Effects of Childhood Malnutrition and Child Obesity

A literature review is a compilation of resources that provide the ground work for further study. It is frequently found as a subsection of a published research study. Literature review refers to the activities involves in searching for information on a topic and developing a comprehensive picture of the state of the knowledge on the topic.

Review of literature is a written summary of the study conducted previously related to the present study topic. (Polit and Hungler, 1999)

The researcher carried out an extensive review of literature on the research topic in order to gain deeper insight into the problem and to collect maximum relevant information for building the foundations of the study.

In the present study the review of literature is organized under the following headings;

• Section-I: Studies related to malnutrition and obesity at school level.
• Section-II: Studies related to effect of planned nursing intervention.
• Section-III: Studies related to knowledge and practice on Healthy Food Habits among children.
• Section-IV: Studies related to
  
  Pender’s Health Promotion Model
  
  Theory
• Section-V: Studies related to Conceptual framework based on Pender’s health promotion model (2002)

SECTION-I: STUDIES RELATED TO MALNUTRITION AND OBESITY

Malnutrition in early childhood causes irreparable damage to the development of child and results in wastage of human resources. Hence reduction in the high rate of child mortality and morbidity due to malnutrition becomes an important task of policy makers and social development planners survey conducted in rural areas of India revealed that abut 90% of the children suffer from different grades of malnutrion and about 15% of them are in extreme degrees of malnutrition.

Shetty, P.S.,(2000) concluded that the reduction in energy intake below the acceptable level of requirement for an individual results in a series of physiological and behavioural responses, which are considered as an adaptation to the low energy intake. This ability of the human body to adopt to a lowering of the energy intake is without doubt beneficial to the survival of the individual. Increases in metabolic efficiency are not ready seen in individuals who on long term marginal intakes probably from childhood, have developed into short statured, low body weight adults with a different body composition. The evidence that behavioural adaptation in habitual physical activity patterns which occurs on energy restriction is not necessarily beneficial to the individual raises doubts about the role of adaptation to low intakes in determining one’s requirement for energy.

Hensrud, DD., (2000) reviewed a journal nutrition screening and assessment which revealed the both under nutrition and over nutrition contribute to increased risk of morbidity and mortality. For patients determined to be at risk further nutrition assessment can be performed to help drive at specific nutritional treatment goals. Identifying and treating malnutrition can potentially have an important impact on decreasing mortality and mortality and morbity and in the population.

Rio-Grande Dosul., (2004) obese increased by about 60% in middle school children for every additional serving per day of sugar sweetened beverage. Obesity occurs more frequently in the more developed regions of the country (South and South East) due to the changes in habits associated with this process. Food intake has been related to obesity not only in terms of the volume of food ingested ,but also in terms of the composition and quality of the diet. Further more, eating habits have also changed and current habits -including the low consumption of tidbits goodies(cookies with fillings ,salty industrialized snacks, sweets)and soft drinks, as well as not having breakfast-help explain, atleast partially, the continuous increase in adiposity among children.

Rodriguez, NR., (2005) concluded that the children have distinct nutritional needs relative to growth. Adequate intakes of energy and essential amino acids are necessary for optimal deposition of lean body mass and normal growth in young children. Most recommendations for children represents an inter-population of data derived from infants and adults. Indeed current protein status in children was evaluated using classic nitrogen balance protocols. This work indicates that a wide range of protein intakes (0.6-2.9g/kg)can be considered for young ,growing children. The ability of nitrogen balance studies to accurately reflect protein utilization has been examined and it appears that further investigations of protein utilization in children using stable isotope methodology, as well as traditional nitrogen balance protocols are necessary to better evaluate protein needs of growing children.

Charles., (2005) the prevalence of obesity has risen dramatically among children in the U.S. and throughout the world since the 1960s.many factors are thought to have contributed to the epidemic of pediatric obesity. one factor that has received increasing attention is consumption of sugar sweetened beverages. feeding studies suggest physiological mechanisms by which sugar in liquid form may be less satiating than other foods

Veteri, F.E., (2010) aimed at providing information on a series of question related to the adequate protein and energy intakes that allow adequate growth and function in children and work performance and productivity in adults. The effect of different sources of protein on nitrogen balance and the requirements of essential aminoacids in young children were also explored in fully recovered previously malnourished children housed in the metabolic ward of the biomedical division of INCAP. Animal experiments and studies in children recovering from protein energy malnutrition (PEM) strongly suggest that even when requirements of all nutrients are satisfied. Inactivity reduces the rate of linear growth and physical activity improves it as well as lean body mass repletion. The effects of different energy intake modifies the need to ingest different amounts of protein to satisfy protein requirements. (PMID-20461903)

As to knowledge concerning aspects of nutrition 90.8% of the children correctly responded to the questions concerning foods that were sources of vitamins and minerals 23.4% to the questions concerning healthier foods, 19% to the questions concerning foods rich in fats 25.8% to the questions on food sources of fibers and 4.9% to the questions on food that supply the body with more energy.

Collaborating a tendency that has been reported in the literature the present study indicates an association between eating habits that are less healthy and obesity consumed.96 children ages 8-10 years in children a developing nation characterized as undergoing a nutrition transition, the subjects selected for current sugar -sweetened soft drink consumption will be randomly assigned to intervention.

SECTION-II: STUDIES RELATED TO EFFECT OF PLANNED NURSING INTERVENTION

Piffer.S, Kaisermann.D., (2003) presented paper reports the results of a survey on dietary habits of 1,398 children attending first class of primary school in Trento province (Northern Italy)the following items were investigated. Frequency of break fast and food intake .frequency of foods at school the conception of tracer foods as vegetables, fruits, and sweet was also investigated. The results were analysed according gender, area of residence, teaching method and educational level of parents. The data about nutritional style are satisfactory even if they are strongly associated to education level of parents, above all of the mother. The adequacy of nutritional style is increasing with the increasing of educational level. School meal, offering selected foods to all children attending fulltime teaching section, can re-equalibrate nutritional style, decreasing the differences associated to education level of the parents.

Delisle, H., (2010) conducted study on dietary patterns in different groups of African origin undergoing nutrition transition, University of Montreal, Canada. In population undergoing nutrition transition, it is important to identify healthy and culturally relevant dietary patterns that can be promoted as a means of preventing diet-related chronic diseases. Dietary pattern analyses using data driven methods are useful for the purpose. The central question addressed in this overview paper is whether there are culture – specific healthy eating patterns, or whether healthy diets may be more universal. Our studies on dietary patterns in population groups of African origin living in Canada (Miontreal), Europe (Madrid), and West Africa (urban and rural Benin) inform the discussion. Healthy or prudent, as opposed to Western, eating patterns are identified in several cultures, including groups of African origin. It appears that a limited number of foods predict diet quality and health outcomes in various population groups; in particular, fruit and vegetables, fish, whole grain cereal, and legumes do so on the protective side, and sweets, processed meats, fried foods, fats and oils, and salty snacks do so on the negative side. Further research on dietary patterns and their healthfulness is required in diverse food cultures. In groups of African origin, traditional diets are healthier than the nontraditional dietary patterns that have evolved with globalization, urbanization, or acculturation, although micronutrient intakes need to improve. Additionally, healthy eating patterns are only feasible if access to food is adequate.

Present data can be used for implementing and improving health promotion action on correct dietary habits in child hood, keeping count of the role of education level of the parents. As children develop, they require appropriately, sized, portions of the same healthy foods adults eat along with more vitamins and minerals to support growing bodies. This means whole grains (whole wheat oats, barley, rice, millet) a wide variety of fresh fruits and vegetables a source of calcium for growing bones (milk, yogurt) and healthy protein (fish, eggs, poultry, lean meat, nuts and seeds).

SECTION-III: STUDIES RELATED TO KNOWLEDGE AND PRACTICE ON HEALTHY FOOD HABITS AMONG CHILDREN:

This article examines the nutrition practices of black African children attending farm schools and looks at what they know about nutrition. Two schools participated in the study, which involved 132 primary school children aged 8-16years.A structured questionnaire revealed the children’s knowledge about nutrition related issues, and focus group discussions brought to the lives of the children living on commercial farms in the North west province. The findings provide strong support for the view that while nutrition education is important to children’s development of nutrition knowledge, good dietary practices and overall nutritional status, so also are influences from the children’s social, economic and psychological environment.

