The document is a project report by Dr. Ankita Bali submitted for the Diploma in Nutrition and Health Education, focusing on creating awareness about dietary roles in common nutritional deficiency disorders at MMG District Hospital, Ghaziabad. Key findings indicate that nutritional deficiencies are prevalent in low socio-economic groups, with specific diseases affecting different demographics, and emphasizes the importance of education and government programs to combat these issues. It outlines a comprehensive study that included methodology, observations, and significant conclusions regarding nutrition and health education.

1. DNHE IGNOU
PROJECT REPORT
By,
Dr. Ankita Bali

2. ANNEXURE 2
Form for Submission of Final Project Report to School of Continuing Education.
SECTION A: BACKGROUND INFORMATION
Name : Dr. Ankita Bali
Enrollment No. : 151478543
Name and Designation : Shilpa Mittal (Counsellor)
Of Project Counselor
Name and Designation : Dr. Priyank Sharma
Of Field Guide
Title of Project : A Study to Create Awareness about the Role of Diet in
Common Nutritional Deficiency Disorders.
Theme Selected : Theme 1- Assessing Message, Media and Methods
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Name Of Place Where : MMG District Hospital, Ghaziabad
Project Was Conducted
State Where Place Is : Uttar Pradesh
Located
Date of Approval of : 7th
April, 2019
Project Proposal
Date of Submission : 7th
April, 2019
Of Project Proposal
(Approved and Duly
Signed) to Study Centre
Coordinator
Date of Dispatch Of : 7th
April, 2019
Project Proposal
(Approved and Duly
Signed) to School of
Continuing Education,
IGNOU

3. SECTION B: CERTIFICATE OF PROJECT
COUNSELLOR AND FIELD GUIDE
We certify that the candidate Ms. Ankita Bali has planned and conducted the project entitled ‘A
Study to Create Awareness about the Role of Diet in Common Nutritional Deficiency
Disorders’ under our guidance and supervision and that the report submitted herewith was the
result of bonafide work done by the candidate in ___________________________ from
_______________ to ______________.
Date: Signature of Project Counsellor
Place:
Signature of Field Guide
SECTION C: COMMENTS OF CANDIDATE ON PROJECT WORK
I undertake the nutritional project titled “‘A Study to Create Awareness about the Role of Diet
in Common Nutritional Deficiency Disorders’ and present this project under the Theme-1
(Assessing media, messages and methods).
Most important conclusions and learnings from the project are as below:
1. Nutritional deficiency disorders are mostly prevalent in low socio-economic sector of the
society.
2. PEM and Xeropthalmia are the disorders mainly affecting children, whereas Anemia and
IDD are the disorders found mostly in adults.
3. There are many affordable dietary food items which can be included in the diet to
prevent nutritional deficiency disorders.
4. Education and awareness about these disorders is very critical to prevent and reduce
their prevalence in low socio-economic sector.
5. Marasmus and Kwashiorkor can be avoided in children if mothers are educated about
the diet and hygienic measures to be adopted during pregnancy and infancy.
6. Government has introduced several programs to reduce these disorders. Eg. Vit. A
administration in children, distributing iron and folic acid tablets etc.
This project has helped a small group by creating awareness and has also enhanced my
knowledge about Nutritional deficiency disorders. Nutritional deficiency disorder is a major
problem in our country but we can reduce the prevalence by creating programs to generate
awareness among the general public.
Date :
Place : Signature of Candidate

4. ANNEXURE 3
1. Name : Ankita Bali
2. Enrollment No. : 151478543
3. Address : KB-19, Kavinagar, Ghaziabad-201002, U.P
4. Name and Address of : Shilpa Mittal
Project Counsellor
5. Name and Address of : Dr. Priyank Sharma
Field Guide
6. Date of Submission : 7th
April, 2019
of Approved Project
Proposal to Study Centre
7. Date of Dispatch/ :
Submission of Final
Project Report to
A. Study Centre
B. IGNOU
8. Title of Project : A Study to Create Awareness about the Role of
Diet in Common Nutritional Deficiency Disorders.
9. Place where Project : Ghaziabad
was Conducted
10. State in India where : Uttar Pradesh
Place is Located
11. Institution and/ or : MMG District hospital
Voluntary Organization
Involved
12. Comments on Project Work :
And Supervision by Project
Counsellor and Field Guide
Date:
Place: Signature of Candidate

5. TITLE : A STUDY TO CREATE AWARENESS ABOUT
THE ROLE OF DIET IN COMMON
NUTRITIONAL DEFICIENCY DISORDERS
NAME : ANKITA BALI
A project report submitted in partial fulfillment of the
requirements for the Diploma in Nutrition and Health Education
School of Continuing Education
Indira Gandhi National Open University
Year 2019-20

6. Index
S.No. Topic Page No.
SECTION 1: THEORY
1 General introduction to common nutritional deficiency
disorders.
1
a) Protein and Energy 2
b) Vitamin A 3
c) Iron, Folic Acid and Vitamin B12 4
d) Vitamin C 5
e) Riboflavin 6
f) Niacin 6
g) Thiamine 7
h) Vitamin D 8
i) Iodine 10
2 Protein Energy Malnutrition 11
a) Definition, Affected group, severity and causative factors 11
b) Marasmus 13

7. c) Kwashiorkor 15
d) Subclinical forms of PEM 17
e) Prevention of PEM 17
f) Hyderabad Mix 19
3 Xerophthalmia 20
a) Definition, Affected group and causative factors 20
b) Clinical Manifestations 21
c) Treatment and Prevention 23
4 Anaemia 24
a) Definition, Affected group and causative factors 24
b) Clinical Manifestations 25
c) Risk Factors 26
d) Treatment and Prevention 27
5 Iodine Deficiency Disorders 28
a) Definition, Affected group and causative factors 28
b) Clinical Manifestations 29
c) Treatment and Prevention 30

8. SECTION 2: PRACTICAL
6 General Aims and Objectives of Project 31
7 Methodology 32
8 Observations 34
a) Survey Form 36
b) Response summary of survey form 39
c) Pre-test and Post-test Questionnaire 45
d) Result of Pre-Test 48
e) Activity (Poster copies) 53
f) Analysis of Posters 57
e) Result of Post-test 58
9 Analysis 63
10 Conclusion 74

9. 1
INTRODUCTION TO COMMON NUTRITIONAL
DEFICIENCY DISORDERS
In this project report we shall present a brief overview of all the nutritional disorders, but
then will majorly focus on 4 nutritional disorders ie. PEM, Xerophthalmia, Anaemia and
IDD.
The common nutrients deficiencies and disorders arising from them are as follows:
S.No. Nutrient Deficiency Deficiency Diseases
1. Protein and Energy PEM (Kwashiorkor and Marasmus)
2. Vitamin A Xeropthalmia
3. Iron, Folic Acid and
Vitamin B12
Nutritional Anaemias
4. Vitamin C Scurvy
5. Riboflavin Ariboflavinosis
6. Niacin Pellagra
7. Thiamine Beriberi
8. Vitamin D Rickets (in children),Osteomalacia (in adults)
9. Iodine Any of these depending on age of onset and
severity.
(Goitre and Cretinism present the extreme ends
of the spectrum)
Goitre, Hypothyroidism, Subnormal intelligence,
Mental deficiency, Squint, Spasticity, Muscular
weakness, Endemic cretinism and Intrauterine
death.

