07 Chapter4

Results and Discussion
4
RESULTS AND DISCUSSION
The results and discussion for the present study entitled, “Assessment and Impact
of Millet Based Micronutrient Rich Supplement on the Nutrition and Cognition of School
Going Children in Coimbatore” is given under the following headings:
Phase I
Baseline Study
4.1.1. Sample Distribution
4.1.2. Parents Profile
4.1.3. Family Details
4.1.4. Nutritional Profile
i Anthropometric Parameters
ii. Clinical Assessment
iii. Biochemical Markers
iv. Dietary Assessment
4.1.5. Details of Health and Hygiene
i. Occurrence of Minor Ailments
ii. Functional Consequences of Anaemia
iii. Personal Hygiene
Phase II
Millet Based Micronutrient Product
4.2.1. Sensory analysis
4.2.2. Nutrient Analysis
4.2.3. Shelf Life Study
Phase III
Intervention Study
4.3.1. Impact on the Anthropometric Parameters
4.3.2. Impact on the Biochemical Parameters
4.3.3. Impact on the Cognition
Assessment and Impact of Millet based Micronutrient Rich Supplement on Nutrition and Cognition of School going Children in Coimbatore 76
4.1 Baseline Study

An attempt has been made to study the socioeconomic parameters and nutrition
status of 7 to 9 year old children to understand the various parameters involved in the
status of children. The findings are presented in the first section of the results and
discussion.
4.1.1. Sample Distribution

Children are considered to be the most important natural resource and biggest
human investment for development in every community. However even after so many
years of independence our country has made little progress in improving the health
condition of our school children in comparison to the developed countries (WHO, 2000).
There is a growing concern over the child health all over the world with rapid economic
growth and social changes. Major determinant of health status in an adult is their
nutritional status in childhood (Shivaprakash and Joseph, 2014). So the present study was
carried out among school children in an attempt to assess the health status and evolve a
solution using locally available food based solutions.
Age and Gender Wise Distribution
Human development is a continuous process that proceeds in a fairly orderly

manner throughout life. All individuals experience the various stages of physical,
psychological, and social development. Age, gender and body weight largely determine
the nutrient requirement of an individual. Growth rate of children in the primary school
age is slower than during infancy, but show a slow and steady growth. A number of factors
like parental influences, socioeconomic factors and environmental conditions have an
influence on the growth of children.
Two private schools, one aided school and five government schools were selected
for the study. The highest number of students was taken from RVS Matriculation School
which was 139. Fifty four children were taken from CSI Primary school which was the least
number from among the seven schools selected. Out of the seven selected schools we
could recruit more than 100 children from five of the schools. The two schools that had
fewer than 100 were in less populated locations of the district.
Table XI
Age and Gender Wise Distribution
n=720
7 Years 8 Years 9 Years

S.No School Total
B G T B G T B G T
1 A 28 14 42 09 28 37 35 25 60 139
2 B 16 10 26 14 27 41 20 15 35 102
3 C 10 06 16 07 12 19 14 05 19 54
4 D 14 14 28 13 32 45 21 21 42 115
5 E 24 10 34 18 29 47 27 20 47 128
6 F 18 17 35 19 21 40 18 16 34 109
7 G 14 11 25 10 15 25 13 10 23 73
Total 124 82 206 90 164 254 148 112 260 720
B-Boys G-Girls T-Total
A-RVS Matriculation School, Sulur, B- Kennedy Matriculation School, Sulur, C- CSI Primary School, Sulur,
D- Panchayat Union Primary School, North, E- Panchayat Union Primary School, South, F-SLV Nagar School,
G-Panchyat Union Primary School, Kannampalayam
In the 7 year age group there were 124 boys and 82 girls. The number of eight year
girls was high than the 9 year old boys. In the 9 year age category 112 girls and 148 boys
were covered. The total number of 7 year old children was 206. A total of 254 and 260
children were taken from the eight and nine year old category. There were 124 male and
82 female students in the 7 years age group. It was noted that a total of 164 girls were in
the 8 year age group and they outnumbered the boys in that particular age. From the total
of 260 children in the 9 year age group 148 were boys and the remaining 112 were girls.
There are a total of 785950 recognised schools in our country in 2007-2008. Total
number of students enrolled in these schools was 136229962 out of which 71469118 are
boys and 64760644 are girls (Annual report of 2009-2010, Department of School
education and literacy).
In a cross-sectional study conducted by Kolekar and Sawant (2013) in healthy

school children from the urban and rural areas of Sangli district in West Bengal it was
found that, urban school children have higher values for all measurements when
compared to rural school children. The reason attributed was the better socioeconomic
status in urban children as compared to lower socioeconomic status in rural children. The
present study was also conducted among rural children.
Class Wise Distribution
For the conduct of the study school children in the age group of 7 to 9 years were
selected. The class wise distribution of the selected children in given in the table below.
Table XII
Class Wise Distribution
n=720
Boys Girls Total
S.No Class
No % No % No %
1 II 134 37 98 27.4 232 32.2
2 III 106 29.3 169 47.2 275 38.2
3 1V 122 33.7 91 25.4 213 29.6
Total 362 358 720
The structure adopted for school at the national level envisages a general
education for all children during the first ten years of schooling. At the higher secondary
level (grades 11 and 12), courses are diversified into different streams of study, such as
Science, Humanities, Commerce, etc. The stages of school education in India are as
follows: Primary (grades 1 to 5; 5 years duration); Upper Primary (grades 6 to 8; 3 years
duration); Secondary (grades 9 and 10; 2 years duration) and Higher Secondary (grades 11
and 12; 2 years duration). The education cycle from grade 1 till grade 8 is referred to as
the elementary education cycle Some states in the country have a fragmented system at
primary and upper primary stage (e.g., primary schools with grades 1-5 and upper primary
schools with grades 6-8) while others have separate primary schools (grades 1-5) and
upper primary schools with both primary and upper primary grades (grades 1-8). Similarly,
some secondary schools may have only grades 9-10, or they may include upper primary
grades (grades 6-10). In some states there are higher secondary schools which go up to
grade 12. These include schools which include only the secondary and higher secondary
stages (grades 9-12) and schools which also include the upper primary stage (grades 6-12)
(UNICEF, 2014).
According to the above citied structure for school education in the country the
selected children in the 7 to 9 year category were studying in classes between II to IV
standard. Among the boys the highest per cent (37%) was in class II. In the girls it was
noted that more number of girls (47.2%) was in class III.
Gender Wise Distribution of Selected Children

There has also been impressive progress towards bridging gender gap in enrolment
and retention in elementary education. Between 2000-01 and 2013-14, the enrolment of
girls as percentage of total enrolment in primary education has increased from 43.8 per
cent to 48.2 per cent, while the enrolment of girls as per centage of total enrolment in
upper primary education increased from 40.9 per cent to 48.6 per cent. The Gender Parity
Index (GPI) for GER in primary education improved from 0.82 in 2000- 01 to 1.03 in 2013-
14, while the GPI for GER in upper primary education improved from 0.75 to 1.08 during
this period (National University of Educational Planning and Administration, 2014).
Table XIII
Gender Wise Distribution of Selected Children
n=720
S.No Age Boys % Girls % Total

1 7 124 60.2 82 39.8 206
2 8 90 35.4 164 64.6 254
3 9 148 56.9 112 43.1 260
Total 362 50.3 358 49.7 720
The above table gives the gender wise distribution of the selected children. There
were 124 male and 82 female students in the 7 years age group. It was noted that a total
of 164 girls were in the 8 year age group and they outnumbered the boys in that particular
age. From the total 260 children in the 9 year age group 148 were boys and the remaining
112 were girls.
As per 2011 Census, the top three states recording the highest value of overall sex
ratio are neighbours located in the southern part of India namely Kerala (1084), Tamil
Nadu(995), and Andhra Pradesh (992) (Bindu, 2012) . It can be concluded that there was
equal distribution of male and female students in the present study.
4.1.2. Parents Profile
Socioeconomic Profile of Parents of Selected Children
Socioeconomic factors such as income, education, physical environment and race

directly and indirectly contribute to children’s nutritional status. These factors may
increase a child’s risk for malnutrition, weight gain and obesity. Parents’ role in the
upbringing of the child is very crucial. Studies show that the education and income of the
family are important determinants of the health of the child. So a careful study of
socioeconomic parameters of the parents of the children in the study population was
undertaken.
According to a study by Babar (2010) paternal literacy level is indirectly associated

with child nutritional status. Father's education may be important because he plays more
active role in certain health-seeking decisions and household income. The results showed
that nutritional status that 50.9% children of illiterate fathers’ were malnourished as
compared to 19.5% children of literate fathers.
The study by Iyer et al., (2011) assessed the nutritional status of 376 urban and
rural adolescents of Vadodara district and found the determinants of malnutrition. An
attempt was made to look into some of the variables on the prevalence of under nutrition
and over nutrition. The variable studied where per capita income (PCI), literacy levels of
parents, energy and protein intake. All the variables had significant influence on the
prevalence of under nutrition but not on over nutrition. India is a country of sharp
inequalities in income and health risks. The determinants identified for under nutrition
(PCI, mother’s education and energy intake) stresses the role of socioeconomic and
dietary factors on nutritional status.
In a study conducted at district Malir, Karachi, maximum malnutrition regarding

underweight (62.63%) and stunting (48.99%) was seen in children whose fathers were
illiterate and maximum wasting (38.46%) was seen in children of fathers who could only
read and write (Ali and Haider, 2005).
Table XIV
Socioeconomic Profile of Parents of Selected Children
Father (n=706) Mother (n=715)

Details
Number Percent Number Percent
Level of Education
Graduate or post graduate 87 12.3 51 7.1
Intermediate or post high school diploma 115 16.3 105 14.7
High school certificate 150 21.3 190 26.6
Middle school certificate 159 22.5 185 25.9
Primary school certificate 133 18.8 132 18.5
Illiterate 62 8.8 52 7.2
Total 706 100 715 100
Occupation
Semi profession 92 13.0 29 4.1
Clerical, Shop owner, Farmer 167 23.7 79 11.0
Skilled Worker 40 5.7 84 11.8
Semiskilled Worker 83 11.8 79 11.0
Unskilled Worker 282 39.9 208 29.1
Unemployed 42 5.9 236 33.0
Total 706 100 715 100
Income
Rs. -16020-32049 215 30.5 07 1.0
Rs.12020-16019 126 17.8 69 9.7
Rs.8010 – 12019 80 11.3 94 13.1
Rs. 4810-8009 88 12.5 115 16.1
Rs.1601 – 4809 73 10.3 61 8.5
≤ Rs.1600 124 17.6 369 51.6
Total 706 100 715 100
The socioeconomic profile of 715 mothers and 706 fathers of the selected children
were available.
In our study 12% of the fathers and seven per cent of the mothers of the selected
children had obtained their graduation. Nearly nine per cent of the fathers and seven per
cent of the mothers were illiterates.
With regard to the occupation details it was observed that the highest number of
the fathers of the children in the study was employed as unskilled labourers. One third of
the mothers of the children were unemployed.
The classification of the income was done according to Kumar et al., 2013 which
shows that 18% of fathers and half of the mothers of the children had a monthly income
of ≤ Rs.1600.The higher number of mothers in the lowest income category may be
attributed to the low educational background.
The nutrition status in relation to factors like fathers’ education, mothers’

education and income of the family was analysed among 700 children of different age
groups ranging from 6 to 11 years drawn from different schools of Patna by Kumari.K
(2007). The results supported the fact that educated parents look after their children
better. Data show that the maximum number of normal children was found in this
category. Children of illiterate, primary educated or under-graduate mothers suffered
from severe malnutrition (Grade II and Grade III category. In case of illiterate, primary
educated and undergraduate mothers, the percentage of grade III and II malnutrition 273
showed higher incidence. But in contrast malnutrition was almost nil in families where
mothers possessed technical or post-graduate qualification. The study concluded that
sound educational status was a vital factor in maintaining the nutritional status of the
family. The result also showed that the higher the economic status, the lower the
percentage of malnutrition and vice-versa.
The results of the present study also show that the children come from low
socioeconomic status with low education of parents which will influence the nutrition
status and cognition of the children
4.1.3. Family Details

Socioeconomic Status
The socio economic status (SES) is an important determinant of health, nutritional
status, mortality and morbidity of an individual. SES also influences the accessibility,
affordability, acceptability and actual utilization of available health facilities (Agarwal et

al., 2005). All community-based studies focus on socio-economic stratification, as this is
the key to understanding nutrition security (Dudala, 2013).
Almost all community- based studies focus on socio-economic stratification, which

is the key parameter for proper understanding the affordability of the community of
health services, amenities and their purchasing capacity. When it is taken as a summation
of education, occupation and income, it reflects the value system expected for that level
of education and occupation (Kumar et al., 2013).
To get a better idea of the socioeconomic status of the families of the children
selected the socioeconomic classification given by Revised Kuppuswamy’s Socio-Economic
Status Scale given by Kumar et al., (2013) was used. The scale takes into account the
education, occupation and monthly income of the family into account. Among the 720
children selected for the study 29 belonged to lower socioeconomic class as the score
obtained was less than 5.One hundred and eighty five of the families obtained as score of
in between 5 and 10 which shows that they belong to Lower/Upper lower (5-10) class. The
highest number of children belonged to Middle/Lower middle as the score obtained was
between 10 and 15.
4%
24%
26%
Lower
Lower/Upper lower
Middle/Lower middle
Upper middle
46%
Fig. 8 Distribution of the Families of the Selected Children according to

Kuppusamy (2012) Scale
Religion and Family Type of the Children

Religion
Religion in India is characterized by a diversity of religious beliefs and practices.