Gil, A., (2009) the study assessed dietary patterns and quality in Bubi immigrants (from Equatorial Guinea) using cluster analysis and comparing different diet quality indexes. A Ninety nine items food frequency questionnaire was administered, body weights and heights were self reported and socio-demographic and health information was collected during interviews. Two dietary patterns were identified. The ‘healthier’ pattern, so confirmed by two dietary quality indexes, featured a higher consumption of fish, fruits, vegetables, legumes, dairy products and bread while the “western” pattern included more processed meat, animal fat, and sweetened foods and drinks. One third of the subjects were in the ‘Healthier’ food cluster, with the same proportion of men and women. Age >of = 30 and residence in Madrid > or = 10 years were independently associated with the healthier diet. Consumption of traditional foods was unrelated to dietary pattern, however. Overall, Bubi diets were somewhat protective because of high intakes of fruits and vegetables and monounsaturated fat (olive oil), but not with respect to sugar, cholesterol, omega-3 fatty acids and fibre. Less than two thirds of subjects had adequate intakes of iron, calcium and folate in both dietary phenotypes. Body mass index, physical exercise, and self-reported health and cardiovascular disease condition showed no significant association with the dietary pattern.

SECTION-IV: STUDIES RELATED TO PENDER’S HEALTH PROMOTION MODEL

Austin David, R., (2000) it describes the Health promotion model of therapeutic recreation. following a brief introduction and an overview of the model, concepts that underlie the model are presented. concepts included are the humanistic perspective, high level wellness, the stabilization and actualization tendencies, and health. It is a description of the various components of the model and information on utilization of the model in practice. The final sections of the article are concern with the model’s strengths and limitations and the continuing development of the model. Health, nursing, psychology, therapeutic recreation, and recreation and leisure studies literature are drawn upon for support of the model.

Calderon, (2002) the programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non compliance. It involves the combination of educational and environmental support for actions and conditions conductive to health behavior and consists of the following components;(i)a culture and cohort sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client physician relationship.(ii)training for primary care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico and(iii)co-ordination of necessary support services to facilitate access to clinical breast exams and mammograms programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long term impact of the programme results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p<0.05) in beliefs after the health education sesstions.Interventions in breast cancer early detection practices showed significant changes(p.<0.05) for mammogram and clinical breast examination.

CONCEPTUAL FRAMEWORK BASED ON PENDER’S HEALTH PROMOTION MODEL (2002)

Conceptual framework is interrelated concepts on abstractions that are assembled together in some rationale scheme by virtue relevance to a common theme (Polit and Beck, 2004). It is a device which to stimulate research and the extension of knowledge by providing both direction and impetus. A framework may serve as a spring board for scientific findings meaningful and generalizable. The present study is aimed at developing and assessing the effectiveness of planned nursing intervention in terms of knowledge and practice on health food habits among primary school children in selected school at Salem. The conceptual framework of this study is based on Pender, Murdaugh, C and Parson., (2002) Health Promotion Model.

Pender, (2002) defines health as the actualization of inherent and acquired human potential through goal directed behavior, competent self care and satisfying relationships with others, while adjustments are made as needed to maintain structural integrity and harmony with relevant environment.

Health Promotion Model is based primarily on three theories of human behavior the theory of reasoned action, the theory of planned behavior and social cognitive theory. The theory of reasoned action explains that the major determinant of behavior is the person’s intent for that behavior, when she believes that she has control over the situation.

Prior Related Behavior:

It highlights the experience with the promoting behavior. In this study prior related behavior of knowledge and practice of primary school children on 1st day. It includes adequate -inadequate knowledge and practice towards health food habits, bringing / not bringing healthy foods will be assessed by pre-test on 1st day.

Personal Factors:

Factors about the person, that influences health promoting behaviour. This includes biological and socio-cultural factors in this study.

Biological Factors:

Includes age of the sample, gender, type of the family.

Socio-cultural factors:

Education of the mother, occupation of the mother, religion.

Health Promoting Behaviour:

Behaviours (or) actions that people carry out with the intentions of improve their health. In this study is specified, health promoting knowledge and practice of healthy foods to children pamphlet distributed to the children giving information regarding healthy food habits to the mothers of children. Regular practicing of health food habits.

Perceived Control of Health :

Children can understand about the in effects of taking junk foods.

Perceived Health Status:

The researcher perceived that there is slight improvement in the food habits of children of bringing health snacks.

Perceived Benefits of Action:

Belief about the positive or reinforcing consequences of a health promoting behaviour. Here it includes children will perceive benefits of good balanced diet, sample develops the health food habits and improvement in knowledge regarding health food habits, stay health and energetic.

Perceived Barriers of Health Promoting Behaviour:

Belief about children decreased attention span, more attracted to advertisements, working mothers.

Interpersonal Influences:

Belief about teaching programme on health food habits and promoting practice of bringing health foods on 3, 6, 10th day of practice assessment by this researcher.

Situational Influences:

Peer group.

Immediate Competing Preferences:

Distracting idea about other attractive activities to do immediately before engaging in a health promotes behaviour. In this study, it includes child’s health, taking healthy foods.

Commitment to a Plan of Action:

Commitment to carry out a health promotes bahaviour. The plan should be specific to time and place, and specify whether it will be with identified person or alone. Practice healthy food habits at school setting after teaching, this study describe about the formulation of a realistic plan to practice healthy food habits by bringing healthy food habits by bringing healthy snacks, and healthy lunch daily (morning and afternoon) to the school with the supervision of researcher in alternative days.

SUMMARY

This chapter deals with the review of literature regarding studies related to malnutrition and obesity, effects of Planned Nursing Intervention, knowledge and practice, Pender’s Health Promotion Model Theory and also it dealt with conceptual framework based on Pender’s Health Promotion Model Theory.

A literature review is a compilation of resources that provide the ground work for further study. It is frequently found as a subsection of a published research study. Literature review refers to the activities involves in searching for information on a topic and developing a comprehensive picture of the state of the knowledge on the topic.

Review of literature is a written summary of the study conducted previously related to the present study topic. (Polit and Hungler, 1999)

The researcher carried out an extensive review of literature on the research topic in order to gain deeper insight into the problem and to collect maximum relevant information for building the foundations of the study.

In the present study the review of literature is organized under the following headings;

• Section-I: Studies related to malnutrition and obesity at school level.
• Section-II: Studies related to effect of planned nursing intervention.
• Section-III: Studies related to knowledge and practice on Healthy Food Habits among children.
• Section-IV: Studies related to
  
  Pender’s Health Promotion Model
  
  Theory
• Section-V: Studies related to Conceptual framework based on Pender’s health promotion model (2002)

SECTION-I: STUDIES RELATED TO MALNUTRITION AND OBESITY

Malnutrition in early childhood causes irreparable damage to the development of child and results in wastage of human resources. Hence reduction in the high rate of child mortality and morbidity due to malnutrition becomes an important task of policy makers and social development planners survey conducted in rural areas of India revealed that abut 90% of the children suffer from different grades of malnutrion and about 15% of them are in extreme degrees of malnutrition.

Shetty, P.S.,(2000) concluded that the reduction in energy intake below the acceptable level of requirement for an individual results in a series of physiological and behavioural responses, which are considered as an adaptation to the low energy intake. This ability of the human body to adopt to a lowering of the energy intake is without doubt beneficial to the survival of the individual. Increases in metabolic efficiency are not ready seen in individuals who on long term marginal intakes probably from childhood, have developed into short statured, low body weight adults with a different body composition. The evidence that behavioural adaptation in habitual physical activity patterns which occurs on energy restriction is not necessarily beneficial to the individual raises doubts about the role of adaptation to low intakes in determining one’s requirement for energy.

Hensrud, DD., (2000) reviewed a journal nutrition screening and assessment which revealed the both under nutrition and over nutrition contribute to increased risk of morbidity and mortality. For patients determined to be at risk further nutrition assessment can be performed to help drive at specific nutritional treatment goals. Identifying and treating malnutrition can potentially have an important impact on decreasing mortality and mortality and morbity and in the population.

Rio-Grande Dosul., (2004) obese increased by about 60% in middle school children for every additional serving per day of sugar sweetened beverage. Obesity occurs more frequently in the more developed regions of the country (South and South East) due to the changes in habits associated with this process. Food intake has been related to obesity not only in terms of the volume of food ingested ,but also in terms of the composition and quality of the diet. Further more, eating habits have also changed and current habits -including the low consumption of tidbits goodies(cookies with fillings ,salty industrialized snacks, sweets)and soft drinks, as well as not having breakfast-help explain, atleast partially, the continuous increase in adiposity among children.

Rodriguez, NR., (2005) concluded that the children have distinct nutritional needs relative to growth. Adequate intakes of energy and essential amino acids are necessary for optimal deposition of lean body mass and normal growth in young children. Most recommendations for children represents an inter-population of data derived from infants and adults. Indeed current protein status in children was evaluated using classic nitrogen balance protocols. This work indicates that a wide range of protein intakes (0.6-2.9g/kg)can be considered for young ,growing children. The ability of nitrogen balance studies to accurately reflect protein utilization has been examined and it appears that further investigations of protein utilization in children using stable isotope methodology, as well as traditional nitrogen balance protocols are necessary to better evaluate protein needs of growing children.