10. 2
PROTEIN AND ENERGY
Deficiency diseases: PEM, Kwashiorkor and Marasmus
1. KWASHIORKAR
a. Symptoms:
i. Oedema
ii. Failure of growth
iii. Irritability
iv. Skin changes
v. Hair changes
b. Treatment:
i. High calorie liquid foods
introduced directly into the
stomach in severe cases.
ii. Energy and protein rich diets.
iii. Vitamin capsules
c. Prevention:
i. Adequate intake of energy and protein rich foods.
2. MARASMUS
i. Symptoms:
1. Muscle wasting
2. Growth failure
3. Loss of fat layers beneath skin leading to wrinkling of skin.
ii. Prevention:
1. Proper child feeding practices
2. Prompt treatment of infectious diseases
3. Immunization
Comparison of Kwashiorkor and Marasmus

11. 3
VITAMIN A
Deficiency disease: Xerophthalmia
XEROPHTHALMIA
a. Symptoms:
i. Night blindness
ii. Conjunctival xerosis
iii. Bilot’s spots
iv. Corneal xerosis
v. Keratomalacia
b. Treatment:
i. In severe cases: Vitamin A injections into the muscle (1,00,000 IU)
followed by 2,00,000 IU.
ii. In mild cases: 2,00,000 IU of Vitamin A.
c. Prevention
i. Good intake of vitamin A sources including green leafy vegetables,
papaya, mango and other orange-yellow fruits and vegetables.
ii. Prompt treatment of infectious diseases particularly measles.
iii. Immunization.

12. 4
IRON AND FOLIC ACID
Deficiency diseases: Nutritional Anaemias
NUTRITIONAL ANAEMIAS
a. Symptoms:
i. Fatigue
ii. Giddiness
iii. Loss of appetite
iv. Paleness or
pallor of eyes,
tongue and nail
beds
v. Spoon shaped
brittle nails
vi. Atrophy of
tongue
b. Treatment:
i. For iron deficiency anaemia: One ferrous sulphate tablet (one tablet
150-180 mg) twice or thrice a day sweet liquid preparation for infants
and children.
ii. For folic acid deficiency anaemia: Tablet containing folic acid (1-2
mg) and B17 (10 ug)
c. Prevention
i. Diet including foods from all three food groups particularly rich
sources of iron and folic acid.
ii. Fortification of some food stuffs like salt, baby foods, etc with iron.
iii. Distribution of iron and folic acid tablets to pregnant and lactating
women.
Symptoms of Anaemia

13. 5
VITAMIN C
Deficiency disease: Scurvy
SCURVY
a. Symptoms:
i. Spongy, bleeding gums
ii. Tiny blood spots on skin above knees
b. Treatment:
i. Acute cases: Vitamin C administration intravenously
ii. In mild and moderate cases: Vitamin C tablets
c. Prevention
Consumption of Vitamin C rich foods- amla, guava, citrus fruits, sprouted
pulses.

14. 6
VITAMIN B- Complexes
Deficiency disease: Ariboflavinosis, Pellagra, Beriberi
ARIBOFLAVINOSIS (Deficiency of Riboflavin)
a. Symptoms:
i. Angular stomatitis
ii. Glossitis
iii. Cheilosis
b. Treatment:
One tablet of B complex daily for one week to ten days
c. Prevention:
Consumption of good sources of riboflavin- green leafy vegetables, whole
cereals and pulses
PELLAGRA (Deficiency of Niacin)
a. Symptoms:
i. Dermatosis (symmetrical)
ii. Diarrhoea
iii. Mental changes
iv. Glossitis
b. Treatment:
300 mg nicotinamide per day
c. Prevention:
Consumption of good sources- nuts, oil seeds and organ meats, milk
(source of tryptophan)

15. 7
BERIBERI (Deficiency of Thiamine)
a. Symptoms:
i. Loss of appetite
ii. Weakness, heaviness of legs
iii. Feeling of pins and needles in legs.
iv. Accumulation of fluids
b. Treatment:
i. Acute cases: Thiamine injected into muscles for 3 days.
ii. In mild or moderate cases: Thiamine tablets thrice a day.
c. Prevention:
Consumption of good sources- whole cereals, pulses.

16. 8
VITAMIN D
Deficiency disease: Rickets, Osteomalacia
RICKETS (in children)
a. Symptoms:
i. Loss of muscle firmness
ii. Distended abdomen
iii. Delayed development milestones
iv. Pigeon chest, knock knees, rachitic rosary, delayed closure of
anterior fontanelle, frontal and parietal bossing
b. Treatment:
i. Vitamin D preparations given daily for about 4 weeks
ii. Calcium supplements
c. Prevention:
i. Exposure to sunlight
ii. Vitamin D in cod liver oil
iii. Consumption of food sources
OSTEOMALACIA (in adults)
a. Symptoms:
i. Pain in ribs, hip bone, lower back and legs, muscular weakness.
ii. Difficulty in climbing stairs.
iii. Pain on application of pressure on bones.
iv. Bone fractures and deformations
b. Treatment:
i. Daily Vitamin D and calcium

17. 9
ii. In severe cases: injection of Vitamin D
c. Prevention:
i. Exposure to sunlight
ii. Vitamin D supplements for individuals at risk

18. 10
IODINE
Symptoms/ Clinical Features
Any of these depending on age of onset and severity
a. Symptoms:
i. Goitre (swelling of
thyroid glands)
ii. Hypothyroid
(varying
combination of
clinical signs)
iii. Subnormal
intelligence
iv. Mental deficiency
v. Squint
vi. Spasticity
vii. Muscular
weakness
viii. Endemic
cretinism
ix. Intrauterine death
b. Prevention:
i. Addition of iodine to salt
ii. Use of tablets of sodium or potassium iodide
iii. Use of iodized oil

19. 11
PROTEIN ENERGY MALNUTRITION (PEM)
Definition
PEM can be defined as a range of pathological conditions arising from the deficiency of
protein and energy and is commonly associated with infections.
Affected Group
Protein energy malnutrition is widely prevalent among young children (0-6 years) but is
also observed as starvation in adolescents and adults, mostly lactating women,
especially during a period of famine or other emergencies.
Severity
PEM has serious consequences on the health of individuals (particularly children) and
can even result in death.
Clinical Features of PEM
PEM is condition characterized chiefly by the following two forms:
1. Marasmus
2. Kwashiorkor
Causative Factors
1. Poverty: PEM occurs in poor Indian communities . It is commonly seen in
families of landless agricultural labourers and tribal communities without any
regular earnings among others. In India PEM is seen in backward communities of
Harijans, nomadic tribes and children in urban slums. These communities are
poor, illiterate and generally have large families.
2. Maternal malnutrition: If the nutritional status of the mother is poor, the chances
of the offspring being malnourished are higher. Maternal malnutrition results in

20. 12
low weight of offspring at the time of birth. Children who develop PEM often
begin life with a low weight.
3. Infection and poor hygiene: Generally kwashiorkor follows attacks of diarrhoea
(frequent loose motion) or an attack of measles. The mothers may follow
unsound and unhygienic methods of feeding the child. Feeding bottles may not
be properly sterilized. Flies may be allowed to sit on the nipple of the feeding
bottles which may lead to frequent diarrhoea and marasmus.
4. Ignorance and Wrong feeding practices: Both the forms of PEM occur as a
result of ignorance of the mother in addition to poverty. The mother due to
ignorance delays the introduction of supplementary food (in addition to breast
milk) even up to the age of 1 year. This has serious consequences because
mother’s milk alone is not enough for the child by the age of 6 months. The
infants should be given supplementary food in addition to breast milk. In
addition, mothers restrict the diet when the child is suffering from infection such
as diarrhoea, measles and common fevers. The practice is not good since such
as dietary restriction leads to PEM in children who are underfed.
5. Nutrition related disorder: The child should be given frequents meals at least
five to six times a day to meet the daily requirement of nutrients. However usually
an Indian child is fed thrice a day. Consequently the child is not able to get
enough energy and protein which is the major cause of PEM in India.

