wife?
3. What are the responsibilities of the relatives in parenting?
4. What is the importance of mother’s milk?
5. What is weaning food? (define). When it should be started?
6. What are the foods you can give along with mother’s milk?
7. What are the growth stages (first month, second month
)?
8. What are the advantages of play materials?
9. What type of play materials are good for children?
10. Do all children have same type of growth?
11. What are the disadvantages of beating children?
12. What are the disadvantages of using bad language to children?
The needs assessment did not suggest any changes in the plan but most of the
participants expressed that they were not able to stay at RUHSA on first day night, so
the cultural programmes were dropped.
Day 1
The first session was an introduction to the parenting programme in which the
definition of parenting, role of the husband and relatives in case of a pregnant women,
the age at marriage, the ill effects of early marriage and the shared responsibilities in
17
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child care were discussed. In the same session, the role of animators in the parenting
programme was also presented.
In the second session (2.00-3.30 p.m.) the flash cards (UNICEF) were used
I
and the growth and development of the child, the important concepts in child
development, physical, emotional and social development, the responsibilities of the
1
relatives, safety measures, play and learning processes were discussed.
In the third session the 'messages’ were given to each participant and they
were asked to read and explain the points one by one. Much in-depth discussion and
controversial statements were made and analysed during the session.
Day 2
The second day started with the MET Report and review of the first day’s
programme. The first session started with the issues in parenting. It included the
burden of the lactating mother, the issues related to breast-feeding and the harmful
effects in childcare. A 'role play’ was demonstrated during the session.
The second session was on nutrition. Food preparation, the nutrition myths
and misconception in food practices were discussed. Low cost nutritious food items
were demonstrated.
The participants enjoyed this demonstration and suggested
additional food items.
The third session started with the distribution of 'flash cards’ on parenting to
each participant.
They were divided into groups and after a group exercise they
demonstrated the flash cards. The communication techniques to use these flash cards
were explained to them in their group education.
Finally in the last session they started with planning their one-day programme
and group education programme.
Followed by a post evaluation quiz the programme ended.
Travelling
allowance for two days were provided. Food arrangements were made without any
difficulties.
This was the next level of training being provided at the community level.
One day campaigns were organised in the following villages:
18
One Day Campaign on Parenting - SHG Members
Date
Venue
18.12.01
08.02.02
13.02.02
15.02.02
19.02.02
22.02.02
25.02.02
26.02.02
27.02.02
28.02.02
MOOLA KANGUPP AM
MALIAPATTU_________
THURAIMOOLAI_______
PANAMADANGI________
VANNIYARPATTI
SEMMAN KUTTAI
SENJIMOTTUR________
SENJI_________________
OLD THONDANTHULASI
KANGUPPAM
No. of members
attended
40
58
83
90
40
42
48
86
90
105
682
ONE DAY CAMPAIGN ON PARENTING TRAINING - SHG MEMBERS
This was the next level of capacity building.
After training the SHG
representatives, they in turn trained the members of their groups. RUHSA staff also
supported this process. This is described in greater detail.
A SYSTEMS APPROACH
Introduction
Parenting is one of the most important roles in the life of an adult.
The
children of today are the parents of tomorrow and therefore the attitudes and well
being of children are inseparably linked to peace and prosperity in the future.
Children need support and guidance in all areas of their life to develop fully.
Physical, mental, spiritual, emotional and intellectual well being are all areas of
children’s lives that need to be nurtured and perfected to enhance a child’s holistic
development.
All human beings are bom with the potential and the ability to grow and
develop. Parenting is an important factor in this growth and unfortunately the cost of
poor parenting is failed human potential. Therefore it is essential that all parents are
aware of the impact that positive parenting practices have on the lives of their
children.
19
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17
Needs Assessment
1. Basic needs assessed through previous workshop, baseline survey and through
information gained from focus groups.
2. Pre entry knowledge to be assessed through discussion
3. Participants expressed needs to be assessed through discussion
General Objectives
1. To discuss positive parenting practices
2. To emphasise the importance of antenatal care
3. To stress the role of men in parenting
4. To involve the relatives in child care
5. To discuss the importance of play in child development
6.
To emphasise the significance of good nutrition for both mothers and their
children
7. To develop awareness of the significance of love, affection and tenderness in a
child’s life.
Methodology
Lecture
Discussion
Group Work
Street Play
Flash Card Show
Exhibition
Street Play_______
Implementation
Medium: Tamil
Resource Persons
Mr. Stalin
Mr. Sekar
Mrs. Jayalakshmi & RCOs
RUHS A has planned to conduct one day training programme for forty selected
groups in their village itself Also for training the animators this one-day training
(about 10 programmes) was organised.
The RCO informed the groups in his area well in advance.
The animator
imparted the basic messages to the group members by using a set of flash cards. To
strengthen this process RUHSA had planned to conduct the total one-day training
programme.
20
'•1
•a
The groups in their villages selected the venue. Four or five groups joined
together and made all the physical arrangements. Apart from RUHSA’s contribution,
the groups took care of the lunch, snacks, tea and other expenses.
All the SHG training programmes started a little late at RUHSA Campus
(about 11.00 a.m.). In the village also the same time was followed by the groups
because they had lots of personal commitments.
The village leaders, including panchayat leaders, were invited. The women
/
panchayat leaders showed more interest in SHG group activities on parenting.
The first session started with formal process of inauguration, needs assessment
and an informal pre evaluation asking questions on parenting and their own current
practices on parenting and nutrition.
The second session was a brief introduction about what i
is happening, what
happened and what is going to happen in parenting in their villages.
The group members contributed to the next session. They were asked to bring
along nutritious foo(1
low cos,
wottderful/ddtctous food items to exhibit. They individually explained how they
prepared the food materials.
Following by that Mrs.Jayalakshmi held a session on
nutrition, weaning food,
'
The demonstration carried out by
Jayalakshmi was appreciated by many of the members,
---- A small exhibition was
conducted on the premises.
low cost food items and nutritional deficiencies.
After the lunch break Mr. Sekar took a session an 'Issues in parenting' using
ft.p charts.
He started with songs, dance and beautifn! stories, then explained
different issues in parenting and their solutions.
After the informatory session, the RCOs planned with the individual groups
about then- special programmes for their einages. The groups came up with different
i eas to disseminate these parenting messages.
That evening, the street play was performed
in the same area. The groups
invited all the village people and it was a great success in
many places. Parenting
messages were communicated through dance, skits and songs.
21
F'l
bf
f-
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STREET PLAY
Introduction
RUHSA introduced Street Play in HIV/Amc
infanticide programmes. Street Plays attract all lev
be easily communicated in this medium S'
H 7
effectively the ’change’ h t v
y, me cnange has taken place eacilv
ur.i,
"
rneSSages were dramatised
——streetpl
From Latten area, 'Been Street Play performers were
SHGs. The help of the area RCO
-J ™ Missed in selecting ta|ented artis(s A
week training programme on
"■ess.ge fomiatio^ d<!veloiJing
took place at RUHSA C
attendVth” ' ' ea,1V dayS
'h'S parenti"8 pr0Ject- The street
play performers also
the two days taming
with the animators to internalise the
concepts. Twenty Street Plays were performed in
all forty selected SHG areas.
The Process
The street play was performed between 5 SO o on
Were eiVen pint “'““'■ed sarees and blouses as a Street X
f"6
Perfi’r”’erS
P'nyer aiways accompanied the group with a'loud bea
7
A 'ThaVil'
poMe address systems were insmlled in all street olav
clear messages on parenting.
’ ’
Eff ,
'
an<i
Order to “^nicate
Bve^, street play staned with an inauguration
’Blase level leaders. All the SHG groups |„ lhat
The local SHGs invited the
(about 4 to 5 groups) made all
e Phystca, arrangements for snacks, tea and sometimes dinner
ormed Key roies in coordinating this fieid .eve! programme
prayer so7
The street play has
too.