According to the 2011 census, 79.8% of the population of India practices Hinduism and
14.2% adheres to Islam, while the remaining 7.37% adheres to other religions
(Christianity, Sikhism, Buddhism, Jainism and various indigenous ethnically-bound faiths
( Census of India,2011). The food habits and customs vary from one religion to the other
which may have an impact on the nutrition status of the children.
Table XV
Religion and Family Type of the Children
n=720
Particulars Total
Number Per centage
Religion
Hindu 537 74.58
Christian 127 17.64
Muslim 56 7.78
Total 720 100
Family Type
Joint Family 164 22.78
Nuclear Family 556 77.22
Total 720 100
A similar trend was noted in our study also with regard to the religion with around
75% of the children belonging to Hinduism.
On the basis of size or structure and the depth of generations’ family can be
classified into two main types as Nuclear or the single unit family and Joint family in India.
Historically, the traditional, ideal and desired family in India is the joint family. With the
advent of urbanization and modernization, younger generations are turning away from
the joint family form. Some scholars specify that the modified extended family has
replaced the traditional joint family. Among the children selected for the study majority
(77.22%) came from nuclear families.
In a study by Choudhary et al., ( 2008 ) it was concluded that with increasing level
of highest education in the family significant (p<0.01) decline in under-nutrition was
noticed among study subjects. Under-nutrition was to the extent of 86.10% in subjects
either illiterate or just literate; corresponding value for subjects with education primary
and middle, and high school and above were 64.04% and 45.0% (p<0.001).There existed
significant (p<0.001) difference in nutritional status of adolescent girls with varying level of
father’s education. As much as 66.67% and 41.67% subjects with father’s education high
school plus intermediate, and graduate and above, respectively were under-nourished;
corresponding values for subjects with father’s education as illiterate plus just literate and
high school plus intermediate were 73.3% and 78.08%, respectively. Extent of under-
nutrition in subjects with main occupation of the family as agriculture, service and labour
was 64.52%, 73.68% and 79.45%, respectively; being least 53.19% in subjects with main
occupation of the family as business. (p < 0.05). Maximum (82.54%) under nutrition was
observed in subjects belonging to lower SES, followed in middle (69.92%) and then in the
high (54.05%) Socio Economic Scale.
Generally joint families are headed by oldest person of the family having
traditional outlook restricting them to adopt modern culture technique and living
practices. On the other hand the new generation adopts these culture and practices very
easily to pace with the modernization and western culture. These reasons have
significantly affected increase of nuclear families (Mishra and Singh, 2006)
4.1.4. Nutritional Profile
School children constitute a major segment of the community whose health and
nutritional status will indicate the changing trend of nutritional profile of a region. They
are the inheritors of our past and seeds of our future. The main nutritional problems
facing the school children include growth retardation, stunting, underweight, Anaemia
and vitamin-A deficiency (Department of Women and Child Development, 2007). Nutrition
is a core pillar of human development and concrete large scale programming not only can
reduce the burden of under nutrition and deprivation but also advances the progress of
nations.
Body weights and heights of children reflect their state of health, nutrition and
growth rate, while weights and heights of adults represent what can be attained by an
individual with normal growth. The results of the nutrition status assessment of the
selected children are presented in the following tables.
i. Anthropometric Parameters
The physical growth of children is reflected by different anthropometric

measurements especially weight and height. The physical dimensions of the body are
much influenced by nutrition in growing period of school age. Poor health and nutritional
status will affect work capacity as well as cognitive functions. This age group is a dynamic
period of growth and development as children undergo physical, mental, emotional and
social changes. Hence, it is necessary to assess the nutritional status of this demographic
group (Bharati et al., 2005).
Height
Height and weight are the most commonly used indicators of the nutritional status
of a child. There is sufficiently evidence to show that poor growth and smaller size in
school children is associated with impaired development, and a number of studies have
demonstrated a relationship between growth status and school performance or
intelligence (Grantham - McGregor et al., 1991). Complex environmental, socio-cultural
and economic factors affect both growth and development.
Table XVI
Mean Height of Selected Children
n=720
Age ICMR Mean Std. Mean
Gender t NS/S
(yr) (cm) (cm) Deviation Difference
Boys 124.3 118.42 4.76 13.76 5.882 S**
7
Girls 123.6 117.83 3.70 14.12 5.774 S**
Boys 130.1 121.30 5.23 15.97 8.800 S**
8
Girls 129.2 122.38 3.93 22.22 6.819 S**
Boys 134.6 128.06 5.27 15.10 6.536 S**
9
Girls 135.0 125.81 4.46 21.80 9.186 S**
**Significant at 5% level
Table XIV gives the mean height of the selected children. It is seen that the mean
height of all the three age groups selected were less than the re
reference
ference value given by
ICMR (2010)) for their respective age category. On comparison of the mean height of the
children with the ICMR standard value given for the respective age shows a significant
difference (5% level) for all the three age groups for both the genders.
140
135
130
Height (Cm)
125 WHO
120
ICMR
115
110 MEAN
105
Boys Girls Boys Girls Boys Girls
7 8 9
Age (Yrs)
Fig. 9 Comparison of Mean Height with Reference Values

Value
The above gives the mean height of the selected children and the reference values
for height for the 7 to 9 year old children given by WHO (2007)and
and ICMR (2010). It is seen
that the mean height of all the age groups were less than both the reference values.
value
In a study conducted by Murugkar et al., 2013 among the 6-9

9 year school going
children in rural area of Bhopal it was found out that the height and weight obtained for
each age group was found to be significantly (p
(p≤0.05)
≤0.05) less than the reference value.
The z-score,
score, which indicates the deviation of an individual from reference population, was
more for height and weight of 8 year old boys followed by height of 7 years old girls.
The results of the present study are in accordance with the findings of the above stated
study.
Srivastava et al., (2012) conducted a cross-sectional study among school-age in

urban slums of Bareilly, Uttar-Pradesh (UP), India showed that the mean height of boys
and girls of the study group was lower than the CDC 2000 standards in all age groups.
Weight
Changes in body weight are an important indicator of nutritional status, being

underweight or overweight adversely influences mortality and morbidity. The changing
life style of children with reduced exercise pattern and inclusion of a variety of processed
foods will definitely have an impact on their body weight.
Table XVII
Mean Body Weight of Selected Children
n=720
Age ICMR Mean Std. Mean
Gender t NS/S
(yr) (kg) (kg) Deviation Difference
Boys 22.7 19.47 2.67 13.485 3.229 S**
7
Girls 22.3 19.30 2.32 11.693 3.001 S**
Boys 25.2 22.16 4.12 6.994 3.035 S**
8
Girls 25.0 21.59 2.81 15.550 3.412 S**
Boys 28.0 24.85 4.86 7.885 3.151 S**
9
Girls 27.6 23.81 3.11 12.879 3.789 S**
The above table gives the mean weight of the children involved in the study and
the reference weight given by ICMR (2010). The mean height of 8 year old boys and girls
was 22.2 kg and 21.6 kg respectively which are three kilograms less than the reference
weight. The mean height of both and girls in all the age group selected were less than the
reference weights. The weight of girls was less than the weight of the boys of the
particular age. There was a significant different in the mean weight of all the three age
groups of school children studied when compared with the reference values which may be
attributed to low socioeconomic status and lack of adequate nutrition.
The results of the study conducted by Hunshal and co-workers 2010 indicated that
there was 2.75 Kg increase in weight between 10-11 years, 0.5 kg between 11-12 years
and 6.54 kg in weight between 12

12-13
13 years. There was increase in weight of girls as
compared
d to boys which was observed between 12
12-13
13 years. This could attribute to early
beginning of pubertal growth spurt in girls than boys. However, the mean weight of girls of
entire age group was significantly below (50th percentile)
ile) of NCHS and ICMR standards
standard
except at the age of 13 years. Surprisingly, the mean weight of girls of entire age group
was also below ICAR norms. This might be attributed to poor nutrition of girls. The results
of the present study are in line with the above quoted study.
30
25
Weight (Kg)
20
15 MEAN
10 ICMR
5 WHO
0
7 8 9
Age (Years)
Fig. 10 Comparison of Mean Weight with Reference Values
The comparison of the mean weight of the 720 children with the Reference weight
for their particular age shows a lesser value in all the age groups in both the genders. The
low socioeconomic status may have limited the access to quality food in the children
which has caused a decrease in their weight.
Body Mass Index
Body Mass Index is a useful clinical calculation to diagnose the imbalances of

nutrition adequacy namely underweight and over nutrition. It is most
m often used to
diagnose obesity, but it is equally applicable to defining those who are underweight. So it
is used across heights and gender.
Table XVIII
Mean Body Mass Index of Selected Children
n=720
Age Gende Std. Mean

ICMR Mean t NS/S
(yr) r Deviation Difference
Boys 14.7 13.84 1.25 7.701 0.861 S**

7
Girls 14.6 13.87 1.29 5.142 0.732 S**
Boys 14.9 14.95 2.13 0.206 0.046 NS
8
Girls 15.0 14.37 1.34 5.975 0.625 S**
Boys 15.5 15.19 1.80 2.111 0.313 S**

9
Girls 15.1 15.04 1.72 0.396 0.064 S**
NS-Not Significant, **Significant at 5% level
Body Mass Index which is an important anthropometric parameter is presented in

the above table. The mean BMI of 7 year old boys’ was 13.84 as against their standard
value of 14.7given by ICMR, 2010. It was striking to note that the mean BMI both 8 year
boys and 9 years girls were almost the same as that of the standard BMI for their
respective age. The was a significant difference in the BMI value of 8Year old boys and
girls which may be attributed to the early growth spurt seen in girls.
The prevalence of thinness and overweight among rural school children and
adolescents in Midnapore was undertaken by Das and co workers (2015). It is clear that
overall girls were heavier than boys except for ages (6, 7, 8, 11, 12 and 13) in years. It is
also clear that girls were taller than boys except for ages 7, 8, 9, 11, 14 and 16 years. There
were significant age differences in weight, height and BMI (p< 0.001) of the studied
population. A similar trend was seen in the present study also.
The Mean BMI of the children in the present study was compared with the
standard BMI given by WHO and ICMR in an attempt to see the level of thinness in the
children. It is found that the mean BMI was less in all the categories compared. The
difference was more in the 7 year boys and girls.
17
Body Mass Index 16
15
14 MEAN
13 ICMR
WHO
12
7 8 9
Age (Years)
Fig. 11 Comparison of Body Mass Index with Reference Values

Value
Prevalence of Underweight
The prevalence of underweight was categorised according to the Body Mass Index
given by ICMR, 2010. The individual values of the children were compared with the
standard to identify underweight and the WHO (200
(2007) criteria of < - 2 WAZ (Z-score
(Z for
weight-for
for age) was used to identify underweight.
In a study conducted by Kamath et al.,

., (2012) a total of 1630 students from
11 schools of Mangalore comprised the study sample. There were 1501 males (49.1%) and
1554 (50.9%) females. The maximum number of students were from class VII (398; 24.4%),
and the least number of students were from in class III (259; 15.9%). Undernourishment
was seen in 82 (5.03%) children, while overweight and obesity were seen in 37(2.3%) and
16 (1%) of the students, respectively. Undernourishment was more common in boys
(6.87%) than in girls (3.12%).
12%).
A observational cross sectional study of 484 children of age group 6-12

6 years,
studying in Mandya district, Karnataka was carried out by Shivaprakash and Joseph
2014.The overall prevalence of underweight in the studied school children was 30.3%
(147)) . The prevalence of underweight in boys was 32.3% (82) and in the girls, it was
28.3% (65). The prevalence of underweight was more among boys compared to girls
(32.3% vs 28.3%). Among the boys underweight was seen more commonly in the age
group 6-7 years (44.4%) and among girls in 11-12 year age group (34.1%).
TABLE XIX
Prevalence of Underweight with reference to ICMR and WHO standards
n=720
Age Mean Boys Mean Girls Total