21. 13
MARASMUS
Definition
It is a condition characterized by very low body
weight for age loss of subcutaneous fat (fat under
the skin) and gross muscle wasting.
Affected Group
It is observed more frequency in infants and very
young children.
Clinical Features
Some common clinical features of Marasmus
include:
1. Muscle Wasting: The characteristic sign of Marasmus is the extensive wasting
of muscle with little or no fat under the skin. ‘Wasting’ means emaciation or
thinness of the body. The ribs become very prominent. Because of the absence
of fat, the skin will develop a number of folds, particularly on the buttocks.
2. Failure to thrive: There is failure to thrive and the child suffering from marasmus
usually is irritable and fretful. In fact, the child it often so weak that the cry of
the child cannot even be heard.
3. Growth failure: Failure to grow is another important feature of the disease.
Children suffering from Marasmus often weigh about 50 percent or less than a
normal child for that age. For example, a healthy normal one year old child
The child with Marasmus can be described as Skin and
Bones.
Clinical depiction of Marasmus

22. 14
weighs about 10 kg. Whereas, a marasmic child would weigh about 5 to 6 kg
only.
Symptoms
Other symptoms include
1. Watery diarrhoea associated often with dehydration (loss of fluids).
2. The child may also have other deficiencies particularly vitamin A

23. 15
KWASHIORKOR
Definition
This is a condition characterized by oedema
(excessive accumulation of fluid in the
intercellular spaces of tissue) and very low body
weight for age.
Affected Group
The syndrome is most frequently observed in
children aged 1-3 years.
Precipitating Factor
Precipitated by an inflection or more commonly
by a series of infections.
Clinical Features
Some common clinical features of Kwashiorkor include:
1. Oedema: Oedema is usually observed on the lower limbs, but it may also be
distributed all over the body including the face. Kwashiorkor should not be
diagnosed without the presence of oedema.
2. Failure of growth: Growth failure is an early sign this is noticed by taking body
weight. Children with kwashiorkor weigh only about 60 percent of the
weight of normal children for that age.
3. Irritability: A child suffering from kwashiorkor is generally irritable and has no
interest in his/her surroundings.
Clinical Depiction of Kwashiorkor

24. 16
4. Skin changes: In addition to the above manifestation, there may be
characteristic skin changes. The skin becomes thick and appears as though it
has been varnished. The skin of the child may peel off easily leaving behind
cracks or sores.
5. Hair changes: The hair may become sparse and can be easily pulled off. The
hair usually loses its black colour and appears reddish brown.
6. Moon face: The face of child suffering from kwashiorkor may appear puffy with
cheeks sagging. This sign is normally known as moon face.
7. Associated deficiencies: The children may have signs of other deficiencies like
those of vitamin A and B complex deficiencies.
8. Associated diseases : the child is often brought to the hospital with watery
diarrhoea (frequent loose motion) or severe respiratory infection (cough).the
children often will be recovering from measles, a childhood disease ,which is
characterized by skin rash and fever .
Growth failure is characteristic of both Marasmus and Kwashiorkor, however it is much more
pronounced in Marasmus.
Oedema is characteristic of Kwashiorkor.

25. 17
SUBCLINICAL FORMS OF PEM
Definition
Subclinical forms of PEM include cases of children whose heights and weights are
considerably below that of healthy children of the same age. These children do not
show typical signs of either Kwashiorkor or Marasmus.
Prevalence
A large proportion of PEM affected cases exists in this form.
Diagnosis
Subclinical condition means that we do not see the clinical features of the disease.
These forms of the disease can be identified only via special investigations or tests. In
this case of PEM we can detect subclinical status by measuring body weight.
Prevention of PEM
1. Ensuring Maternal Nutrition: Prevention of PEM should start with the mother of
the child. The main reason for low birth weight is maternal malnutrition; i.e.: the
mother of the child consumes inadequate quantities of energy and protein during
her pregnancy. A simple thumb rule is to ensure that pregnant women consume
MARASMIC KWASHIORKOR
Children who show characteristic signs of both Marasmus and Kwashiorkor.
. The children are not only extremely wasted like in marasmus but also have signs of
kwashiorkor
i.e. have swelling of feet (oedema)
MAJORITY CASES OF PEM ARE SUBCLINICAL
In our country only 2-3 children out of a hundred in the age group of 1-5 years exhibit these
clinical forms of PEM. Many more subclinical cases of PEM which cannot be easily detected by
simple clinical examination are widely prevalent. For each case of kwashiorkor there may
usually be 10 to 15 subclinical cases of PEM.

26. 18
additional amounts of foods equal to one normal meal every day during the
pregnancy. In poorer families, supplementary food can be given to the pregnant
women during the last 3 months of pregnancy under government feeding
programmes.
2. Infant Nutrition: These steps would help in improving the birth weights of the
children.
1. Mother’s milk is the best food for an infant. Lactating mothers should be
encouraged to breastfeed their children as long as possible.
2. Supplementary Food: By the age of about 6 months, however, mother’s
milk alone is not adequate for the child. Supplementary food should be
provided to the children by the age of six months, in addition to breast
milk. These can be cereal- pulse and nut mixes and can be prepared at
home by the mother.
3. Children should be fed 5-6 times a day. We have already learnt that cereal
based Indian diets are quite bulky and unless the child is fed frequently it
cannot meet the energy and protein requirements.
3. Treating infections in infants: Infections like diarrhoea and respiratory
infections increase the risk of PEM. Prompt treatment of these infections help to
prevent PEM.
4. Supplementary Programs by Government: These programs are incorporated:
1. To supplement the diets of the weaker sections of the community to combat
undernutrition and
2. To educate the community for combating and preventing malnutrition
Treatment for PEM
PEM is caused due to deficiency of energy and protein in the diet. So the major
objective of the treatment is to feed the child energy and protein rich foods so that his
requirement is met and there is adequate weight gain.