The RCO
p— staned „,th Tamd
<™ pans. The first paB (al,M 25 mi„utes)
correct age for marriage, care
0 pregnant women, the role of the husl)Md, the
Qf
relatives and preparation for delivery. A nutritious die,
was given in the form of a
-nx::--x.
22
messages
The villagers enjoyed these street plays.
In most of the street plays
participation of men was high. Since street play performers are also mothers arid
grand mothers, the messages were very effectively conveyed through this medium *
Many young people helped with arranging lights and a P.A. System.
The street play performers never felt shy in acting out or dancing this message
in public because in almost all villages the known SHG members organised the
performance.
The street play performers did informal evaluation soon after the show. Based
on the feedback, modifications were made.
THE PROGRAMME OUTPUT
Based on the various inputs provided the following is the total output of the
programme:
Staff Capacity Building
5
Staff and student orientation programme
45
SHG Representatives
236
SHG Members
682
SHG Special Programme
3264
SHG Street Play - Audience
4605
THE POST EVALUATION
As the project was only one year in duration and with a tight programme going
on till the end of the project, instead of a formal data based survey, qualitative
information was obtained through group processes. There were three levels at which
this information was obtained.
a. The programme implementors including Rural Community Officers and Training
Officers of RUHS A.
b. The Animators of the forty SHGs.
c. Members of three SHGs through focus group discussion
23
The information obtained focused on the effectiveness of the methods, the
changes within the community, and the problems faced in implementing the
programme. For the first two levels the review was held at RUHSA Campus while
the SHG members were interviewed at the community level.
A. THE PROGRAMME IMPLEMENTORS
This was the first time the community had an opportunity to share their talents
around a theme. The people used the freedom to express in many ways. The people
enjoyed the messages as it was not such a sensitive topic as HIV/A1DS. The way the
community prepared nutritious items for contest and their explanations were unique.
Resourceful women were identified for future work. The participation of men was
more than what had been expected of men in parenting. The time of year was very
ideal as it did not compete/interfere with farm labour. The staff of RUHS A also put
up a united show as never before.
Weaknesses
Some poor women who were absent for long periods of time due to work
could not participate freely. There was some rivalry by those wanting to take on more
responsibility sometimes making it difficult get the work done. The involvement of
some men was less even as some women were shy. The delayed introduction of flip
chart and audio cassettes meant that they were not fully utilised.
Problems Experienced
The main problem related to time management.
In the villages, the
community arrived late due to other pressing work at home. Similarly the staff had
difficulties in balancing their time with other competing work.
Learning Experience
The following points indicate some of the learning experiences from the
project:
I.
Don’t do any programme without community participation.
2. Team work at all levels is very effective.
3.
I'lie initial relationship between the community and the implementors made it an
ideal learning environment.
24
4. With community participation the level of expectation was high and budgeting
was not adequate. More funds may be allotted for community level especially in
poor communities.
5. Transparent decision making
6. Importance of committed involvement of field staff to the success of the project.
Sustainability
The following factors would contribute to sustainability.
building of the animators is the most important.
The capacity
The availability of educational
resources such as flash cards, flip charts and audio cassettes would also help. The
community has started introducing parenting into other programmes. Some periodic
follow up with a newsletter would be helpful.
Replicability
The following are some of the methods by which similar programmes can be
repeated elsewhere.
1. Organise Master Trainer Programmes
2. Produce additional learning materials
3. Prepare a curriculum for animators training
4. Work through NGO ’Network'
5. Documentation of nutritious foods
6. Publish a book on parenting
Anecdotes
In Purjunamoolai Village one women sang a folksong relating to parenting,
indicating how a child grows and the future plans the parents have for the child. This
song captivated people’s attention.
In the same village another woman explained in detail why the ’Valaikappu’
ceremony is performed and the meaning of each step.
The interest of the
SHG members and their involvement in the special
programme at the community level was spontaneous. They gave the impression it
was their programme rather than that of the institution.
25
I
I
5
In Thondanthulasi a family enacted a role play highlighting a real life situation
in their family.
An animator by the name of Anna^Poorani from Malyapattu was touched by
the two days training.
Since she has no children, she committed herself to this
parenting programme.
In Thuraimoolai village, one woman gathered all the other women and
prepared them for lullaby songs. The staff had tried for 15 minutes but failed. Not
only did this woman sing two songs but she encouraged others to sing as well.
Unmarried girls also joined in this programme voluntarily. They were able to
state the main points of parenting.
In one of the villages, a role play was used to explain the rituals practiced in
families.
In Kalyanaperumankuppam, one woman had prepared a very nice nutritious
food/meal for children. It consisted of vegetables, milk etc. This was a low cost and
very nutritions food. One of the staff went home and prepared it for his children. He
said it was very nice.
B. FEEDBACK BY ANIMATORS
A total of 34 SHG animators participated in the review. They were asked to
give feedback on the effectiveness of the methods used in education, changes
observed in the SHGs, change among men, the anticipated changes in the future, and
changes in practice.
They were asked to list the problems they faced and their
suggestions to improve the programme. They were also asked to estimate the number
of families contacted through the members and to rank each of the methods in order
of preference of what worked best.
Effectiveness of Methods Used
One Day Campaign
This was an effective medium where individuals were able to participate.
There was good participation by both men and women.
The nutrition programme was effective with preparation of varieties of food
items using locally available materials, method of preparation and nutritional values
explained to participants. Appropriate nutritional advice for children, adolescent girls
and pregnant women were also given.
26
The whole area of mother and child care were adem.aMl
from care dllri„8 pregmncy an(|
and chddhood tamunisations mi ,he
provided by all family menlbeis
u ■
J ™ptaSed s,arti„8
’
d security that should be
P
A. Feedback on Methods used for Education
1. Flash Cards
The audience understood the messages through Flash Cards
The messages
—d »h™ Provided through flash
"7
cards than if stated only
ora y. More than for teaching individuals, flash cards
were useful for groups. It was
easy to pass on messages through flash cards to the audience.
2. Flip Charts
Those not educated found the pictures usefol to understand the growth
processes of a child.
nt.lte.ual development of the child was well understood.
There was also an opportunity to understand
the development of children. All
members of the family benefited ff<
™ the games. The pictures „ore beiutifij| and
details on child development ■
™ clear.
People u„derstoot| (he
providing toys according to age.
3. Message Sheet
This gave an opportunity to know the foil ranop
f
t0 dlstnbute to one person in the family so that tho
Otocrs. There was no need contact eveiyone Ze
tllsseminating
the messages, which shLld be ZZ
understand. Messages should be brief and clear.
als° heIped
“““ S,"re ™“’
‘0
8
4. Street Theatre
Play, they underZdZ Za^b
Sloe, the messages were s.Z /
,he
‘
the community accepted the mBsages°P With”h°U<T1 llK '''ll"Se thr°USh !‘reet pta>'-
27
of all the community members from children to adults. The folk songs helped people
to understand easily. It was a unique gift because women planned and enacted the
8:1
'W
street play.
Special Programmes
t
Each of the activities during this programme were described including their
problems and limitations.
Well baby competition
Mothers brought their children for the contest. Based on weight and timely
immunisation, children were selected and prizes given. Mothers had an opportunity
to know their children’s weight. They were able to overcome their traditional belief
regarding the evil eye’ or ’drishti’ . The importance of childhood immunisation was
re-emphasized.
Food Competition
Again the focus was on low cost, locally available foods, methods of
preparation and their nutritional usefulness. Skills in preparation and new methods
were presented. Mothers indicated the suitability and easy digestibility of the foods.
Emphasis was given on iron rich food and the importance of home made foods.
Speech Contest
Because of the speech contest even the ignorant people learnt new facts.
People were able to express their feelings. The role of men was emphasized as well
as the importance of playing with children. Real life situations were enacted by both
men and women. They realised that everyone can participate in sharing about child
development.
Lullaby Songs
Women came forward with lullaby songs, which were filled with valuable
lessons.
