PRACTICAL SKILL DEVELOPMENT IN PREPARATION OF PROTOTYPE PLAN ON HEALTH PROMOTION IN SPORT CENTERS

1. i
PRACTICAL SKILL DEVELOPMENT IN
DEVELOPMENT OF INTERPERSONAL HEALTH
COMMUNICATION MEDIA AND ITS APPLICATION FOR
COUNSELING ON MATERNAL, INFANT AND YOUNG
CHILD NUTRITION
PSD submitted to fulfill the partial requirements of Masters in Public Health
(MPH) Third semester (Applied Health Communication, PSD 624)
Submitted by:
Mohammad Aslam Shaeikh
Sarmila Baral
Submitted to:
Master of Public Health Program
School of Health and Allied Science
Faculty of Health Sciences
Pokhara University, Kaski, Nepal
November, 2019

2. ii
DEVELOPMENT OF INTERPERSONAL HEALTH
COMMUNICATION MEDIA AND ITS APPLICATION FOR
COUNSELING ON MATERNAL, INFANT AND YOUNG
CHILD NUTRITION
Submitted by:
Mohammad Aslam Shaiekh, 1870003
Sarmila Baral, 18700006
PSD report submitted to fulfill the partial requirements of Masters in Public
Health (MPH) Third semester (Applied Health Communication, PSD 624)
Submitted to:
Master of Public Health Program
School of Health and Allied Science
Faculty of Health Sciences
Pokhara University, Kaski, Nepal
November 2019

3. iii
Approval
Mr Mohhamad Aslam Shaeikh and Ms Sarmila Baral have prepared the project report
entitled “Development of interpersonal health communication media and it’s application for
counseling counseling on maternal, infant and young child nutrition The project report has
been prepared and presented for the partial fulfillment of the requirement for the degree of
Master of Public Health (MPH) and forwarded for final evaluation.
……………………………………..
Dr. Dipendra Kumar Yadav
Associate Professor, School of Health & Allied Sciences
Date:
Master of Public Health (MPH) Program, School of Health and Allied Sciences, Faculty of
Health Sciences, Pokhara University, Pokhara Metropolitan-30, Kaski, Nepal.
This report/proposal has been reviewed and accepted
Accepted with condition
Not accepted
Not accepted
External Examiners
1. Name: _____________________ Signature: _____________ Date: _________
2. Name: _____________________ Signature: ______________ Date: __________
__________________ ______________________________
Chiranjivi Adhikari Dr. Damaru Parsad Paneru
Program Coordinator, MPH Director
School of Health & Allied Sciences School of Health & Allied Sciences

4. iv
Declaration
To the best of our knowledge and belief we declare that this project entitled “Development
of interpersonal health communication media and its application for counseling on Maternal,
Infant and young child nutrition. “Is the result of our own project and contains no material
previously published by any other person except where due acknowledgement has been
made. This project report contains no material, which has been accepted for the award of any
other degree or diploma in any university.
Signature
Name Mohammad Aslam Shaiekh Sarmila Baral
Roll No 18700003 18700006
PU Regd No 2018-4-70 2018-4-70-
Date 2019 Novemeber 2019 November

5. v

6. vi
ACKNOWLEDGEMENT
Our heartiest gratitude goes to our subject teacher, Associate Professor, Dr. Dipendra Kumar
Yadav for his continuous inspiration, valuable guidance and suggestion.
We express our hearty thanks to, Mr. Chiranjeevi Adhikari, MPH coordinator and Associate
Professor Dr. Damaru Prasad Paneru, Director of School of Health and Allied Sciences for
providing me the opportunity to conduct Practical Skill Development (PSD) for enhancing
skills in practical setting.
We would like to thank our entire MPH team who kindly helped us by providing feedbacks
and comments throughout the study and during presentation. We would like to utilize this
opportunity with great pleasure to thank all those who were participated on our PSD work.
Mohammad Aslam Shaeikh, Sarmila Baral
MPH 3rd
semester

7. vii
TABLE OF CONTENTS
Approval ................................................................................................................................................iii
Declaration.............................................................................................................................................iv
ACKNOWLEDGEMENT .....................................................................................................................vi
TABLE OF CONTENTS......................................................................................................................vii
CHAPTER I: INTRODUCTION............................................................................................................2
Background.........................................................................................................................................2
Rationale .............................................................................................................................................3
Objective.............................................................................................................................................4
General objective ................................................................................................................................4
Specific objective:...............................................................................................................................4
CHAPTER II: LITERATURE REVIEW ...............................................................................................5
CHAPTER III: METHODOLOGY ........................................................................................................7
3 ..........................................................................................................................................................7
CHAPTER IV: ACTIVITIES.................................................................................................................8
CHAPTER IV: CONCLUSIONS, RECOMMENDATIONS AND SKILL DEVELOPMENT ..........25
Conclusions.......................................................................................................................................25
Recommendations.............................................................................................................................25
REFERENCES .....................................................................................................................................26
ANNEXES............................................................................................................................................26