27. 19
The treatment can be very well done at home with judicious selection of energy and
protein rich foods. However the children with severe malnutrition most often require
hospitalization since they may also have associated infections like severe
gastroenteritis or respiratory infection.
The main principle in the treatment of severe forms of PEM is to provide through the
foodstuffs usually consumed by the community like cereals pulses nuts and sugar and
jaggery. Addition of milk is not compulsory but if added will improve the quality of the
diet.
Simultaneously, other deficiencies like those of vitamin A and B-complex should also be
treated with vitamin A capsules and tablets of B-complex. In addition, associated
infections should be controlled with appropriate antibiotics.
The mother should be educated to continue feeding of additional food by increasing the
quantities of the home diet even after discharge from the hospital so that the child may
not get PEM once again.
Mild and moderated cases of PEM can be treated at home by giving energy and protein
rich diets. They do not require adequate hospitalization.
HYDERABAD MIX
A preparation based on local foods which was developed by the National Institute of
nutrition, Hyderabad and was successfully used in the treatment of kwashiorkor or
marasmus.
It consists of roasted wheat(40 grams), roasted Bengal gram dal(15 grams), roasted
groundnut(10 grams) and sugar/jaggery(30 grams). Ladoos or sweet kheer with this mix
can be prepared or it can be cooked with milk to improve the taste and quality.
In about 4-6 weeks the children with kwashiorkor recover fully with dietary treatment
through cases of marasmus take longer periods. During the first week the child requires
persuasive efforts and coaxing for feeding. After this, once the child recovers, feeding
becomes much easier. In young children of 6-24 months, who have a problem in
swallowing solid one can make a thin gruel of the Hyderabad mix by adding a few grams
(1/2 teaspoon) of ARF powder(germinated wheat flour powder). Addition to ARF to the
gruel would help make it thin but at the same time retain its nutritive value. The child with
PEM can easily drink this up.

28. 20
XEROPHTHALMIA
Definition
Xerophthalmia refers to the eye manifestations(signs)
arising due to vitamin A deficiency.
Affected Group
It is a chronic public health problem in India. It is
estimated that a quarter of the 15 million blind
people in the country are due to xerophthalmia.
Although vitamin A deficiency may become apparent at
all ages, the preschool child (in the fourth year of life) is the most frequent victim of this
debilitating disorder.
The younger the child, the more serious the manifestations and the greater the mortality
rate. The cornea is rarely affected in children beyond the age of five years. In fact, the
prevalence of corneal xerophthalmia is maximum between the ages of 1 and 3 years.
The disease is relatively more frequent among males.
Causative factors of Xerophthalmia:
Xerophthalmia is common in the families of low socio-economic group living in rural
areas and urban slums. In India, the disease is more common among the poorer
sections of the community.
Vitamin A deficiency may become apparent at all ages but the most common,
predominantly nutritional variety occurs in the third and fourth years of life, at least in
countries where breastfeeding is prolonged. The causes of Xerophthalmia are:
1. Dietary inadequacy of vitamin A:
The primary cause of xerophthalmia is dietary inadequacy of vitamin A. In the villages
and urban slums among the low income groups, the intake of vitamin A is less than a
quarter of the Recommended Dietary Intake(RDI).
Clinical Depiction of Xerophthalmia

29. 21
2. Material Malnutrition:
Indian children of very poor, rural families are born with low liver stores of vitamin A
because their mothers are also have vitamin A deficiency. The women during
pregnancy consume very low amounts of vitamin A due to poverty or ignorance. As a
result, the children have low vitamin A reserves in the body. As long as the child is
breast fed, the vitamin A status of the infants is apparently adequate because the infant
gets reasonable amounts of vitamin A through breast milk.
3. Infections Infestations:
Diarrhoea and respiratory infections and worm infestations like roundworm disease are
very common in children. These are known to decrease the absorption of Vitamin A and
lead to deficiency. Measles, one of the childhood infections, is another cause of
xerophthalmia leading particularly to corneal sores and blindness.
Clinical Manifestations
The clinical manifestations in Xerophthalmia pertain to changes in the eye. It is the
conjunctiva and the cornea of the eye which are most often affected by the deficiency.
Following are the clinical manifestations of Xerophthalmia:
1. Night blindness:
One of the earliest manifestations of Xerophthalmia is night blindness. Individuals
suffering from night blindness cannot see in dim light or around dusk. The child will be
unable to see even a meal plate kept in front him/her in dim light. This condition is
known by different names in different regions. For example, in the rural areas of the
north(Hindi belt) this condition is commonly known as Rathoundi.
Xerosis in Greek means dryness.

30. 22
2. Conjunctival Xerosis:
Conjunctival xerosis therefore means dryness of the conjunctiva (thin transparent
membrane that covers the cornea and lines the inside of the eyelid). In normal eyes, the
conjunctiva is bright, white and moist. In case of xerophthalmia it becomes discoloured
(muddy coloured), dry and loses its brightness.
This is known as conjunctival xerosis, Even when there are tears in the eyes, the
conjunctiva cannot be wetted.
3. Bitot spots
In addition to xerosis, dry, foamy, triangular spots may appear on the conjunctiva.
These are known as Bitot’s spots. Usually, these are more common on the temporal
side(towards the ear) of the eye rather than the nasal (towards the nose) side.
In our country there is a practice among girls to apply “kajal” to their eyes. In such
cases, Bitot spots also take up the black colour of the “kajal” and can be seen even from
a distance. Though conjunctival changes are in xerophthalmia do not lead to blindness,
they should be considered as warning signs. If neglected, the changes may progress
affecting the cornea and may lead to irreversible blindness.
4. Corneal xerosis:
When vitamin A deficiency becomes severe, the cornea becomes dry and dull and
appears like ground glass. This condition is called corneal xerosis which means dryness
of the cornea. This condition should be treated as an emergency. If it is not treated
immediately with vitamin A, the child can develop ulcers(sores) in the cornea. Corneal
ulcers(corneal sores) when healed leave white scars called leucoma. Such white scars
on the black of the eye can interfere with normal vision.
5. Keratomalacia:
In this condition, the cornea becomes very soft and raw and easily infected. It leads to
destruction of the eye. In other words, the eye gets completely melted and destroyed.
This condition inevitably leads to irreversible blindness.
Keratomalacia is the most dangerous form of Xerophthalmia. Generally this condition
is seen in both the eyes and is common in children between the ages 1-5 years. Sixty
to sixty five percent of these children die. In addition, the prevalence of infections is
also high in these children. About 95-96 percent of the children with keratomalacia also
have either kwashiorkor or marasmus.

31. 23
Treatment and Prevention
For the purpose of treatment, firstly, cases of milder and severe forms of vitamin A
deficiency have to be distinguished.
Severe cases should be treated without delay. Such cases need vitamin A injections
into the muscle in the dose of 1,00,000 IU
Children with night blindness, conjunctival xerosis and Bitot spots are treated with a
massive oral dose of 2,00,000 IU of vitamin A.
Preventions of vitamin A deficiency:
1. Consume vitamin A diet:
Inexpensive foods like green leafy vegetables, yellow vegetables and fruits are good
sources of beta carotene which is a precursor of vitamin A. Consumption of as little as
40 grams of green leafy vegetables daily is enough to maintain the normal vitamin A
status in children. However, the improvement of Indian diet requires extensive nutrition
educational programmes.
2. Periodic administration of vitamin A:
Blindness due to xerophthalmia is a serious problem and requires the most urgent
measures. It is possible to build up sufficient vitamin A stores in a child by giving large
doses of vitamin A periodically. Using this principle, a national programme of prevention
of blindness due to xerophthalmia has been developed by the National Institute of
Nutrition(NIN) and is operated by the Government of India in the different states of the
country. Under the programme, the children between the ages of one and five years are
given a massive oral dose of vitamin A once every six months. The distribution of
vitamin A is carried out by the villagers level health workers like multipurpose health
workers of the state government. Such a programme when properly done, reduces the
blindness due to xerophthalmia significantly in young children. Simultaneously nutrition
education is also important for the success of the programme.