Competition for School Children
School children also participated in the competition and obtained prizes.
28
Changes in SHGs
Emphasis was made on the participation of everyone in the village including
-0
I
men and women. All 20 members were motivated to share about parenting in the
community. Even at the group level, there was some resistance to move away from
certain traditional practices.
Changes among men
I .
Everyone welcomed the change among men. Men participated in parenting
programmes, shared their experiences and assured of their support.
Fathers have started taking their children out, feeding them, purchasing toys
for them, playing with them, singing and dancing with them, taking children for
treatment and taking care of children while,mothers go out for work. Now men are
encouraging their wives to take part in different programmes.
Other Changes Anticipated
They recognize that changes are needed in more areas. Practice in handling
children is needed. Encouraging children and learning lullaby songs are important.
There is a need to get over some of the traditional beliefs and practices like normal
diet following delivery, giving papayas to pregnant women, and about ’Dhristy’ or
evil eye.
Problems Faced
1. Participation from mothers and elders in the family was sometimes inadequate.
2. Insisting on tradition of giving sugar water in some families.
3. People sometimes listen to doctor and
nurses more than SHG members.
4. Reluctance to weigh children.
5. Resistance shown to message about marriage above 21 years
6. Many people expected prizes in contests.
7. When prizes were offered to low
cost preparations those who made
preparations were angry.
8. Indifference among elderly to new messages.
29
costly
1
T
9. Too many messages in too short a time.
10. People unable to participate because of work.
Suggestions
*
V
1. Simplify message sheet
t
2. Street Play is an effective medium for villages
3. Flip charts should be used in house visits
i
_
^<7
4. Should focus on any one method
5. There should be an exclusive training on 'Parenting for Men'.
6. Video show on parenting would have been useful.
7. New games should have been taught
8. There should be a time frame to promote different messages
9. Repeat training and resource materials should be made available to those who are
resource persons.
/u
Ranking of various methods
All the methods used in parenting education were listed and they were asked
to vote which was the best method. They could vote any number of times for the
methods they thought were important.
The Street Theatre and special programmes were rated highest by the SHG
Animators.
C. FOCUS GROUP DISCUSSION - MALIYAPATTU VILLAGE
Staff Participated
Group Participated
Dr.Rajaratnam Abel
Mr. Stalin
Mr.Jayaraman
Annai Theresa
Mullai Mahalir Group
Malligai Mahalir Group
At the start of the discussion,
Mrs.Annapurani explained in detail all the
activities carried out under the parenting project.
30
i
Happiness on becoming Parents
In general in the village people are happy to become parents. While there is
more happiness at the birth of a boy now, there is conscious effort to treat both sexes
equally. Nowadays the sex of a child is not important in determining happiness.
Age at Marriage
Women expressed the importance of marriage at age 21. There is adequate
physical growth including the growth of the uterus. The child bom will be healthy.
The girl will be able to understand herself and her family better.
Gently they brought out a problem.
Delayed age at marriage is causing
difficulties in finding suitable bridegrooms.
Husband’s Role in the Support of the Pregnant Women
Husbands should help the wife in all work including carrying water, obtaining
food when necessary, giving adequate rest. Husbands should take their wives for
antenatal check up and immunisation. They should take them in a vehicle and not
make them walk too much. They should show love to their wives. Nowadays there is
more happiness in the birth of a girl child.
Support from other Relatives
Most relatives support pregnant women in all necessary work especially
cooking of food when they are weak and tired.
Even though mother-in-laws fight with their daughter-in-laws, during
pregnancy they help them because they realise that their grandchild is being formed
inside the mother’s womb.
Male Female Sex differences
People are very happy if it is a male child although they are generally happy
with both and they accept both as equal. There is no female infanticide in this village.
Whatever the sex, after having two children, most have birth control through
tubectomy. Those who have no children go through hardships. For them a child of
any sex is all right.
31
I
IJ
I
Advantages of Breastfeeding
Breast milk has resistance against diseases. It is easily digestible and prevents
vitamin A deficiency. A relationship is built between mother and child including
bonding. When a mother breast feeds her child she forgets all her worries. There is
increased lactation if the mother keeps gently massaging the babies’ head, hands and
legs.
Supplementary Feeding
There is some confusion in the minds of people.
Earlier they were taught
breast feeding should be given for 4 to 5 months, but now it is 6 months.
Supplementary feeding helps the child to grow well.
Speaking and Playing with Child
Bonding and love grows if mother holds the baby close to her and speaks
tenderly to the child. There is a need for the father to spend more time with their
child. Toys should be colourful and those that make noise are appropriate for the
cranking child. Encourage the child to walk and show happiness.
Milestones of Child Development
•
•
•
•
•
•
•
Sleeping more soon after birth
There is a belief that if a child is bom at night it will sleep at day time
Smiles at third month
Turning over at fifth month
Crawling at sixth month
Standing by holding on to an object or the wall and walking with support
by eight months.
If a mother is healthy and provides breast milk her child will be healthy.
Teething Diarrhoea
This occurs because of the child putting dirty objects in their mouth.
If
diarrhoea is severe the parents should take the child to the Doctor.
Wrong Traditional Practices during Pregnancy
Women in the community are taught not to eat jack fruit, jamun (Navapalam)
black grapes and papaya during pregnancy. It is believed that the child will become
wet and is believed to lead to a condition called sevappu.
32
Special Lessons Learnt by Parents during Parenting
1. Children should not be beaten
2. Children should be taught what is correct
3. Good pet name can be given to children
4. Names that appear to be teasing a child should not be used
5. Teasing a child makes a child lose self esteem and affects the mind
6. Parents should support one another
7. Children should be given toys
Street Play/Theatre
This helped to identify how the mother-in-law could help her daughter. There
is a role for the husband. These points came out through street play.
Possibility of Women organising parenting programme on their own
Women indicated that they will do what RUHSA counsels them to do.
Already both have done many programmes together. It is possible to cany out street
play, rally by school children as well as use a public address system.
Problems Faced
The common refrain heard in the village was, “Have we not given birth to
children and taken care of them. What new thing can you teach us?”.
Changes in Parenting Behaviour as a result of programme
1. Husbands’ role in parenting has increased
2. Male - female difference have decreased
3. Female infanticide has vanished
4. Allowing children of different families to play together
5. Children are not beaten
6. SHG women have become more confident to talk with others
7. Purchasing toys for children has increased
8. Better nutritional practices including supplementary feeding on time
9. Parents are encouraging one another to ensure optimal growth of their children.
10. Avoiding harmful toys
33
Lessons Learnt
What did we learn through this programme?
1. Community ownership of an activity is essential for long lasting and deep seated
change. The response of the community was way beyond our expectations. This
process is being now introduced into the far more challenging HIV/AIDS
behaviour programme.
2. Involving men has been difficult in many of our programmes. Their participation
was a key element to the success of this programme at RUHSA.
3. Since the parenting role is to be played by all members in a family, enlisting total
community participation was another key factor to success.
4. The principles of SHGs when implemented well become a solid base for both
programme implementation and sustainability.
5. Valuing community/traditional knowledge is important. Our SHGs refused to be
put down by RUHSA staff pressure to modify certain child rearing practices.
6. A systematic and step by step approach to community education is essential for
success.
7. Curriculum based approach to community education leads to behaviour
modification.
8. Multi-channel communication reinforces key messages.
9. Street theatre is a valuable means of changing behaviour.
34
References
1. Aarons A, Hawes H & Gayton J (1979). Child to child Macmillan Press: London
2. Abel R (2002). Sustainable Development: RUHSA's Experiences. RUHSA.
3. Babcock DE (1962). Introduction to growth, development and family life.
F. A.Davies & Co, Philadelphia.
4. Bhauna B & Mukhopadhyay B. eds. (1998) Better child care. Voluntary health
association of India: new Delhi.
5. Henry DR (1978). 'The psychological aspects of child abuse'. In Smith S (ed.)
The maltreatment of children, University Park Press: Baltimore.