Standard
(Years) (Kg) Number % (Kg) Number % Number %
ICMR 22.7 106 85.48 22.3 67 81.71 173 83.98
7
WHO 18.6 31 25.00 17.6 9 10.98 40 19.42
ICMR 25.2 48 53.33 25.0 149 90.85 197 77.56
8
WHO 20.4 20 22.22 19.6 21 12.80 41 16.14
ICMR 28.0 99 66.89 27.6 73 65.18 172 66.15
9
WHO 22.2 25 16.89 22.0 11 9.82 36 13.85
ICMR 253 69.89 ICMR 289 80.73 542 75.28
Total
WHO 76 20.99 WHO 41 11.45 117 16.25
TH
(ICMR, 2010 -95 Percentile &WHO, 2007- Underweight : < - 2 WAZ (Z-score for weight-for age)
The Body mass index given by ICMR (2010) was compared with individual BMI
values of the children to find out the level of under nutrition. The prevalence rate was
calculated by finding the number of children with less weight to the total number of
children in the particular age group. The percentage of boys with less than the reference
BMI value for their age was 69.89%. The under nutrition was high in girls than boys which
was 80.73%. Seventy five per cent of the children who participated in the study had a BMI
less than the reference BMI given by ICMR (2010) for their age indicating under nutrition.
It was saddening to note the prevalence of under nutrition was high in all groups in both
the genders. When the BMI of the samples was compared with WHO standards it was
found out that highest percentage (25) of underweight was seen among 7 years boys. In
the boys it is noted the prevalence of underweight decreases with increase in age. In the
girls the lowest prevalence of underweight was seen in 8 years which was 13.85%.When
the two genders are compared it is observed the prevalence of underweight based on the
WHO standards was slightly higher (20.99%) than the girls (16.25%).
According to WHO (2009) report on global health risks the leading risk factor for
low-income countries (gross national income per capita of US$825 or less) is underweight,
which represents about 10% of the total disease burden. In combination, childhood
underweight, micronutrient deficiencies (iron, vitamin A and zinc) and suboptimal
breastfeeding cause seven percent of deaths and 10% of total disease burden. The
combined burden from these nutritional risks is almost equivalent to the entire disease
and injury burden of high-income countries. The findings of our study corroborates with
the report by World Health Organisation.
A study conducted by Patel et al.,( 2015) in Ahmedabad city in western India

among 5-13 years of school children that a total 8319 (29.44%) children were found
underweight, in which 4041 (26.8%) were boys and 4278 (32.5%) were girls. 72.3% boys
between the ages of 5 and 13 years were healthy (BMI between 5 and <85th percentiles);
26.8% were underweight (BMI <5th percentile), 0.8% were overweight (BMI between
85th and <95thpercentile) and only 0.01% were obese (BMI ≥95th percentile). While 66.9%
girls between the ages of 5 and 13 years were healthy; 32.5% were underweight and only
0.6% were overweight Prevalence of overweight (>85th percentile) was 0.76% (0.8% boys
and 0.6% girls). No significant difference was observed between the genders distributions
in over-weight children however under nutrition was more pronounced in girls. The results
of the present investigation are on par with the above mentioned study.
Prevalence of Stunting
Stunting is a good long-term indicator of the nutritional status of a population

because it does not vary appreciably by the season of data collection or other short-term
factors, such as epidemic illnesses, acute food shortages, or shifts in economic conditions
(Arnold, et al., 2009). Stunting (low height for age), appeared to be a persistent
phenomena beyond the third year of life among rural children and it had the significant
impact at 10+ years of age. Majority of rural children enter adolescence with poor
nutritional status (Rao, 2001). The WHO (2007) cut off of < - 2 HAZ (Z-score for height-
for age) was used to identify stunting in the selected population.
Table XX
Prevalence of Stunting with reference to WHO standards
(Number and percentage below standard)
n=720
Boys Girls Total

Age
(Years) WHO Standard Standard
No % No % Number %
(Cm) (Cm)
7 113.6 5 4.03 112.4 0 0.00 5 2.43
8 118.3 14 15.56 117.6 4 2.44 18 7.09
9 122.8 12 8.11 123 9 8.04 21 8.08
Total 31 8.56 Total 13 3.63 44 6.11
(WHO, 2007-Stunting : < - 2 HAZ (Z-score for height-for age)
The above table gives prevalence of stunting in selected children. The prevalence
of stunting was highest in 8 year old boys with 15.66%. Among the girls eight per cent of
the 9 year old girls had stunted growth. Thirty one and 13 girls of 9 year old children were
stunted in the population studied. The percentage of stunting was slightly higher in boys
than in girls.
A cross-sectional study conducted by Srivastava et al., (2012) among school-age

slum children 5 to 15 years old, in urban slums of Bareilly (UP), India showed that the
mean height and weight of boys and girls in the study group was lower than the CDC 2000
(Centre for Disease Control and Prevention) standards in all age groups. Regarding
nutritional status, prevalence of stunting and underweight was highest in age group 11 yrs
to 13 yrs whereas prevalence of wasting was highest in age group 5 yrs to 7 yrs. Among
boys, 30.7% and 18.1% belonged to wasted and stunted nutritional status. 16.1% of girls
belonged to stunted nutritional status indicating higher prevalence of long duration
malnutrition among girls. Overall 33.3% of children were wasted whereas 18.5% were
stunted and 46.8% were in normal nutritional status. The nutritional status was positively
correlated to age indicating poor nutritional status of younger children. No significant
association was found between gender and nutritional status of children. The results
highlighted the higher prevalence of malnutrition among younger children; therefore,
younger age groups should be the main target for nutritional surveillance and
interventions.
In an attempt to assess the health and nutritional status of school children those
participate mid day meal of school a study was conducted in three government schools of
Burdwan district in West Bengal state. The overall prevalence of underweight was 40.23%
(173), thinness 55.11% (237) and stunting was 19.76% (85). According to the study 40%
boys and 30% girls are stunted on the basis of WHO standard (Pramanik et al., 2015).
Childhood stunting is one of the most significant impediments to human

development, globally affecting approximately 162 million children under the age of five
years. Stunting, or being too short for one’s age, is defined as a height that is more than
two standard deviations below the World Health Organization (WHO) recommended child
Growth Standards median 0 (World Health Organization, 2014).
Prevalence of Thinness
Thinness i.e. low BMI for age is one of the biggest problems of children residing in
rural or tribal areas in our country then their urban counterparts (Das et al., 2012).
The overall prevalence of thinness (thin+ severely thin) among 350 school-age
children in Aligarh showed that the prevalence of thinness among children of non
working and working mothers was 91.9% and 57.5% respectively. There was highly
significant association between mothers working status and BMI for age of school-going
children (Sultan, 2014).
An attempt was made to find the prevalence of under-nutrition among school

children in 4 – 14 year age group and the role of socio-demographic characteristics of
mother on child nutrition. A total of 786 students were randomly selected from six schools
in the study area and nutritional status of the children was assessed by anthropometric
measurements. Among 786 students, 26% of the students were found to be
undernourished and 13% stunted, 12% wasted and only 1% both stunted and wasted. The
study showed highly significant association (p<0.005) of maternal factors like literacy,
occupation, diet knowledge and monthly per-capita income respectively with child
nutrition (Joshi et al., 2011).
Table XXI
Prevalence of Thinness with reference to WHO standards
(Number and percentage below standard)
n=720
Boys Girls Total

Age WHO
(Years) No % Standard No % Number %
Standard
7 13.2 30 24.19 12.8 14 17.07 44 21.36
8 13.4 18 20.00 13.0 22 13.41 40 15.75
9 13.6 22 14.86 13.3 10 8.93 32 12.31
Total 70 19.34 Total 46 12.85 116 16.11
WHO, 2007 - Thinness : < - 2 BMIZ (Z-score for BMI-for-age)
Table XXI gives the prevalence of thinness in selected children. A total of around 16
per cent of the children had a BMI value of less than -2SD as given by WHO. It is noted that
the percentage of thinness decreased with increase in age in both girls and boys. A total of
30 boys and 14 girls in the age group of 7 years were stated to be thin. The prevalence of
thinness was slightly higher in boys than in girls.
A study was conducted by Kapil and Sethi (2004) among 6-9 year old children in
Delhi. A total of 471 (48.7%) boys and 495 (51.2%) girls were included in the study. The per
cent of children underweight, stunted, and wasted were 52.5, 45.1 and 11.1%,
respectively. It was observed that 9.7, 15.3, and 2.8% of the children were severely (< 3SD)
underweight, stunted, and wasted, respectively. The prevalence of underweight and
stunting was significantly higher in boys as compared to girls.
CLINICAL EXAMINATION
Physical signs and symptoms exhibited can be used as effective tools in detecting
nutritional deficiencies. Some of the symptoms include delayed growth, pallor of the skin,
oedema, bleeding gums, mucous membranes of the mouth and eyes, nail beds or palm
surfaces
Table XXII
Clinical Profile of the selected children
n=720
S. No Organ Clinical symptom Number of Subjects Percentage (%)
Lack of lustre 273 37.91
1 Hair Thinness 130 18.05
Brittle/ easy pluck ability 82 11.39
Dry skin 63 8.75
2 Skin/face Pigmentation 25 3.47
Pallor 92 12.78
Angular cheliosis 122 16.94

3 Lips
Angular stomatitis 176 24.44
Pale and bloated 27 3.75

Tongue
4
Inflamed and oedematous 43 5.97
Ulcerated 42 5.83
Discoloured/ Mottled enamel 116 16.11

Teeth
5
Dental caries 202 28.05
Spongy bleeding gums 86 11.94
The findings of the clinical assessment among the school children show that 37% of
the children had lack of lustre. Thinness of hair was a problem in 130 children. Around
17% of the children had angular chelosis and another 245 of the children had angular
stomatitis indicating Vitamin B complex deficiency. Dental caries was one of the most
common problems noted in the children. The results indicate the magnitude of
micronutrient deficiency seen in the study population.
Dietary Assessment
A 24 hour dietary recall was conducted for a subsample of 50 children to find out
the actual intake of nutrients. For the 24
24-hour
hour dietary recall, the respondent is asked to
remember and report alll the foods and beverages consumed in the preceding 24 hours or
in the preceding day. To complete a dietary record, the respondent must be trained in the
level of detail required to adequately describe the foods and amounts consumed and
portion sizes. The help of the parents were sought to collect the information in our study.
Adequate dietary intake is of vital importance to children’s growth and

development, not only in physiological terms but also mental and behavioral aspects. Both
excessive and inadequate intake of energy or nutrients may have detrimental influence on
children’s health and predisposes to diet
diet-related
related diseases, such as hypertension,
atherosclerosis, obesity, osteoporosis and type 2 diabetes later in life
li (Merkiel and
Chalcarz , 2007).
Type of Diet
Nutritional status of the children solely depends on food habit of the children.
Protein is very much essential for the construction and repair of tissues and ultimately
physical and mental growth of the children. Animal proteins have been considered better
than the vegetable proteins (Mishra and Singh, 2006).
In India based upon the religious beliefs the food habits change. Around one fourth
of the children (28.61%) were in the habit of consuming vegetari
vegetarian
an diet. A small (7) per
cent of the children were including egg. More than half of the children were consuming
non vegetarian foods.
Similar results were found in the study carried out by Mishra and Singh (2006) in
which 63% of the children were non veget
vegetarians.
arians. It further showed that majority of the
children aged 7 to 9 years were habituated to consuming non
non-vegetarian
vegetarian diets (65.67%)
than their counterparts’ children in 4 to 6 years age group (50.00%). The consumption of
non-vegetarian
vegetarian diet was irregular (60.33%) due to poor economic status and non-
non
availability of these diets. There was significant association between age and food habit of
the children.
Table XXIII
Mean Daily Nutrient intake of 8 year Old Girls
n=50
RDA Mean Daily

S.No Nutrient (ICMR, 2010) intakes Std dev t value S/NS
1 Energy(kcal) 1690 1199.00 155.17 22.374 S**
2 Protein(g) 29.5 23.00 2.83 17.108 S**
3 Fat(g) 30 22.00 2.59 22.001 S**
4 Iron(mg) 16 10.42 1.79 22.061 S**
5 Calcium(mg) 600 316.70 66.11 30.303 S**
6 Zinc(mg) 8 5.46 0.86 21.009 S**
7 Retinol(µg) 600 277.42 53.29 42.801 S**

