RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE Mr. SURAJ. R

AND ADDRESS GOUTHAM COLLEGE OF NURSING,
MANJUNATHNAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE – 560 010

2. NAME OF THE GOUTHAM COLLEGE OF NURSING

INSTITUTION MANJUNATHNAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE-10.

3. COURSE OF STUDY AND M. Sc. (NURSING) I YEAR

SUBJECT CHILD HEALTH NURSING

4. DATE OF ADMISSION TO 03-06-09

COURSE

5. TITLE OF THE TOPIC A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAM ON
DEVELOPMENTAL SCREENING IN
UNDER FIVE CHILDREN AMONG
ANGANWADI WORKERS IN
SELECTED ANGANWADIES AT
BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR STUDY

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 Developmental refers to a progressive increase in skill and
capacity to function it causes a qualitative change in child functioning
development is orderly not hammered there is a direct relation between each
stage and the next the terms maturations is often used a s synomum for
development maturation has most limited application however it reference to
the development of trait carried through the genes maturation procedures can
increase in competence and ability to function at a higher level of depending
on Childs heredity. A study conducted by WHO in Canada, the main aim of
the study is to assess the social and emotional problems and delays in under
five children, among 1237 children 85.5% having normal result of subclinical
or clinical scores, 10.2% having milder problems of development that are in
the age group of 2-3 years and 5.3% having severe developmental problems
mainly speech and language, motor and cognitive delays.1

WHO estimated that the annually 200 million children having

problems with developmental delay under five years of age. To achieve the
millennium development goals of reducing poverty, primary school
completion for both boys and girls.

UNICEF more than 180 million are estimated to developmental

delay occur every year among under five in developing countries, accounting
for more than 86 percent of all problems worldwide. In sharp contrast to only
8% in developed countries. Between 11-20 million need early intervention in
developmental problems. Asia have highest incidence of developmental
problems among under five.2

Journal of pediatrics psychology reports more than half of the

annual social emotional problems are concentrated in just in 4 countries where
23% of children aged less then 5yr live .India 18 million, China 21 million &
Pakistan 3 million & Bangladesh, Indonesia & Nigeria 3 million each.
According to the official estimates from WHO for the year 2004-05,2/3rd of
all global developmental problems occurs in South East Asian countries.3

India accounts for 14.1 million of 160 million annual under

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five children with developmental delay globally. Thereby 21 percent global
burdens of childhood problems.

IAP reports on 2005 that nearly 24820 children having

developmental problems and the prevalence of developmental delay in general
population is high has 1.4-2.4% among under five children and between 2-6
years of age the prevalence of developmental disability is 2.7%.4

A study conducted by WHO in Canada, the main aim of the

study is to assess the social and emotional problems and delays in under five
children, among 1237 children 85.5% having normal result of subclinical or
clinical scores, 10.2% having milder problems of development that are in the
age group of 2-3 years and 5.3% having severe developmental problems
mainly speech and language, motor and cognitive delays.3

A descriptive study by American Academy Pediatrics group on

global estimated incident of developmental problems. The aim of the study
was to identify the developmental problems among under five children The
study found that yielding prevalence for pervasive developmental disorder of
49 per 10000, the prevalence for specific developmental disorder like autism
was accounts about 21.6 of 10000.5

A Cross sectional study was conducted in ordered to identified

the developmental delays among the under five children The study shows that
72.5% of under five children achieved mile stones in time in 252 children.

A research study conducted by Child development institute

university of north Carolina at chapel hill. According to him in 2002, 159% of
children having problems in development in correct time due to malnutrion
and poverty that is in Saudi Arabia- 3.76% have problems, Ghana-18%in 1000
population. In northern Ethiopia-4.9% south Africa-35.6%, Jamaica -249%,
Pakistan-15.2%, bangaladesh-14.7%, srilanka-12.2%, china-136% and in
India-6.68% in 1000 population.6

An article published by WHO in 2000 it is estimated that about

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 10% of the world’s population having some problem with developments and it
is most common in developing countries. In 8th volume state that some of the
factors affecting the child developmental problems in children are more
common in developing countries.