Charles., (2005) the prevalence of obesity has risen dramatically among children in the U.S. and throughout the world since the 1960s.many factors are thought to have contributed to the epidemic of pediatric obesity. one factor that has received increasing attention is consumption of sugar sweetened beverages. feeding studies suggest physiological mechanisms by which sugar in liquid form may be less satiating than other foods

Veteri, F.E., (2010) aimed at providing information on a series of question related to the adequate protein and energy intakes that allow adequate growth and function in children and work performance and productivity in adults. The effect of different sources of protein on nitrogen balance and the requirements of essential aminoacids in young children were also explored in fully recovered previously malnourished children housed in the metabolic ward of the biomedical division of INCAP. Animal experiments and studies in children recovering from protein energy malnutrition (PEM) strongly suggest that even when requirements of all nutrients are satisfied. Inactivity reduces the rate of linear growth and physical activity improves it as well as lean body mass repletion. The effects of different energy intake modifies the need to ingest different amounts of protein to satisfy protein requirements. (PMID-20461903)

As to knowledge concerning aspects of nutrition 90.8% of the children correctly responded to the questions concerning foods that were sources of vitamins and minerals 23.4% to the questions concerning healthier foods, 19% to the questions concerning foods rich in fats 25.8% to the questions on food sources of fibers and 4.9% to the questions on food that supply the body with more energy.

Collaborating a tendency that has been reported in the literature the present study indicates an association between eating habits that are less healthy and obesity consumed.96 children ages 8-10 years in children a developing nation characterized as undergoing a nutrition transition, the subjects selected for current sugar -sweetened soft drink consumption will be randomly assigned to intervention.

SECTION-II: STUDIES RELATED TO EFFECT OF PLANNED NURSING INTERVENTION

Piffer.S, Kaisermann.D., (2003) presented paper reports the results of a survey on dietary habits of 1,398 children attending first class of primary school in Trento province (Northern Italy)the following items were investigated. Frequency of break fast and food intake .frequency of foods at school the conception of tracer foods as vegetables, fruits, and sweet was also investigated. The results were analysed according gender, area of residence, teaching method and educational level of parents. The data about nutritional style are satisfactory even if they are strongly associated to education level of parents, above all of the mother. The adequacy of nutritional style is increasing with the increasing of educational level. School meal, offering selected foods to all children attending fulltime teaching section, can re-equalibrate nutritional style, decreasing the differences associated to education level of the parents.

Delisle, H., (2010) conducted study on dietary patterns in different groups of African origin undergoing nutrition transition, University of Montreal, Canada. In population undergoing nutrition transition, it is important to identify healthy and culturally relevant dietary patterns that can be promoted as a means of preventing diet-related chronic diseases. Dietary pattern analyses using data driven methods are useful for the purpose. The central question addressed in this overview paper is whether there are culture – specific healthy eating patterns, or whether healthy diets may be more universal. Our studies on dietary patterns in population groups of African origin living in Canada (Miontreal), Europe (Madrid), and West Africa (urban and rural Benin) inform the discussion. Healthy or prudent, as opposed to Western, eating patterns are identified in several cultures, including groups of African origin. It appears that a limited number of foods predict diet quality and health outcomes in various population groups; in particular, fruit and vegetables, fish, whole grain cereal, and legumes do so on the protective side, and sweets, processed meats, fried foods, fats and oils, and salty snacks do so on the negative side. Further research on dietary patterns and their healthfulness is required in diverse food cultures. In groups of African origin, traditional diets are healthier than the nontraditional dietary patterns that have evolved with globalization, urbanization, or acculturation, although micronutrient intakes need to improve. Additionally, healthy eating patterns are only feasible if access to food is adequate.

Present data can be used for implementing and improving health promotion action on correct dietary habits in child hood, keeping count of the role of education level of the parents. As children develop, they require appropriately, sized, portions of the same healthy foods adults eat along with more vitamins and minerals to support growing bodies. This means whole grains (whole wheat oats, barley, rice, millet) a wide variety of fresh fruits and vegetables a source of calcium for growing bones (milk, yogurt) and healthy protein (fish, eggs, poultry, lean meat, nuts and seeds).

SECTION-III: STUDIES RELATED TO KNOWLEDGE AND PRACTICE ON HEALTHY FOOD HABITS AMONG CHILDREN:

This article examines the nutrition practices of black African children attending farm schools and looks at what they know about nutrition. Two schools participated in the study, which involved 132 primary school children aged 8-16years.A structured questionnaire revealed the children’s knowledge about nutrition related issues, and focus group discussions brought to the lives of the children living on commercial farms in the North west province. The findings provide strong support for the view that while nutrition education is important to children’s development of nutrition knowledge, good dietary practices and overall nutritional status, so also are influences from the children’s social, economic and psychological environment.

Gil, A., (2009) the study assessed dietary patterns and quality in Bubi immigrants (from Equatorial Guinea) using cluster analysis and comparing different diet quality indexes. A Ninety nine items food frequency questionnaire was administered, body weights and heights were self reported and socio-demographic and health information was collected during interviews. Two dietary patterns were identified. The ‘healthier’ pattern, so confirmed by two dietary quality indexes, featured a higher consumption of fish, fruits, vegetables, legumes, dairy products and bread while the “western” pattern included more processed meat, animal fat, and sweetened foods and drinks. One third of the subjects were in the ‘Healthier’ food cluster, with the same proportion of men and women. Age >of = 30 and residence in Madrid > or = 10 years were independently associated with the healthier diet. Consumption of traditional foods was unrelated to dietary pattern, however. Overall, Bubi diets were somewhat protective because of high intakes of fruits and vegetables and monounsaturated fat (olive oil), but not with respect to sugar, cholesterol, omega-3 fatty acids and fibre. Less than two thirds of subjects had adequate intakes of iron, calcium and folate in both dietary phenotypes. Body mass index, physical exercise, and self-reported health and cardiovascular disease condition showed no significant association with the dietary pattern.

SECTION-IV: STUDIES RELATED TO PENDER’S HEALTH PROMOTION MODEL

Austin David, R., (2000) it describes the Health promotion model of therapeutic recreation. following a brief introduction and an overview of the model, concepts that underlie the model are presented. concepts included are the humanistic perspective, high level wellness, the stabilization and actualization tendencies, and health. It is a description of the various components of the model and information on utilization of the model in practice. The final sections of the article are concern with the model’s strengths and limitations and the continuing development of the model. Health, nursing, psychology, therapeutic recreation, and recreation and leisure studies literature are drawn upon for support of the model.

Calderon, (2002) the programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non compliance. It involves the combination of educational and environmental support for actions and conditions conductive to health behavior and consists of the following components;(i)a culture and cohort sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client physician relationship.(ii)training for primary care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico and(iii)co-ordination of necessary support services to facilitate access to clinical breast exams and mammograms programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long term impact of the programme results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p<0.05) in beliefs after the health education sesstions.Interventions in breast cancer early detection practices showed significant changes(p.<0.05) for mammogram and clinical breast examination.

CONCEPTUAL FRAMEWORK BASED ON PENDER’S HEALTH PROMOTION MODEL (2002)

Conceptual framework is interrelated concepts on abstractions that are assembled together in some rationale scheme by virtue relevance to a common theme (Polit and Beck, 2004). It is a device which to stimulate research and the extension of knowledge by providing both direction and impetus. A framework may serve as a spring board for scientific findings meaningful and generalizable. The present study is aimed at developing and assessing the effectiveness of planned nursing intervention in terms of knowledge and practice on health food habits among primary school children in selected school at Salem. The conceptual framework of this study is based on Pender, Murdaugh, C and Parson., (2002) Health Promotion Model.

Pender, (2002) defines health as the actualization of inherent and acquired human potential through goal directed behavior, competent self care and satisfying relationships with others, while adjustments are made as needed to maintain structural integrity and harmony with relevant environment.

Health Promotion Model is based primarily on three theories of human behavior the theory of reasoned action, the theory of planned behavior and social cognitive theory. The theory of reasoned action explains that the major determinant of behavior is the person’s intent for that behavior, when she believes that she has control over the situation.

Prior Related Behavior:

It highlights the experience with the promoting behavior. In this study prior related behavior of knowledge and practice of primary school children on 1st day. It includes adequate -inadequate knowledge and practice towards health food habits, bringing / not bringing healthy foods will be assessed by pre-test on 1st day.

Personal Factors:

Factors about the person, that influences health promoting behaviour. This includes biological and socio-cultural factors in this study.

Biological Factors:

Includes age of the sample, gender, type of the family.

Socio-cultural factors:

Education of the mother, occupation of the mother, religion.