**Significant at 5% level,
Energy
The energy intake of the selected school going children was 1199 kcal which was
only 70% of the RDA given by ICMR, 2010.The findings of the study by Sati and Dahiya
(2013) showed that the energy intake of school children only 56.66 % of RDA. Similar
results were found by Hakeem et al. (2002) in rural Pakisthani children. Mitra et al. (2007)
also observed that energy intake of school children was low when compared with RDA.
Similarly, children of Varanasi district received inadequate energy (73% of RDA) as
investigated by Mishra and Tiwari (2007). The results of our study corroborates with the
earlier studies quoted here. The inadequacy in energy intake can be due to low purchasing
power of the family and also due to lack of nutrition awareness.
100
80
60
Percentage
40
20
0
Energy Protein Fat Iron Calcium Zinc Retinol
Nutrients
Fig. 12 Mean Daily Nutrient Intake as per cent of RDA (n=50)
Protein
On computation of the protein intake of the children it was found that they were
having a mean protein intake of 23 gm as against their RDA of 29 gm. The deficit in protein
intake was 13%. Handa et al. (2008) studied that the protein intake of school going
children of Allahabad district which showed that it was only 30.17g/day. Similarly a study
by Agrahar-Murugkar, 2005 among Khasi girls (7-9Y) of Meghalya showed a lower protein
intake of 33.48g.The studies clearly state the condition of protein intake in various parts of
India. The fewer amounts of protein and energy has hampered the growth of the children
as seen in tables (XVI- XXI)
Iron
The intake of iron was only 10.42 mg as against their recommended intake of
16mg. The intake was only 65%. Hakeem et al. (2002) assessed and reported that the
Mean intake of iron was 28.6% in the diet of Pakistani school children was which was
significantly lower than RDA. Iron intake of school children was found to be significantly
(P≤0.01) lower than the recommended intake among children by Sati and Dahiya (2013).
The occurrence of anaemia and prevention of the problems associated with it can be
reduced by inclusion of iron rich foods.
Zinc
The intake of zinc by the children was 5.46mg which was only 68% of the RDA
given by ICMR, 2010. A study by Handa et al., (2008) found that the zinc intake of 7 year
boys and girls was 4.84mg±1.46 and 5.19 mg±1.32 respectively. The intake of zinc by 8 and
9 year old girls was 5.75 mg±1.22 and 5.88mg±1.76. The intake of zinc by 8 and 9 year old
boys was 4.86 mg±1.27, 5.59 mg±1.79 respectively.
In a study by IIfeoma et al., (2011) the intake of iron was only 92% of DRI among
5 to 8 year old children which is similar to the intake of the children in the present study.
Vitamin A
The intake of calcium was only 52%.The retional content of their diets was only
227 µg.
Dietary record gives a clear intake of the nutrient intake of the selected children.
The intakes of all the nutrients were significantly lower when compared with the
reference value given by ICMR. The intake of the macronutrients was only around 75 % of
the recommendations. The intake of micronutrients was comparatively lesser. The data
shows that only 65.12% of iron and 68.25% of zinc recommendations were met by their
diet.
A study by among 7 to 9 year-old children of India [Nagpur] and Ethiopia

[Nekemte] show that the daily mean energy intake for children between the age group of
7-9 years was 1295.78 and 1291.66 Kcal / day which was 76.62 and 76.42 per cent of
RDA in Nagpur and Nekemte respectively. The mean daily intake of protein for children
was 25.03 and 24.02 which is lower than the daily ICMR Recommended Allowances of
29.5 g/ day (ICMR 2010). The deficit intake of calcium in Nagpur and Nekemte children
was -14 per cent and - 49.62 per cent. The daily mean intake of iron for children between
the age group of 7-9 years was 11.09 and 13.14 mg. i.e 69.31 and 82.12 per cent of RDI.
The mean daily intake of zinc for children between the age group of 7-9 years was found
to be 4.00 and 5.49 mg/day which was 50 and 68.62 in Nagpur and Nekemte respectively.
The deficit intake of β - carotene in Nagpur and Nekemte children was -93.67 per cent and
-89.42 per cent. Similar findings have been supported by other workers (Glynn et al., 2005;
Mitra et al., 2007) who reported that mean intake of most of nutrients was lower than
the RDA.
Calcium
The mean calcium intake of the children was 316.70mg /day which was only half of
the recommendations.
In a 556 healthy school children (adolescents 10 -18 yr of age) from New Delhi,
who were documented to have an calcium intake of 314 + 194 mg / day among low
socio-economic group children and 713 + 241 mg/day among high socio economic group
children (Marwaha et al., 2005).
Biochemical Examination
Haemoglobin is the most common and easy method of finding the iron status of an
individual. So the haemoglobin level of one hundred and fifty willing 8 year old girls was
estimated. Based on the results the children who were in the mild and moderate anaemic
state were selected for the intervention study.
Table XXIV
Distribution of children (8 years girls) according to Haemoglobin levels
n=150
WHO
S.No Degree of Anaemia Reference Number Percentage
Value (g/dL)
1 Normal >11.5 45 30.0
2 Mild 10.9 -11.4 56 37.3
3 Moderate 8.0-10.9 49 32.7
4 Severe <8.0 00 00.0
Total 150 100
The results show that among the 150 children who were analysed for the
haemoglobin content, 45 had a haemoglobin level of above 11.5 g/dl which indicates that
they are non anaemic. It is seen that 32.7% of the selected children were in moderate
anaemic state with a haemoglobin value between 10.9 to 11.4 g/dl. World Health
Organization (2011) guidelines were used as cut off points for screening anaemia. So the
prevalence of anaemia in the selected 150 eight year old girl children was 70%. For the
intervention study anaemic children who were willing to participate were selected.
A total of 900 children in the age group of 8-16 years were selected from
Kattankulathur in Tamil Nadu to assess the prevalence of anaemia. The results of the
study showed that 52.88% were anaemic; the prevalence of Anaemia in girls (67.77%) was
higher than in the boys (35.55%) ( Sudhagandhi et al., 2011). The result of the present
study corroborates with the findings of the above mentioned study. The high prevalence
of anaemia may be attributed to the low intake of food, economic status and ecological
conditions in which the children live.
Health Status
In developing countries, children and adults are vulnerable to malnutrition because

of low dietary intakes, infectious diseases, lack of appropriate care, and inequitable
distribution of food within the household. Children’s nutritional status is a reflection of
their overall health. When children have access to an adequate food supply, are not
exposed to repeated illness, and are well cared for, they reach their growth potential and
are considered well nourished (Ali and Raza, 2014).
The frequency of the incidence of minor ailments was collected in an attempt to

check the health status of the selected children.
Table XXV
Occurrence of Minor Ailments in the Selected Children
n=720
Frequent Incidence
S.No Disease condition
Present %
1 Stomach discomfort 232 32
2 Fever 167 23
3 Diarrhoea 102 14
4 Dysentery 14 1.94
5 Cold 316 43.89
6 Respiratory problems 124 17.2
7 Specific health problem if any 78 10.8
Total 720 100
The health status of the children is in a dismal state with 32% of the children
having more than two episodes of stomach discomfort in a period of one month. Fever
was common among 23 % of the children. Nearly half of the children experienced cold
more frequently.
The findings of the study carried out in Kedar, a village in Tamil Nadu by
Ananthakrishnan (2001) highlight that fever ("joram"), respiratory infections ("shali,
irumal"), abdominal pain ("vayathuvali") and headache ("thalaivali") were common
morbidities in school age children and that fever and respiratory infections were more
frequent during rainy season. Other morbidity that they considered common in children
was dental and skin problems. On probing further many people said that worm
infestation, Anaemia and angular stomatitis were also present in school age children.
People generally felt that children in primary school fell ill more often than older children
and that both girls and boys fell ill with similar frequency. Improvement of health and
hygienic condition will definitely lessen the health ailments seen among them.
Functional Consequences of Anaemia

Anaemic children are reported to exhibit poor attentiveness, poor memory, and
poor academic performance. They are often disruptive, irritable, and restless and show
behavioural abnormalities like lack of attention, fatigue, insecurity, and reduced learning
ability. Poor attention span, memory, and concentration, as well as concept acquisition
leading to poor school performance have been attributed to Anaemia during this phase of
critical learning. Recent studies have established the fact that Anaemia in school age
children is related to poor mental capabilities, lower IQ, lowered scholastic performance,
and behavioural modifications resulting in poor social interactions and other related
problems (Passi and Vir, 2001).
The help of the class teacher was taken to get the details of information pertaining
to the functional consequences of anaemia. Poor academic performance was the one of
the most common problem observed. The teachers also expressed that 25% of the
children had problem in concept acquisition. Frequent absenteeism was the main problem
noted among the children. These results suggest the need iron and zinc intervention which
may alleviate these symptoms.
Table XXVI
Functional Consequences of Anaemia
n=720
S.No Criteria Number Per cent
1 Poor attention span 68 9.44
2 Poor memory 85 11.80
3 Poor-academic performance 143 19.86
4 Disruptive 24 3.33
5 Irritable 38 5.28
6 Restless 44 6.11
7 Fatigue 125 17.36
8 Insecurity 32 4.44
9 Poor concept acquisition 18 25.00
10 Irregularity to school 226 31.38
Personal Hygiene
Hygienic practices have an important role to play in preventing infections. The
information on the personal hygiene of the children was collected in an attempt to
understand its role in health.
Table XXVII
Personal Hygiene
n=720
Number of subjects
S.No Personal Hygiene (Percentage)
Yes %
1 Bath regularly/daily 653 90.69
2 Brush teeth twice a day 156 21.67
Wash hands before and
3 680 94.40
after a meal
4 Clean and cut nails 321 44.58
5 Neat clothes 210 29.16
Most of the children who participated in the study had the habit of taking bath
daily. Only 29% of the children brushed their teeth twice in a day. There was awareness
among the children about the importance of washing the hands. More than half of the
children did not have clean and cut nails.
A School based cross-sectional survey was conducted among 450 schoolchildren

aged 7-14 years in Dale Woreda, southern Ethiopia which reported that children with
poor personal hygiene score were more likely to be stunted (Wolde et al., 2015).
A study among 261 boys and 285 girls studying in a rural school of Puducherry
showed that 40.3% of children had morbidities of various kinds related to nutrition, 20.9%
children had refractive errors, 30.9% had dental problems, 6.2% had skin disorders, 14.5%
children had pediculosis and 3.9% had history of worm infestations. The study concluded
that the most common morbidities among school children were related to nutrition and
personal hygiene. Regular school health programmes should focus to educate and
promote health among children. There is a definite need to explore the gap between
various national health programmes and health status of children (Joice, 2013).
The present study also yielded similar results as the referenced citied above. Stress
has to be given to impart knowledge among the children to reduce morbidities.
4.2 FORMULATION OF PRODUCT
Composite flours are either binary or ternary mixtures of flours from some other
crops with or without wheat flour. Composite flour is considered advantageous in
developing countries as it reduces the importation of wheat flour and encourages the use
of locally grown crops as flour (Hugo et al., 2000; Hasmadi et al., 2014).Cookies can serve
as vehicle for delivery of important nutrients if made readily available to the population
(Chinma and Gernah, 2007). Among ready-to-eat snacks, biscuits/cookies possess several
attractive features, including a wider consumption base, relatively long shelf life, greater
convenience and good eating quality (Hooda and Jood, 2005). Several studies have
reported the use of wheat-based composite flour in cookies production (Ajanaku et al.,
2011; Nasir et al.,2010; Onoja et al., 2010; Gernah et al., 2010; ). Cookies with high
nutritional and sensory properties have been produced from non-wheat-based composite
flour (Okpala and Okoli, 2011; ; Chinma et al., 2012).
4.2.1. Sensory analysis

Table XXVIII
Mean Sensory Scores of Cookies
Product Appearance Colour Flavour Texture Taste

CC 8.83±0.42 8.86±0.34 8.60±0.28 8.68±0.24 8.56±0.33
CFC I A 8.86±0.61 8.76±0.62 8.90±0.66 8.86±0.62 8.68±0.56
CFC I B 8.13±0.57 7.63±0.58 7.56±0.48 8.40±0.61 8.40±0.60
CFC I C 8.83±0.76 8.33±0.65 8.43±0.62 8.13±0.56 7.73±0.78
CFC I D 8.43±0.86 8.26±0.88 8.50±0.62 8.00±0.84 8.03±0.81
CFC II A 7.96±0.61 7.96±0.61 8.43±0.67 8.63±0.61 8.26 ±0.69
CFC II B 7.36±0.92 7.36±0.92 7.53±1.07 7.53±0.94 7.60± 1.03
CFC II C 7.43±0.89 7.29±1.73 7.16±1.20 7.20±0.98 7.36 ±1.15
CFC II D 7.06±1.11 7.96±0.61 6.90±1.18 6.96±0.99 7.06 ±1.26
CFC I (A-D) - Various Proportion of Composite Flour Cookies-I
CFC II (A-D) - Various Proportion of Composite Flour Cookies-II
The results of the sensory analysis show that the appearance of CFC I A cookies
was the highest with a score of 8.86±0.61. CFC II Cookies obtained the lowest score for the
criteria colour among the various cookies prepared. The taste of CFC I A was better than
the standard as it obtained a higher score than the standard. The acceptability of
composite mix I cookies was better than the composite mix II cookies in all the criteria.
The scores obtained for the composite mix IA cookies were on par with the values
obtained for the standard cookies. The cookies developed with 30% of little millet (CFC I A
and CFC II A) scored the highest in both the composite mix developed with regard to the
taste criteria. So these two cookies were selected for the feeding trail.
The results of a previous study carried out by Vijayakumar and Mohankumar

(2009) showed that the Millet flour blend prepared by mixing equal proportion of kodo
Millet flour and barnyard Millet flour improved the quality of composite flour in terms of
increasing nutrient density, thinned the gruel by lowering viscosity and increased in the
level of syneresis which may improve the resistant starch content on storage. The study
also showed that the Millet flour blend incorporation significantly modified the properties
of composite flour in such a way that it was found suitable for the preparation of pasta,
crackers, rusk, suji toast, biscuits, chapati etc. and not suitable for bread and cake
preparation
The mean sensory analysis scores of the present study also show that millets based
composite flour improved the quality of cookies which is in accordance with the above
mentioned study.
In both formulated composite flour cookies the variation with thirty percent Little
millet incorporation obtained the highest score in the sensory attributes. So CFC I A and
CFC II A was taken for the further study with the Standard (CC).
4.2.2. Nutrient Analysis
In our study two composite flour cookies were prepared by incorporating iron and
zinc rich components. To determine the nutritional contribution the cookies were
subjected to nutrient analysis. The results are summarised below.
Table XXIX
Nutrient Content of Cookies
S. No Nutrients Standard(CC) CFC I CFC II