According to ICMR, the prevalence of developmental

disabilities up to 2 years of age was 2.31 and from 2-5years it is 2.6% in rural
children. The study conducted in the selected states of India.7

In light of above facts the investigator evidences the

characterizes of developmental delays or problems in the under five age group,
so majority of rural population will depended upon the anganwadi .So the
anganwadi worker can help in order to detect the children with developmental
problems as early .So the investigator plan to give a STP on developmental
screening of under five children to the anganwadi workers, so that she can help
the rural children in early screening of developmental problems.
6.2 REVIEW OF LITERATURE-
Review of literature is a key step in research process. The typical purpose
for analyzing a research existing literature is generate research question to
identify what is known and what is unknown about the topic. The major goals
of review of literature are to develop a strong knowledge base to carry out
research and non-research scholarly activity. The review of literature was done
on the following aspects:

a) Studies Related to Developmental problems in under five age group

b) Studies Related to Knowledge on developmental screening among
anganwadi workers.
c) Studies Related to Structured teaching programme among anganwadi
workers.

a) Studies Related to Developmental problems in under five age

group

A study conducted by WHO in India, that is national sample of

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9854 2-3 year old studied in India showed has a delay rate of 8.9% in a
population based survey of 5478, 2-9 year old in Jamaica and overall
prevalence of 9.4% were reported using a 2 face design survey of 22 thousand
2-9 year children, Durkin et al., the reported childhood delay prevalence of
15.2% in Jamaica, 14.7% in Pakistan and 8.2% in Bangladesh statistics from
the different sources indicate that in India 3.8% of population has sum from of
delay and the same was found to be more common among the children of the
lowest socio economic class families were compared with the next two lowest
class families a nationwide survey under NSSO-2002 in India showed a
prevalence rate of 1.77% delays among all age groups in a house to house
survey of 3560 children 0-6years of age at Delhi delay was identified in 6.8%
of those assessed. Infants with Neuro developmental abnormalities need early
therapy.8

A crossectional study conducted They screened infants in

slums of Delhi for psycho social development. In these cross sectional study
202 infants and their mother included psycho social development screening
test developed by ICMR was used to assess the developmental status of infants
mothers were interviewed for social demographic details infants who achieved
milestones in time were 92.5% for personal skills, 91.8% for hearing and
language concept development and 90.6% for gross motor milestones,
respectively these percentages were lower for vision and fine motors(88.6)
and social skills (81.4). Sex of infant and socio economic status of their
families significantly influences the few domains of development. Other
factors like age of infant’s literacy of their mothers were not significantly
influencing the development of infants.9

A study conducted by American Pediatric Association in

pervasive developmental disordered in children they screened 180 children
among 82.8% are males, having developmental disordered diagnosis who
attend the surveyed schools, yielding a prevalence for pervasive developmental
disordered 64.9 per 10000 the prevalence for specific pervasive developmental
disordered subtypes were for autistics disordered in pervasive developmental
disordered in children they screened 180 children among 82.8% are males,
having developmental disordered diagnosis who attend the surveyed schools,

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yielding a prevalence for pervasive developmental disordered 64.9 per 10000
the prevalence for specific pervasive developmental disordered subtypes were
for autistics disordered 21.6 of 10000, for pervasive developmental disordered
not otherwise specified 3.8 of 10000 and for asperger syndrome. 10.1 of 10000
a statically significant linear increase in pervasive developmental disordered
prevalence was not yet during the study period. The prevalence of pervasive
developmental disordered in thimerosal: free birth cohort was significantly
higher than that in thimerosal- exposed cohorts (82.7 of 10000 vs. 59.5 of
10000) using the logistic regression of models.10

A study conducted in anganwadi of 3 districts of Kerala

(kottayam, Kozhikode, thrivanthapuram) India, toddlers 1.6-3years of age
where 429. The result of that study that data scores between 33and 28
suggested at risk for developing developmental delays. A score of less than or
equal to 27 suggested already delayed milestones. a score of 27-16 suggested a
mild delay, a score of 5-15 suggested a moderate delay and less than or equal
to 4 suggested severe delay in development.11

b) Studies Related to knowledge on developmental screening among

anganwadi workers

A study conducted by National institute of health and family

welfare under government of India – it is a study to find out knowledge and
practice about the developmental screening among anganwadi workers and
auxiliary nurse midwives those who are working under ICDS scheme among
these survey 94.44% are participated . among these only 55.55% anganwadi
workers have knowledge that were for the developmental screening in children
the report was average knowledge and practice of developmental screening
was adequate 20% of those who surveyed scored higher than 15 and 74%
scored between 20& 25 and 66% scored less than 10 out of 20. In their study
pre test revealed that 11.11% of the participants got very good scores, 6388%
got good, 19.44 got average and 5.55% got below average scores.12

A study conducted on the anganwadi workers of ICDS scheme

Jamamajid, Delhi the objective of the study is to assess the fulfillment of
criteria of selection of anganwadi workers, the adequacy of training undergone

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by workers, the type and frequency of services provided by the anganwadi
workers, the extent of coverage of population and perception f the beneficiary
about the anganwadi workers the study was carried out at the urban integrated
child development scheme they assessed 65 anganwadi workers among 65
workers 43.5% having adequate knowledge about the developmental problems
associated with the children, and 26.5% are having an average knowledge.
19.5% below average knowledge a workshop conducted about the
developmental screening in children and the post test knowledge improved by
72.5% instead of 43.5%.12