6. 'How to feed your children right' (2001). Health . Vol.79, No.4. pp.2-9
7. Ife J (2001) Human rights and Social Work. Towards Rights Based practice.
University of Cambridge Press: Cambridge UK.
8. Kuppuswamy B (1994). An introduction to social psychology. Lily Jayasinghe:
Mumbai.
9. Meier JH & Malone PJ. (1979).
Facilitating children's development. A
systematic guide for open learning. Toddler learning episodes. University Park
Press: Baltimore.
10. Morley D & Woodland M. (1979). MacMillan: London.
H.Murickan Fr. J (2001).
pp.21-22.
'Emotional Intelligence' Health Action vol 14. No.4,
12. Ronald S (1987). The development of the young infant and young child: Normal
and abnormal. Churchill Livingstone: London.
13. Silva D (2001) 'Influencing health behaviour. Songs and storytelling: Bringing
health messages to life in Uganda'. Education for Health. Vol. 14, No.l, pp.-5160.
14. "The Best Start" extracts from "To every child a childhood" Health Action. April.
Vol. 14, 2001; No.4, pp.23-26.
15. United Nations Commission on Human rights (1989). The Convention on The
Rights of the Child.
16. World Breastfeeding Week. 1-7, August, leaflet (2001).
//PREPORT. DOC
87.3//
35
STORY BY A CHILD
During the one day special programme organised by the SHGs, in one of the villages
a small girl came forward and told the following story which capivated the hearts of
the audience. Her stoiy went like this.
In a village there were two small girls. One day both of them went to a neighbours
garden and stole some brinjals and gave them to their mothers respectively.
The first mother cut the brinjals and made a tasty preparation. Her daughter enjoyed
what her mother had made. Each day thereafter this girl went and stole something
and she grew up as a thief.
The second mother wanting to teach her daughter a lesson prepared a dish using the
brinjals. Instead of making it tasty like the first mother, she cut along with the brinjals
bitter gourds. The little girl could not eat the vegetable and never again went to steal.
The girl concluded by saying that what the mother teaches so will her children grow
up and emphasised the important role of parents.
The Programme Output
Based on the various inputs provided the following is the total output of the
programme:
Staff Capacity Building
Staff and student orientation programme
SHG Representatives Trained
SHG Members Trained
SHG Special Programmes for women
SHG Street Play - Audience
5
45
236
682
3264
4605
Post Evaluation
Initially the service providers were asked their opinion on the best methods of
community education provided. Street play and community organised programmes
ranked the best. As these were very effective programme flash cards, flip charts and
messages on pamphlets came very low in perceived effectiveness.
The one day programme planned by Self Help Group was probably was the
most effective learning outcome. From this programme it could be concluded that
this can be replicated in other community behaviour modification programme.
This one day programme ensured the involvement of school children,
adolescents, men, grand parents, mothers and even the unmarried women. When the
community was asked on their feed back on the parenting programme they indicated
that the tremendous change among their husband’s in their support to parenting was
totally unexpected and surprising.
In conclusion this parenting programme involving Self Help Group women
was a successful attempt at changing parenting behaviour. Community participation
and ownership of the programme was established with people of all ages taking part.
The role played by men was beyond our expectations.
EXECUTIVE SUMMARY
CAMPAIGN TO PROMOTE AWARENESS AND ACTION ON
NUTRITIONAL STATUS OF RURAL CHILD IN TAMIL NADU
THROUGH IEC ACTIVITIES
TNVHA - NIP PROJECT
Ac Vp.
*0
S,
SINCE 1971
TAMIL NADU VOLUNTARY HEALTH ASSOCIATION
X°r
Al?!,AdUrai Main Street’ Ayanavaram, Chennai - 600 023. Tamil Nadu India
I « : (MM450462 / 64795S5, Fax , 044-6601S29. E,„ad : „„ halfn.dZ.
Web site : www.tnvha.org
EXECUTIVE SUMMARY
PILOT PROJECT ON PARENTING & NUTRITION
INTRODUCTION
Family which is the fundamental unit of the society has undergone tremendous change during the
last few decades. Indian society which is unique for its joint family system has undergone a
major shift; joint family system was taken over by the nuclear family system. Life as such seems
to be very fast changing and dynamic. Family conversation, face to face contact, frequency of
family members eating together, spending leisure hours together and so on are reduced
considerably. Similarly parenting and nutritional practices, especially for the children below 3
years have undergone significant changes over the last few decades, due to remarkable drastic
changes in human life styles.
On account of these changes, children, especially the below 3 years category have been deprived
of care which has scientifically proved to have affected the development of the child. There is
now an. urgency felt to look into this matter as the children cannot wait for tomorrow. There is a
strong need to sensitise the families, communities and society at large on the importance of care
for the children from foetal state through the early years.
A group of concerned individuals and organisations which frequently' met together and discussed
on this subject of parenting and nutrition initiated a network called Network for Information on
Parenting (NIP) to address the parenting and nutritional issues specific to children below 3 years.
1 he Tamil Nadu Voluntary Health Association (TNVHA) which is a networking body in the
promotion of community health has been also one of the active members of this network, since
its inception.
In 2001, TNVH.-a nas been chosen as one of the partner organisations for the implementation of
a Pilot Project on 'Campaign to Promote Awareness and Action on Nutritional Status of Rural
Child in Tamil Nadu through 1EC Activities'.
^3
Under the able guidance of Network for Information on Parenting (NIP), the Tamil Nadu
Voluntary Health Association undertook this pilot project through its 10 member organizations
in 5 districts of Tamil Nadu (Nagapattinam, Erode, Tiruvannamalai, Virudhunagar and
Sivagangai). From each district 2 FNGOs were identified based on their previous as well as
current work experiences with women groups and children. Of the 10 Field NGOs (FNGOs)
identified one FNGO has dropped out due to pressure to complete the other on-going projects of
the organization.
General Objective
To improve the nutritional status of children below 3 years through training programmes and
IEC activities of community groups.
Specific Objectives
1.
To build the capacity of NGOs, community leaders in Parental Practices for ECCD.
2.
To create awareness among the community to prevent low birth weight, mal-nourishment
among children below three years during normal days and when they are sick, in their
area.
3.
In the training to assess the nutritional status of children below 3 years and to understand
the knowledge, perception, attitude and behaviour of the mothers in regard to the
nutritional care (feeding practices) of their children.
4.
To campaign and advocate the families to change food habits using locally available
nutrients.
5.
To motivate mothers to utilise locally available Government services for ensuring
nutritional health of their children.
6.
To document all the informations for future reference and activity.
METHODOLOGY
Strategies and Activities
1.
Identification of field NGOs
>• Selecting the Districts
> Briefing the Potential NGOs about the TNVHA’s Pilot Project on Parenting and
Nutrition
>> Inviting Applications
>> Screening and Short-listing of NGOs
>' Finalising the NGOs
2.
Capacity-building of NGOs
Training of Master Trainers
Orientation to Stake-holders of the Project
Providing Training to
•
Head of the NGOs & Senior Staff
•
Staff of the field NGOs and Leaders of Women’s SHGs
•
Training on Use of IEC Material
- Flip Chart
- Age-specific Nutrition Schedule
- Guidelines for Organising Activities at the Village-level
- Other Material
Training to Staff of field NGOs to document the progress of children below 3 years.
1.
2.
3.
Campaign by FNGOs
•
Organising Training to Staff
•
Meetings with CBOs, especially women’s SHGs and Organising Health Camps
•
Family Visits and Monitoring the Nutritional Status of Children.
Building Linkages with Structures and Services
•
Facilitating Discussion among the Women’s SHGs and other CBOs
•
Utilising the Services of PHCs / ICDS / TINP / Other Private, Volunteer and Govt,
services.
Documentation of the Process
•
Preparation of Family Profile
•
Monitoring Child’s (below 3 years) Growth and Development
•
Recording of Case Studies
•
Sending Monthly / Quarterly / Final Reports to TNVHA
4.