1. Energy(Kcal) 485.00 517.0 541.0
2. Protein(g) 4.80 11.8 8.0
3. Fat(g 20.20 22.5 20.3
4. Carbohydrates(g) 53.70 68.8 67.8
5 Calcium (mg) 236.00 242.0 230.0
6. Iron(mg) 6. 80 15.8 12.2
7 Zinc(mg) 0.52 3.5 4.6
CFC IA=CFC I, CFC IIA=CFC II
The nutrient content of the cookies that scored the highest in sensory analysis and
the standard cookies were analysed. The energy content of 100g of the standard cookie
and the CFC I A and CFC II A was 485 kcal, 517 kcal and 540 kcal respectively. The protein
content was double and increased up to three times in CFC II A and CFC I A when
compared with the standard cookies. The iron content and zinc content of CFC IA and CFC
II A was 15.8 mg, 12.2 mg and 3.46 mg and 4.56 mg respectively.
In a study conducted by Sivakumar and Sarojini, (2013) Coconut meal available as

thin flakes was shade dried for 5-7 days and finally powdered using micropulverizer. Rice
flakes were powdered separately to a fine texture. By changing the proportion of the
ingredients, ten variations were finally selected for acceptability trials. Processing
improved the texture of the biscuits. The biscuits from the variation V with 20 g coconut
meal scored highest level (4.10±0.74). The general acceptability of the value added
biscuits were influenced by processing, the ratio of ingredients in the flour mixture and
organoleptic attributes of flavour, texture and colour. In terms of overall acceptability, the
panel list preferred the product of the variation V (4.05±0.74), this could be attributed to
the beneficial of processing which improved colour, flavour and texture of the products.
All the biscuits sample variation had acceptability scores expect variation VII due to
incorporation of garden cress seed at 2.5 g. The acceptability of the products, particularly
those from incorporation of high amount of deoiled coconut meal and rice flakes mixture
indicates possible opportunity for further use of the biscuits in confectionery products and
formulation of complementary foods. Iron content of the baked biscuits was about 14 mg,
in addition it provide 35 g of fat, 8.56 g of protein and 29 g of carbohydrate, totally 100 g
of value added biscuits provide 464 kcal energy.
Addition of the composite mixture improved the nutrient content of cookies as in

the present study as indicated by the above table. So it can be concluded that the results
of the present study shows similar result as that of the above mentioned study.
4.2.3. Shelf Life Study

Sensory analysis
The ASTM E2454 Standard (2005) defines sensory shelf life (SSL) as: “the time
period during which the products’ sensory characteristics and performance are as
intended by the manufacturer. The product is consumable or usable during this period,
providing the end-user with the intended sensory characteristics, performance, and
benefits.”
The best formulation from the two composite cookies along with the standard
were kept in airtight
tight containers and stored in room temperature. The Products were
evaluated to analyse the organoleptic qualities on storage.
10
8
Sensory Score
6 CC
4 CFC I
CFC II
2
0
1 15 30
Day of Storage
Fig. 13 Mean Sensory Score on Storage of Cookies
The initial overall mean score was 8.7.The CFCI and CFCII has a mean score of 7.81
and 7.53 at the stat of the study. It is seen from the above figure that there was decrease
in the sensory score during the storage study for a period of one month. However there
was no undesirable change.
Microbial Analysis of Cookies

Shelf-life studies can provide important information to product developers
enabling them to ensure that the consumer will see a high quality product for a significant
period of time after production. Bacteria need certain conditions for growth – namely
available moisture,
ture, the proper pH, the right temperature and nutrients and time. By
controlling these conditions one can prevent the growth of these organisms and extend
the shelf life. Once the product has been developed utilizing a combination of the proper
ingredients,
s, pH, water activity and microbiological inhibitors, its shelf life can be
determined in real time at the various temperatures, which may be encountered during
storage and distribution. The growth of yeasts, mold, spoilage and pathogenic bacteria,
etc., can
an be monitored by microbiological methods (Labuza, 2002).
Table XXX
Microbial Analysis of Cookies
Sample ID
S.No Day
Sample CFU Quality
1 CFCI Nil Satisfactory
2 I CFCII Nil Satisfactory
3 CC Nil Satisfactory
4 CFCI Nil Satisfactory
5 14 CFCII Nil Satisfactory
7 CFCI 1x103cfu/g Satisfactory
8 29 CFCII 2x103cfu/g Satisfactory
4 5
Satisfactory = S- <10 CFU per gram/mL; Marginal = M-< 10 CFU per gram/mL;
5
Unsatisfactory = US- Greater than or equal to 10 CFU per gram/mL; Potentially
Hazradous = PH
The total plate count on nutrient agar medium did not show any colonies for fresh
cookies before storage. The microbial analysis of the standard cookies and formulated
cookies CEM A I was found to be 1x103cfu/g and for CFM IIA was 2x103cfu/g after one
month of storage when the total bacterial count was estimated.
Nagi et al., 2012 studied the microbial quality of full fat cereal bran biscuits of
different cereal bran biscuits under ambient conditions. Oat bran biscuits had least
bacterial count (11.15x102 cfu g-1) whereas rice bran biscuits had maximum bacterial
count (21.68x102 cfu g-1).Microbiological studies indicated that the cereal bran biscuits
packaged in HDPE and laminates and placed at room temperature up to three months had
better stability as the microbial load remained within the permissible limits. According to
Indian standards, (BIS, 1986) - (3137), Specification for high-protein mixes for use as food
supplements and (IS: 7487) -Specification for protein-enriched biscuits total bacterial
count/g should not be more than 50,000 in high protein biscuits. So it can be stated that
the cookies had a shelf stability of one month.
4.3. INTERVENTION STUDY

An intervention study design was formed based on the base line study to improve
the nutrition status of the children with special reference to zinc and iron. Locally available
iron and zinc rich composite flours were formulated to explore the possibilities of these
foods in improving the nutrition status and cognition of children. The experimental group
children CFC I and CFCII were supplemented with 60 g of the CFCI and CFCII cookies
respectively which was sufficient to bridge the gap in their two micronutrients namely iron
and zinc. The control group children were given 60 g of the standard cookies. The
supplementation was carried out for a period of six months. Out of the 90 children
selected two children in CFC I group and one child in CFC two group could not complete
the study. The study is presented under the following headings
4.3.1. Anthropometric Indices

4.3.2. Biochemical Parameters
4.3.3. Cognition Scores
4.3.1. Anthropometric Indices
Anthropometry is the most common technique used to assess the nutrition status.
Anthropometry is the measurement of body parameters to indicate nutritional status.
Anthropometry can be used to measure an individual to determine the need for nutrition
intervention or to measure prevalence of malnutrition in a population. The parameters
that are used to assess growth and development in children include length, height, and
weight and weight-for-length. Individual measurements are usually compared to
reference standards on a growth chart.
Supplement-based approaches and food fortification have been the most

commonly used strategies for micronutrient deficiency control and have been successful
in several countries because they are relatively cost-effective, easy to deliver and have a
rapid impact. Food fortification programs have been more or less triumphant in the
control of certain micronutrient deficiencies, through salt iodization, because they can
provide the micronutrients inexpensively over a long time period (Grillenberger, 2006).
Impact on height
Null hypothesis 1: There is no favourable impact on the height increase of the selected
children on supplementation with the formulated micronutrient rich cookie in their
diet.
Growth is the progressive increase in the size of a child. The assessment of growth
and development is very helpful in finding out the state of nutrition and health status of a
child. The factors that have a direct impact on the growth includes inadequate nutrition
due to less intake of energy, protein and micronutrients which caused by illness, lack of
purchasing power, or food insecurity. The growth and development of children is
determined by genetic and environmental factors. The environmental factors, such as
adequate nutrition, facilitate the achievement of the genetic potential of growth and
development. Malnutrition and infections limit the growth potential of children. To
promote optimum growth, these environmental factors can be removed or minimized.
Once they are removed there is improvement in growth.
Zinc is known to play a critical role in cell growth, differentiation and

metabolism and deficiency in this micronutrient restricts childhood growth and
contributes significantly to morbidity and mortality in young children. Deficiency may
be common, especially in populations with low consumption of zinc-rich animal-source
foods and high intakes of foods rich in phytates, which inhibit zinc absorption. Mild to
moderate deficiency may increase the susceptibility to infections and growth
retardation. According to the study by Imdad and Bhutta (2011) A dose of 10 mg zinc
per day for 24 weeks led to a net a gain of 0.37 (±0.25) cm in height of children who
received zinc supplements compared to those who did not.
Table XXXI
Impact of Food based Intervention on the Height
(n=87)
Intervention Pre Post ‘t’

Parameter N df NS/S
Group Mean Std.Dev Mean Std.Dev Value
CFCI 28 122.5 5.8 126.4 5.5 28 22.997 S**
Height
CFCII 29 121.7 4.5 125.4 4.7 29 13.431 S**
(Cm)
CC 30 123.8 3.8 125.9 3.6 30 13.396 S**
**Significant at 5%level
There was a significant increase in the height of the children selected for the
intervention when the pre and post intervention height was compared in all the three
groups. There is a steady growth that takes place in the 7 to 9 year age group and the
study was conducted for six months period. So we observed an increase in all the three
groups.
Malnutrition among school-age children is due to inadequacies in one or more of

the three main preconditions for good nutrition: food, care and health. Children stunted at
school age are likely to have been exposed to poor nutrition since early childhood.
Interventions for school age children can supplement efforts to reduce levels of stunting
in the preschool years. A descriptive cross sectional design was used by
Mwaniki and Makokha (2013) to assess the nutrition status and associated risk factors of
children in selected public primary schools in Dagoretti Division, Nairobi. A total of 208
students aged 4–11years of both gender were randomly selected from four public primary
schools. Among the children surveyed, 24.5% were stunted, 14.9% underweight and 9.7%
were wasted. There were more boys than girls who were stunted.
Table XXXII
Comparison of Increase in Height (cm) of the three Different Intervention Groups
(n=87)
Sum of Degrees of Mean square
Source F statistic p-value
squares freedom
Treatment 59.0128 2 29.5064 32.2882 S**
S**Significant at 5%level
The p-value corresponding to the F-statistic of one-way ANOVA is lower than 0.05,
suggesting that the one or more treatments are significantly different.
Table XXXIII
Comparison of Increase in Height (cm) between the three Different Intervention Groups
(n=87)
Tukey HSD Tukey HSD Tukey HSD
Comparisons
Q statistic p-value inference
CFCI VS CFCII 1.6263 0.488 NS
CFC I VS CC 10.4891 0.001 S*
CFC IIVS CC 8.9294 0.001 S*
NS-Not Significant, S*Significant at 1%level
There was no significant difference between the mean heights when the mean
increases in height of children during intervention phase between CFC I and CFC II. So it is
proved that both the formulated iron and zinc rich cookies had an effect in improving the
t
weight of children. Further there was significant difference when the comparison was
made between CFC I VS CC and CFC I VS CC group. This confirms the efficacy of the
formulated cookies in improving the height of the children.
Subjects were 200 volunteer primary school children in Iran. Both case and control
groups comprised of 100 individuals each with 50 males and 50 females. Intervention
supplementation was zinc sulfate tablets (10 mg elemental) and placebo tablets for both
groups,
roups, administrated for a period of six months. The height, weight, height for age and
weight for age Z-scores
scores and Body Mass Index (BMI) were measured at 0, 2, 4, and 6
months. There was a significant increase in linear growth and weight amongst both male
and female of the case group compared to the control after six months of receiving zinc
sulfate tablets (10 mg elemental) (p<0.05). This study provides evidence of positive effect
of zinc supplementation on the growth of school children living in low socioeconomic
soci
suburbs (Vakhil et al., 2015))
4
Increase in Height (cm)
0
CFCI
CFCII
CC
Intervention Groups
Fig
Fig. 14 Impact of Intervention on Height
The increase in the mean height of the children gives a clear picture of the extent
of the treatment on the intervention groups.CFC I cookies brought a better improvement
in the height than the CFC II cookies. The CC cookies also improved the height of the
children to some extent.
According to the study by Ramesh et al.,(2013) to study the effect of spirulina

on anthropometric parameters and the bio-chemical parameters before and after its use
as nutritional supplement in 11 to 13 years girl children. Nearly 89% of girls
have significant weight gain after intake of spirulina. There existed a significant increase in
height difference of >1.5cms in 87 children and borderline increase in BMI. The
finding of our study also shows an increase in height similar to the findings of the quoted
study.
The results of the intervention on the anthropometric values showed a significant

increase in the anthropometric parameters when the initial and final values after the
intervention was evaluated. There was an increase a twofold increase in the mean height
of the CFC I and CFC II Group children when compared with the mean value of CC group
children.
Conclusion: In this regard, interventions to improve the height of the children

had significant difference in the groups given the formulated micro-nutrient rich
cookies. Therefore the null hypothesis 1 is rejected and we conclude that the formulated
cookies were effective.
Impact on weight
Null hypothesis 2: The supplementation of the formulated micro-nutrient rich cookies

will not have any impact on the weight increase of the children.
Growth monitoring is universally used to assess nutritional status, health

and development of individual children, and also to estimate overall nutritional status and
health of populations. Compared to other health assessment tools, measuring
child growth is a relatively inexpensive, easy to perform and non-invasive process.
Table XXXIV
Impact of Food based Intervention on the Weight
(n=87)
Pre Post
Intervention ‘t’
Parameter N df NS/S
CFCI 28 21.6 3.6 24.6 3.6 28 18.450 S**