8. 2
CHAPTER I: INTRODUCTION
Background
Good nutrition is the bedrock of child survival, health and development. Well-nourished
children are better able to grow and learn, to participate in and contribute to their
communities
Nutrition education and counselling is a widely used strategy to improve the nutritional status
of women during pregnancy. The strategy focuses primarily on:
 promoting a healthy diet by increasing the diversity and amount of foods consumed
 promoting adequate weight gain through sufficient and balanced protein and energy
intake
 Promoting consistent and continued use of micronutrient supplements, food
supplements or fortified foods.
The period between conception and the age of two years that, with good health and nutrition
i.e. MIYCN practices can mitigate the risks of malnutrition that hamper a child’s long-term
physical and cognitive development.
Infant and young child feeding practices have a direct effect on the nutritional status of
under two children which ultimately impact child survival.(WHO 2015). The optimal
feeding practices are poor with complementary feeding practices among 6 to 23 months
of age.(Basnet D, 2016). Good nutrition and dietary behaviors in childhood are important to
achieve full growth potential and appropriate body composition, to promote health and well-
being, and to reduce the risk of chronic diseases in adulthood. Growth continues at a steady
rate during childhood, then accelerates during adolescence, creating increases in nutrient
needs to support the rapid growth rate and increase in body weight. In addition to the impact
on growth and development, children’s diets are important to ensure overall health and
wellbeing. (Adhikari 2008)
Problem Statement
More than one-third (36%) of children under five in Nepal are stunted, or too short for their
age. Stunting is more common in rural children (40%), compared to urban children (32%).
Overall, 10% of children are wasted (too thin for height), a sign of acute malnutrition. In

9. 3
addition, 27% of children are underweight, or too thin for their age. Similarly 36% of
children’s are stunted. Stunting is more common in the mountain and hilly areas while
wasting and underweight are more common in Terai areas. Overall, 53% of children are
suffered from some degree of anemia, 26% mildly anemic and less than 1% severely anemic.
The prevalence of anemia decreases with age, ranging from high of 74% among children age
12-17 months to a low of 36% among children age 48-59 months. About 24% of newborns
are born with low birth weight. Only 66% of infants get exclusive breastfeeding in the first
six months of life. Only 47 per cent children aged 6-23 months are receiving diversified diets
and 36 per cent of them receive a minimum acceptable diet.
Four in ten women age 15-49 in Nepal are anemic. The proportion of women (BMI less than
18.5, which indicates under nutrition) is 17% and the prevalence of anemia among pregnant
women is 46%. NDHS 2016
Skills needed to address the Problem
Rationale
The first 1,000 days from the start of a woman’s pregnancy to a child’s second birthday offer
an extraordinary window of opportunity for preventing undernutrition and its consequences.
About 80% of mental development occurs within 2 years of age We need to target our actions
to this critical period, using widely accepted and evidence-based interventions, including
support for breastfeeding, appropriate complementary foods for infants over six months, and
micronutrient supplementation for women and children to address deficiencies. These
investments in nutrition – particularly in the earliest years of life – can yield dramatic results
for children, their families, and communities.
Among various professional skills of Health promotion and education/ Public health
professionals, different media designing, developing, producing, using and evaluating is one
of the most important competency/ skill.

10. 4
Objective
General objective:
To develop interpersonal health communication medias and apply for counseling on
Maternal, Infant and young child feeding (MIYCF) practice
Specific objective:
 To develop interpersonal health communication Medias on Maternal, infant and
young child nutrition
 To conduct counseling on Maternal, infant and young child nutrition