A study conducted include the knowledge and practice of

anganwadi worker about infant development in Gondi district a total of 36
female anganwadi supervisors are registered and included in the study group
before the trailing the score of the participants are as followed- very good-23,
(63.88%), good-7(19.44%), average-and 2(5.5%) below average scores. The
lowest pretest score was 11(55%), the highest was 18(90%) which was out of a
maximum score of 20% the lowest post test score was 14(70%) while the
highest was 20(100), which was out of a maximum score of 20, 16 (14.44% of
the participant got very good scores, 19 (52.77%) got good, and 1 (2.77%) got
an average score. There were no below average scores in the post test all
almost all 100% of the supervisors have correct knowledge about development
assessment in infants.13

c) Studies Related to Structured teaching programme among

anganwadi workers

A study conducted from jyotsnadevi patil pediatrics centre

medical college, Jabalpur, Madhya Pradesh India. The aim of the study is to
teaching of non professional health workers in a simple technique of
developmental screening of infants and young children 20 anganwadi workers
were trained for developmental screening of infants and young children (6
weeks-2years) and there results compared with that of trained medical
praticitoner. The screening tool was used the wood side system screening a
reference test (GESCLL’S Developmental schedule) was give to 56.5% of the
sample. That tester reliability worked out on 50% of testers was comparable.

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 The results of the tester reliability worked out on 150 children were statically
comparable. A high level of proficiency of workers were retrained throughout
the study through constant supervision and cross checked y the author the
successfully training of insufficiently used paramedical manpower for
decreasing the cost of medical care and improving the utilization of the health
delivery system was highlighted in these cross sectional study 619 children
were assessed by the anganwadi workers.14

A study conducted by Health and Family welfare under

Government of India with the help of UNICEF arranged health training
program of (teaching program) on developmental screening in preschool
children among anganwadi workers the units were schedule in flexible way
attendance rated workshop and ability to complete the assignment. A checklist
of skills is provided for each unit and the trainees were expected to acquire pre
established minimal level although each unit may be completed in three
months more time is given to the trainee so that failures can be avoided and the
minimal level of skill acquisitation may be achieved. The finally evaluation is
performed by a committee of specialized ,supervisors and the trainees, rating
consists of a 5 point scale divided into observation of field work (50marks)
individual assessment (20marks)written examinations(15marks) and viva
(15marks) among 34 workers, 82.6% got higher score and 17,.4% got an
average knowledge15
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching
programme on developmental screening in under five children among
anganwadi workers in selected anganwadies at Bangalore”
6.3 OBJECTIVES OF THE STUDY

1) To assess the existing knowledge on developmental screening in under

five age children among anganwadi workers.
2) To evaluate the effectiveness of STP on developmental screening in under
five children among anganwadi workers.
3) To determine the association between the knowledge scores of pre & post
test with selected demographical variables.

6.3.1 OPERATIONAL DEFINITION

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 Effectiveness: Refers to the significant difference of pre test and post test
knowledge scores on developmental screening of under five children.
Structured teaching program: Refers to organized teaching strategy, which
provides information regarding developmental assessment in under five
children using developemental assessment scale
Developmental screening: It refers to determine gross motor ,fine motor,
language, personal & social development in under five children
Anganwadi workers: refers to persons who work under the ICDS
programme under government of India in the community area.
Under five children: refers to children between the age group of 2-5 years.

6.3.2 HYPOTHESIS

H1: There will be a significant difference between the pre test and post test
knowledge scores among anganwadi workers.
H2: There will be a significant association with the knowledge score on
developmental screening in selected demographic variables among anganwadi
workers

6.3.3 ASSUMPTION

• The effectiveness of structured teaching may improve the

knowledge level of anganwadi workers towards developmental screening in
under five children.

• Knowledge level of anganwadi workers varies with selected

demographic variables.

6.3.4 DELIMITATIONS-
1. The study is to the selected anganwadi center in Bangalore.
2. The study is only to the anganwadi workers present at the time.
3. The study is only to developmental screening in the age group of 2-
5 years.

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7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from the
anganwadi workers in selected anganwadi in
Bangalore.

7.2 METHODS OF COLLECTION OF DATA

7.2.1 SAMPLING CRITERIA 1. The anganwadi workers who are

INCLUSION CRITERIA willing to participate in the study.
2. The anganwadi workers who are
available during the period of study.
3 Able to understand kannada.

EXCLUSION CRITERIA 1) The anganwadi worker who are not

willing to participate in the study.
2) The anganwadi workers already under
gone training on developmental
screening of under five children.

7.2.2 RESEARCH DESIGN The research design adopted for the present
study is ‘pre-experimental design’. one
group pre test & post test study.

7.2.3 VARIABLES UNDER THE

STUDY
INDEPENDENT VARIABLE Structured teaching program

DEPENDENT VARIABLE Knowledge of developmental screening in

under five children

7.2.4 SETTING In selected anganwadi centers in Bangalore.

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7.2.5 SAMPLING TECHNIQUE The investigator will use purposive
sampling method.