32. 24
ANAEMIA
Definition
Anaemia is a condition where
haemoglobin levels in blood fall below the
normal levels.
IRON(HAEM)+ PROTEIN(GLOBIN) ->
HAEMOGLOBIN
Normal haemoglobin is about 11- 15gm
per decilitre(100ml).
Affected Group
Anaemia is a nutritional disorder
commonly seen among Indian women of low socio-economic group. It is also observed
even among women of higher income group. It is estimated that about 60-70% of
pregnant women in the rural areas and urban slums suffer from anaemia. Anaemia is
also a common in preschool children(1-5 years), school going children and women in
the reproductive age group group(15-45 years of age).
Causative Factors
Anaemia can be due to iron deficiency or folic acid and vitamin B12 deficiency. The
various causes of iron losses from the body.
1. Dietary Inadequacy:
Dietary deficit in the body can be due to two reasons- low dietary intake of iron or
reduced(low) absorption of iron in the body. Iron requirement is high in the body in
certain physiological conditions especially in infants, children and women in
reproductive years. If iron intake during these periods of life is not adequate, anaemia
can set in.

33. 25
2. Losses of Iron:
The second major cause of anaemia is increased loss of iron from the body. In adult
women loss of iron occurs every month due to menstrual loss of blood. Apart from
menstrual loss, loss of iron occurs during pregnancy, delivery and lactation. During
delivery, due to loss of blood and iron content of the placenta, the loss is substantial.
Similarly, when the women are breast feeding their babies, they lose iron in the milk. If
proper care of women is not taken during these periods, it can lead to anaemia.
Iron losses from the body are also more in case of people suffering from hookworm, and
other worm infestations. This is because worms residing in the small intestine of an
individual feed on his/her blood. Heavy loss of iron from the body in conditions of
surgery or accident can also lead to anaemia.
3. Folic acid and Vitamin B12 Deficiency:
Folic acid deficiency is common only among pregnant women who consume diets which
do not contain vegetables, fruits, milk or animal foods right through their lives. Women
and children are affected by the folic acid deficiency more than men.
Anaemia due to deficiency of vitamin B12 is rather rare. The disorder is due to failure to
absorb vitamin B12 either due to lack of a substance called intrinsic factor or dietary
deficiency. Dietary deficiency may arise in people who are strict vegetarians or eat no
animal products. This is one of the main reasons why milk should be added to our diets
particularly to those depending on vegetarian diets totally.
Clinical Manifestations:
The clinical symptoms of anaemia arise when the transport of oxygen by the blood is
insufficient to meet the needs of the body. The symptoms are therefore related to
physical activity.
Following are the clinical features:
1. Fatigue
2. Breathlessness on exertion
3. Sleeplessness
4. Palpitation

34. 26
5. Loss of appetite
6. Paleness(pallor) is one of the clinical signs based on which the anaemia is
diagnosed. Paleness of the tongue, conjunctiva(white of the eye) and the nail beds
is seen in anaemic person.
7. The patient may feel that someone is pricking him/her with pins(pins and needles)on
the fingers and toes.
8. Some patients may complain of chest pain due to reduced oxygen supply to heart
muscle.
9. In severe anaemia, the nails of the fingers and toes become brittle and spoon
shaped.
10.The tongue may appear smooth and glazed due to atrophy(destruction) of the
papillae (numerous projections in the tongue).
Risk Factors
Severe anaemia can even led to death. The risk of death is higher in anaemic women
particularly during pregnancy and delivery. Long term pregnancy is about 9 months.
Pregnant women with anaemia are likely to deliver babies before completing the normal
term. They usually give birth to low birth weight babies. Infections of uterus, kidneys,
and the urinary tract are more common in anaemic people.
In general, anaemic people are at a greater risk of catching infection.
Treatment
Haemoglobin in blood can be raised by giving iron in the form of tablets. Ferrous
sulphate is the preparation of choice to treat anaemia. Treatments should be continue
for at least 3 months after haemoglobin level returns to normal. In case of infants and
children, sweet liquids (syrups) are available. In case of folic acid and vitamin B12
deficiency anaemia, tablets containing folic acid (1-2 mg) and B12(10ug)are given.
Associated infections should be treated with appropriate antibiotics. In areas where
hookworm disease is common, suitable medicines should be given to treat the disease.

35. 27
Prevention
Given below are few preventive measures which can help us to prevent anaemia:
1. Dietary measures:
Iron-rich foods should be consumed regularly. Inexpensive sources of iron are green
leafy vegetables, rice flakes, groundnuts. If these foods are consumed as sources of
iron , care should be taken that enough vitamin C-rich and protein rich foods are
consumed along with them. Meat and liver are preferably good dietary sources, if one
likes and can afford them.
2. Fortification of foods:
Common salt is consumed by the rich and the poor daily in our country. It has been
identified as the vehicle for fortification with iron. Studies have shown that consumption
of common salt to which iron has been added leads to an increase in haemoglobin
levels, thus reducing the prevalence of anaemia. This programme has not yet been
initiated in the country. This will be one of the approaches to control anaemia in future.
Baby foods are also fortified with iron to protect infants fed for long periods on artificial
milk formulas from anaemia.
3. Distribution of iron and folic acid tablets:
One of the approaches that has been in practice in the country for over 20 years is
distribution of tablets containing iron(60mg) and folic acid(500 μg) to the vulnerable
sections of the community - women, pregnant and lactating women, family planning
acceptors(women who have been sterilized or those using intrauterine contraceptive
devices). The Government of India has been implementing a programme called
National Nutritional Anaemia Control Programme, since the year 1970. Under the
programme, the beneficiaries receive 100 tablets of iron and folic acid. This is expected
to control the widespread prevalence of anaemia in the country.

36. 28
IODINE DEFICIENCY DISORDERS
Definition
The term IDD includes a spectrum of disabling conditions
(like cretinism, goitre and hypothyroidism) affecting the
health of humans starting from life in the womb through
adulthood resulting from an inadequate dietary intake of
iodine.
Affected Group
Till recently, the disease was observed only in Himalayan
and Sub Himalayan belts of India (hilly regions) extending
from Jammu and Kashmir in the North to Nagaland in the
East. In the recent past, however, newer areas of south of Vindhyas in Maharashtra,
Andhra Pradesh and Karnataka and Delhi in the North are being identified as regions
where IDD is becoming more common.
Causative Factors:
When iodine is inadequate, the thyroid gland enlarges in an attempt to produce
thyroxine for the body needs.
Humans require very small quantities of iodine (150g per day). This can be obtained
through food and water. In areas where IDD is very common, the environment is
deficient in iodine so that soil, water and foods have greatly reduced amounts of iodine.
In mountainous and hilly regions, environmental iodine deficiency occurs due to years of
washing of soil by heavy rains and glaciers. In case of the plains, repeated floods
deplete the environment of iodine. As a result, water and all animal and vegetable foods
which are dependent on the soil are deficient in iodine. Thus, when foods which are
deficient in iodine are consumed, the diet will also be deficient and this produces iodine
deficiency.