11. 5
CHAPTER II: LITERATURE REVIEW
A cross-sectional study was conducted in Rupandehi district of Western Nepal to assess
complementary feeding practices, and associated factors. Face-to-face interviews were
conducted among 178 mothers of young children aged 6–23 months using a structured
questionnaire and data on complementary feeding practices, only 57 % of mothers initiated
complementary feeding at the age of 6 months. While the proportion of young children
receiving minimum meal frequency was reasonably high (84 %), meal diversity (35 %) and
minimum acceptable diet (33 %) remained low. Maternal education and having had their
children’s growth monitored were independently associated with receiving minimum
acceptable diet. Study concluded that This study reported only one-third of infants met the
recommended meal diversity and acceptable diet showing a major gap in infant and young
child feeding practices in Western Nepal. Study recommended that the health promotion
programs that educate and enhance the skills of mothers should be a priority for future
nutrition interventions.(Gautam et al., 2016)
For assessing the nutritional status of under-five children and factors associated a cross-
sectional study was conducted in Kapilvastu district, Nepal. Total 450 children i.e. 15
children from each VDC were chosen conveniently. Study showed that the Better socio-
economic status, mother’s age 20-35 years, birth order up to second, gap more than two year
between two pregnancies, recommended exclusive breast feeding, early recommended
supplementary foods, complete immunization and timely care seeking had positive effect on
children health, which were also statistically significant. More than 60% of children’s were
found with malnutrition(Bhandari, 2013)
A quasi-experimental design was employed in three rural villages of 3 districts in Nepal to
assess the impact of peer facilitators for improving maternal, infant and young children’s
nutritional status. Differences over time between comparison (C) and intervention (I) groups
show that the PF approach had a significant positive impact on several indicators of mothers’
knowledge and practices relating to maternal and child nutrition: (i) knowing that fruits and
vegetables are good for children 6–23·9 months (ii) child dietary diversity (iii) child
minimum dietary diversity (iv) maternal dietary diversity and (v) maternal minimum dietary
diversity Additionally, exposure to a PF three or more times in the past 6 months was
positively associated with a small improvement in maternal and child dietary diversity
scores(Singh A et all, 2018)

12. 6
Nutrient requirements are high during pregnancy and lactation because of the need to support
fetal growth and production of breast milk. In regions such as South Asia, meeting nutrient
needs during the first 1000 days is a major challenge. Pregnant and lactating women and their
young children need diets with high micronutrient density, but in low-income populations,
intakes are usually well below recommended amounts for several key nutrients because diets
are dominated by staple foods with low nutrient density and poor mineral bioavailability.
Several options for improving diets of pregnant and lactating women and their infants exist,
including dietary diversification and increased intake of nutrient-rich foods, improved
complementary feeding practices, micronutrient supplements and fortified foods or products
specifically designed for these target groups. In South Asia women’s are poorly nourished
with poor hygiene and sanitation.(Dewey, 2016)
Poverty is the most important determinant for poor nutrition in Nepal. Nepal ranks at 157th
position out of 187 countries in Human Development Index with 54 percent of total
population living on US$ 1.25 per day (NPC & CBS, 2013).
Infant and young child feeding practices have a direct effect on the nutritional status of
under two children which ultimately impact child survival.(WHO 2015). The optimal
feeding practices are poor with complementary feeding practices among 6 to 23 months
of age.(Basnet D, 2016).
A cross-sectional study was conducted in in Lamjung, Gorkha and Tanahun to find the
nutritional status of 6 to 59 months of children and its associated factors. Results showed that
the significant numbers of under-five children were malnourished. The prevalence of
wasting, stunting and underweight among the children were 10.6%. 53.9% and 20.8%
respectively. Boys were more likely to be wasted, stunted and underweight compared to
girls.(Dhungana GP,2017)
Poor nutritional status is an alarming public health problem in Nepal. Malnutrition, iron
deficiency anemia and other micronutrient deficiency disorders among the children,
adolescents and women are some major nutritional health problems prevailing in Nepal
(WHO, 2008).

13. 7
CHAPTER III: METHODOLOGY
3.1 Project method
3.2 Project Area
The study was conducted on Pokhara-30 Khudi targeting Pregnant and mothers of under 2
year children. Total 10 mothers were counselled.
3.3 Ethical consideration:
Approval was taken from subject teacher and coordinator to conduct the program
Identification of the major nutrition problem through literature review
Title selection through group discussion with group members and teachers
Media selection: Poster and flipchart for interpersonal communication
Development of media: poster, and flip chart and development of counseling
script
Conduction of counseling with application of media in the community

14. 8
CHAPTER IV: ACTIVITIES
At first group division was done and the major types of communication was aligned to each
group .As one of the method of interpersonal health communication counseling was selected.
Situation analysis was done and maternal and child nutrition as one of the leading issue of
Nepal was chosen. Through various literatures and the activities of nutritional organizations
flip chart was chosen and counselling done.
Flip chart
Flip chart comprised of the following components
 Importance of nutrition
 Maternal nutrition
 Role of husband and family members in maternal nutrition
 Importance of breastfeeding
 Correct Positions and attachment for breastfeeding
 Complementary feeding, Active feeding
 Nutritious food preparation method
 Care of sick children
 Essential hygiene action
 Growth monitoring
 Farm to plate
Counselling script
Counselling script based on developed flip chart

