CHAPTERRESEARCH METHODOLOGYMethodology is the significant part of any research study which enables the researcher to project a blue print of the research undertakingThis chapter describes the methodology followed to assess the physical, nutritional, psychosocial health status of under five children among migrantpopulation at selected setting, Tamil NaduThis phase of the study included selecting a research approach, research design, research variables, setting, population, sample, with sample sizesample technique, criteria for selection of the sample, development and description of the tool, content validity, pilot study, reliabilityprocedure for data collection, and plan for data analysisRESEARCH APPROACHThe research approach utilized in this study was quantitative research approachRESEARCH DESIGN WAS USED. The research design was adopted non experimental descriptive designVariablesResearch VariablesThe study variables are physical, nutritional, psychosocial health status of underfive children among migrant populationDemographic VariablesUnder five children: Age of the child, gender, religion, immunization status, birth order of the child, No. of siblingFamily: Birth history, family size, father’s education, mother’s education, occupation of father, occupation of mother, family monthly income, typeof family, age at marriage of mother, family history of hereditary and communicable diseases, availability of health services, accommodation facilitySetting of the studyThe study was conducted at a gypsy settlement, Jaya Nagar, Thirumulaivoyal, Avadi, Chennai. It covers about 445 migrant populations. Healthfacility is available through Community Health Centre, Primary Health Centre and Sub Centers. They have adequate transport facilityPopulationTarget populationTarget population comprised of all under five children of migrant populationAccessible populationAccessible population comprised of all under five children of migrant population who were residing in gypsy settlement areas at JayanagarThirumulaivoyal, Avadi, ChennaiSampleThe study sample comprised of all under five children, who were residing at selected community and who have fulfilled theCriteria for Sample selectionThe following criteria’s were adopted for the selection of respondentsInclusive CriteriaUnderfive mothers who were willing to participate in the studyUnderfive mothers who were willing to assess theirUnderfive mothers who can speak and understand tamilUnderfive mothers who were able to comprehend and respond to the questionUnderfive children who cooperated for the health status assessmentExclusive CriteriaUnderfive mothers who had mental illnessUnderfive children who had birth disorder or any mental illnessSample sizeThe sample size of the study consisted of 60 under five children, who were residing at selected gypsy settlement areaSAMPLING TECHNIQUENon probability convenient sampling was used to select the samples for this studyDEVELOPMENT AND DESCRIPTION OF THE TOOL DEVELOPMENT AND DESCRIPTIONAfter an extensive review of the literature and discussion with experts in the field of medical and nursing . The tool was developed and used for datacollection3. 10. 1 Section -A: Questionnaire to collect demographic dataThis section consisted of demographic variable details such asUnder five children: Age of the child, gender, religion, immunization status, birth order of the child, No. ofFamily: Birth history, family size, father’s education, mother’s education , occupation of father, occupation of mother, family monthlytype of family, age at marriage of mother, family history of hereditary and communicable diseases, availability of health services and accommodationfacilitySection – B: Observational check list to assess the physical health status of under five children amongThis consisted of head to foot assessment. It comprised of 14 components such as skin, posture, gait, hair, scalp, pediculosis, eye, ear, nose, cavity, oral mucosa, respiratory system, cardio vascular system, gastro intestinal systemScoring keyIf abnormalities present the scoring key-‘1’markIf abnormalities absent the scoring key-‘0’ markSCORING KEY IN PERCENTAGE LEVEL OF PHYSICAL HEALTH STATUS > 75% Ill health 50-75% Mild IllnessOptimum healthSection-C: Observational check list to assess the Nutritional status of underfive children among migrant populationThis consisted of midarm circumference and calculating degree of malnutrition of under five childrenTo identify the degree of malnutrition (Gomez Classification -The expected weight of the child was calculated by using formula asExpected weight = Age in years xThe degree of mal nutrition was computed by using formula asDegree of malnutrition = Actual weight /Expected weight xThis scores were distributed and interpreted as followsSCORING KEY IN PERCENTAGE LEVEL OF NUTRITIONAL HEALTH STATUS Between 90 and 110 % Normalmild malnutrition Between 60 and 74 % 2nd degree moderate malnutrition UnderSection – D: Rating scale to assess the Psychosocial status