Health Promoting Behaviour:

Behaviours (or) actions that people carry out with the intentions of improve their health. In this study is specified, health promoting knowledge and practice of healthy foods to children pamphlet distributed to the children giving information regarding healthy food habits to the mothers of children. Regular practicing of health food habits.

Perceived Control of Health :

Children can understand about the in effects of taking junk foods.

Perceived Health Status:

The researcher perceived that there is slight improvement in the food habits of children of bringing health snacks.

Perceived Benefits of Action:

Belief about the positive or reinforcing consequences of a health promoting behaviour. Here it includes children will perceive benefits of good balanced diet, sample develops the health food habits and improvement in knowledge regarding health food habits, stay health and energetic.

Perceived Barriers of Health Promoting Behaviour:

Belief about children decreased attention span, more attracted to advertisements, working mothers.

Interpersonal Influences:

Belief about teaching programme on health food habits and promoting practice of bringing health foods on 3, 6, 10th day of practice assessment by this researcher.

Situational Influences:

Peer group.

Immediate Competing Preferences:

Distracting idea about other attractive activities to do immediately before engaging in a health promotes behaviour. In this study, it includes child’s health, taking healthy foods.

Commitment to a Plan of Action:

Commitment to carry out a health promotes bahaviour. The plan should be specific to time and place, and specify whether it will be with identified person or alone. Practice healthy food habits at school setting after teaching, this study describe about the formulation of a realistic plan to practice healthy food habits by bringing healthy food habits by bringing healthy snacks, and healthy lunch daily (morning and afternoon) to the school with the supervision of researcher in alternative days.

SUMMARY

This chapter deals with the review of literature regarding studies related to malnutrition and obesity, effects of Planned Nursing Intervention, knowledge and practice, Pender’s Health Promotion Model Theory and also it dealt with conceptual framework based on Pender’s Health Promotion Model Theory.

A literature review is a compilation of resources that provide the ground work for further study. It is frequently found as a subsection of a published research study. Literature review refers to the activities involves in searching for information on a topic and developing a comprehensive picture of the state of the knowledge on the topic.

Review of literature is a written summary of the study conducted previously related to the present study topic. (Polit and Hungler, 1999)

The researcher carried out an extensive review of literature on the research topic in order to gain deeper insight into the problem and to collect maximum relevant information for building the foundations of the study.

In the present study the review of literature is organized under the following headings;

• Section-I: Studies related to malnutrition and obesity at school level.
• Section-II: Studies related to effect of planned nursing intervention.
• Section-III: Studies related to knowledge and practice on Healthy Food Habits among children.
• Section-IV: Studies related to
  
  Pender’s Health Promotion Model
  
  Theory
• Section-V: Studies related to Conceptual framework based on Pender’s health promotion model (2002)

SECTION-I: STUDIES RELATED TO MALNUTRITION AND OBESITY

Malnutrition in early childhood causes irreparable damage to the development of child and results in wastage of human resources. Hence reduction in the high rate of child mortality and morbidity due to malnutrition becomes an important task of policy makers and social development planners survey conducted in rural areas of India revealed that abut 90% of the children suffer from different grades of malnutrion and about 15% of them are in extreme degrees of malnutrition.

Shetty, P.S.,(2000) concluded that the reduction in energy intake below the acceptable level of requirement for an individual results in a series of physiological and behavioural responses, which are considered as an adaptation to the low energy intake. This ability of the human body to adopt to a lowering of the energy intake is without doubt beneficial to the survival of the individual. Increases in metabolic efficiency are not ready seen in individuals who on long term marginal intakes probably from childhood, have developed into short statured, low body weight adults with a different body composition. The evidence that behavioural adaptation in habitual physical activity patterns which occurs on energy restriction is not necessarily beneficial to the individual raises doubts about the role of adaptation to low intakes in determining one’s requirement for energy.

Hensrud, DD., (2000) reviewed a journal nutrition screening and assessment which revealed the both under nutrition and over nutrition contribute to increased risk of morbidity and mortality. For patients determined to be at risk further nutrition assessment can be performed to help drive at specific nutritional treatment goals. Identifying and treating malnutrition can potentially have an important impact on decreasing mortality and mortality and morbity and in the population.

Rio-Grande Dosul., (2004) obese increased by about 60% in middle school children for every additional serving per day of sugar sweetened beverage. Obesity occurs more frequently in the more developed regions of the country (South and South East) due to the changes in habits associated with this process. Food intake has been related to obesity not only in terms of the volume of food ingested ,but also in terms of the composition and quality of the diet. Further more, eating habits have also changed and current habits -including the low consumption of tidbits goodies(cookies with fillings ,salty industrialized snacks, sweets)and soft drinks, as well as not having breakfast-help explain, atleast partially, the continuous increase in adiposity among children.

Rodriguez, NR., (2005) concluded that the children have distinct nutritional needs relative to growth. Adequate intakes of energy and essential amino acids are necessary for optimal deposition of lean body mass and normal growth in young children. Most recommendations for children represents an inter-population of data derived from infants and adults. Indeed current protein status in children was evaluated using classic nitrogen balance protocols. This work indicates that a wide range of protein intakes (0.6-2.9g/kg)can be considered for young ,growing children. The ability of nitrogen balance studies to accurately reflect protein utilization has been examined and it appears that further investigations of protein utilization in children using stable isotope methodology, as well as traditional nitrogen balance protocols are necessary to better evaluate protein needs of growing children.

Charles., (2005) the prevalence of obesity has risen dramatically among children in the U.S. and throughout the world since the 1960s.many factors are thought to have contributed to the epidemic of pediatric obesity. one factor that has received increasing attention is consumption of sugar sweetened beverages. feeding studies suggest physiological mechanisms by which sugar in liquid form may be less satiating than other foods

Veteri, F.E., (2010) aimed at providing information on a series of question related to the adequate protein and energy intakes that allow adequate growth and function in children and work performance and productivity in adults. The effect of different sources of protein on nitrogen balance and the requirements of essential aminoacids in young children were also explored in fully recovered previously malnourished children housed in the metabolic ward of the biomedical division of INCAP. Animal experiments and studies in children recovering from protein energy malnutrition (PEM) strongly suggest that even when requirements of all nutrients are satisfied. Inactivity reduces the rate of linear growth and physical activity improves it as well as lean body mass repletion. The effects of different energy intake modifies the need to ingest different amounts of protein to satisfy protein requirements. (PMID-20461903)

As to knowledge concerning aspects of nutrition 90.8% of the children correctly responded to the questions concerning foods that were sources of vitamins and minerals 23.4% to the questions concerning healthier foods, 19% to the questions concerning foods rich in fats 25.8% to the questions on food sources of fibers and 4.9% to the questions on food that supply the body with more energy.

Collaborating a tendency that has been reported in the literature the present study indicates an association between eating habits that are less healthy and obesity consumed.96 children ages 8-10 years in children a developing nation characterized as undergoing a nutrition transition, the subjects selected for current sugar -sweetened soft drink consumption will be randomly assigned to intervention.

SECTION-II: STUDIES RELATED TO EFFECT OF PLANNED NURSING INTERVENTION

Piffer.S, Kaisermann.D., (2003) presented paper reports the results of a survey on dietary habits of 1,398 children attending first class of primary school in Trento province (Northern Italy)the following items were investigated. Frequency of break fast and food intake .frequency of foods at school the conception of tracer foods as vegetables, fruits, and sweet was also investigated. The results were analysed according gender, area of residence, teaching method and educational level of parents. The data about nutritional style are satisfactory even if they are strongly associated to education level of parents, above all of the mother. The adequacy of nutritional style is increasing with the increasing of educational level. School meal, offering selected foods to all children attending fulltime teaching section, can re-equalibrate nutritional style, decreasing the differences associated to education level of the parents.

Delisle, H., (2010) conducted study on dietary patterns in different groups of African origin undergoing nutrition transition, University of Montreal, Canada. In population undergoing nutrition transition, it is important to identify healthy and culturally relevant dietary patterns that can be promoted as a means of preventing diet-related chronic diseases. Dietary pattern analyses using data driven methods are useful for the purpose. The central question addressed in this overview paper is whether there are culture – specific healthy eating patterns, or whether healthy diets may be more universal. Our studies on dietary patterns in population groups of African origin living in Canada (Miontreal), Europe (Madrid), and West Africa (urban and rural Benin) inform the discussion. Healthy or prudent, as opposed to Western, eating patterns are identified in several cultures, including groups of African origin. It appears that a limited number of foods predict diet quality and health outcomes in various population groups; in particular, fruit and vegetables, fish, whole grain cereal, and legumes do so on the protective side, and sweets, processed meats, fried foods, fats and oils, and salty snacks do so on the negative side. Further research on dietary patterns and their healthfulness is required in diverse food cultures. In groups of African origin, traditional diets are healthier than the nontraditional dietary patterns that have evolved with globalization, urbanization, or acculturation, although micronutrient intakes need to improve. Additionally, healthy eating patterns are only feasible if access to food is adequate.