7.2.6 SAMPLE SIZE The sample size for the present study is:60

7.2.7 TOOLS OF RESEARCH 1) Structured questionnaire to assess the

socio demo graphic variables.
2) Structured questionnaire will be
developed by researcher to assess
knowledge regarding developmental
screening in under five children.
7.2.8 COLLECTION OF DATA  A prior formal permission will be
obtained from higher authority
 Informal permission will be
obtained from the subjects after
explaining the purpose of the study.
 A structured questionnaire will be
administered to assess the
demographic data and pre test
knowledge related to developmental
screening of under five children.
 A structured teaching program on
developmental screening in under
five children will be given on same
day.
 Post test will be conducted after 7
days.
 Duration of data collection will be
30 days.
7.2.9 METHODS OF DATA Appropriate statistical method will be used.
ANALYSIS AND The plan of data analysis will be as follows:
PRESENTATION  Organize the data in a master sheet

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 or computer
 Assessment of pre test score with
interpreted by descriptive statistical
such as mean
 Frequency and percentages for the
analysis of background data
 Mean, standard deviation and paired
“t” values to determine the
significance of pre test and post
score.
 Association of STP with
demographic variables analyzed by
“X2” (Chi square).
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER
HUMAN OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
Yes, the study requires administration of STP to anganwadi workers
in selected anganwadi in Bangalore

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED YOU’RE

YOUR INSTITUTION INCASE OF 7.3?
Yes, informed consent will be obtained from the institution, hospital,
authorities and Ethical Committee clearance where the study will be
intervened.
Also informed consent will be obtained from subjects; Privacy,
autonomy, confidentiality and anonymity will be guarded.
Scientific objectivity of the study will be maintained with honesty
and impartiality.

8. LIST OF REFERENCES-
1. world statics of developmental problems in children available on
www.who.org (date of access24-11-2009)
2. fombonne Eric, zakarian Rita , Andrew Bennett , pervasive
developmental disorder bin children a cross sectional study 2006
July 212(118): 2005-2993

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3. Malntyre, Lee Laura: parent training for young children with
developmental delay : randomized controlled trial issn : 0895-8017
American journal of mental retardation vol no 113, pages 356-368
4. MKC Nair, Psrussell, rs rekha: validation of developmental assess
mental tool for anganwadi, Indian pediatrics , 2009 available on
www.indian paediatrics.net Dorothy .Marlow text book of
pediatrics nursing Elsevier publication page no 31-36
5. Rene Hebert , Garry l martin , behavior development in children
Canadian journal of behavioral science 2009,vol 41,no 1,31-36
6. M.J Briggs: Gowon and A S Carter: social and emotional status in
early childhood predicts elementary school outcomes published by
American journal of pediatrics may 1 2008, 121(5) : 957-962
7. R.Gupta, patil,: training of non professional health workers in a
simple techniques of developmental screening of infants and young
children published by ,the department of child health of university
of Glasgow edbenburgh, 1996, 851-858
8. Mercedes de Omnis, study Coordinator Department of nutrition
WHO Acta pediatrics suppl450: 86-95
9. Meenkshi Malik ,S.K Pradhan ,psychosocial development in infants
a crossectional study Indian journal of pediatrics 2007;74(9):841-
845
10. Amar, taksande, satish tiwari alkakuthe: knowledge and attitudes of
anganwadi supervisor about infants development, Indian journal of
community medicine vol no 34, issue no-3, July 2009 downloaded
from www.ijcm.org assessed on December 1, 2009
11. Babu Jeorge, j.Padhma Mohan, RM Sunitha: developmental delay
and disability among under five children in a rural ICDS block
supply 2009:, 46available on www.indianpeadtirc.snet assessed on
30-11-2009
12. Training of anganwadi workers published by ICDS department of
women and child development 1975 vol no 32, page no 576-580
13. Patel NV, Kaul KK, : behavioral developmental of Indian rural and
urban infants in comparison to American infants Indian pediatrics

13
 -1981, 8: 443-450
14. Mini Saluank, swaminathan “training fro health care workers in
India note book no.12, December 1992, published by Indian journal
of community medicine volume no 24, 35-42.
15. NV Patel, KK Kaul, : behavioral developmental of Indian rural and
urban infants in comparison to American infants Indian pediatrics
-1971, 8: 443-450.
16. Illingwrth, Ronald Development of infant and young children,
normal and abnormal, Edinburgh and London:,e&s Livingston
limited 9th edition 1990.
17. M.Kelvin velderman, MR crone: identification and management of
psychosocial problems among toddlers by preventive child health
care professionals October 25, 2009,(2009) European journal of
public health.

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