37. 29
Apart from this, certain chemical substances called goitrogens (goiter-producing
substances) interfere with utilization of iodine by the thyroid gland. Foods like cabbage
and radish are known to contain goitrogens. Consumption of these foods in large
quantities in some cases may produce iodine deficiency. There is, however, no
evidence, as yet, to state that these foods by themselves produce IDD, at least in India.
Clinical Manifestations:
Goitre and cretinism are the best known and easily recognizable forms of iodine
deficiency. However, these are not the only manifestations of iodine deficiency
disorders. In fact, the term “Iodine Deficiency Disorders” includes a spectrum of
crippling conditions affecting the health and wellbeing of mankind starting from early in
foetal life through adulthood as mentioned earlier.
Clinical manifestation of both goitre and cretinism.
Goitre: The word ‘Goitre’ means swelling or enlargement of the thyroid gland.
In case of deficiency of iodine in the body, thyroid gland enlarge in order to trap more
iodine (whatever is available). The swelling or enlargement vary in size depending on
the severity of the goitre. The prevalence rate (number of cases in 100 individuals) of
goitre increases with age reaching a maximum of adolescence. It is more frequent in
girls than boys.
Cretinism: It is the most severe manifestation of IDD. Cretinism refers to advance
effects of iodine deficiency on the infant and young child. Iodine deficiency interferes
with the brain development of the foetus. This means it can cause irreversible brain
damage even before the birth. If an infant is born to an iodine deficient mother, he or
she is likely to suffer from hypothyroidism. If this condition of iodine deficiency or
hypothyroidism continues further after the birth. The child may suffer from a series of
disorders which may include mental retardation, growth failure, speech and learning
defects, neuromuscular disorders, paralysis.
All these defects might lead to mentally retarded deaf-mute or cretin ( a child suffering
from cretinism).

38. 30
Treatment and Prevention
Since IDD is primarily due to reduced intake of iodine, the control strategy aims at
ensuring sufficient intake of iodine by the population living in the areas where IDD is
common. A few methods have commonly been used to increase the iodine intake of the
people residing in endemic regions include:
1. Use of Iodised salt: The oldest and most extensively used method is fortification
(enrichment) of common salt with iodine (Potassium iodate). Daily consumption of
common salt would ensure daily requirements of iodine. In India distribution of
iodized salt in the endemic areas, is in practice for about 25 years.
Among the various methods available for control of IDD, salt fortification seems to be
the method of choice for long term solution of the problem. In fact fortification of
common salt with iodine is the major aspect of India’s National Programme for
control of iodine deficiency disorders.
2. Use of tablets of sodium or potassium iodide: Provision of sodium/potassium
iodate tablets to school children and addition of iodine to the drinking water supplies
have been tried in some countries. However, this is not a widely accepted method of
administering iodine.
3. Use of Iodized oil: During the last decade, injection of oil, to which iodine has been
added has been adapted for the control of goitre and cretinism is areas where the
IDD is severe. The advantage is that an injection of 1 ml dose of iodized oil can
provide protection to an individual for 3-5 years. But this is more expensive and
reaching all those at risk by this method is difficult. It is used as a temporary
measure, particularly in areas which are not accessible and iodized salt may not
reach due to communication problems.

39. 31
GENERAL AIMS AND OBJECTIVES OF THE PROJECT
Aim
1. To identify the current level of awareness about the nutritional deficiency disorders.
2. To create awareness of nutritional deficiency diseases among low socio-economic
class of society.
3. To educate people about the diet to be followed for prevention and treatment of
nutritional deficiency disorders (PEM, Xeropthalmia, Anaemia and IDD)
Objective
To achieve the above mentioned aims, following objectives will be followed:
1. To review the literature about nutritional deficiency disorders, keeping primary
focus on PEM, Xeropthalmia, Anaemia and IDD.
2. To study and access current level of awareness among the study group about
nutritional deficiency disorders.
3. To educate and create awareness about economical diet supplements to prevent
and treat nutritional deficiency disorders.
4. To enhance the capability of the mother to look after the normal health and
nutritional need of the child through proper nutrition and health education.
5. To spread awareness about fatal consequences of nutritional deficiency disorders.
6. To assess post interventional knowledge and practice.
7. To conclude the effectiveness of the study and project conducted to access the
awareness and educate the same about nutritional deficiency disorders.

40. 32
METHODOLOGY
The topic of the project is ‘A Study to Create Awareness about the Role of Diet in
Common Nutritional Deficiency Disorders’
Nutritional deficiency disorders generally prevail among lower socio-economic sector,
so the methodology would be adopted in such a way so as to conduct the project in the
best suited way for the above sector.
The methods of communication that has been used for the project are:
Non- Machine Media- POSTERS
Non-machine media are the most versatile aids to make the nutrition and health
education effective. They can be easily planned, prepared and used in nutrition and
health teaching situations.
Poster
Posters are designed to make a public announcement of a special idea.
It usually includes an illustration with brief caption.
Poster is designed to:
1. Catch the attention of passer by.
2. Impress on him a fact or an idea.
3. Stimulate him to support an idea.
4. Make him seek more information and to move him to action.
Tools
Posters are only a visual aid and cannot be used in isolation. It can only support other
activities. Hence, for this project we have gathered a group and explained them about
the nutritional deficiency disorders.
Sampling
We conducted this project in a government hospital where majority of population was
low socio-economic population.
The crowd of around 50-60 gathered, and we selected a sample of 30 married females
in the age group 18-35 to conduct my survey.

41. 33
Techniques
1. The crowd was informed about the activity
2. A group of 30 was selected from among them.
3. A survey form was filled for all the cases.
4. Then we asked them questions and filled up a pre-test form. This was done to
access the level of awareness they were having.
5. Then they were educated about common nutrition deficiency disorders.
6. This was conducted with the aid of posters that were distributed among them.
7. After this, a post-test was conducted to check the retainership and how much
they were able to gain out of the activity.
Target Area- Ghaziabad (U.P)
Target Group- Lower socio-economic group married females (Age Group- 18-35
yrs.)
Intervention- Creating awareness among lower socio-economic sample group about
nutrition deficiency disorders. Also, educating them about causes, symptoms,
prevention and treatment of 4 common nutritional deficiency disorders ie. PEM,
Xerophthalmia, Anemia and IDD.
Methodology-
1. Survey- A survey form was filled to access the crowd and their behavior.
2. Pre- Test- The sample group will be assessed based on their current level of
awareness about Nutritional deficiency disorders.
3. Posters Presentation- The sample group will then be explained about
nutritional deficiency disorders with the aid of posters.
4. Post- Test- I conducted a post-test to check the retainership and how much
they were able to gain out of the activity.