of under five childrenThis sections assess the psychological health status of the children by using Modified children behavior psychological ratingSCORING KEYTotal number of items was 20 and each item score was given like, never0, occasionally1, Negative questionsPositive questionsTotal scoringITEM ITEM NO NEVER OCCASIONALLY ALWAYS Positive 1, 3, 5, 7, 9, 11, 13, Less than 13 -Moderate adequate psychosocial health statusAbove 26 -CONTENT VALIDITYThe content validity of the tool was established on the basis of opinion given by experts in the field of 3 community health nursingmedical experts in psychiatry, 1 medical experts minor suggestions regarding rearrangement of the suggestion of question were made in the toolexperts incorporated in the tool used for the main study hence the tool was finalizedETHICAL CONSIDERATIONEthics is a system of moral values that is concerned with the degree to which the research procedures adhere to the professional, legal and socialobligation to the study participants Polit and HunglerBeneficenceThis study benefited to the study participants by assess the health status of under five childrenstudy participants were protected from harm and discomfort, exploitation by getting informedRespect from human dignityUnderfive children were given full freedom to decide on participating in the study. Those who were interested only selected for the studyJusticeThe under five children who were willing to participate in this study with out the discrimination of health status of under five children among migrantpopulation were selected for the studyPILOT STUDYPilot study was conducted among the migrant mother’s of under five children in Stuartpet, Arakkonam, Vellore district and the study was conducted infirst week of June 2012. After obtaining formal permission from the authorities concerned in Arakkonam municipality corporation, the researcherselected 6 samples from the main population who fulfilled the inclusive criteria by non probability convenient sampling. Aself and the study was given and informed consent was obtained from the sample and it took 45 minutes to 1 hour to collect the data fromThe confidentiality of the responses was assured to the study subjectRELIABILITY OF THE TOOLReliability of the tool was established by inter-rater method to assess the reliability of the questionnaire on physical health, Nutritional healthand the split half method was used to assess the psychosocial health. The reliability score was r= 0. 9. The r value indicated the highly positivecorrelation. Hence the tool was considered highly reliable for proceeding with the main studyPROCEDURE FOR DATA COLLECTIONThe main study was conducted in the gypsy settlement, Jaya Nagar, Thirumulaivoyal, Avadi, ChennaiIt was conducted after receiving the formal permission from the Principal, Omayal Achi College of NursingThe permission was obtained from the ward member of Avadi, and also from head of migrant population of Jaya Nagar where the study wasOn the first day the investigator introduced herself to the ward member of Avadi, and also from head of migrant population and explained about thepurpose of studyOn 2 nd day the investigator met the under five children with migrant mothers and briefly explained the purpose of the visit. Privacyand confidentiality regarding the data was assured to the migrant mothers so as to get the co operation in the procedure. After getting the writtenconsent, data collection was carried outthe room was ventilated with natural and artificial ventilation. Women were made to comfortably sit on the floor in a circular order over the matthe investigator gave the small introduction about health status with the help of head of migrant population and research assistantthe physical, nutritional, psychosocial health status of under five children was assessedThe duration of the assessment was 45 minutes to1 hour. In the test initially the personal characteristics were collected by using personalsheet and followed by that assessment was done by using observational check list and rating scaleConfidentiality was ensured and their feelings were respectedPLAN FOR DATA ANALYSISThe data collected will be analyzed by using descriptive and inferential statistics. The frequency and percentage distribution will be used to analyze the demographic variables of under five children. Mean and standard deviation will be used to assess the health status of underfive children among migrant populationInferential StatisticsChi-square test for assessing the association of health status of underfive children among migrant population with selected demographic variableswill be usedCHAPTERDISCUSSIONThis chapter discusses in detail about the findings of the study based on the interpretation from statistical analysis. The findings are discussed in pertinence to the objectives of the study. The findings are supported by the review of literatureThe study was to assess the physical, nutritional and psychosocial health status of underfive children among migrant populationThe first objective was to assess the physical, nutritional and psychosocial health status of underfive children among migrant populationThe analysis of the physical health status showed that majority 53(88. 