Dissemination of Information
•
Sharing in Different Forums (such as district consultations, local news papers..
magazines, local cable T.V., TNVHA Newsletters and other medias)
Documentation and Reporting
This being an ‘action-process study’, the FNGOs had a major responsibility of documenting the
process evolved by them in their work and report the same to TNVHA in time. Necessary
guidelines and formats for reports were given to the field NGOs for documentation and
reporting.
Criteria used for Selecting Field NGOs for the NIP Project
•
Member organisation of TNVHA
•
Organisation must have MCH component in their on-going work
•
Availability adequate staff to carry out the NIP Project
•
Organisation should have trained / experienced staff in MCH
•
Organisation must be working with women’s SHGs
•
Staff to have regular field / house visits in their work
•
Organisation should have financial stability in the continuation of the project.
•
Willingness of field NGOs to take up the work.
Role of Project Co-ordinator
•
Identification of FNGOs
•
Organising training programmes to FNGOs (for capacity building)
•
Monitoring the FNGOs and their documentation
•
Reporting
Role of FNGOs in NIP Project
1.
Identification of Project Area
2.
Enumeration of women with children below 3 years.
3.
Providing training to their staff on issues pertaining to parenting and nutrition.
4.
Providing training to the parents having children below 3 years and the significant others.
5.
Monitoring the families with children below 3 years old.
6.
Creating linkages with the existing structures and services for promoting parenting skills
and nutritional practices.
7.
Collecting and Documenting of Information related to Parenting and Nutrition. This
include
•
Current child rearing practices and
•
Care of children during illness
•
KAPB of parents and significant others before and after the intervention.
Recording of information and reporting the same to the respective DRCs, secretariat
of TNVHA in the given format on monthly, quarterly basis as well as a consolidated
report at the end of the project period.
Role of the Zonal Officers
•
Keep track of the field NGO’s programme schedule in relation to NIP Project.
•
Enable the field NGOs to design an appropriate medium / tool for disseminating the
parenting and nutrition messages.
•
Orient the organisations for proper use of IEC material provided to them.
•
Verify whether the process evolved and used is in accordance with the requirement and
confirm that reporting to TNVHA is regular.
The Process
In order to document as well as to take up intervention activities, the head of the implementing
organizations and the field level staff were trained separately on parenting and nutrition concepts
as conceived and developed by NIP and also on the methodology of the implementation of the
project. Afivo-day orientation programme to 10 implementation organisations was organised on
28*1 & 29"' August 2001 at ICS A, Chennai. Of the 20 participants expected, 19 attended the
programme. Separate report (Ref. Annexure II) was made available to the NIP Secretariat, soon
after the orientation programme. Again a two-day training on 13lh & 14th September 2001, to the
semor staff and leaders of women’s self help groups, a training was organised. Twenty eight
participants attended the training. (Ref. Annexure III) This was also already reported to the NIP
Secretariat, after the training. The implementing organizations were also provided with
•
tools for collecting basic information about the project (Form A, B] & B2)
•
tools for documenting the parenting and nutrition practices at the beginning of the
intervention program (Form C, and C2).
tools for monitoring and reporting the intervention program (Form D1; D2, E|, E2, F, and F2)
•
tools for studying the effectiveness of the intervention and IEC materials utilised (Form G, H
& I) for enabling and supporting the community intervention activities.
The following is the list of IEC material provided to FNGOs of NIP project :
1.
‘Learning Through Play’ (Birth to 3 years) - Flip Chart (Tamil version)
2.
Booklet on Age-specific Nutrition to Children below 3 years (NIP - IEC)
3.
Annaiku Atharavu - (a handbook for promoting breast-feeding) - by M.S.S.R F
Chennai.
4.
‘Engal Madal Ungaluku’ (3 Nos) - TNVHA Publication - Topics covered are
‘Importance of Immunization’, ‘Declining Sex Ratio’, Violation Against Women
(statistics) and Nutrition’.
5.
TNVHA posters (3 Nos) each on Female Infanticide, Foeticide & MCH
6.
Handouts
-
Issues related to women (4 Nos. - Printed by TNVHA)
-
What is parenting (translated from Unicefs Booklet on ‘The Challenges on
Parenting’)
-
How malnutrition affects the child’s intellectual development? (Translated from
Unicefs booklet on ‘The Challenges of Parenting’)
-
Partners in Parenting (Translated from Unicefs booklet on ‘The Challenges of
Parenting’)
-
Main messages to be given in NIP project.
7.
Booklet on Nutrition (TNVHA Publication)
8.
Core messages developed for the NIP project by RUSHA, Vellore.
9.
‘Petrore Kuzhandhai Valarppu’ a set of Flash Cards on Parenting produced by
RUSHA Department, CMC & H, Vellore.
•
tools for assessing the effectiveness of the 1EC material, learnings of different stakeholders
and feedback on utilisation of government services (Form G, H&I) and
•
counselling and guidance services through the Project Coordinator and Zonal Officers of the
respective region for better implementation of the project.
Orientation to Implementing Organisations
During the intervention period, in the months of November and December 2001, the Project
Coordinator made an on-the-spot visit to all the implementing organisations and conducted an
one-day orientation programmes.
Monitoring the Project
The Field NGOs, soon after the training programme, were asked to present a tentative
programme schedule to State Secretariat of TNVHA and a copy to its Zonal Officers who work
at a cluster of districts as facilitators for building the capacities of field based organisations and
institutions.
The Zonal Officers of TNVHA visited the implementing organisations, at least twice during the
project period to monitor the field activities connected to the pilot project on promotion of
favourable parenting and nutrition practices. Such monitoring visits provided opportunity for
checking if the implementing organisations are proceeding as per the expectations, guide them to
adopt innovations in the interventions and also check if the organisations are regular in reporting
the process to the state secretariate of TNVHA.
The Expected Roles and Responsibilities of FNGOs
The FNGOs are expected to
•
identify the target for the intervention
•
document the parenting and nutrition practices
disseminate information on parenting and nutrition by adopting different innovative
strategies to the target communities and groups.
•
provide feedback about IEC material for further improvement
•
share their experience with other organizations implementing NIP pilot project for mutual
learning.
The Intervention Period
The FNGOs have executed their intervention activities during October 2001 - March 2002
Analysis of the Data
TNVHA consolidated the reports submitted by the FNGOs and the following is the final report
oi the pilot project on parenting and nutrition.
The basic information about the project is given in Table 1 were organisation wise details of
target covered. These informations were collected in ‘Form A’ at the beginning of the project.
DOUBTS RAISED DURING THE INTERVENTION
There were hundreds of questions and doubts raised during the period of intervention. They are
classified under some headings. All questions are not given here. Only samples of them are
presented below:
I. Breast-feeding
♦
When not getting breast milk, what to do?
♦
When mother is sick, can she breast-feed the baby?
♦
How long to give breast milk?
♦
Are the modern women not having enough breast milk?
♦
If the milk gets clogged, what to do?
♦
What to take for more milk to secrete
♦
If a woman gets pregnant while feeding the first child, can she continue to breast-
feed?
♦
How many times to give breast milk?
^0-
One mother who suspects here husband to have HIV wanted to know if she could breast feed her
baby. She was advised to express breast milk, boil and give.
IL First Feed to baby
♦
Can donkey's milk be given to baby as soon as it is bom?
♦
Can bottle milk be given?
♦
Why sugar water should not be given?
♦
What are the benefits of colustrum?
♦
Can cow's milk be given?
HL Weight Monitoring - Growth
♦
What to do if the child is below normal weight (LBW)?
♦
Will the baby's weight reduce, if weight is monitored?
/K Feeding
♦
Can fish, meat be given to child?
♦
Feeding gripe water, Castor oil
♦
Child eating sand - how to stop
♦
Feeding Horlicks, Boost
♦
When to start complementary food?