Weight
CFCII 29 21.7 2.9 25.0 2.9 29 27.964 S**
(Kg)
CC 30 23.3 2.7 25.4 2.8 30 20.038 S**
The mean weight of the children in three intervention groups shows a significant
increase which may be ascribed to the provision of the cookies. The mean value of CFC I
group prior to the intervention study was 21.6kg which increased to 24.6kg after the
intervention study. Similarly the increase was from 21.7kg to 25 kg for CFC II group.
A cluster, randomized trial with children ages 3-13 y (n = 1167) was conducted in
the north of Haiti. Six schools were matched and randomized to the control group, Tablet
Yo group (42 g, 165 kcal), or Mamba group (50 g, 260 kcal, and >75% of the RDA for critical
micronutrients). Children in the supplementation groups received the snack daily for
100 days. At baseline, 14.0% of children were stunted, 14.5% underweight, 9.1% thin, and
73% anemic. Mamba supplementation increased body mass index z score (regression
coefficient ± SEE) 0.25 ± 0.06, fat mass 0.45 ± 0.14 kg, and percentage fat mass
1.28% ± 0.27% compared with control at each time point (P < 0.001) (Iannotti, 2015).
Grillenberger et al., (2003) evaluated the growth of 544 Kenyan schoolchildren

(median age 7.1 y) after 23 mo of food supplementation with a meat, milk or energy
supplement (1255 kJ) and compared to a control group without a supplement. For
children with a higher baseline HAZ (above the median of −1.4), no disknct diﬀerences
among any of the groups could be seen, but for children with a baseline HAZ below the
median, the Milk-supplemented children gained 1.3 cm (15%) more height than the
children in the Control group (p = 0.05) and 1 cm (11%) more height than those in the
Meat group (p = 0.09). For change in HAZ, no pronounced supplementation effects were
seen.
Increase in Weight (Kg)

4
0
CFCI CFCII CC
Intervention Groups
Fig
Fig. 15 Impact of Intervention on Weight
The above figure gives the mean increment in weigh of the children in the
intervention groups during the intervention period. We could see the highest increment in
the CFC
C II group followed by CFC I group. There was a marginal increase in the weight of
the control group children which can be attributed to the nutrient content of in the CC
cookies.
According to a study by Sangeetha and Premakumari (2010) on 150 moderately

anaemic children were supplemented with either food based or synthetic micronutrients
for six months had registered height nearing or above the standard values. Over a period
of six months all the children receiving food based supplement recorded a significant
increase (p < 0.01) in their weight and the children who received tablets as their
supplement recorded increments at five per cent level of significance.
Table XXXV
Comparison of Increase in Weight (Kg) of the three Different Intervention Groups
Mean
Sum of Degrees of
Source square F statistic p-value
squares freedom
treatment 22.7893 2 11.3947 23.2074 S**
S**Significant at 5%level
suggesting that the one or more treatments are significantly different. To find out which
group is different the Tukey HSD test was carried out.
Table XXXVI
Comparison of Increase in Weight (Kg) between the three Different Intervention Groups
(n=87)
Comparisons
Q statistic p-value inferfence
CFC I VS CC 6.5634 0.001 S*
CFC IIVS CC 9.3572 0.001 S*
NS- Not Significant, S* Significant at 1%level
The comparison of the mean weight of the three intervention groups showed no
significant effect showing that both had the effect on weight. There was a significant
effect (p<0.01) on comparison of the CC cookies with the iron and zinc rich micronutrient
cookies. So these cookies can be used to reduce the high prevalence of underweight seen
in the selected children.
In view of the apparent benefits of the intervention studies on the weight of

children, we investigated the benefits of two nutrient rich cookies and a standard cookie
in impacting the weight of the children. There was a significant difference in the pre and
post test weight score of all the three groups studied indicating the positive effect of the
cookies given for intervention.
Perhaps with the above mentioned citations and the encouraging results of the
present study, it would be convincingly agreeable to accept the study.
Conclusion: Hence, the null hypothesis stating that the supplementation of the
nutrient rich cookies did not have any impact on the weight of the children is rejected
and be conclude that the food based intervention was effective in improving the height
of the children.
Impact on BMI
Null hypothesis 3: There is no impact of the formulated micro-nutrient rich cookies on
the Body Mass Index of the children
BMI is an important indicator of underweight and obesity in all age groups. When
measurements are taken carefully and compared with appropriate growth charts and
recommended cut offs, BMI provides an excellent indicat
indicator
or of overweight and obesity that
is sufficient for most clinical, screening, and surveillance purposes.
Table XXXVII
Impact of Food based Intervention on BMI
(n=87)

Parameter df NS/S
CFCI 14.3 1.6 15.3 1.4 28 9.506 S**
BMI CFCII 14.6 1.9 15.9 1.3 29 13.070 S**
CC 15.2 1.3 16.0 1.4 30 9.681 S**
S-Significant, NS-Not
Not Significant, **Significant at 5%level,*Significant at 1% level
The mean BMI of CFC I and CFC II group was 14.3 and 14.6. It improved to 15.3 and
15.9 after the intervention period. There was a significant difference in all the three
groups when a comparison was done between the pre and post intervention period.
1.5
Increase in BMI
0.5
0
CFCI CFCII CC
Intervention Groups
Fig. 16 Impact of Intervention on Body Mass Index
A study was undertaken to find the impact of nutritional supplements consumed

by school going children and to determine the relationship between the food supplements
and academic record in Pakistan. The st
study
udy population included 300 male and female
students (47 were for pre-test) in Grade 1-7 from Private and Public schools and the
students of 4 to 12 years age. The result showed that 57.1% were in good health which is
based on BMI (18.6-24.9) Kg/m2, 38% were found in fare health, based on same
criteria and on the other hand only 4.9% were fallen in poor health and suffering
from acute diseases such as chest infections and gastrointestinal tract infections
(Rizwan et al., 2013)
The mean increase was highest in the CFC II group than in the CFC I group. There
was a borderline increase in the CC group children which can be attributed to its nutrient
content. The mean BMI of the experimental groups (CFCI and CFCII) came to the normal
range after the intervention period. This proves that the effectiveness of the two
formulated cookies in improving the BMI of the children.
Table XXXVIII
Comparison of Body Mass Index of the Different Intervention Groups
(n=87)
squares SS freedom ν MS
Treatment 2.7776 2 1.3888 5.2981 **S

Comparison of the increase in BMI of the three different groups showed a

significant difference (p<0.05) suggesting that the one or more treatments are significantly
different.
Table XXXIX
Comparison of Increase in Body Mass Index between the three Different
Intervention Groups
(n=87)
Comparisons
Q statistic p-value inferfence
CFC I VS CC 1.8646 0.390 NS
CFC IIVS CC 4.5841 0.004 S*
NS-Not Significant,*Significant at 1% level
The effect of the food supplements on the BMI of the selected children shows that
there was no significant difference between CFCI VS CFCII and CFC I VS CC. CFC II had a
significant difference in improving the BMI of the children. It is recommended that long
term supplementation of the nutrient rich cookies will provide more beneficial effect.
Conclusion: Therefore the null hypothesis is rejected and the cookies improved
the BMI of the children included in the intervention study. We conclude that the
formulated micro nutrients cookies improved the BMI of the children in the intervention
groups.
4.3.2. Biochemical Parameters
Impact on Blood Haemoglobin
Null Hypothesis 4: The supplementation of the formulated micro-nutrient rich cookies

will not increase the haemoglobin level in the children.
Anaemia is a global public health problem affecting both developing and

developed countries with major consequences for human health as well as social and
economic development. It occurs at all stages of the life cycle, but is more prevalent in
pregnant women and young children. In 2002, iron deficiency anaemia (IDA) was
considered to be among the most important contributing factors to the global burden of
disease (WHO, 2002). Anaemia is the result of a wide variety of causes that can be
isolated, but more often coexist. Globally, the most significant contributor to the onset of
anaemia is iron deficiency so that IDA and anaemia are often used synonymously, and the
prevalence of anaemia has often been used as a proxy for IDA. It is generally assumed that
50% of the cases of anaemia are due to iron deficiency. Anaemia is an indicator of both
poor nutrition and poor health. The negative consequences of IDA on cognitive and
physical development of children and on physical performance – particularly work
productivity in adults – are of major concern (WHO, 2001).
Haemoglobin concentration is the most reliable indicator of anaemia at the

population level, as opposed to clinical measures which are subjective and therefore have
more room for error. Measuring Hb concentration is relatively easy and inexpensive, and
this measurement is frequently used as a proxy indicator of iron deficiency. Given the
multi factorial nature of this disease, correcting anaemia often requires an integrated
approach. In order to effectively combat it, the contributing factors must be identified and
addressed. In settings where iron deficiency is the most frequent cause, additional iron
intake is usually provided through iron supplements to vulnerable groups; in particular
pregnant women and young children (WHO, 2012).
The results of the study shows that there was an increase in mean haemoglobin
level in both CFC I (12.34 g/dL) and CFC II (12.11 g/dL) fed children to normal haemoglobin
levels. There was little increase (11.01 g/dL) in the children fed with the standard cookies.
With regard to the above references, the increase in the haemoglobin level in the children
selected for the study may be ascribed to the supplementation.
Table XL
Impact of Food based Intervention on Blood Haemoglobin Level
(n=87)

Parameter df NS/S
CFC I 10.82 0.68 12.34 0.64 28 9.745 S**

Haemoglobin
CFC II 10.96 0.30 12.11 0.44 29 12.726 S**
(g/dl)
CC 10.78 0.36 11.01 0.37 30 3.564 S**
To embark the sustainability of the effect of iron and food supplementation on

haemoglobin (Hb), intelligence quotient (IQ) and growth of school aged girls a study was
carried out by Jain, (2014). Anaemic subjects were divided into three groups, viz.,
(i) twice weekly supplementation of iron folic acid syrup (53 mg iron/week); (ii) daily
supplementation of 4 niger seed and defatted soyaflour biscuits plus 2 lemons (45 mg
iron/week) and (iii) control. Non anaemic group (NAC) was not intervened. End line data
was collected after 120 days. Follow up for Hb, IQ, weight and height was done 4 months
after cessation of supplementation. Iron supplementation was more effective in raising Hb
and building iron stores than iron rich food supplementation. The impact of iron rich food
supplementation on Hb, IQ and growth sustained for 4 months while that of medicinal
iron did not. So the findings of the above mentioned study suggest that the effects of food
supplementation are sustainable for four months, therefore, this
is strategy holds more
potential to control anaemia, in school aged girls.
Increase in Haemoglobin
1.5
(g/dL)
1
0.5
0
CFC I
CFC II
CC
Intervention Groups
Fig. 177 Impact of Intervention on Haemoglobin
The increment in the haemoglobin levels of the three groups was measured to
check the efficacy of the three treatments. It is clear that the CFC I and CFC II treatments
gave better effect on the haemoglobin levels. This clearly proves the impact of the iron
and zinc rich cookies
Table XLI
Comparison of Blood Haemoglobin Levels of the Different Intervention Groups
(n=87)
Mean
Sum of Degrees of
Source square F statistic p-value
squares freedom
Treatment 2.7776 2 1.3888 5.2981 S**

NS- Not Significant S**- Significant at 5% level
Comparison of the increase in Haemoglobin level of the three different groups

showed a significant difference (p<0.05) suggesting that the one or more treatments are
significantly different.
Table XLII
Comparison of Increase in Blood Haemoglobin Levels between the three
Different Intervention Groups
(n=87)