15. 9

16. 10

17. 11

18. 12

19. 13

20. 14

21. 15

22. 16

23. 17

24. 18

25. 19

26. 20

27. 21

28. 22

29. 23

30. 24

31. 25
CHAPTER IV: CONCLUSIONS, RECOMMENDATIONS AND SKILL
DEVELOPMENT
Conclusions
PSD is quite good for skill development. Many professional as well as non-professionals
skills were developed like literature searching strategies, development of detail framework of
program, designing, developing, producing, using and judging of health communication
material/ media and also provided counselling using developed media. The language used in
the poster as well as in flipchart was understandable. Key message and pictures in the poster
and flipchart was good .Counselling provided on MIYCN was taken beneficial by clients to
improve and maintain nutritional status.
Recommendations
Community based nutrition programs should be strengthened
Details of skills development
 Group work skill was developed.
 Coordination skill was developed while coordinating with local community people.
 Ability to select the appropriate messages and media for appropriate group.
 Ability to develop, design the material i.e flipchart
 Developed counselling skills about MIYCN following GALLIDRA approach

32. 26
REFERENCES
Bhandari, T.R., 2013. Nutritional Status of Under Five Year Children and Factors Associated in
Kapilvastu District, Nepal. J. Nutr. Health Food Sci. 1.
https://doi.org/10.15226/jnhfs.2013.00106
Dewey, K.G., 2016. Reducing stunting by improving maternal, infant and young child nutrition in
regions such as South Asia: evidence, challenges and opportunities. Matern. Child. Nutr. 12,
27–38. https://doi.org/10.1111/mcn.12282
Gautam, K.P., Adhikari, M., Khatri, R.B., Devkota, M.D., 2016. Determinants of infant and young
child feeding practices in Rupandehi, Nepal. BMC Res. Notes 9, 135.
https://doi.org/10.1186/s13104-016-1956-z
Singh, A., Klemm, R., Mundy, G., Pandey Rana, P., Pun, B., & Cunningham, K. (2018).
Improving maternal, infant and young child nutrition in Nepal via peer mobilization. Public
Health Nutrition, 21(4), 796-806. doi:10.1017/S1368980017002993
NPC, & CBS. (2013). Nepal thematic report on food security and nutrition 2013. Kathmandu,
Nepal: National Planning Commission (NPC) and Central Bureau of Statistics (CBS).
ANNEXES
PSD Action Plan
PSD
Topics
Objectives
PSD
activiti
es
Approache
s/ Methods
Setting Logistics
Estimated
time
Indicator
s
Means
of
verifica
tions

33. 27
Develop
ment of
Interper
sonal
Health
Commu
nication
Media
on
Materna
l, Infant
and
Young
Child
Feeding
Practice
s
(MIYCF
) for
counsell
ing
mother.
1. To review the
literature on
Maternal, Infant and
Young Child
Feeding Practices
(MIYCF) in Nepal
and Asian Countries
1.1
Literat
ure
review
1.2
Design
an
action
plan
1.3
Proble
m
identifi
cation
from
literatu
re
review
Desk
review
Consultatio
n
Literature
review
Classroo
m/Home
Setting
Laptop
Dairy
Pen
6 hrs
4 hrs
6 hrs
No. of
literature
review
Action
Plan
developed
Soft
copies
of
literatur
e
Develop
ed
action
plan
2. To develop the
Interpersonal
communication
media on promotion
of MIYCF practices
for Mother and
Young child
2.1Gat
her
inform
ation
on
selecte
d
theme
(MIYC
F)
2.2
Develo
pment
of
media
(Poster
s, Flip
Charts,
Nutriti
on &
WASH
Corne)
for
Interpe
rsonal
commu
nicatio
n
Desk
review
Consultatio
n
Literature
review
Media
Developme
nt
Classroo
m/Home
Setting
Laptop
Dairy
Pen
6hrs
8hrs
No. of
literatures
reviewed
Media
Develope
d
Soft
copies
of
literatur
e
Develop
ed
media

34. 28
3. To provide health
education about
MIYCF practices to
Mothers through
Interpersonal
communication
3.1
Selecti
on of
mother
for
health
educati
on
3.2
Take
approv
al and
plan
for
Interpe
rsonal
commu
nicatio
n
3.3
Provide
health
educati
on
Field visit
Interperson
al HE
approach
Commu
nity
setting
Laptop
Newsprint
Projector
Marker
Masking
Tape
2hrs
2 hrs
6 hrs
No. of
Mother
Particpate
d/attendin
g the
session
Logboo
k
Approva
l letter
Photos
Attenda
nce
sheet
4.
Present
ation Universi
ty
4hrs
PPT
prepared
Soft
copy of
ppt
5.
Report
Writing
Classroo
m/Home
Setting
4hrs
Report
prepared
Final
Copy of
report