♦
More about ’sathumavu'
V. Bathing
♦
Use soap, shampoo
♦
Give oil bath
♦
Giving hot water bath
VI. Normal / Disability / Oth er
L
C
I
4
Why there is development delay?
♦
Reasons to avoid marriage between relations
♦
How to know if the child born is normal?
♦
Feeding child which has not shown growth
♦ Is the child sensitive from birth?
♦ Why the hair is brown?
♦ What is the need for immunization?
♦
Pressing the nipple after it is bom is it right?
♦ If the infant gets jaundice, can one show the baby to the sun?
VII. Childhood Diseases & Health Problems
♦ Discharge in nose or growth
♦ Measles - signs and symptoms
♦ Management of fever
♦ Low appetite
♦ Immunization
♦ Reason for pale face of the child
♦ Getting wounds
4
Giving allopathic treatment
Disease & other - Feeding, bathing, etc.
VIII. Whether eating certain food items, will make child ill?
♦ banana - cold
♦
Diet during diarrhoea
♦
Giving oil bath
♦ Giving incense (Sambirani) to child
♦
Using ISM
♦
Bedwetting
♦
If a child was not immunized for 2 months what to do?
IX. General
♦
Why child suddenly becomes sick?
♦
Some traditional beliefs - their interpretation
♦
How to plan child development?
♦
How to weigh the child?
Parental Practices
♦ Attitude of parents
♦ Behaviour - specially fighting in front of the child
The Tamil version of the 'doubts and clarifications' given were in detail in ANNEXURE I
Form E was used to report about the child rearing practices in the family on monthly basis by
the implementing organisations. The data collected include status of breast-feeding, weight of the
child, health status of the child, details of complementary food given, type of food given during
illnesses, father’s support during the time of child’s illness, grand parents’ support during the
time of child’s illness and the support extended to the mother by the husband and the grand
parents at the time of child’s illness. The following tables describe each aspects one by one.
Data were collected both for male and female children separately to study if there is gender bias
with regard to breast-feeding. The following table depicts the breast-feeding practices during the
period of project implementation.
y
FEEDBACK OF IEC MATERIAL UTILISED IN THE PROJECT
Form G was used to collect feedback pertaining to the utility value of IEC material made
available to the implementing organisations for disseminating information on parenting and
nutrition.
Feedback of IEC Materials
Sl.No
1.
2.
3.
4.
5.
Particulars
Respondents
/ Flip
Responses_____
Chart
For whom the IEC Pregnant Mother
5
materials were utilized?
Lactating Mother 9
Adolescent Girls
4
SHG Women
9
Grand Parents
_
Were you able to handle ’ Yes
9
the IEC material easily?
No________ ___
Were the target group able Fully Understood 9
to understand the message Partially
easily?
Understood
Not Understood
Were
the
messages Clear
9
conveyed through the Not Clear
pictures clear?
Not Answered
Were the informations Clear
clear ?
Not Clear
| Not Answered
Handout
9
9
3
9
3_
9
Flash
Card
4
9
4
9
9___
9
9
9
9
9
From Table 29 it is observed that the IEC material namely the flip chart, hand out and flash
cards were used for various target groups like pregnant and lactating women, adolescent girls,
women in self-help groups and grand parents. The community health workers had expressed
that they were able to handle the IEC material easily and the messages to be conveyed through
the flip charts, hand outs andflash cards were clear.
Suggestion for Improving the IEC Material
Flip Chart
Printed immunization schedule could have been much useful, if attached with the Flip Chart.
Handouts
List of nutritious food preparation, if added could have been much useful.
Flash Card
More details on nutrition can be added.
Importance of hygiene should also be stressed in the reverse of flash cards.
More information on roles and responsibilities of father could be added.
Additional Comments
)
!/
Video cassettes on parenting and nutrition can be screened for effective
dissemination of information.
«> <1 r J'‘ r ;
communication and
r-..r r
o .J r
Follow up of NIP Project is needed.
Support should be continued to make this programme more effective and useful for many others.
Feedback from Implementing Organisations Regarding the NIP Project
bonn H has been used for collecting feedback on the impact of the NIP Project:
All the 9 implementing organisations have stated that
*
their staff have acquired knowledge and skills on promoting parenting and nutrition
practices among their target community.
The women fs leaders expressed that they have learnt
-
the importance of maintaining families with child friendly atmosphere.
-
to internalise gender equality
educate the family members on favourable parenting and nutrition practices.
the necessity of training their group members on immunisation, prenatal, neo-natal
and post-natal care.
-
about training their group members on diarrhoea management
about the development milestones
the importance of stimulus for the development of the child
The Members of Women Groups have learnt
•
the importance of exclusive breast-feeding upto 6 months and the importance of
colustrum to the new born child.
duration and frequency of breast-feeding
the age-specific nutrition for their children
the importance of weighing their children periodically,
the development milestones of children.
the importance of play and stimulation in learning
to tell their child’s age
the importance of immunising their children against certain specific diseases.
the importance of Joint Family system for the growth and development of children.
the roles and responsibilities of father and other family members in the up-bringing of the
children.
The parents of the children monitored learnt
to listen to their children.
the importance of colustrum
the importance of exclusive
complementary food.
breast-feeding,
frequency
of breast-feeding and
the art and science of child care
the importance of play in the learning process
the importance of stimulus and activity based learning
the role and responsibilities of father and family members in the parenting process
to differentiate between the favourable and unfavourable child rearing practices
about the preparation of complementary food
the importance of child birth in hospital or delivery to be attended by trained persons
the importance of monitoring the growth and development of the child
the importance of immunisation
the importance of mother and child-friendly atmosphere in the family
about management of diarrhoea
about child care services by the government.
The implementing organisations have
learnt the revealing part of concepts like ‘Parenting and Nutrition’
learnt to monitor document and report their intervention with their target communities.
learnt to integrate parenting and nutrition programme in their health programme
learnt to disseminate the knowledge on parenting and nutrition using different strategies.
learnt to mobilise people’s participation for the successful intervention
learnt to share the learnings and experiences with other organisations and those
concerned about child development.
built congenial relationship with the target community, especially with those families and
children being taken up for monitoring.
Form I was used to collect data on government senices utilised by the parents for their child
development. The following table describes the same
All were getting Nutrition food (Sathurundai) from the Balwadis. But for four months during the
time of intervention Government has stopped giving mtrition food.
Monitoring the weight of the child is not done in the Ealwadis regularly.
Coverage of Children with Disunities in the Project
Orgn
BMFWF
No. of Children with disabilirv
Already Identified
Idcntifed during
this pngram
1 (CP)
1
Referral
for
these
children with Disability
1
(Visual’/ impaired)
Peace
USSO
SUS
2
2
PCTC
CSI ’
2
2
Blossom
ODAM
CUIRPF
7?
No. of Public Programmes Organised
No. of Public Programmes
Cultural org.
Orgn
Gutturals
BMFWF
Baby Show
Any other
2
Peace
3
4
USSO
4
4
“SUS
PCTC
3
CS!
6
ODAM ’
CHIRPE
16
Total
2
2
2
II
“To"
1
1
~T~
T~
T
To
30
IT
TT
TT
TT
42~
43~
T63
214
48“
T
T
T~
Blossom
Total
Street Play
22
~3T
13
From Table 31 it is understood that of the 640 children monitored, 5 are children with disabilities
and they have been provided with referral services.
With regard to number of public programmes organised, it is revealed from Table 39 that only 8
organisations organised public programmes.
Involvement of Husbands and Women Groups
Implementing
Organisations
BMFWF
PEACE
USSO
svs
PCTC
CS1
BLOSSOM
ODAM
CH1RPE
Involvement of Women
Groups
Information sharing to
family members
Practicing with their own
children
Participation
with
full
involvement
Improvement in the
Involvement of Male
(husband)
Yes
Yes, by spending time with
child and wife
Yes,
by
way
of
participating
in
the
activities of NIP
Yes, improved
Actively participated in all
activities
By participating in group No, but very little effect
meetings
By educating mothers, Yes, by spending time in
making kitchen garden
household works
Taking part in the meetings Yes, by sending their
and trainings organised
spouses to attend the
meetings
Taking part in the meetings Yes, by sending their
and trainings organised
spouses to attend the
meetings
With
involvement
the Satisfactory
women took part in the
meetings
and
training
programmes.
