Key findings:

The study assessed maternal knowledge of malnutrition among rural mothers with children under 5. Out of 400 participants, most were aged 26-30, Hindu, housewives, and delivered in government hospitals. 78.75% had good to very good knowledge levels. Emphasizing breastfeeding initiation, complementary feeding, and meal diversity is crucial for improving child nutrition.

What is known and what is new?

This abstract highlights the significance of maternal knowledge in combating childhood malnutrition in rural areas. Notably, the study reveals that a substantial proportion of mothers possess good to very good knowledge levels regarding malnutrition. The emphasis on breastfeeding initiation, complementary feeding, and meal diversity underscores the importance of targeted education interventions to enhance child nutrition in under 5 children.

What is the implication, and what should change now?

The findings underscore the importance of maternal education in combating childhood malnutrition. Efforts should focus on enhancing awareness among mothers regarding timely breastfeeding initiation, complementary feeding, and meal diversity to improve the nutritional status of children under 5 in rural areas. Implementing targeted educational interventions is crucial for addressing this public health issue effectively.

Malnutrition is a condition which develops as a result of insufficient food nutrients supplied to the body, these nutrients include minerals, vitamins, proteins, fat, and carbohydrates which are necessary for maintaining healthy tissues and organ functions. Malnutrition is an underlying cause of mortality and morbidity of children under 5 years of age. [1-3]

Mother is the person responsible for taking care of a child, so it is very important for mothers to have enough knowledge regarding nutrition of the child. Mothers who have more knowledge about nutrition can bring up their children in a healthy way and can protect their children from this health problem. [4,5]

A number of studies have assessed knowledge about malnutrition in different parts of India; such studies are limited among mothers in rural areas of District Sirmaur. Thus the present study was developed to examine the knowledge towards malnutrition among mothers having under 5 children residing in rural areas of District Sirmaur.

OBJECTIVES OF THE STUDY:

To evaluate the knowledge towards malnutrition among mothers having under 5 children and residing in rural areas of District Sirmaur.

• Research Approach -Descriptive
• Research Design-Hospital based cross-sectional survey design
• Setting of the study- Pediatric OPD in civil hospital Dadahu
• Study duration- between March 2021- August 2021  
• Study population-  Mothers came to Pediatric OPD and  having children aged less than 5 year 
• Sample size- 400 Mothers assuming 50% mothers have adequate knowledge regarding Breast feeding, 5% absolute error, 95% confidence level, and 5% non response rate.
• Sampling Technique- convenience  Sampling technique
• Sampling criteria- first five mothers who came to Pediatric OPD and having children aged less than 5 years were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent/assent was taken from them and confidentiality  of the selected  participants was also maintained 
• Inclusive Criteria- Mothers who were willing to participate in the study.

• Exclusion Criteria: Mothers who were not willing to participate in the study

  Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income, delivery pattern, ANC Check up and many more.
2. Questionnaire: The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know).  The participants have to choose the right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field
• Data collection by  under the guidance of supervisors and mothers were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time
• Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage.

Present study was developed to evaluate the knowledge towards malnutrition among mothers’ of rural areas of District Sirmaur. A total of 400 Mothers came to Pediatric OPD and having children aged less than 5 years were selected after explaining the purpose of the study. Among the total mothers, maximum 246(61.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 182(45.5%) Hindu 329(82.25%), Housewife 359(89.75%), Multigravida 309(77.25%) and delivered in government hospitals 282(70.5%). (Table 1 and 2)

Table 1: Socio Demographic Characteristics of the Participants

Table 2: Responses of the Participants to Various Statements

Table 3: Knowledge towards Malnutrition among Mothers’

Maximum =20 Minimum=6

In the present study 11.75%(47) mothers’ had very good knowledge (16-20 marks) towards malnutrition , 67.0%(268) having good knowledge  (12-15 marks), 13.0%(52) having fair knowledge  (8-11 marks) and 8.25% (33) having poor knowledge  (<8 marks). (Table 3)

Child malnutrition is a major underlying cause of child mortality in India. Rural India is witnessing more malnutrition among children < 5 years as a higher percentage of stunted, wasted and underweight children were reported from rural areas. Most common causes of malnutrition included faulty infant feeding practice, impaired utilization of nutrients due to infection & parasites, Inadequate food and health security, poor environment condition and lack of proper child care practice. [4,5]

NFHS 5 data on complementary feeding in  District Sirmaur showed that there was an increase in  percentage of stunting (height-for-age), severely wasted (weight-for-height),  underweight (weight-for-age) and overweight (weight-for-height) as compared to NFHS-4.  (Table-4)

Table-4: NFHS-5 Data on Malnutrition in District Sirmaur

Improvement of nutritional status of children is an essential component of primary health care. Prevention of malnutrition requires comprehensive and systematic analysis and planning. Mother's education can generate different types of intra household effects and thereby reduce the risk of nutritional deficiency E.g. Malnutrition. The effects which will bring through mothers’ education were; Improvement in health and nutrition knowledge in favor of better nutrition which includes breastfeeding, weaning practices & child feeding and effective dietary behaviour on the part of mother's who manage food resources within the household [7^,8].

Reduction of child malnutrition through breast feeding and appropriate complementary feeding remains an important global health goal. Education about malnutrition targeting behavioral change especially among mothers in rural areas is important to reduce child morbidity and mortality [9].

Limitations of the Study: 

The present study has certain limitations such as cross sectional in nature, and small sample size that made it difficult to generalize the findings. Future research should be focused on larger sample and qualitative studies such as focus group interviews to identify barriers to promote appropriate knowledge and practices about malnutrition among mothers.

However, despite these limitations, the present study findings may be helpful to the health professionals and policy makers in designing the interventions to promote age appropriate feeding and dietary practices related to nutrition.

The present study concludes that the mothers have a good knowledge toward malnutrition. Still there was a significant gap in the knowledge regarding malnutrition as it was not at the optimal level when compared with the recommendations of the WHO.

Education targeting behavioral change is important to reduce child malnutrition, morbidity and mortality. Appropriate education Programmes emphasizing timely initiation, appropriates, fortification, iron supplementation and meal diversity is necessary to improve knowledge and practices regarding malnutrition.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Poanta Sahib, Sirmaur, Himachal Pradesh.

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