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ORIGINAL ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 85-88

Pattern of nutrition and health guidance to adolescents by their teachers and multipurpose health workers in a rural block of district: Jhajjar (Haryana)


1 Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, Haryana, India
2 Department of Community Medicine, Pt B.D. Sharma, PGIMS, Rohtak, Haryana, India

Date of Web Publication6-May-2014

Correspondence Address:
Arun Kumar
Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-019X.131959

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  Abstract 

Context: Adolescence is a period of transition and is associated with the risk of many nutrition and health-related problems. Teachers and grass root level health service providers i.e., multi-purpose health workers, being the key stakeholders, are expected to provide them nutrition and health guidance.
Aims: To assess nutrition and health guidance to adolescents by their school teachers and multipurpose health workers.
Settings and Design: It was a cross-sectional study conducted in rural block in the field practice area attached to Department of Community Medicine, Pt BD Sharma PGIMS Rohtak (India).
Materials and Methods: All the multipurpose health workers (males and females) [i.e., MPHW (M and F)] who were working in the study area i.e., those posted at the sub-centers, Primary Health Centers, or Community Health Centers for more than 6 months were included in the study. For selecting the teachers, 4 large schools with strength of more than 250 students (2 Girls and 2 Boys Senior Secondary Schools) were randomly selected by simple random sampling. All the teachers who were teaching the standards 9 to 12 in those schools were also enrolled in the study. Thus, the study population comprised of 49 and 94 such workers and teachers, respectively. Data were collected with the help of predesigned, pre-tested, and semi-structured schedules by interviewing the study subjects.
Statistical Analysis Used: Proportions, chi square test, Fisher exact test
Results and Conclusion: Only 58/94 (61.7%) and 40/94 (42.6%) teachers stated to have provided guidance on "substance abuse" and "HIV/AIDS/STDs/RTIs/Menstrual hygiene," respectively. Surprisingly, 35/49 (71.4%) workers provided guidance on nutrition and anemia to the adolescents, whereas only 10/49 (20.4%) and 11/49 (22.4%) workers provided the guidance on substance abuse and HIV/AIDS/STDs/RTIs/Menstrual hygiene, respectively.

Keywords: Adolescents, guidance, health, health service providers, health workers, nutrition, teachers


How to cite this article:
Kumar A, Jain RB, Khanna P. Pattern of nutrition and health guidance to adolescents by their teachers and multipurpose health workers in a rural block of district: Jhajjar (Haryana). J Med Nutr Nutraceut 2014;3:85-8

How to cite this URL:
Kumar A, Jain RB, Khanna P. Pattern of nutrition and health guidance to adolescents by their teachers and multipurpose health workers in a rural block of district: Jhajjar (Haryana). J Med Nutr Nutraceut [serial online] 2014 [cited 2020 Mar 31];3:85-8. Available from: http://www.jmnn.org/text.asp?2014/3/2/85/131959


  Introduction Top


Adolescents are young people aged 10-19 years. [1] One-fifth of the world's population is comprised of adolescents, and -80% of them live in developing countries. [1] Adolescence is a period of a magnificent and rapid change and is vulnerable to a number of nutrition and health-related problems. [2],[3],[4],[5],[6],[7],[8],[9],[10],[11] Behavioral patterns acquired during adolescence (such as gender relations, sexual conduct, use of tobacco, alcohol and other drugs, eating habits, and dealing with conflicts and risks) could last a lifetime. [9],[12] Teachers and grass root level health service providers, i.e., multi-purpose health workers female/male, are among the educated key stakeholders, and hence are expected to provide adolescent students the basic nutrition and health guidance. [13] With this view in mind, we assessed the extent and pattern of nutrition and health-related guidance to adolescents by their school teachers and multipurpose health workers from the perspective of teachers and workers themselves. This study was part of a larger study, which assessed overall support and guidance to adolescents by their teachers and health services providers.


  Materials and Methods Top


This cross-sectional study was conducted in a rural Block of district Jhajjar. This area was also attached to Department of Community Medicine, Pt BD Sharma PGIMS Rohtak (India) for teaching, training and research purposes. This area was being looked after by Senior Medical Officer, community health center (CHC) Dubaldhan. There were 21 sub-centers, 3 primary health centers (PHCs), 1 general hospital (GH) under this CHC. Apart from this, there were 49 multipurpose health workers (male and female) [i.e., MPHW (M and F)] posted at those sub-centers, PHCs, or CHC and who were working in the area for more than 6 months, and hence were included in the study.