Comparisons
CFCI VS CFCII 3.1787 0.0692027 NS
CFC I VS CC 11.8375 0.0010053 S*
CFC IIVS CC 8.7106 0.0010053 S*
S- Not Significant S*- Significant at 1% level
The results of the study shows that there was an increase in mean haemoglobin
level in both CFC I (12.34 g/dL) and CFC II (12.11 g/dL) fed children to normal haemoglobin
levels. There was little increase (11.01 g/dL) in the children fed with the standard cookies.
With regard to the above references, the increase in the haemoglobin level in the children
selected for the study may be ascribed to the supplementation.
Conclusion: As there is an increase in the haemoglobin levels it rejects the null

hypothesis. So we conclude that both the CFC 1 and CFC 2 cookies improved the blood
haemoglobin levels of the children.
Impact on Serum ferritin level
Null Hypothesis 5: There is no significant difference in the mean serum Ferritin levels on
supplementation of the formulated micro-nutrient rich cookies.
Iron deficiency Anaemia can be diagonised by Complete Blood Count (CBC) as a

low RBC count, low hematocrit (Hct), or low Haemoglobin (Hgb). However, low iron status
will show up long before Anaemia if ferritin is measured. Ferritin is the form in which iron
is stored in the tissues of the body, particularly the liver, spleen, and bone marrow.
Ferritin is a protein complex that contains iron. Ferritin decreases long before iron
deficiency Anaemia shows up on your CBC. Therefore measuring ferritin is the optimal
way to determine your actual iron status. A satisfactory ferritin level is generally over 50
and not much higher than 200. A ferritin level less than 30 indicates iron deficiency, and
less than 18 can indicate absent iron stores. If you do not adequately raise your ferritin
level then you are much more susceptible to repeatedly becoming anemic and may have
difficulty breaking out of a cycle of frequent Anaemia. The subjection of the mean scores
of biochemical parameters obtained by the three groups at the end of the feeding
trial by ANOVA shows that there was a significant increase in the haemoglobin and zinc
levels.
Table XLIII
Impact of Food based Intervention on Serum Ferritin Level
Pre Post
Parameter df NS/S
CFC I 26.57 7.69 32.67 9.11 28 7.111 S**

Serum
CFC II 33.50 13.00 40.57 12.97 29 7.732 S**
Ferritin
(ng/ml) CC 29.71 10.35 32.65 9.50 30 5.630 S**
There was a significant difference in the serum ferritin levels in all the three groups
when the pre and post intervention levels were analysed. So it can be inferred that the
composite flour cookies had a favourable effect on the ferritin level.
The results of a study by Jain (2014) among 8 to 11 year old school age girls in
Rajasthan showed that twice weekly medicinal iron supplementation resulted in a mean
increment in Hb was of 1.0 g. A mean increment of 0.5 g/dl of Hb was observed in iron rich
biscuits and lemons supplemented daily. ANOVA pointed to a significant difference in the
mean serum iron and TIBC of the groups at baseline Mean serum iron rose from
74.5 to 83.3 µg/dl, TIBC decreased from 714.1 to 673.2 µg/dl and transferrin saturation
increased from 10.6 to 12.9% at post intervention stage in medicinal iron
supplementation. The change in serum iron was from 72.1 to 77. 6 µg/dl, in TIBC from
717.2 to 696.6µg/dl and in transferrin saturation from 10.4 to 11.6% in food based
supplementation. Medicinal iron supplementation led to a rise in serum ferritin from 18.2
to 24.9 g/l and the increase was from 15.2 to 19.1 µg/l in iron and vitamin C rich food
supplemented group.
Increse in Ferritin (
8
ng/mL)
6
0
CFC I CFC II CC
Intervention Groups
Fig. 18 Impact of Food based Intervention on Serum Ferritin Level
The comparison of the increase in mean serum ferritin levels of the three group
children shows that the scores of the CFCI and CFC II group was higher than the CC group.
The increase was more in the CFC II than the CFC I group when the two experimental
group values were compared. The analysis of the initial and final values of the mean
serum ferritin levels of the selected children shows a sig
significant
nificant difference in all the three
intervention groups. The increase is due to the addition of iron to their diet in the form of
cookies.
Table XLIV
Comparison of Serum Ferritin Levels of the Different Intervention Groups
(n=87)
squares freedom
Treatment 262.8030 2 131.4015 7.3593 S**
S**- Significant at 5% level
The p-value
value corresponding to the FF-statistic of one-way
way ANOVA is lower than 0.05,
Table XLV
Comparison of Increase in Serum Ferritin Levels between the three Different
Intervention Groups
(n=87)
Comparisons
CFCI VS CFCII 1.1428 0.6828261 NS
CFC I VS CC 3.9666 0.0170251 S**
CFC IIVS CC 5.1651 0.0012974 S*
NS- Not Significant, S*- Significant at 1% level, S**- Significant at 5% level
Perhaps, in the present study with reference to the treatment administered to the
selected groups has shown significant results for the biochemical parameter namely
ferritin after the intervention study. Thus, it can be concluded that there was significant
increase at 5% level for both the CFCI and CFCII groups when compared with the CC group.
Moreover the results also show that both the CFC I and CFC II had similar impact as there
was no significant difference when both the values were compared..
To test the hypothesis that micronutrient beverages can provide the daily iron and
zinc needs forty children aged 6 to 9 years were recruited from Lima, Peru in a study by
Mishaan et al., (2004). Single daily servings of multi nutrient-fortified beverages can meet
much of the mineral needs for small children. Food has a small inhibitory effect on iron,
but not zinc, absorption; therefore, it was concluded that the beverages can be efficacious
even when given with a meal.
Conclusion: It is eminent that there was significant difference when comparison was
made between the control cookies and the micronutrient cookies which show the
efficacy of the supplement on the selected biochemical parameters. So the null
hypothesis is rejected and we conclude that the formulated cookies were effective in
improving the serum ferritin levels of the children
Impact on Serum Zinc levels
Null Hypothesis 6: The serum zinc levels of the children on supplementation with the
formulated micro-nutrient rich cookies will not be different.
Table XLVI
Impact of Food based Intervention on Serum Zinc Level
(n=87)
Pre Post
Parameter df NS/S
CFC I 61.59 4.38 69.66 7.13 28 7.974 S**

Zinc ( µg/dL) CFC II 60.86 2.91 71.10 7.09 29 7.431 S**
CC 60.38 2.72 62.70 3.76 30 4.772 S**
The findings of the study on the zinc level of the selected children show a
significant effect at 5% level. The mean zinc level of the CFCI group increased from
61.59 µg/dL±4.38 to 69.68 µg/dL ±7.13.The elevation of the zinc level on feeding CFCII was
µg/dL
71.1 µg/dL
g/dL ±7.09 from the initial level of 60.86 µg/dL
g/dL ±2.91.The increase in the zinc levels
may be attributed to the inclusion of the nutrient rich cookies (CFC I and CFCII). There was
a marginal increase in the values of the CC group children which may due to the CC
cookies.
Increase in serum Zinc
15
µg/dL)
10
(µ
0
CFC I CFC II CC
Intervention Groups
Fig. 19 Impact of Food b

based Intervention on Serum Zinc Level
A randomized, placebo
placebo-controlled
controlled clinical trial to identify the effect of daily
supplementation with iron, zinc, and iron plus zinc on the morbidity experience of 855
children 0.5–15
15 years of age was carried out in Per
Peru.
u. A key aim of the study was to
compare iron and zinc supplementation alone and in combination for biochemical as well
as morbidity outcomes. Iron with and without zinc increased Haemoglobin concentration
with no significant interaction between iron and zinc. Regarding final zinc concentration,
the interaction term was significant, but when the individual supplement groups were
compared, no difference was noted between the zinc and iron plus zinc supplements.
Both of these findings indicate that the combination supplements will improve
biochemical indicators of iron and zinc status in areas where deficiencies in both nutrients
are common (Richard et al., 2006). The results of the above mentioned study is in
accordance with the current research.
Though there was a increase in the zinc levels of all the three groups included in
the study, it can be seen that the increment in the scores of both the experimental groups
i.e. CFC I and CFC II there was a higher increase which is due to the intervention of zinc
and iron rich cookies for a period of six months.
Table XLVII
Comparison of Serum Zinc Levels of the Different Intervention Groups
(n=87)
Sum of Degrees of Mean
squares freedom square
Treatment 1,011.4406 2 505.7203 16.8091 S**
S**- Significant at 5% level
A recent meta-analysis of 25 intervention trials comprising 1834 children less than

13 years of age, with a mean duration of approximately 7 months and a mean dose of zinc
of 14mg/day (214mmol/day), showed a small but significant positive effect of zinc
supplementation on height and weight increases (Brown and Peerson, 1998). Zinc
supplementation had a positive effect when stunting was initially present; a more
pronounced effect on weight gain was associated with initial low plasma zinc
concentrations. Results from zinc supplementation studies suggest that a low zinc status in
child not only affects growth but is also associated with an increased risk of severe
infectious diseases (Black, 1998). Episodes of acute diarrhoea were characterized by

shorter duration and less severity in zinc-supplemented groups; reductions in incidence of
diarrhoea were also reported.
Other studies indicate that the incidence of acute lower respiratory tract infections
and malaria may also be reduced by zinc supplementation. Prevention of suboptimal zinc
status and zinc deficiency in children by an increased intake and availability of zinc could
consequently have a significant effect on child health in developing countries.
Table XLVIII
Comparison of Serum Zinc Levels of the Different Intervention Groups
(n=87)

Comparisons
CFCI VS CFCII 1.7709 0.4279282 NS
CFC I VS CC 5.9641 0.0010053 S*
CFC IIVS CC 7.8197 0.0010053 S*
NS- Not Significant, S*- Significant at 1% level
A comparison of the three groups namely CFC I, CFC II and CC group was done with
reference to zinc levels. The results clear show that there was a significant difference
among three groups compared. The results of the comparison along with the mean
increment of the zinc levels of the CFC I and CFC II group clearly shows the efficacy of the
formulated cookies in improving the Levels of Zinc in the selected children.
Conclusion: The null hypothesis is rejected as there was an increase in the zinc
values in the pre and post intervention period. So we conclude that the food based
intervention improved the serum zinc levels of the children in the intervention group.
4.3.4. Impact on Cognition
Null Hypothesis 7: There is no effect on the cognition of the children on

supplementation of the formulated micro-nutrient rich cookies.
Cognitive development refers to the development of the ability to think and

reason. Children (6 to 12 years old) develop the ability to think in concrete ways (concrete
operations. Cognition represents a complex set of higher mental functions subserved by

the brain, and includes attention, memory, thinking, learning, and perception (Bhatnagar
and Taneja, 2001). Cognition is influenced by various environmental factors at different
stages of life; however, the effect of nutrition is thought to be crucial throughout life. The
role of nutrition on cognition is getting attention, because people came to realize that the
development of brain occurs at more stages of the life-span than previously understood
(Toga et al., 2006). Nutrition is one of the major environmental variables that can be
manipulated relatively easily with regard to brain function. Not only does nutrition affect
brain development but it also plays a significant role in maintaining function of brain
(Isaacs and Oates, 2008).
Table XLIX
Impact of Food based Intervention on Cognition
(n=87)
PRE POST ‘t’
Parameter Group df NS/S
Mean Std.Dev Mean Std.Dev Value
CFCI 4.07 0.94 4.57 0.57 28 8.438 S**
Personal
Information CFCII 3.97 0.91 4.55 0.63 29 9.175 S**
CC 3.60 0.72 4.03 0.67 30 2.362 S**
CFCI 7.18 1.68 9.14 1.67 28 6.808 S**
Digit Span CFCII 7.83 1.47 9.69 1.61 29 6.422 S**
CC 7.57 1.41 7.93 1.31 30 2.164 S**
CFCI 9.07 1.33 10.89 1.37 28 3.813 S**
Mental Control CFCII 7.28 1.25 8.97 1.21 29 3.524 S**
CC 7.67 1.18 8.03 1.03 30 1.649 S**
Mann-Suiter CFCI 3.04 0.79 3.54 0.58 28 6.604 S**
Visual Memory CFCII 3.07 0.65 3.55 0.51 29 6.009 S**
Screen for
Objects CC 3.43 0.57 3.63 0.56 30 1.682 NS
CFCI 5.32 1.02 6.82 1.25 28 8.043 S**