33%) of underfive children among migrant population had normal physicaland 7(11. 67%) had optimum health status and none of them had mild illness or illThe study findings was found to be consistent with the study conducted by Ferrer . F 2008 states that th review of literature published in the last 20 years. To determine the health of Spanish gypsy community though international midline searchand 57 studies were performed in hospital, 20 in PHC and 13 studies in primary care canters and they found community constitutes group due to ethnic. More over them were also strong social inequalities in health. The analysis of the nutritional health of under five children among migrant population by checking midarm circumference andhad mild malnutrition and 7(11. 66%) had moderate to severeThe analysis of the nutritional health of under five children among migrant population by determining degree of malnutrition revealedof 42(70. 0%) had normal nutritional health status, 4(6. 67%) had 1st degree mild malnutrition, 14(23. 33%) had 2nd degree moderateone had 3rd degree severeThe study findings was found to be consistent with the study conducted by Ngianga-Bakwin Kandala (2011) conducted a study among 8992children in Democratic Republic of Congo using anthropometric and nutritional assessment and results revealed that malnutritionthe boys, (43. 9%) age group ranging from four years, higher in rural areas(48. 4%) children born outside the hospital (49. 8%)and associatedmaternal education in age group , place of birth etcThe analysis of psychosocial health status of under five children among migrant population showed that majority 57(95%) had moderatelypsychosocial health status and 3(5%) had inadequate psychosocial health status and none of them had adequate psychosocial healthThe study findings was found to be consistent with the study conducted by Senaratne BC etal(2011), conducted a cross-sectional comparative surveyamong 253 children aged 0-5 years of women migrant workers in Colombo district using Sinhala translation of child behaviorquestionnaires and found higher rate of mental health problems among the children not having an elder sibling, father not living with the childmother educated up to 5 grade or less, recreational activates at school and change of Principal career leads to abnormalThe second objective was to associate the physical, nutritional and psychosocial health status of underfive children among migrant population withtheir selected demographic variablesThe analysis findings in table 3 showed that the demographic variable, like ” mother’s education” was found to be statisticallyassociation with the level of physical health status at p <0. 05 levelThe findings in table 4 shows that the demographic variables " age of the child" and " religion" were found to be statistically significantwith the level of nutritional health status at p <0. 001 and p <0. 05 level respectivelyThe results in the table 5 shows that the demographic variables " place of birth" and " conducted by whom" were found to havesignificant association with the level of psychosocial health status at p <0. 05 level respectivelyThe study revealed that there was a significant association between physical, nutritional and psychosocial health status of undersfive children withselected demographic variablesHence the research hypothesis RH, stated earlier that " There is a significant association of the level of health status of under five children withselected demographic variables" was accepted for the above variables and rejected for other demographic variablesCHAPTER -REVIEW OF LITERATUREReview of literature is a systematic search of a published work to gain information about a research topic (Politer and Hungler) collecting a reviewof literature is challenging experience. The literature review was based on an extensive survey of journals, books and international nursing indicates. A review of research of non researchliterature relevant to the study was under taken which helps the investigator to develop deep insight in to the problem and gain information on whathas been done in the pastAn extensive review of literature was done by investigator to lay a broad foundation for proceed with the study under the following headingThe literature gathered from exclusive review is depicted under the following headingsSection A: Studies related to physical health status of underfive children among migrant populationSection B: Studies related to Nutritional status of underfive children among migrant populationSection C: Studies related to psychosocial health status of underfive children among migrant populationSection A: Studies related to physical health status of underfive children among migrant populationFerrer F (2008)% conducted a