42. 34
OBSERVATION
The topic of the project is ‘A Study to Create Awareness about the Role of Diet in
Common Nutritional Deficiency Disorders’
The project was conducted in a government hospital where we selected the sample of
age group 18-35 years married females.
For the sample study, we assessed the data of 30 cases. All the questions were filled
using google forms.
The following observations were noted down during the project:
1. Survey: We surveyed the cases to get a better understanding of the community
that was studied. A Google form was filled for all 30 cases by asking them
questions of the pre made survey form.
2. Pre- Test: We gathered the crowd and made them comfortable in order to ask
them questions. And then collected this data with the help of a questionnaire.
This test had basic questions about nutritional deficiency disorders. A Google
form was filled by me for all 30 cases by asking them questions of the pre made
survey form.
3. Activity- This was followed by the activity in which we used the posters attached
herewith along with the explanation we gave them about nutritional deficiency
disorders.
a. Responses: In this activity we had observed that we got mixed responses
of enthusiastic, hurried, dull, uninterested and neutral faces. (Reaction
report is attached herewith)
b. Activity: Posters were distributed to the crowd, followed by general
explanation about nutritional deficiency disorders.
4. Post- Test: We conducted a post-test to check the retainership and how much
they were able to gain out of the activity. This was also done with the help of a

43. 35
questionnaire. A Google form was filled for all 30 cases by asking them questions
of the pre made survey form.
5. Mode of Language- We gave them posters in Hindi. The questions were asked
verbally and then filled up through google forms. The questions are in English as
they were filled after asking them the same translated in Hindi language.

44. 36
SURVEY FORM
The images of the survey form (made on google form) are attached herewith.

45. 37

46. 38

47. 39
Response Summary of Survey
Attached below are the analytics of each question based on 30 responses

48. 40

49. 41

50. 42

51. 43

52. 44

53. 45
PRE-TEST & POST- TEST
(This test was filled twice, once before the activity and once
post activity)
SECTION-1
Preliminary Information
1. Name-
2. Age -
3. Location-
SECTION- 2
PRE-TEST TO ASSESS THE AWARENESS OF THE CROWD
1. When should supplementary food be introduced in a pregnant mother’s diet?
a. 0- 3 months of pregnancy
b. 4- 6 months of pregnancy
c. 7-9 months of pregnancy
d. It is not required
2. When should supplementary food be introduced in an infant’s diet?
a. Before 4 months
b. 4- 6 months
c. After 6 months
d. After 1 year
3. How often should an Indian infant be fed in a day?
a. 3 times
b. 5-6 times
c. More than 7 times
4. What is the name of the disease that can happen as a result of deficiency of Vitamin
A?

54. 46
a. Anaemia
b. Xerophthalmia
c. Goiter
d. Marasmus
5. What are the food items richest in Vitamin A?
a. Nuts
b. Papaya, Carrot, Mango and Spinach
c. Rice and wheat
d. Pulses
6. Weakness, vertigo and paleness of skin in females are the common symptoms of
which disorder?
a. Goiter
b. Xerophthalmia
c. Anaemia
d. Kwashiorkor
7. How should Anaemia be treated?
a. Eat green vegetables and ask doctor for Iron and folic acid tablets
b. Exercise regularly
c. Consume Iodized salt
d. Consume Milk products
8. What is the basic prevention step to avoid iodine deficiency disorders?
a. Eat jaggery and gram
b. Consume Iodized salt
c. Exercise regularly
d. Consume meat
9. What are the common disorders of Iodine deficiency?
a. Anaemia
b. Kwashiorkor

55. 47
c. Marasmus
d. Goiter and Cretinism
10. How can you prevent nutritional deficiency disorders in children?
a. By taking care of nutrition of pregnant mothers and infants
b. By taking care of nutrition of pregnant mothers
c. By taking care of nutrition of infants
d. By eating green leafy vegetables

56. 48
RESULT OF PRE- TEST
Attached below are the analytics of each question based on 30 responses

57. 49

58. 50

59. 51

60. 52

61. 53
ACTIVITY (POSTER COPIES)
Posters were distributed to the sample crowd. After the distribution, I explained them
about all the problems. All the posters copies are attached herewith.

62. 54

63. 55

64. 56

65. 57
ANALYSIS OF POSTERS
(Based on target group members reviews)- Total- 30
• Alive
• Animated
• Interested
• Understanding
How many people
looked like this?
22
• Somewhat
interested but
not totally
involved
How many people
looked like this?
3
• Indifferent or
not able to
understand
fully
How many people
looked like this?
3
• Unhappy due
to lack of
interest or
hurry
How many people
looked like this?
2

66. 58
RESULT OF POST-TEST
After the activity, I asked them the questions again. Following are the
responses post- activity.
Attached below are the analytics of each question based on 30 responses

67. 59

68. 60

69. 61

70. 62

71. 63
ANALYSIS OF DATA
HYPOTHESIS 1
Age Distribution of Sample Cases
S. No. Age Distribution
1 30
2 24
3 22
4 27
5 31
6 25
7 31
8 29
9 31
10 25
11 26
12 26
H0 = The average age of a woman with children younger than 5 years old and suffering
from nutrition deficiency is between 25 to 29 years.
Sampling
We took a sample of 12 women and then plotted a t-distribution curve of the sample.
Confidence Interval
Confidence Interval
25.31354104 29.186459
Then we found the confidence interval of that sample with 95% probability. We got the
confidence interval between 25.314 and 29.186. Hence, we can say that there is a 95%
possibility that the average age of a woman with children younger than 5 years old and
suffering from nutrition deficiency lies between the age of 25 and 29.

72. 64
T-Test
Then we performed a t-test to test the Hypothesis:
Ht: Avg age of a woman with children younger than 5 years old and suffering from
nutrition deficiency is 26 years.
T- Test
1. Sample Size- 12
2. Mean-
Sum of all age groups/ 12 = 327/12 = 27.25
3. Standard Deviation-
means 'the mean'
= 3.078517943
4. Standard Error- Standard Deviation/ Square root of sample size= 0.888691582
5. Hypo Mean= 26
6. Alpha= 0.05
7. Degree of Freedom= Sample Size- 1= 12-1= 11
8. T Stat= (Mean- Hypo Mean)/ Standard Error= (27.25- 26)/ 0.888691582
= 1.406562216
9. P value= 0.093587511
10.t critical= 1.795884819

73. 65
HYPOTHESIS 2
Age Distribution of Sample Cases
S. No. Age Distribution
1 22
2 30
3 24
4 34
5 22
6 28
7 27
8 20
9 29
10 30
11 29
12 25
13 31
14
29
15 31
16 24
17 28
18 27
19 25
20 26
21 30
22 27
23 25
24 26
H0= The average age of a woman (with children) suffering from Anaemia or Goiter is
between 25 to 29 years
Sampling
We took a sample of 24 women and then plotted a t-distribution curve of the sample.

74. 66
Confidence Interval
Confidence Interval
25.0657 29.01763
Then we found the confidence interval of that sample with 95% probability. We got the
confidence interval between 25.0657 and 29.01763. Hence, we can say that there is a
95% possibility that the average age of a woman (with children) who has Anaemia or
Goitre lies between the age of 25 and 29.
T-Test
Then we performed a t-test to test the Hypothesis:
Ht: Avg age of a woman (with children) suffering from Anaemia or Goiter is 26 years.
T- Test
1. Sample Size- 24
2. Mean-
Sum of all age groups/ 24 = 649/24 = 27.04167
3. Standard Deviation-
means 'the mean'
= 3.316352
4. Standard Error- Standard Deviation/ Square root of sample size= 0.676947
5. Hypo Mean= 26

75. 67
6. Alpha= 0.05
7. Degree of Freedom= Sample Size- 1= 24-1= 23
8. T Stat= (Mean- Hypo Mean)/ Standard Error= (27.04167- 26)/ 0.676947
= 1.53877
9. P value= 0.068753
10.t critical= 1.713872