Benton Visual
Retention Test CFCII 6.03 0.94 7.00 1.04 29 5.975 S**
CC 6.10 0.99 6.37 0.85 30 2.919 NS
CFCI 6.00 0.94 7.57 0.92 28 8.438 S**
Cattells
Retentivity Test CFCII 5.83 0.76 6.97 0.87 29 9.175 S**
CC 6.00 1.11 6.63 0.96 30 2.362 S**
S-Significant, NS-Not Significant, **Significant at 5%level
The negative consequences of IDA on cognitive and physical development of

children and on physical performance particularly work productivity in adults is of major
concern (Stoltzfus, 2001). To assess the cognition of children six standardised tests given
by NIMHANS (2002) was used. The tests were done at the start and at the end of the
intervention study. The findings are presented in this section.
A study was undertaken by Umamageshwari et al., (2011) to evaluate the effect of

iron and zinc deficiency on short term memory of 100 children in the age group of
6-11 years and to assess the response to supplementation therapy of Iron (2mg/kg
bodyweight in two divided doses) and zinc (5mg once-a-day) supplementation for a period
of three months for children in the deficient group. The results showed that all children
with iron and zinc deficiency had memory deficits. Combined deficiency in 9-11 years
group showed severe degree of affectation in verbal (P<0.01) and non-verbal memory
(P<0.01), and improved after supplementation (P = 0.05 and P<0.01, respectively). In 6-8
years group, only non-verbal form of memory (P =0.02) was affected, which improved
after supplementation.
The results showed that there was significant difference (P<0.005) in all the
cognition tests in both the CFCI and CFCII groups. In the control group there was no
significant difference in Mann-Suiter Visual Memory Screen for Objects and Benton Visual
Retention test. There is a improvement in children as they grow due to the normal process
of growth which may seen in the CC group children also. The increase in all the six tests in
the CFCI and CFCII group children is due to the positive influence of the micronutrient rich
cookies.
Chaudhary and co-workers (2015) highlighted the association between iron and
zinc deficiency with memory deficits in children and found a marked improvement in
memory and concentration after supplementation. The study results highlighted that
identification of the common micronutrient deficiency at an early age and proper
supplementation would prevent derangement in cognitive function in the later age.
A study was designed to test the efficacy of iron, zinc and combined iron and zinc
supplementation on cognitive functions of female adolescents in Chennai, India.
Haemoglobin, serum ferritin, serum zinc, seven cognitive tests of mental speed, sustained
attention, abstract reasoning, verbal and visual memory and verbal and visual recognition
and three behavioural outcomes including anxiety, depression and perceived general
fatigue were assessed at baseline and after 4 months of supplementation. Post
intervention, the groups supplemented with Fe and Fe Zn scored higher on the cognitive
function of visual memory than the Zn alone and PC groups. Iron and Zinc either as single
supplements or in the combined form were equally efficacious in improving the cognitive
function of mental speed on accuracy levels. The Fe,Zn, and FeZn groups did not improve
in other cognitive measures: sustained attention, abstract reasoning immediate and
delayed recall of verbal material and verbal and visual recognition compared with the PC
group. Supplementation with FeZn significantly reduced Beck Depression Inventory scores,
sc
but there was no change in the Fe, Zn and PC groups
groups. Daily supplementation with Fe, Zn
and FeZn benefitted only certain cognitive functions among female adolescents in the
college setting (Chellappa and Karunanidhi. 2012).The findings of our study also
al showed
that food sources of iron and zinc improved the cognition abilities in children.
2
Increase in Scores
1.5 CFCI
CFCII
1
CC
0.5
CFCI
0
1 2 3 4 5 6
Cognition Tests
Fig. 20 Impact of Food based Intervention on cognition
Low et al., (2013)

2013) reviewed 16,501 studies to evaluate the effect of iron
supplementation on cognition scores which showed that iron supplementation improved
global cognitive scores, intelligence quotient among anemic children (mean difference
4.55, 95% CI 0.16 to 8.94, p = 0.04) and measures
res of attention and concentration.
Though there was a significant improvement in the cognition scores when the pre
and post intervention scored were compared it is evident from the above graph that there
marked improvement in CFC I and CFC II group. The study highlights the role of locally
available food based iron and zinc rich foods in improving the cognition of children.
Table L
Comparison of Cognition Scores of the Different Intervention Groups
(n=87)
Sum of Degrees Mean

F Level of
Cognition test squares of square p-value
statistic Significance
SS freedom ν MS
Personal
0.3817 2 0.1908 0.3385 0.7138 NS
Information
Digit Span 47.1035 2 23.5518 20.7419 4.7758e-08 S**
Mental Control 39.9388 2 19.9694 12.4272 1.8716e-05 S*
Mann-Suiter Visual
1.3314 2 0.6657 1.3672 0.2604 NS
Memory Screen
Benton Visual
22.2368 2 11.1184 11.4129 4.1240e-05 S**
Retention Test
Cattells Retentivity
13.7589 2 6.8795 5.9266 0.0039 S**
Test
S-Significant, NS-Not Significant,,**S Significant at 5%level. S*Significant at 1%level.
A study by Stuijvenberg etal.,1999 among 115 children (age 6-11) showed that
supplementation of biscuits fortified with iron, iodine, and beta-carotene improved not
only the blood parameters but there was a significant between-group treatment effect (P
< .05) in cognitive function with the digit span forward task (short-term memory) which
corroborates with the present study.
A comparison was made between the different to find out effect of the food based
intervention. It is proved beyond doubt that both the CFCI and CFC II cookies had a similar
effect on the cognition abilities of the children. Except personal information test and
Mann-Suiter Visual Memory Screen test there was a significant difference when the
CC cookies were compared either with CFCI or CFCII cookies. The above table provides
strong evidence for the use of locally available iron and zinc food components in bringing a
positive effect.
Sandstead et al., (1998) brought out the effect of zinc therapy or zinc and other
micronutrients or micronutrients on cognition with the Cognition Psychomotor
Assessment System. In the group receiving both zinc and other micronutrients, there was
a significant improvement in fine and gross motor skills, sustained attention, and capacity
for concept formation and abstract reasoning.
Table LI
Comparison of Cognition Scores between Different Intervention Groups
(n=87)
Tukey
Tukey HSD Tukey HSD
Test Treatment pair HSD
Q statistic inferfence
p-value
Personal Information
CFC I VS CC 0.222 0.899 NS
CFC IIVS CC 1.106 0.697 NS
Digit Span
CFC I VS CC 8.069 0.001 *S
CFC IIVS CC 7.621 0.001 *S
Mental Control
CFC I VS CC 6.318 0.001 *S
CFC IIVS CC 5.811 0.001 *S
Mann-Suiter Visual
CFC I VS CC 1.763 0.431 NS
Memory Screen
Benton Visual CFCI VS CFCII 2.891 0.108 NS
Retention Test CFC I VS CC 6.725 0.001 *S
CFC IIVS CC 3.845 0.021 **S
Cattells Retentivity CFC I VS CFCII 2.148 0.287 NS
Test CFC I VS CC 4.852 0.002 *S
S-Significant, NS-Not Significant, **Significant at 5%level, *Significant at 1%level
Three primary schools situated in Salem District, Tamil Nadu, India were selected
to assess the efficacy of different types of biscuits on the anthropometric measurements,
Haemoglobin content, clinical picture and cognitive performance. The results showed a
significant difference in all the parameters on intervention of the biscuits. Cognitive
performance better results was obtained in Group II (supplemented with potato flour
biscuits) followed by Group III (supplemented with wheat biscuits) and Group IV
(supplemented with ragi biscuits). Least was obtained by control group children who are in
their home diet (Naznini et al , 2010).
The results of the findings of the present study are in accordance with the above
mentioned studies in improving the cognition of children. So it can be stated that locally
available food supplements have a positive effect in improving the cognition of mild
anaemic children.
Conclusion: As there is improvement in the cognition scores in the pre and post
intervention testing the null hypothesis is rejected. So we conclude that the formulated
iron and zinc rich cookies improved the cognition of the children
14.3.5 Comparison of the cognition scores of the children in the intervention study with
non-participating children
To verify the effect of the food intervention on the cognition of the selected
children, the cognition scores of 30 other children for whom the haemoglobin analysis was
done but did not participate in the study were taken. All the children taken for the
comparison of cognition tests were Anaemic.
Table LII
Comparison of the cognition scores of the children involved in the study
and other children
n=117
Degrees Mean
Sum of F Level of
Cognition test of square p-value
squares SS statistic Significance
freedom ν MS
Personal
10.6115 3 3.5372 8.3801 4.4493 S**
Information
Digit Span 94.1081 3 31.3694 14.8335 3.3013 S**
Mental Control 181.6533 3 60.5511 46.3640 1.1102 S**
Mann-Suiter
Visual Memory 5.9189 3 1.9730 6.3753 0.0005 S**
Screen
Benton Visual
16.9510 3 5.6503 5.5988 0.0013 S**
Retention Test
Cattells
21.3996 3 7.1332 8.9406 2.3007 S**
Retentivity Test
Results and Discussion Results and Discussion
Table LIII
Comparison of the cognition scores of the children involved in the study and other children
Tukey
Treatment Tukey HSD Tukey HSD Treatment Tukey HSD Tukey HSD Tukey HSD
Test HSD Test
pair p-value inferfence pair Q statistic p-value inferfence
Q statistic
Personal CFCI VS CFCII 0.161 0.899 NS Mann- CFCI VS CFCII 0.153 0.899 NS
Information Suiter
CFC I VS CC 4.457 0.011 S** Visual CFCI VS CC 0.944 0.899 NS
CFC I VS OC 5.562 0.001 S* Memory CFC I VS OC 4.537 0.009 S*
CFC IIVS CC 4.333 0.014 S** Screen CFC II VS CC 0.796 0.899 NS
CFCII VS OC 5.447 0.001 S* CFCII VS OC 4.735 0.006 S*
CC VS OC 1.124 0.839 NS CC VS OC 0.153 0.899 NS
Digit Span CFCI VS CFCII 2.007 0.490 NS Benton CFCI VS CFCII 0.948 0.899 NS
CFC I VS CC 4.476 0.010 S** Visual CFC I VS CC 2.436 0.316 NS
CFC I VS OC 6.203 0.001 S* Retention CFC I VS OC 4.222 0.017 S**
CFC IIVS CC 6.558 0.001 S* Test CFC II VS CC 3.423 0.079 NS
CFCII VS OC 8.301 0.001 S* CFCII VS OC 5.225 0.001 S*
Mental Control CFCI VS CFCII 9.002 0.001 S* CFCI VS CFCII 3.620 0.056 NS
CFC I VS CC 13.466 0.001 S* Cattells CFC I VS CC 5.652 0.001 S*
CFC I VS OC 15.350 0.001 S* Retentivity CFC I VS OC 6.857 0.001 S*
CFC II VS CC 4.429 0.011 S** Test CFC II VS CC 2.019 0.485 NS
CFCII VS OC 6.330 0.001 S* CFCII VS OC 3.235 0.107 NS
The above table shows the cognition groups of the three intervention groups and
the other children who were not involved in the study. When the other group children
where compared with either with the CFC I group of CFC II group it is noted that there was
significant difference either at 1% level or 5% level of significance. This clearly
demonstrates the efficacy of the iron and zinc cookie supplementation on the selected
children.
The comparison between the CC group and the children do did not participate in
the intervention study showed that there was no significant difference in all the six
cognition tests.

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Results and Discussion

4.1 Baseline Study

4.1.1. Sample Distribution

Age and Gender Wise Distribution

Human development is a continuous process that proceeds in a fairly orderly

7 Years 8 Years 9 Years

In a cross-sectional study conducted by Kolekar and Sawant (2013) in healthy

Class Wise Distribution

Gender Wise Distribution of Selected Children

S.No Age Boys % Girls % Total

4.1.2. Parents Profile

Socioeconomic Profile of Parents of Selected Children

Socioeconomic factors such as income, education, physical environment and race

According to a study by Babar (2010) paternal literacy level is indirectly associated

In a study conducted at district Malir, Karachi, maximum malnutrition regarding

Father (n=706) Mother (n=715)

The nutrition status in relation to factors like fathers’ education, mothers’

4.1.3. Family Details

affordability, acceptability and actual utilization of available health facilities (Agarwal et

Almost all community- based studies focus on socio-economic stratification, which

Fig. 8 Distribution of the Families of the Selected Children according to

Religion and Family Type of the Children

Religion in India is characterized by a diversity of religious beliefs and practices.

4.1.4. Nutritional Profile

The physical growth of children is reflected by different anthropometric

Fig. 9 Comparison of Mean Height with Reference Values

In a study conducted by Murugkar et al., 2013 among the 6-9

Srivastava et al., (2012) conducted a cross-sectional study among school-age in

Changes in body weight are an important indicator of nutritional status, being

and 6.54 kg in weight between 12

Fig. 10 Comparison of Mean Weight with Reference Values

Body Mass Index

Body Mass Index is a useful clinical calculation to diagnose the imbalances of

Age Gende Std. Mean

Boys 14.7 13.84 1.25 7.701 0.861 S**

Boys 15.5 15.19 1.80 2.111 0.313 S**

Body Mass Index which is an important anthropometric parameter is presented in

Fig. 11 Comparison of Body Mass Index with Reference Values

In a study conducted by Kamath et al.,

A observational cross sectional study of 484 children of age group 6-12

Age Mean Boys Mean Girls Total

A study conducted by Patel et al.,( 2015) in Ahmedabad city in western India

Stunting is a good long-term indicator of the nutritional status of a population

Boys Girls Total

A cross-sectional study conducted by Srivastava et al., (2012) among school-age

Childhood stunting is one of the most significant impediments to human

An attempt was made to find the prevalence of under-nutrition among school

Boys Girls Total

WHO, 2007 - Thinness : < - 2 BMIZ (Z-score for BMI-for-age)

S. No Organ Clinical symptom Number of Subjects Percentage (%)

Lack of lustre 273 37.91

1 Hair Thinness 130 18.05

Brittle/ easy pluck ability 82 11.39

Dry skin 63 8.75

2 Skin/face Pigmentation 25 3.47

Angular cheliosis 122 16.94

Pale and bloated 27 3.75

Discoloured/ Mottled enamel 116 16.11

Spongy bleeding gums 86 11.94

Adequate dietary intake is of vital importance to children’s growth and

RDA Mean Daily

1 Energy(kcal) 1690 1199.00 155.17 22.374 S**