To select teachers for the study, the schools were selected and then all the teachers who were involved in teaching to senior classes in those schools were selected. As majority of the school teachers are likely to be found in large schools and because of the feasibility/approachability reasons, out of the total 7 Government (Govt.) High schools and 19 Govt. Senior Secondary schools located in the block, 4 large schools with strength of more than 250 students (2 Girls and 2 Boys/co-ed Senior Secondary Schools) were selected by simple random sampling. Teachers from 2 different strata of girls' and boys' schools were selected separately by stratified random sampling to eliminate the possible variability in guidance provided by the teachers coming in contact with adolescents of different sexes i.e., male and female. Thus, all the 94 teachers who were involved in teaching the standards 9 th to 12 th in those schools were included in the study and interviewed. Data were collected with the help of pre-designed, pre-tested, and semi-structured schedules by interviewing the study subjects. Confidentiality of their responses was also maintained. Ethical approval/prior permission to conduct the study was sought from Institutional Post Graduate Board of Studies.


  Results Top


Response rate was 100% among the study participants i.e., teachers and health workers as all of them completed the interviews. Age distribution was more or less equal among the teachers. However, the younger teachers i.e., those with age less than 30 years of age, were only the females as shown in the [Table 1].In totality, number of male teachers was less as compared to the female counterparts. 92/94 (97.9%), 86/94 (91.5%), and 86/94 (91.5%) teachers narrated that they had provided adolescents the guidance regarding character-building and/or moral values, personal hygiene, and oro-dental hygiene, respectively, for laying foundation for overall development of the adolescents. Only 58/94 (61.7%) and 40/94 (42.6%) teachers stated to have provided guidance on "substance abuse" and "HIV/AIDS/STDs/RTIs/Menstrual hygiene," respectively [Table 2].
Table 1: Age and sex distribution of study participants

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Table 2: Nutrition and health guidance provided by study teachers to adolescents

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Out of 49, 35 (i.e., 71.4%) workers provided guidance on nutrition and anemia to the adolescents whereas only 10/49 (20.4%) and 11/49 (22.4%) workers provided the guidance on substance abuse and HIV/AIDS/STDs/RTIs/Menstrual hygiene, respectively. The issues like character-building and/or and moral values, personal hygiene, and oro-dental hygiene were the neglected areas of guidance by the health workers, as only 2/49 (4.1%), 3/49 (6.1%), and 4/49 (8.2%) workers, respectively, provided some kind of guidance on these areas [Table 3].
Table 3: Nutrition and health guidance provided by health workers to adolescents

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  Discussion Top


Limited number of studies had been carried out on this topic. However, whatever the studies were available have been discussed here. The two-tailed P value was found to be 1.0, and hence the association between teachers of both the sexes and those providing guidance on character-building/moral values and those not providing the guidance was considered to be statistically non-significant. [P = 1.0] [Table 2]. Similarly, the table showed that this difference was found to be non-significant as regards other kinds of studied guidance, except one i.e., guidance on substance abuse. On comparison to female teachers, more male teachers were providing the guidance on substance abuse [P = 0.02]. Perhaps, it was because of the more commonality of the problems of substance abuse among male adolescents [15] and more number of male teachers working in boys' schools. At times, negative roles might be played by teachers in developing ill health behavior among adolescents. [16]

About 71% workers provided guidance on nutrition and anemia to the adolescents, whereas only ˜20% and ˜22% workers provided the guidance on substance abuse and HIV/AIDS/STDs/RTIs/Menstrual hygiene, respectively. These low figures indicated that HSPs emphasized less on the later areas and seemingly focused more on the curative services or the preventive and health promotive services on other areas. In comparison to male workers (˜29%), significantly higher proportion of female workers (˜89%) provided guidance on nutrition and anemia to the adolescents. [P ≤ 0.0001*]. On the contrary, higher proportion of male workers (˜57%) as compared to female ones (˜5.7%) provided the guidance on substance abuse. [P = 0.0002*] [Table 3]. Importance of growth charts have been highlighted many times before. [17],[18] But, the need for correct nutrition guidance to the adolescents had been a relatively neglected issue. On the other side, the health guidance might be extended, as the case might be, to motivational interviewing of selected adolescent cases. [19]