Present data can be used for implementing and improving health promotion action on correct dietary habits in child hood, keeping count of the role of education level of the parents. As children develop, they require appropriately, sized, portions of the same healthy foods adults eat along with more vitamins and minerals to support growing bodies. This means whole grains (whole wheat oats, barley, rice, millet) a wide variety of fresh fruits and vegetables a source of calcium for growing bones (milk, yogurt) and healthy protein (fish, eggs, poultry, lean meat, nuts and seeds).

SECTION-III: STUDIES RELATED TO KNOWLEDGE AND PRACTICE ON HEALTHY FOOD HABITS AMONG CHILDREN:

This article examines the nutrition practices of black African children attending farm schools and looks at what they know about nutrition. Two schools participated in the study, which involved 132 primary school children aged 8-16years.A structured questionnaire revealed the children’s knowledge about nutrition related issues, and focus group discussions brought to the lives of the children living on commercial farms in the North west province. The findings provide strong support for the view that while nutrition education is important to children’s development of nutrition knowledge, good dietary practices and overall nutritional status, so also are influences from the children’s social, economic and psychological environment.

Gil, A., (2009) the study assessed dietary patterns and quality in Bubi immigrants (from Equatorial Guinea) using cluster analysis and comparing different diet quality indexes. A Ninety nine items food frequency questionnaire was administered, body weights and heights were self reported and socio-demographic and health information was collected during interviews. Two dietary patterns were identified. The ‘healthier’ pattern, so confirmed by two dietary quality indexes, featured a higher consumption of fish, fruits, vegetables, legumes, dairy products and bread while the “western” pattern included more processed meat, animal fat, and sweetened foods and drinks. One third of the subjects were in the ‘Healthier’ food cluster, with the same proportion of men and women. Age >of = 30 and residence in Madrid > or = 10 years were independently associated with the healthier diet. Consumption of traditional foods was unrelated to dietary pattern, however. Overall, Bubi diets were somewhat protective because of high intakes of fruits and vegetables and monounsaturated fat (olive oil), but not with respect to sugar, cholesterol, omega-3 fatty acids and fibre. Less than two thirds of subjects had adequate intakes of iron, calcium and folate in both dietary phenotypes. Body mass index, physical exercise, and self-reported health and cardiovascular disease condition showed no significant association with the dietary pattern.

SECTION-IV: STUDIES RELATED TO PENDER’S HEALTH PROMOTION MODEL

Austin David, R., (2000) it describes the Health promotion model of therapeutic recreation. following a brief introduction and an overview of the model, concepts that underlie the model are presented. concepts included are the humanistic perspective, high level wellness, the stabilization and actualization tendencies, and health. It is a description of the various components of the model and information on utilization of the model in practice. The final sections of the article are concern with the model’s strengths and limitations and the continuing development of the model. Health, nursing, psychology, therapeutic recreation, and recreation and leisure studies literature are drawn upon for support of the model.

Calderon, (2002) the programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non compliance. It involves the combination of educational and environmental support for actions and conditions conductive to health behavior and consists of the following components;(i)a culture and cohort sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client physician relationship.(ii)training for primary care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico and(iii)co-ordination of necessary support services to facilitate access to clinical breast exams and mammograms programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long term impact of the programme results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p<0.05) in beliefs after the health education sesstions.Interventions in breast cancer early detection practices showed significant changes(p.<0.05) for mammogram and clinical breast examination.

CONCEPTUAL FRAMEWORK BASED ON PENDER’S HEALTH PROMOTION MODEL (2002)

Conceptual framework is interrelated concepts on abstractions that are assembled together in some rationale scheme by virtue relevance to a common theme (Polit and Beck, 2004). It is a device which to stimulate research and the extension of knowledge by providing both direction and impetus. A framework may serve as a spring board for scientific findings meaningful and generalizable. The present study is aimed at developing and assessing the effectiveness of planned nursing intervention in terms of knowledge and practice on health food habits among primary school children in selected school at Salem. The conceptual framework of this study is based on Pender, Murdaugh, C and Parson., (2002) Health Promotion Model.

Pender, (2002) defines health as the actualization of inherent and acquired human potential through goal directed behavior, competent self care and satisfying relationships with others, while adjustments are made as needed to maintain structural integrity and harmony with relevant environment.

Health Promotion Model is based primarily on three theories of human behavior the theory of reasoned action, the theory of planned behavior and social cognitive theory. The theory of reasoned action explains that the major determinant of behavior is the person’s intent for that behavior, when she believes that she has control over the situation.

Prior Related Behavior:

It highlights the experience with the promoting behavior. In this study prior related behavior of knowledge and practice of primary school children on 1st day. It includes adequate -inadequate knowledge and practice towards health food habits, bringing / not bringing healthy foods will be assessed by pre-test on 1st day.

Personal Factors:

Factors about the person, that influences health promoting behaviour. This includes biological and socio-cultural factors in this study.

Biological Factors:

Includes age of the sample, gender, type of the family.

Socio-cultural factors:

Education of the mother, occupation of the mother, religion.

Health Promoting Behaviour:

Behaviours (or) actions that people carry out with the intentions of improve their health. In this study is specified, health promoting knowledge and practice of healthy foods to children pamphlet distributed to the children giving information regarding healthy food habits to the mothers of children. Regular practicing of health food habits.

Perceived Control of Health :

Children can understand about the in effects of taking junk foods.

Perceived Health Status:

The researcher perceived that there is slight improvement in the food habits of children of bringing health snacks.

Perceived Benefits of Action:

Belief about the positive or reinforcing consequences of a health promoting behaviour. Here it includes children will perceive benefits of good balanced diet, sample develops the health food habits and improvement in knowledge regarding health food habits, stay health and energetic.

Perceived Barriers of Health Promoting Behaviour:

Belief about children decreased attention span, more attracted to advertisements, working mothers.

Interpersonal Influences:

Belief about teaching programme on health food habits and promoting practice of bringing health foods on 3, 6, 10th day of practice assessment by this researcher.

Situational Influences:

Peer group.

Immediate Competing Preferences:

Distracting idea about other attractive activities to do immediately before engaging in a health promotes behaviour. In this study, it includes child’s health, taking healthy foods.

Commitment to a Plan of Action:

Commitment to carry out a health promotes bahaviour. The plan should be specific to time and place, and specify whether it will be with identified person or alone. Practice healthy food habits at school setting after teaching, this study describe about the formulation of a realistic plan to practice healthy food habits by bringing healthy food habits by bringing healthy snacks, and healthy lunch daily (morning and afternoon) to the school with the supervision of researcher in alternative days.

SUMMARY

This chapter deals with the review of literature regarding studies related to malnutrition and obesity, effects of Planned Nursing Intervention, knowledge and practice, Pender’s Health Promotion Model Theory and also it dealt with conceptual framework based on Pender’s Health Promotion Model Theory.

A literature review is a compilation of resources that provide the ground work for further study. It is frequently found as a subsection of a published research study. Literature review refers to the activities involves in searching for information on a topic and developing a comprehensive picture of the state of the knowledge on the topic.

Review of literature is a written summary of the study conducted previously related to the present study topic. (Polit and Hungler, 1999)

The researcher carried out an extensive review of literature on the research topic in order to gain deeper insight into the problem and to collect maximum relevant information for building the foundations of the study.

In the present study the review of literature is organized under the following headings;

• Section-I: Studies related to malnutrition and obesity at school level.
• Section-II: Studies related to effect of planned nursing intervention.
• Section-III: Studies related to knowledge and practice on Healthy Food Habits among children.
• Section-IV: Studies related to
  
  Pender’s Health Promotion Model
  
  Theory
• Section-V: Studies related to Conceptual framework based on Pender’s health promotion model (2002)

SECTION-I: STUDIES RELATED TO MALNUTRITION AND OBESITY

Malnutrition in early childhood causes irreparable damage to the development of child and results in wastage of human resources. Hence reduction in the high rate of child mortality and morbidity due to malnutrition becomes an important task of policy makers and social development planners survey conducted in rural areas of India revealed that abut 90% of the children suffer from different grades of malnutrion and about 15% of them are in extreme degrees of malnutrition.

Shetty, P.S.,(2000) concluded that the reduction in energy intake below the acceptable level of requirement for an individual results in a series of physiological and behavioural responses, which are considered as an adaptation to the low energy intake. This ability of the human body to adopt to a lowering of the energy intake is without doubt beneficial to the survival of the individual. Increases in metabolic efficiency are not ready seen in individuals who on long term marginal intakes probably from childhood, have developed into short statured, low body weight adults with a different body composition. The evidence that behavioural adaptation in habitual physical activity patterns which occurs on energy restriction is not necessarily beneficial to the individual raises doubts about the role of adaptation to low intakes in determining one’s requirement for energy.