Varied positive responses are inoticed
‘
’ regard to the involvement of the husbands and women
with
groups in the parenting and nutrition promotion efforts.
MAIN FINDINGS
Basic Information
1.
Nine per cent of the women and 4 per cent of the men were below 20 years. On an
average, 7 per cent of the parents of the children monitored are found to have got married
in their early ages, i.e. 15-19 years.
2.
Most of the parents (80 per cent) whose children were monitored in the project were
found in the 20-34 years age group.
3.
Nearly half were non literate. More than one-fourth (26 per cent) of the parents are
illiterates and another 20 per cent had attended only Primary School. Very negligible
percentage of the parents studied beyond their school studies. Dropouts were found to be
high at the primary and secondary stages in both sex.
4.
Most of the parents (92 per cent) whose children were monitored are from the Hindu
religion, 5 per cent of them are Christians and 3 per cent are Muslims.
5.
A majority (54 per cent) of the parents are agricultural coolies, 14 per cent of them are
involved in agricultural operations in their own lands, 38 per cent of the mother are
reported to be house-wives, 13 per cent of them are engaged in various occupations like
tailoring, petty business, govt, employees, private employees and construction workers.
6.
Most of the families are from economically backward status. 40 per cent of the parents
live in huts, 46 per cent in tiled houses and only 14 per cent have concrete houses. In this
91 per cent of the parents live in their own houses and 9 per cent in the rented houses.
7.
01 the children taken for intervention and monitoring 12 per cent fall in the below 3
months age group, 28 per cent in the 7lh to 1 year age group, 35 per cent in the 1 yr to 2 yr
age group and 25 per cent fall in the 2-3 years age group.
8.
More mothers (65 per cent) than fathers (18 per cent) were exposed to health education
during the pre-intervention period.
So
9.
More than 70 per cent of the parents contacted the Nutrition Centre for one reason or the
other. Immunisation, nutritious food and organising of women groups are some of the
purposes for which the Nutrition Centres have been contacted by the parents.
10.
All mothers have expressed their willingness to care for their children and but 15 per cent
of the fathers have expressed their reluctancy in caring their children.
Details about the Children
Place of Birth
11.
With regard to birth place of the child, most were born at Government Hospital, 17 per
cent of the children were born at home and 28 per cent at the private hospitals.
Birth Weight
12.
16 per cent of the target children’s weight at the time of birth is less than 2-5 kg, of them,
girl children are slightly high. Sixty per cent of the children were in the 2-5 and 3 kg, 14
per cent of them were above 3 kg and 10 per cent of them did not weigh their children.
Initiation of Breast-feeding
13.
Most of them gave colustrum on the first day. Thirty six per cent of the mothers initiated
breast-feeding within 30 minutes of the child’s birth, 32 per cent of them between 30 and
60 minutes, 20 per cent of them between 1-2 hours. Three per cent of them have initiated
breast-feeding after one day and 7 per cent of them between 2 hours to 12 hours of
child’s birth. No significant gender difference was seen with regard to initiation of breast
feeding.
14.
Sixty two per cent of the parents have admitted that they have given sugar water, 27 per
cent have given honey and 11 per cent have given items like cow milk, sugar water and
so on, at the time of birth.
15.
I wenty five per cent of the mothers have breast-fed their children even after 2 years, 35
per cent of them for 1 to 2 years, 12 per cent of them for 6 months and 28 per cent of
them for 7-12 months.
31
Immunisation
16.
The parents have, in general, given importance for immunisation, but there has been a
declining trend seen with regard to administering of DPT and Polio Drops for the second
and third time. Only 27 per cent of the parents have given Vitamin A.
Complementary Food
17.
Among the children of 4-6 month age group, 78 per cent were not initiated with
complementary' food. Among the 7-9 month age group, 61 per cent of them were given
complementary food and among the 10-12 age group 96 per cent had complementary
food.
Health Status of Children (Trend Observation)
18.
Gender difference is not noticed with regard to complementary' food given to children.
•
Green soup was given to children only by 13 per cent of the parents, only 32 per
cent of them gave fish and meat to the children.
•
But biscuits were fed to children as complementary' food by 86 per cent of the
parents.
•
42 per cent of the parents used tined food as complementary food.
19.
Data with regard to frequency of feeding the children shows a positive trend. Most of the
parents (49 per cent) have the practice of feeding more than 4 times a day. 39 per cent of
the parents have the practice of feeding 4 times a day and 12 per cent 3 times a day.
20.
Orientation on Parenting and Nutrition’ was given to parents and women groups every'
month during the intervention period. Every month more than a minimum of 119 women
groups and a maximum of 131 were covered under the orientation programme. Number
of parents oriented on parenting and nutrition every month range from 763 to 1169.
21.
More than 90 per cent of the families were covered with follow-up activities in each
month of the intervention period.
%
%
22.
Monitoring the child’s health, including weighing of the child was cent percent followedup each month by the implementing organisations.
23.
During the early intervention period the percentage of children found below the expected
weight were calculated as 38 per cent which has been reduced to 21 per cent at the end of
the intervention. Similarly percentage of children affected by diarrhoea has been reduced
from 36 per cent to 16 per cent, percentage of children having fallen sick due to fever and
cold were reduced from 58 per cent to 48 per cent.
%
Breast-feeding Practices
%
24.
It is quiet very positive observation that exclusive breast-feeding is reported among the
children below 4 months.
25.
Breast-feeding is continued upto 1 year to al! children under monitoring. Breast-feedina
is gradually stopped in the 1-3 years age group.
Weight
26.
During the intervention period, the number of children whose weight have been observed
as “above 80%” have increased from 12 to 21 per cent for girls, 9 to 19 per cent for boys.
No. of children who were at the 1 & 2 malnutrition have found to be static but children
with 3° malnutrition have been reduced from 39 per cent to 24 per cent for girls. 37 per
cent to 25 per cent for boys.
27.
The perception ol the parents about child s health has been positively increased from 46
per cent to 63 per cent tor both boys and girls. Likewise the percentage of parents who
have rated their child’s health as ‘bad’ has been reduced from 14 per cent to 5 per cent.
Complementary Food
28.
Children taking biscuits as their complementary food has been reduced from 157 to 12
children over a period of 6 months. Similarly, the number of children fed with tined food
were reduced from 235 to 130. Except food items like biscuits and tined food, the other
food items fed to children were considerably increased. On the whole, a positive trend
has been noticed with regard to the pattern of intake of complementary food.
Illnesses
29.
No. of children having fallen sick to fever, cold & cough, jaundice, diarrhoea and measles
have been observed to be fluctuating but being in the declining trend over a period of 6
months.
Management of Diarrhoea
30.
No. of parents who have used ORS for management of diarrhoea has been significantly
increased from 33 to 102. Breast-feeding is not increased to manage diarrhoea.
31.
During the intervention period a positive trend has been noticed with regard to support
extended by the husbands and grand parents. With regard to accompanying the mother by
the husband to the hospital was reported to be 34 per cent which has increased to 83 per
cent, similarly the support extended by the grandparents have increased from 15 per cent
to 43 per cent. Helping the mother in the household activities by the husband has
increased from 8 per cent to 39 per cent, similarly help extended by grand parents has
increased from 18 to 42 per cent. Similar trend also noticed in taking care of the child
which the mother was taking rest.
Family Atmosphere for the Lactating Mothers
32.
Positive trend has been reported with regard to the family atmosphere in the following;
during the pre-intervention period only 10 per cent of the mother reported to have
congenial atmosphere in the family and this has been sharply increased to 48 per cent at
the end of the intervention period.