76. 68
PRE TEST
Case details of the Sample with their scores
S. No.
Patient Name Scores
1 Maya Rani
2
2 Kavita
3
3 Rajni
6
4 Rajni K
5
5 Savita
2
6 Pooja Rani
2
7 Gurpreet Kaur
1
8 Kamla
3
9 Vimla Devi
0
10 Shalu Kumari
1
11 Nisha Rani
9
12 Meenakshi
0
13 Sarita Rano
1
14 Pallavi Rani
2
15 Ravina
1
16 Rashmi Singh
0
17 Meena S
1
18 Pooja
2
19 Sarita K
2
20 Nandini
3
21 Dhara
1
22 Nitu
1
23 Aasha
6
24 Sarita
9
25 Prachi
2
26 Rajni Rani
1
27 Prachi S
1
28 Fatima
7
29 Ruksana
0
30 Sabina
0

77. 69
H0 = The average score of a woman with children in a model quiz about nutrition will be
around 2, as the awareness is quite low.
Sampling
We took a sample of 30 women and then plotted a t-distribution curve of the sample.
Confidence Interval
Confidence Interval
1.4498 3.4835
Then we found the confidence interval of that sample with 95% probability. We got the
confidence interval between 1.4498 and 3.4835. Hence, we can say that there is a 95%
possibility that the average score of a woman with children will be 2.
T-Test
Then we performed a t-test to test the Hypothesis:
T- Test
1. Sample Size- 30
2. Mean-
Sum of all age groups/ 30 = 74/30 = 2.4666667
3. Standard Deviation-
means 'the mean'

78. 70
= 2.556039
4. Standard Error- Standard Deviation/ Square root of sample size= 0.466667
5. Hypo Mean= 2
6. Alpha= 0.05
7. Degree of Freedom= Sample Size- 1= 30-1= 29
8. T Stat= (Mean- Hypo Mean)/ Standard Error= (2.466667- 2)/ 0.466667
= 1
9. P value= 0.162791
10.t critical= 1.699127

79. 71
POST TEST
Case details of the Sample with their scores
S. No. Patient Name Scores
1 Maya Rani 5
2 Kavita 9
3 Rajni 8
4 Rajni K 8
5 Savita 6
6 Pooja Rani 8
7 Gurpreet Kaur 6
8 Kamla 5
9 Vimla Devi 1
10 Shalu Kumari 8
11 Nisha Rani 10
12 Meenakshi 7
13 Sarita Rano 8
14 Pallavi Rani 7
15 Ravina 10
16 Rashmi Singh 7
17 Meena S 6
18 Pooja 6
19 Sarita K 8
20 Nandini 7
21 Dhara 6
22 Nitu 6
23 Aasha 8
24 Sarita 6
25 Prachi 6
26 Rajni Rani 6
27 Prachi S 7
28 Fatima 8
29 Ruksana 8
30 Sabina 10

80. 72
H0 = The average score of a woman with children in the model quiz post counselling
about nutrition will be around 7, as the awareness improves considerably after
counselling
T- Distribution Curve
We took a sample of 30 women and then plotted a t-distribution curve of the sample.
Confidence Interval
Then we found the confidence interval of that sample with 95% probability. We got the
confidence interval between 6.321036 and 7.745631. Hence, we can say that there is a
95% possibility that the average score of a woman with children will be 7.
Confidence Interval
6.321036 7.745631
T-test
Then we performed a t-test to validate the same hypothesis
T- Test
1. Sample Size- 30
2. Mean-
Sum of all age groups/ 30 = 211/30 = 7.03333
3. Standard Deviation-
means 'the mean'
= 1.79046

81. 73
4. Standard Error- Standard Deviation/ Square root of sample size= 0.326892
5. Hypo Mean= 6
6. Alpha= 0.05
7. Degree of Freedom= Sample Size- 1= 30-1= 29
8. T Stat= (Mean- Hypo Mean)/ Standard Error= (7.033333- 6)/ 0.326892
= 1
9. P value= 0.001832
10.t critical= 1.699127

82. 74
CONCLUSION
The project was conducted as part of IGNOU’S DNHE curriculum on the topic, ‘A Study
to Create Awareness about the Role of Diet in Common Nutritional Deficiency Disorders.’
The conclusion of the project can be summarized as follows:
1. Total 30 cases were selected for the project work. These cases were from the
female ward. The sample group constituted of married females of the age group
18-35 yrs.
2. A Survey form was filled in the beginning to assess the sample crowd behavior.
Following are the conclusions of the same:
a. Age Group- The age group of the participants was evenly distributed
between 18- 35 years.
50% were in age group 25-30 years.
33.3% were in age group 18-25 years and
16.7% were in age group 30-35 years.
b. Number of Kids- 40% of the women had 2-4 kids or 1-2 kids. Only 10% of
the women had 0 or more than 4 kids.
c. Number of visits to doctor for their kids- Around 53.3% of the women
visited their doctors for only 0-2 times/ year. Hence, awareness has to be
created among women for frequent checkups of the infants as this would
reduce the prevalence of nutrition deficiency disorders.
d. Underweight babies: 56.7% of the babies were diagnosed underweight
(by their doctors) and 13.3% had not consulted the doctor. This shows the
poor health conditions among low-socio economic group and how we need
to create programs to improve the health of the infants.
e. Nutritional Deficiency disorders- Most of the sample cases have been
diagnosed with some or the other nutritional deficiency disorders. Also if not
themselves, then they have some family member suffering from the same.

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Hence, this proves the relevance of creating awareness of nutritional
deficiency disorders among low socio-economic communities.
f. Infections Frequency in infants- 60% of the sample cases complain of
frequent infections in their babies. Infections and Nutritional deficiency
disorders are interlinked. Hence, it is very essential to create awareness
about these disorders.
g. Supplementary Food Awareness- More than 60% of the sample cases
introduced supplementary food for their infants after 6 months. This has to
be introduced before 6 months. So, creating awareness is very much
essential for the healthy baby and to prevent nutritional deficiency disorders.
3. A Pre Test was done before the activity, which was followed by Post Test. In
these test, we saw around 45% improvement in their scores. This helped to assess
their existing level of awareness and to test the result of our activity. Awareness
was created on major nutritional deficiency disorders.
The insights of pre and post test result is as follows:
Pre-test Insights

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Post-test Insights
4. Activity- Activity of poster distribution with explanation was conducted
successfully.
Most important conclusions and learnings from the project are as below:
1. Nutritional deficiency disorders are mostly prevalent in low socio-economic sector
of the society.
2. PEM and Xeropthalmia are the disorders mainly affecting children, whereas
Anemia and IDD are mainly the disorders prevalent in adults.
3. There are many affordable dietary food items which can be included in the diets
to prevent the nutritional deficiency disorders.
4. Education and awareness about these disorders is very critical to prevent and
reduce the prevalence of these disorders in low socio-economic sector.
5. Marasmus and Kwashiorkor can be avoided in children if mothers are educated
about the diet and hygienic measures to be adopted during pregnancy and in
early age group.
6. Government has introduced several programs to reduce these disorders. e.g.:.
Vitamin A administration in children, distributing iron and folic acid tablets etc.
This project has helped a small group by creating awareness and has also enhanced
my knowledge about Nutritional deficiency disorders. Nutritional deficiency disorder is a

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major problem in our country but we can reduce the prevalence by creating programs to
create awareness and help the sector impacted.