Hensrud, DD., (2000) reviewed a journal nutrition screening and assessment which revealed the both under nutrition and over nutrition contribute to increased risk of morbidity and mortality. For patients determined to be at risk further nutrition assessment can be performed to help drive at specific nutritional treatment goals. Identifying and treating malnutrition can potentially have an important impact on decreasing mortality and mortality and morbity and in the population.

Rio-Grande Dosul., (2004) obese increased by about 60% in middle school children for every additional serving per day of sugar sweetened beverage. Obesity occurs more frequently in the more developed regions of the country (South and South East) due to the changes in habits associated with this process. Food intake has been related to obesity not only in terms of the volume of food ingested ,but also in terms of the composition and quality of the diet. Further more, eating habits have also changed and current habits -including the low consumption of tidbits goodies(cookies with fillings ,salty industrialized snacks, sweets)and soft drinks, as well as not having breakfast-help explain, atleast partially, the continuous increase in adiposity among children.

Rodriguez, NR., (2005) concluded that the children have distinct nutritional needs relative to growth. Adequate intakes of energy and essential amino acids are necessary for optimal deposition of lean body mass and normal growth in young children. Most recommendations for children represents an inter-population of data derived from infants and adults. Indeed current protein status in children was evaluated using classic nitrogen balance protocols. This work indicates that a wide range of protein intakes (0.6-2.9g/kg)can be considered for young ,growing children. The ability of nitrogen balance studies to accurately reflect protein utilization has been examined and it appears that further investigations of protein utilization in children using stable isotope methodology, as well as traditional nitrogen balance protocols are necessary to better evaluate protein needs of growing children.

Charles., (2005) the prevalence of obesity has risen dramatically among children in the U.S. and throughout the world since the 1960s.many factors are thought to have contributed to the epidemic of pediatric obesity. one factor that has received increasing attention is consumption of sugar sweetened beverages. feeding studies suggest physiological mechanisms by which sugar in liquid form may be less satiating than other foods

Veteri, F.E., (2010) aimed at providing information on a series of question related to the adequate protein and energy intakes that allow adequate growth and function in children and work performance and productivity in adults. The effect of different sources of protein on nitrogen balance and the requirements of essential aminoacids in young children were also explored in fully recovered previously malnourished children housed in the metabolic ward of the biomedical division of INCAP. Animal experiments and studies in children recovering from protein energy malnutrition (PEM) strongly suggest that even when requirements of all nutrients are satisfied. Inactivity reduces the rate of linear growth and physical activity improves it as well as lean body mass repletion. The effects of different energy intake modifies the need to ingest different amounts of protein to satisfy protein requirements. (PMID-20461903)

As to knowledge concerning aspects of nutrition 90.8% of the children correctly responded to the questions concerning foods that were sources of vitamins and minerals 23.4% to the questions concerning healthier foods, 19% to the questions concerning foods rich in fats 25.8% to the questions on food sources of fibers and 4.9% to the questions on food that supply the body with more energy.

Collaborating a tendency that has been reported in the literature the present study indicates an association between eating habits that are less healthy and obesity consumed.96 children ages 8-10 years in children a developing nation characterized as undergoing a nutrition transition, the subjects selected for current sugar -sweetened soft drink consumption will be randomly assigned to intervention.

SECTION-II: STUDIES RELATED TO EFFECT OF PLANNED NURSING INTERVENTION

Piffer.S, Kaisermann.D., (2003) presented paper reports the results of a survey on dietary habits of 1,398 children attending first class of primary school in Trento province (Northern Italy)the following items were investigated. Frequency of break fast and food intake .frequency of foods at school the conception of tracer foods as vegetables, fruits, and sweet was also investigated. The results were analysed according gender, area of residence, teaching method and educational level of parents. The data about nutritional style are satisfactory even if they are strongly associated to education level of parents, above all of the mother. The adequacy of nutritional style is increasing with the increasing of educational level. School meal, offering selected foods to all children attending fulltime teaching section, can re-equalibrate nutritional style, decreasing the differences associated to education level of the parents.

Delisle, H., (2010) conducted study on dietary patterns in different groups of African origin undergoing nutrition transition, University of Montreal, Canada. In population undergoing nutrition transition, it is important to identify healthy and culturally relevant dietary patterns that can be promoted as a means of preventing diet-related chronic diseases. Dietary pattern analyses using data driven methods are useful for the purpose. The central question addressed in this overview paper is whether there are culture – specific healthy eating patterns, or whether healthy diets may be more universal. Our studies on dietary patterns in population groups of African origin living in Canada (Miontreal), Europe (Madrid), and West Africa (urban and rural Benin) inform the discussion. Healthy or prudent, as opposed to Western, eating patterns are identified in several cultures, including groups of African origin. It appears that a limited number of foods predict diet quality and health outcomes in various population groups; in particular, fruit and vegetables, fish, whole grain cereal, and legumes do so on the protective side, and sweets, processed meats, fried foods, fats and oils, and salty snacks do so on the negative side. Further research on dietary patterns and their healthfulness is required in diverse food cultures. In groups of African origin, traditional diets are healthier than the nontraditional dietary patterns that have evolved with globalization, urbanization, or acculturation, although micronutrient intakes need to improve. Additionally, healthy eating patterns are only feasible if access to food is adequate.

Present data can be used for implementing and improving health promotion action on correct dietary habits in child hood, keeping count of the role of education level of the parents. As children develop, they require appropriately, sized, portions of the same healthy foods adults eat along with more vitamins and minerals to support growing bodies. This means whole grains (whole wheat oats, barley, rice, millet) a wide variety of fresh fruits and vegetables a source of calcium for growing bones (milk, yogurt) and healthy protein (fish, eggs, poultry, lean meat, nuts and seeds).

SECTION-III: STUDIES RELATED TO KNOWLEDGE AND PRACTICE ON HEALTHY FOOD HABITS AMONG CHILDREN:

This article examines the nutrition practices of black African children attending farm schools and looks at what they know about nutrition. Two schools participated in the study, which involved 132 primary school children aged 8-16years.A structured questionnaire revealed the children’s knowledge about nutrition related issues, and focus group discussions brought to the lives of the children living on commercial farms in the North west province. The findings provide strong support for the view that while nutrition education is important to children’s development of nutrition knowledge, good dietary practices and overall nutritional status, so also are influences from the children’s social, economic and psychological environment.

Gil, A., (2009) the study assessed dietary patterns and quality in Bubi immigrants (from Equatorial Guinea) using cluster analysis and comparing different diet quality indexes. A Ninety nine items food frequency questionnaire was administered, body weights and heights were self reported and socio-demographic and health information was collected during interviews. Two dietary patterns were identified. The ‘healthier’ pattern, so confirmed by two dietary quality indexes, featured a higher consumption of fish, fruits, vegetables, legumes, dairy products and bread while the “western” pattern included more processed meat, animal fat, and sweetened foods and drinks. One third of the subjects were in the ‘Healthier’ food cluster, with the same proportion of men and women. Age >of = 30 and residence in Madrid > or = 10 years were independently associated with the healthier diet. Consumption of traditional foods was unrelated to dietary pattern, however. Overall, Bubi diets were somewhat protective because of high intakes of fruits and vegetables and monounsaturated fat (olive oil), but not with respect to sugar, cholesterol, omega-3 fatty acids and fibre. Less than two thirds of subjects had adequate intakes of iron, calcium and folate in both dietary phenotypes. Body mass index, physical exercise, and self-reported health and cardiovascular disease condition showed no significant association with the dietary pattern.

SECTION-IV: STUDIES RELATED TO PENDER’S HEALTH PROMOTION MODEL

Austin David, R., (2000) it describes the Health promotion model of therapeutic recreation. following a brief introduction and an overview of the model, concepts that underlie the model are presented. concepts included are the humanistic perspective, high level wellness, the stabilization and actualization tendencies, and health. It is a description of the various components of the model and information on utilization of the model in practice. The final sections of the article are concern with the model’s strengths and limitations and the continuing development of the model. Health, nursing, psychology, therapeutic recreation, and recreation and leisure studies literature are drawn upon for support of the model.

Calderon, (2002) the programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non compliance. It involves the combination of educational and environmental support for actions and conditions conductive to health behavior and consists of the following components;(i)a culture and cohort sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client physician relationship.(ii)training for primary care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico and(iii)co-ordination of necessary support services to facilitate access to clinical breast exams and mammograms programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long term impact of the programme results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p<0.05) in beliefs after the health education sesstions.Interventions in breast cancer early detection practices showed significant changes(p.<0.05) for mammogram and clinical breast examination.