meta analysis study on health status of gypsy community . The main aim is to determine health related matters amongcommunities, ethnic differences and social inequalities in health . The study was conducted at Spanish, 96 related health topics wereinferential statistics was used found that the Spanish gypsy community constitutes high risk group of ethnic and genetic factors strong socialinequalities in health existing related to mortality. Mortality due to chronic and environment to socio-economic culturefactors as well as insufficient assessors to and use of health servicesSastre Gussani. E (2006) conducted a retrospective analysis study on health status of gypsies and non gypsies’ children, with the aim tohealth status and to improve the health status of children. The study was conducted among 149 gypsy children and 239 non gypsy childrenhealth centre. It was found that majority of samples were having continuation of breast feeding was till 3 month's . Gypsy children were 3. 53more likely to be admitted in neonatal unit. Incomplete follow up was 5. 24 times more for gypsySection B: Studies related to nutritional status of under five children among migrant populationAparna Kuna and Poshadri. A (2012) reported that micronutrient malnutrition deficiencies of vitamins D, zinc, foliate, vitamin c, calcium are thewidespread from of malnutrition in the world. More than two billion people in the world suffer from various micronutrient deficiencies that leads toblindness, mental retardation, reduced resistance to infectious disease and even deathPonne S (2012) reported that worldwide malnutrition accounts for 11 percent of all diseases, are caused by long-term poor healthAccording to WHO in developing countries about 40 percent of pre school children are estimated to be anemic and 20 percent of all maternal deaths are due to malnutrition. Millennium Development Goals are a set of internationally agreed goals that, countries and institutions have committed to reach between 1990 and 2015. Bilswar Tamoghna et al (2011) conducted a cross sectional, observational community based study on assessment of health, nutrition andstatus of under five children among migrant population of periurban Kolkata by house to house visit . Clinical examination and anthropometricmeasurement of children and interview of adult care giver was done. It was found that prevalence of under weight, muscle wasting and stunting amongthe study population were 64. 9%, 20. 3%and 64. 9% respectively. Proportion of exclusively breast fed children was only 18. 1% and nofully immunizedNgianga-Bakwin Kandala (2011) conducted a study on Malnutrition among 8, 992 under five children in Democratic Republic of Congo. anthropometric and nutritional assessment were used and result revealed those 50. 8 % were female, and overall prevalence of malnutrition (stunting) was 43. 9 %to girls. Bechir M et al (2010) cconducted a cross-sectional study on 653 normal children and 579 sedentary children ranging in age fromSamples were randomly selected 17. 9% to 13. 7% (p = 0. 03) in normal children and 16. 5% to 10. 6% (pfor the logistic regression model). These findings demonstrated the critical state of the nutritional situation in the Sahel and rural areasParikh K, et al (2010) conducted a cross-sectional study in Dominican republic they selected five rural communities age. Children were five years and younger also eligible for routine health care from mobile clinics. Among 175 children in 2005, 52% were female57% were <5years of age. rates chronic under nutrition decreased from 33% to 18% after the initiation in food supplementation programme. bhanderi d, et al (2006) conducted a cross sectional study among malnutrition children at " high risk''in study. around 300 age group 0-5 years were selected by systematic sampling method. prevalence rate and 50. 3%. found be stunted with their higher 2nd 5th year life. wasting was comparatively very low (23. 2%) nutritional parameters should that significant association parental education, socio-economic status, family size, environmental conditions & episodes commonv. g. rao (2005) asses status pre-school gonad community madhya pradeshpreschool probability sampling, details collected using structured performa, anthropometric measurements. findings shows thatof suffered various health problems is 71% had moderate anaemia. severe anaemia observed 71%stunting, 27. 8% (midarmsection c: studies related psychosocial five migrantd. souza ramani (2012) reported underlies over 50% all 5 deaths worldwide. increases chances death, but also affects mental development, limits learning abilities . even if getswere not able do well at school, because subsequent capacity limitedsenaratna bev etal (2011) comparative survey 253 (ages 5-10 years) women migrantcolombo district. sex matched control neighborhood on risk factor for problem. translation child behavior checklist (cbcl-s questionnaire socio-demographic>
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