  Conclusion Top


Nearly 98%, 92%, and 92% teachers provide guidance regarding character building/moral values, personal hygiene, and oro-dental hygiene, respectively, for laying foundation for overall development of the adolescents. Only 61.7% and 42.6% teachers provide guidance on "substance abuse" and "HIV/AIDS/STDs/RTIs/Menstrual hygiene," respectively. Guidance on nutrition and anemia to the adolescents is provided by 71.4% workers while that on substance abuse and HIV/AIDS/STDs/RTIs/Menstrual hygiene is far less i.e., by only 20.4% and 22.4% workers, respectively. Issues like character-building and moral values, personal hygiene, and oro-dental hygiene are relatively the neglected areas for guidance by the workers, as only 4.1%, 6.1%, and 8.2% of them respectively provide some guidance on these areas.

There is a need to sensitize, train, and mobilize teachers as well as health workers on the nutrition and health guidance needs of adolescents and also to facilitate them in realizing their responsibilities in health education of the adolescents. Some period in time table of schools, say weekly, can be earmarked for adolescents' nutrition and health guidance needs. Appropriate educational materials could be developed to orient teachers and HSPs on adolescents' needs of nutrition and health guidance. Appropriate mechanisms might be developed for the coordination and intense monitoring and evaluation of progress in the implementation of RCH program and other ongoing programs for adolescents. However, quality of the services being provided by health workers was not assessed and, hence, is warranted to be further assessed.

 
  References Top

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World Health Organisation. Adolescent friendly health services: An agenda for change. Geneva: World Health Organization; 2002. p. 5.  Back to cited text no. 1
    
2.
Twenge JM, Nolen-Hoeksema S. Age, gender, race, socioeconomic status and birth cohort differences on the Children's Depression Inventory: A meta-analysis. J Abnorm Psychol 2002;111:578-88.  Back to cited text no. 2
    
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Chambers RA, Taylor JR, Potenza MN. Developmental neurocircuitry of motivation in adolescence: A critical period of addiction vulnerability. Am J Psychiatry 2003;160:1041-52.  Back to cited text no. 4
    
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Johnston LD, O'Malley PM, Bachman JG. Monitoring the future: National survey results on adolescent drug use: Overview of key findings, 2000 (NIH Publication No 00-4923). Rockville: National Institute on Drug Abuse; 2001.  Back to cited text no. 5
    
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Warheit GJ, Vega WA, Khoury EL, Gil AA, Elfenbein PH. A comparative analysis of cigarette, alcohol, and illicit drug use among an ethnically diverse sample of hispanic, African American, and non-hispanic white adolescents. J Drug Issues 1996;26:901-22.  Back to cited text no. 6
    
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Romerl D, Stanton BF. Feelings about risk and the epidemic diffusion of adolescent sexual behavior. Prev Sci 2003;4:39-53.  Back to cited text no. 7
    
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Moffitt TE. Natural histories of delinquency. In: Weitekamp EG, Kerner HJ, editors. Cross-national longitudinal research on human development and criminal behavior. Netherlands: Springer; 1994. p. 3-61.  Back to cited text no. 8
    
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12.
Ministry of Health and Family Welfare, Government of India. National Rural Health Mission: Implementation guide on RCH II: Adolescent reproductive sexual health strategy. New Delhi: Ministry of Health and Family Welfare Government of India; 2006. p. 23.  Back to cited text no. 12
    
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Jain RB, Kumar A, Khanna P, Goel MK, Tyagi A. Knowledge regarding changes in adolescence among health service providers and teachers in a rural block of District - Jhajjar (Haryana). Int J Med Public Health 2013. [In Press].  Back to cited text no. 14
    
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Ahmad A, Khalique N, Khan Z. Analysis of substance abuse in male adolescents. Iran J Pediatr 2009;19:399-403.  Back to cited text no. 16
    
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Khadilkar V, Khadilkar A. Growth charts: A diagnostic tool. Indian J Endocrinol Metab 2011;15 Suppl 3:S166-71.  Back to cited text no. 17
    
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Khadilkar V, Kalra S, Khadilkar A. Growth charts. Indian J Endocrinol Metab 2011;15 Suppl 3:S154-5.  Back to cited text no. 18
    
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  [Table 1], [Table 2], [Table 3]



 

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