CONCEPTUAL FRAMEWORK BASED ON PENDER’S HEALTH PROMOTION MODEL (2002)

Conceptual framework is interrelated concepts on abstractions that are assembled together in some rationale scheme by virtue relevance to a common theme (Polit and Beck, 2004). It is a device which to stimulate research and the extension of knowledge by providing both direction and impetus. A framework may serve as a spring board for scientific findings meaningful and generalizable. The present study is aimed at developing and assessing the effectiveness of planned nursing intervention in terms of knowledge and practice on health food habits among primary school children in selected school at Salem. The conceptual framework of this study is based on Pender, Murdaugh, C and Parson., (2002) Health Promotion Model.

Pender, (2002) defines health as the actualization of inherent and acquired human potential through goal directed behavior, competent self care and satisfying relationships with others, while adjustments are made as needed to maintain structural integrity and harmony with relevant environment.

Health Promotion Model is based primarily on three theories of human behavior the theory of reasoned action, the theory of planned behavior and social cognitive theory. The theory of reasoned action explains that the major determinant of behavior is the person’s intent for that behavior, when she believes that she has control over the situation.

Prior Related Behavior:

It highlights the experience with the promoting behavior. In this study prior related behavior of knowledge and practice of primary school children on 1st day. It includes adequate -inadequate knowledge and practice towards health food habits, bringing / not bringing healthy foods will be assessed by pre-test on 1st day.

Personal Factors:

Factors about the person, that influences health promoting behaviour. This includes biological and socio-cultural factors in this study.

Biological Factors:

Includes age of the sample, gender, type of the family.

Socio-cultural factors:

Education of the mother, occupation of the mother, religion.

Health Promoting Behaviour:

Behaviours (or) actions that people carry out with the intentions of improve their health. In this study is specified, health promoting knowledge and practice of healthy foods to children pamphlet distributed to the children giving information regarding healthy food habits to the mothers of children. Regular practicing of health food habits.

Perceived Control of Health :

Children can understand about the in effects of taking junk foods.

Perceived Health Status:

The researcher perceived that there is slight improvement in the food habits of children of bringing health snacks.

Perceived Benefits of Action:

Belief about the positive or reinforcing consequences of a health promoting behaviour. Here it includes children will perceive benefits of good balanced diet, sample develops the health food habits and improvement in knowledge regarding health food habits, stay health and energetic.

Perceived Barriers of Health Promoting Behaviour:

Belief about children decreased attention span, more attracted to advertisements, working mothers.

Interpersonal Influences:

Belief about teaching programme on health food habits and promoting practice of bringing health foods on 3, 6, 10th day of practice assessment by this researcher.

Situational Influences:

Peer group.

Immediate Competing Preferences:

Distracting idea about other attractive activities to do immediately before engaging in a health promotes behaviour. In this study, it includes child’s health, taking healthy foods.

Commitment to a Plan of Action:

Commitment to carry out a health promotes bahaviour. The plan should be specific to time and place, and specify whether it will be with identified person or alone. Practice healthy food habits at school setting after teaching, this study describe about the formulation of a realistic plan to practice healthy food habits by bringing healthy food habits by bringing healthy snacks, and healthy lunch daily (morning and afternoon) to the school with the supervision of researcher in alternative days.

SUMMARY

This chapter deals with the review of literature regarding studies related to malnutrition and obesity, effects of Planned Nursing Intervention, knowledge and practice, Pender’s Health Promotion Model Theory and also it dealt with conceptual framework based on Pender’s Health Promotion Model Theory.

A literature review is a compilation of resources that provide the ground work for further study. It is frequently found as a subsection of a published research study. Literature review refers to the activities involves in searching for information on a topic and developing a comprehensive picture of the state of the knowledge on the topic.

Review of literature is a written summary of the study conducted previously related to the present study topic. (Polit and Hungler, 1999)

The researcher carried out an extensive review of literature on the research topic in order to gain deeper insight into the problem and to collect maximum relevant information for building the foundations of the study.

In the present study the review of literature is organized under the following headings;

• Section-I: Studies related to malnutrition and obesity at school level.
• Section-II: Studies related to effect of planned nursing intervention.
• Section-III: Studies related to knowledge and practice on Healthy Food Habits among children.
• Section-IV: Studies related to
  
  Pender’s Health Promotion Model
  
  Theory
• Section-V: Studies related to Conceptual framework based on Pender’s health promotion model (2002)

SECTION-I: STUDIES RELATED TO MALNUTRITION AND OBESITY

Malnutrition in early childhood causes irreparable damage to the development of child and results in wastage of human resources. Hence reduction in the high rate of child mortality and morbidity due to malnutrition becomes an important task of policy makers and social development planners survey conducted in rural areas of India revealed that abut 90% of the children suffer from different grades of malnutrion and about 15% of them are in extreme degrees of malnutrition.

Shetty, P.S.,(2000) concluded that the reduction in energy intake below the acceptable level of requirement for an individual results in a series of physiological and behavioural responses, which are considered as an adaptation to the low energy intake. This ability of the human body to adopt to a lowering of the energy intake is without doubt beneficial to the survival of the individual. Increases in metabolic efficiency are not ready seen in individuals who on long term marginal intakes probably from childhood, have developed into short statured, low body weight adults with a different body composition. The evidence that behavioural adaptation in habitual physical activity patterns which occurs on energy restriction is not necessarily beneficial to the individual raises doubts about the role of adaptation to low intakes in determining one’s requirement for energy.

Hensrud, DD., (2000) reviewed a journal nutrition screening and assessment which revealed the both under nutrition and over nutrition contribute to increased risk of morbidity and mortality. For patients determined to be at risk further nutrition assessment can be performed to help drive at specific nutritional treatment goals. Identifying and treating malnutrition can potentially have an important impact on decreasing mortality and mortality and morbity and in the population.

Rio-Grande Dosul., (2004) obese increased by about 60% in middle school children for every additional serving per day of sugar sweetened beverage. Obesity occurs more frequently in the more developed regions of the country (South and South East) due to the changes in habits associated with this process. Food intake has been related to obesity not only in terms of the volume of food ingested ,but also in terms of the composition and quality of the diet. Further more, eating habits have also changed and current habits -including the low consumption of tidbits goodies(cookies with fillings ,salty industrialized snacks, sweets)and soft drinks, as well as not having breakfast-help explain, atleast partially, the continuous increase in adiposity among children.

Rodriguez, NR., (2005) concluded that the children have distinct nutritional needs relative to growth. Adequate intakes of energy and essential amino acids are necessary for optimal deposition of lean body mass and normal growth in young children. Most recommendations for children represents an inter-population of data derived from infants and adults. Indeed current protein status in children was evaluated using classic nitrogen balance protocols. This work indicates that a wide range of protein intakes (0.6-2.9g/kg)can be considered for young ,growing children. The ability of nitrogen balance studies to accurately reflect protein utilization has been examined and it appears that further investigations of protein utilization in children using stable isotope methodology, as well as traditional nitrogen balance protocols are necessary to better evaluate protein needs of growing children.

Charles., (2005) the prevalence of obesity has risen dramatically among children in the U.S. and throughout the world since the 1960s.many factors are thought to have contributed to the epidemic of pediatric obesity. one factor that has received increasing attention is consumption of sugar sweetened beverages. feeding studies suggest physiological mechanisms by which sugar in liquid form may be less satiating than other foods

Veteri, F.E., (2010) aimed at providing information on a series of question related to the adequate protein and energy intakes that allow adequate growth and function in children and work performance and productivity in adults. The effect of different sources of protein on nitrogen balance and the requirements of essential aminoacids in young children were also explored in fully recovered previously malnourished children housed in the metabolic ward of the biomedical division of INCAP. Animal experiments and studies in children recovering from protein energy malnutrition (PEM) strongly suggest that even when requirements of all nutrients are satisfied. Inactivity reduces the rate of linear growth and physical activity improves it as well as lean body mass repletion. The effects of different energy intake modifies the need to ingest different amounts of protein to satisfy protein requirements. (PMID-20461903)

As to knowledge concerning aspects of nutrition 90.8% of the children correctly responded to the questions concerning foods that were sources of vitamins and minerals 23.4% to the questions concerning healthier foods, 19% to the questions concerning foods rich in fats 25.8% to the questions on food sources of fibers and 4.9% to the questions on food that supply the body with more energy.

Collaborating a tendency that has been reported in the literature the present study indicates an association between eating habits that are less healthy and obesity consumed.96 children ages 8-10 years in children a developing nation characterized as undergoing a nutrition transition, the subjects selected for current sugar -sweetened soft drink consumption will be randomly assigned to intervention.