33
Number of husbands who have extended support to their lactating wives has increased
from 52 to 213 during the 6 months intervention period. Similar trend is also recorded
with regard to help extended to the lactating mother by the grand parents and others.
34.
Supported extended to the lactating mothers by neighbours and friends by way of playing
with the children, feeding and bathing the children have increased during the intervention
period.
35.
Children having fallen sick to diarrhoea have decreased from 36 per cent to 16 per cent.
Management of Diarrhoea
36.
Number of parents utilising ORS for diarrhoea management has increased from 14 per
cent to 43 per cent and another positive trend that would be inferred is that the number of
parents having gone to the hospital for treatment of diarrhoea has slightly increased.
Parenting Practices
37.
More mothers than fathers were found to be patient while feeding the children.
38.
Mothers spend more time with their children. They are very loving, singing lullaby and
cuddling their children than their spouses.
Fathers at times brought play material for their children. More mothers than fathers
spend time in telling stories to the children, responding to their questions, help in
redressing fear in the minds of the children and play with their children. Both fathers and
mothers have expressed to have helped the children in motivating than for learning.
Feedback on IEC Material
39.
All the 9 implementing organisations have utilized the IEC material made available for
them. They have used the material for orienting women groups, pregnant and lactating
mother, adolescent girls and grand parents.
All have expressed that they were able to handle the material easily, the message
conveyed were comprehensive, the messages intended to be conveyed through the IEC
material were clear.
Suggestions put-forth by the implementing organisations :
Feed Back of IEC Materials given
In the end of the project a format was sent to the implementing NGOs to get feed back
regarding the IEC materials used during the health education and awareness programme. Form G
was used to collect this information. The following questions were asked:
1. To whom the IEC materials were utilized?
2. Was it easy to use the materials - Flipchart, Flashcard, and Handout
3. Were the parents and women able to understand the content
4. Were the pictures clear
5. Was the information given clear
6. Suggestion for change in each material
7. Any other information
The following are the suggestions from this.
•
Printed immunisation schedule could be much useful, if attached with the flip chart for easy
reference.
•
In the handouts, list of nutritious food preparation could be added.
•
More details on nutrition could be added in the flash card.
•
Importance of personal hygiene and more pictures on roles and responsibilities of father
could be much useful.
40.
Implementing organisations have expressed a list of learnings from the implementation of
the parents and nutrition project. They have also listed what the leader of women group
%
have learnt and members of women groups have learnt, the learnings of the parents
whose children were monitored and so on.
!
0j
/ 41.
It is found that of the 640 children taken for monitoring 5 are children with disabilities.
42.
All the implementing organisations have organised public programmes in relation to the
promotion of parenting and nutrition practices.
43.
Implementing organisations of NIP project are very positive about the involvement
shown by the members of women groups and husbands of lactating mothers in the efforts
to improve the parenting and nutrition practices.
LEARNINGS FROM THE PROJECT
1.
I he NIP Project to campaign to promote awareness and action on Nutritional Status of
Rural Child in Tamil Nadu through IEC activities had much learning in various quarters.
The reports and module prepared by TNVHA as an outcome or documentation were
written using the data collection format are given in findings.
But many experience and
learning related to NGO activities, health education and IEC materials are given in
learning which is not given earlier.
This project had made some criteria before selecting the NGOs. This included that the
NGOs should have been already active in health field, had trained staff.
Learning : Inspite of the pre conceived notion that if we select trained and equipped
NGOs, there was a need to train them again.
O To use health education materials
O To go indepth in health education
O To closely monitor those who were selected and given health education
O Specially to concentrate on parenting technique and focus on behaviour change
2. NGOs could be motivated to integrate indepth strategy to promote parental practices in
Child Care and Development.
3. The insight from the project is that with appropriate, motivated organisations this project
could be a success.
4. Appropriate organisation should be already working in the area of mother and child care,
have staff and volunteers trained in this field, have a regular community activity with
health education, home visits, women's group, etc
♦ TNVHA also learnt that so far the health education conducted by NGOs did not have
indepth follow up or strategies to ensure behaviour change.
5. Capacity Building
The NGO trainers and health workers were well experienced in MCH activities.
a) Learning . But this project showed that there were many areas not covered by them
during the health education and that is why there were nearly 200 doubts collected
from parents.
b) This project also helped the health workers to document their activities, the impact
and outcome better. So, was able to collect much information given in the report of
the project.
c) The health education method using flip chart helped the health worker
to focus on
issues better than just generally giving information on MCH.
d) The attitude of the health workers also changed while they used the flip chart and
learnt parenting skill. From giving importance only to mothers as care givers they
learnt that the involvement of both parents and also other family members were
important.
e) This training was also gender training. The role of father in care of child was
emphasized. And the health workers for the first time included it in their work.
f) The flip chart also kindled the imaginations of health workers,
They had many
interesting interpretation for the flip chart.
♦
This study cum intervention project had close follow up and support
mechanism that even in short duration could bring some changes in the
parental practices.
If it was done for a longer duration there will be
definitely a marked change in the community.
6. Community
This was the first time TNVHA was involved in study cum intervention project in the
area of parenting for health of the child,
So, the study pointed out some interesting
learning.
Child Health : Till now the health education and focus of child health was in the area of
physical health - weight, breast milk, immunization, etc. But in this project other area of
health was also included. Also the action questioned was related to these issues only.
Holistic health and activities:
This project gave scope tor going beyond physical health.
The flip chart and the
exercises helped people to visualize the various aspects of growth and development.
Specially the tasks and the activities that to be carried out by the family members.
7. First feed to the child
Usually all asked if colustrum was fed and for this all answered yes or no. Also the time
was asked. But there was no questions in other studied or in the experience of health
worker asking regarding giving any other feeding at the same time.
In this project they were asked about this and i was found that 62% gave breast milk
within the hour, also other honey, sugar water was given by 62%. But the investigator
could not get the opportunity on how many of those breast-fed gave these.
8. The study showed that parent tried to follow practices that were easy for them to
carry out as well as what they felt was good for their children. Thus already prepared
modern biscuit was preferred to home made Kanji.
9. Most people including NGO, staff and families felt the mother was the main care
giver.
10. The role of father and men was not at all felt as important.
11. Psycho-social Development
•
The parents and health workers e,xpressed that this was the first time they learn about
holistic development that is regarding psychological aspects, cognitive, emotional and
social relationship as part of development. And how the family environment helped
this.
•
They also did not relate brain and cognitive development in the early stage of growth.
•
The need for stimulation for the growth of the brain was new concept.
The
contribution of nutrition for this also new to them according to the feed back from the
health workers.
12. Most know about physical growth, milestones in the child development.
But
information about brain growth, social and psychological needs were not known to
any.
13. The need for stimulation for the growth of the brain was new concept.
14. The health workers also realised that there is a need for close intervention in the
community where most are illiterate to improve the nutritional status of the children.
This study also showed that this intervention could be replicated in other area.
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15. Health Education Materials
During the training programme, the health workers appreciated the flip charts. During
the visits for monitoring also they said it was easy to use among the people.
The pictures and messages were self-explanatory in some aspects. But the interpretation
for holistic aspects had to be given. But the activities that to be followed were very clear.
But they felt the flip chart and the flash card did not have enough on nutrition. Details of
feedback are given in the annex.
On the whole, the project had many learnings. But for some one to verify there was not
time especially in the behaviour of family members. Some of them are given below.
There were many constrain in this.
16. Constrain
In this also there were questions not able to be rechecked like the reasons of fathers not
able to contribute. Some feedback was their work and work timing did not give time for
spending with the child.
Like this there are some questions that can be answered only when the team goes back
now for follow up.
Conclusion
This study cum intervention project has shown that with proper training, tools, encouragement
and monitoring the health promotion activities can yield good result. This project is replicable
and can be used to not only to promote parental practices but also for the promotion of
nutritional status of children.
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