SECTION-II: STUDIES RELATED TO EFFECT OF PLANNED NURSING INTERVENTION

Piffer.S, Kaisermann.D., (2003) presented paper reports the results of a survey on dietary habits of 1,398 children attending first class of primary school in Trento province (Northern Italy)the following items were investigated. Frequency of break fast and food intake .frequency of foods at school the conception of tracer foods as vegetables, fruits, and sweet was also investigated. The results were analysed according gender, area of residence, teaching method and educational level of parents. The data about nutritional style are satisfactory even if they are strongly associated to education level of parents, above all of the mother. The adequacy of nutritional style is increasing with the increasing of educational level. School meal, offering selected foods to all children attending fulltime teaching section, can re-equalibrate nutritional style, decreasing the differences associated to education level of the parents.

Delisle, H., (2010) conducted study on dietary patterns in different groups of African origin undergoing nutrition transition, University of Montreal, Canada. In population undergoing nutrition transition, it is important to identify healthy and culturally relevant dietary patterns that can be promoted as a means of preventing diet-related chronic diseases. Dietary pattern analyses using data driven methods are useful for the purpose. The central question addressed in this overview paper is whether there are culture – specific healthy eating patterns, or whether healthy diets may be more universal. Our studies on dietary patterns in population groups of African origin living in Canada (Miontreal), Europe (Madrid), and West Africa (urban and rural Benin) inform the discussion. Healthy or prudent, as opposed to Western, eating patterns are identified in several cultures, including groups of African origin. It appears that a limited number of foods predict diet quality and health outcomes in various population groups; in particular, fruit and vegetables, fish, whole grain cereal, and legumes do so on the protective side, and sweets, processed meats, fried foods, fats and oils, and salty snacks do so on the negative side. Further research on dietary patterns and their healthfulness is required in diverse food cultures. In groups of African origin, traditional diets are healthier than the nontraditional dietary patterns that have evolved with globalization, urbanization, or acculturation, although micronutrient intakes need to improve. Additionally, healthy eating patterns are only feasible if access to food is adequate.

Present data can be used for implementing and improving health promotion action on correct dietary habits in child hood, keeping count of the role of education level of the parents. As children develop, they require appropriately, sized, portions of the same healthy foods adults eat along with more vitamins and minerals to support growing bodies. This means whole grains (whole wheat oats, barley, rice, millet) a wide variety of fresh fruits and vegetables a source of calcium for growing bones (milk, yogurt) and healthy protein (fish, eggs, poultry, lean meat, nuts and seeds).

SECTION-III: STUDIES RELATED TO KNOWLEDGE AND PRACTICE ON HEALTHY FOOD HABITS AMONG CHILDREN:

This article examines the nutrition practices of black African children attending farm schools and looks at what they know about nutrition. Two schools participated in the study, which involved 132 primary school children aged 8-16years.A structured questionnaire revealed the children’s knowledge about nutrition related issues, and focus group discussions brought to the lives of the children living on commercial farms in the North west province. The findings provide strong support for the view that while nutrition education is important to children’s development of nutrition knowledge, good dietary practices and overall nutritional status, so also are influences from the children’s social, economic and psychological environment.

Gil, A., (2009) the study assessed dietary patterns and quality in Bubi immigrants (from Equatorial Guinea) using cluster analysis and comparing different diet quality indexes. A Ninety nine items food frequency questionnaire was administered, body weights and heights were self reported and socio-demographic and health information was collected during interviews. Two dietary patterns were identified. The ‘healthier’ pattern, so confirmed by two dietary quality indexes, featured a higher consumption of fish, fruits, vegetables, legumes, dairy products and bread while the “western” pattern included more processed meat, animal fat, and sweetened foods and drinks. One third of the subjects were in the ‘Healthier’ food cluster, with the same proportion of men and women. Age >of = 30 and residence in Madrid > or = 10 years were independently associated with the healthier diet. Consumption of traditional foods was unrelated to dietary pattern, however. Overall, Bubi diets were somewhat protective because of high intakes of fruits and vegetables and monounsaturated fat (olive oil), but not with respect to sugar, cholesterol, omega-3 fatty acids and fibre. Less than two thirds of subjects had adequate intakes of iron, calcium and folate in both dietary phenotypes. Body mass index, physical exercise, and self-reported health and cardiovascular disease condition showed no significant association with the dietary pattern.

SECTION-IV: STUDIES RELATED TO PENDER’S HEALTH PROMOTION MODEL

Austin David, R., (2000) it describes the Health promotion model of therapeutic recreation. following a brief introduction and an overview of the model, concepts that underlie the model are presented. concepts included are the humanistic perspective, high level wellness, the stabilization and actualization tendencies, and health. It is a description of the various components of the model and information on utilization of the model in practice. The final sections of the article are concern with the model’s strengths and limitations and the continuing development of the model. Health, nursing, psychology, therapeutic recreation, and recreation and leisure studies literature are drawn upon for support of the model.

Calderon, (2002) the programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non compliance. It involves the combination of educational and environmental support for actions and conditions conductive to health behavior and consists of the following components;(i)a culture and cohort sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client physician relationship.(ii)training for primary care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico and(iii)co-ordination of necessary support services to facilitate access to clinical breast exams and mammograms programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long term impact of the programme results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p<0.05) in beliefs after the health education sesstions.Interventions in breast cancer early detection practices showed significant changes(p.<0.05) for mammogram and clinical breast examination.

CONCEPTUAL FRAMEWORK BASED ON PENDER’S HEALTH PROMOTION MODEL (2002)

Conceptual framework is interrelated concepts on abstractions that are assembled together in some rationale scheme by virtue relevance to a common theme (Polit and Beck, 2004). It is a device which to stimulate research and the extension of knowledge by providing both direction and impetus. A framework may serve as a spring board for scientific findings meaningful and generalizable. The present study is aimed at developing and assessing the effectiveness of planned nursing intervention in terms of knowledge and practice on health food habits among primary school children in selected school at Salem. The conceptual framework of this study is based on Pender, Murdaugh, C and Parson., (2002) Health Promotion Model.

Pender, (2002) defines health as the actualization of inherent and acquired human potential through goal directed behavior, competent self care and satisfying relationships with others, while adjustments are made as needed to maintain structural integrity and harmony with relevant environment.

Health Promotion Model is based primarily on three theories of human behavior the theory of reasoned action, the theory of planned behavior and social cognitive theory. The theory of reasoned action explains that the major determinant of behavior is the person’s intent for that behavior, when she believes that she has control over the situation.

Prior Related Behavior:

It highlights the experience with the promoting behavior. In this study prior related behavior of knowledge and practice of primary school children on 1st day. It includes adequate -inadequate knowledge and practice towards health food habits, bringing / not bringing healthy foods will be assessed by pre-test on 1st day.

Personal Factors:

Factors about the person, that influences health promoting behaviour. This includes biological and socio-cultural factors in this study.

Biological Factors:

Includes age of the sample, gender, type of the family.

Socio-cultural factors:

Education of the mother, occupation of the mother, religion.

Health Promoting Behaviour:

Behaviours (or) actions that people carry out with the intentions of improve their health. In this study is specified, health promoting knowledge and practice of healthy foods to children pamphlet distributed to the children giving information regarding healthy food habits to the mothers of children. Regular practicing of health food habits.

Perceived Control of Health :

Children can understand about the in effects of taking junk foods.

Perceived Health Status:

The researcher perceived that there is slight improvement in the food habits of children of bringing health snacks.

Perceived Benefits of Action:

Belief about the positive or reinforcing consequences of a health promoting behaviour. Here it includes children will perceive benefits of good balanced diet, sample develops the health food habits and improvement in knowledge regarding health food habits, stay health and energetic.

Perceived Barriers of Health Promoting Behaviour:

Belief about children decreased attention span, more attracted to advertisements, working mothers.

Interpersonal Influences:

Belief about teaching programme on health food habits and promoting practice of bringing health foods on 3, 6, 10th day of practice assessment by this researcher.

Situational Influences:

Peer group.

Immediate Competing Preferences:

Distracting idea about other attractive activities to do immediately before engaging in a health promotes behaviour. In this study, it includes child’s health, taking healthy foods.

Commitment to a Plan of Action:

Commitment to carry out a health promotes bahaviour. The plan should be specific to time and place, and specify whether it will be with identified person or alone. Practice healthy food habits at school setting after teaching, this study describe about the formulation of a realistic plan to practice healthy food habits by bringing healthy food habits by bringing healthy snacks, and healthy lunch daily (morning and afternoon) to the school with the supervision of researcher in alternative days.

SUMMARY

This chapter deals with the review of literature regarding studies related to malnutrition and obesity, effects of Planned Nursing Intervention, knowledge and practice, Pender’s Health Promotion Model Theory and also it dealt with conceptual framework based on Pender’s Health Promotion Model Theory.