INTRODUCTION:

In India it is a challenge for health planner to prevent under nutrition. Protein energy malnutrition and micronutrient deficiencies consider as under nutrition. In India 50% of children under 3year are underweight, 30% of newborn are low birth weight and 74% of children are anaemic.

Children who are severely malnourished were 24% according to their height –for-age and 16% according to weight –for- age. In India wasting is an important problem, affecting 20% of children under five years of age. In India girls and boys are equally undernourished. Under nutrition is the underlying cause of 50% death in India each year. It found mostly in rural area and concentrated 10% of villages and 27-28% of districts. Prime cause of low birth weight and poor growth of baby is mother’s malnutrition. If the low birth weight baby who survive also having growth retardation and illness throughout their life.¹

Billion people are affected by one or more types of malnutrition, says Ala Alwan, WHO Assistant Director –General of non communicable disease and mental health. Three main forms of malnutrition are under nutrition, vitamin and mineral deficiencies, and overweight and obesity. WHO e-Library of Evidence for Nutrition Actions (e-LENA) explained about effective health intervention to tackle malnutrition like promote breastfeeding and fortifying staple foods with vitamins and minerals. WHO conducted a movement “Scaling up Nutrition” which include multiple UN agencies and other nutritional stakeholders.²

United Nations report says that ten children die every minute as a result of malnutrition in developing countries, about a quarter of children are underweight and having various disease due to poor diet. According to Ann Veneman, they still have the time to achieve the goals of millennium development goals, but only if the international community acts now to deliver the commitments and resources it has promised. The UNICEF reported that because of insufficient food intake, repeated infectious diseases, muscle wastage and vitamin deficiencies about 146 million children under five are suffering.³

Hunger and malnutrition survey done by the Nandi Foundation in the year of 2011 says that 42% of Indian children under five year old are under weight. This survey said about Indian nutritional status as "nutrition crisis" in 110, 000 children across the country. Prime Minister Manmohan Singh repeatedly said in different occasion that the problem of malnutrition is a matter of national shame. The Manmohan Singh worried about the highest level of malnutrition found in our country. He identified that we need to focus on districts where malnutrition level are high. At end he conclude that with this large number of malnourished children we cannot hope for the healthy future. The statistics in the HUNGaMA (Hunger and Malnutrition) report say that every third malnourished child on the planet is an Indian.⁴

The multiple causes of malnutrition include poverty, common and preventable infections, inadequate care and unsafe water. These play an important role in the half of death in nearly 12 million death in each year. The State of the World's Children 1998 report details the scale of the loss and the steps being taken to stem it. By the result of this malnutrition new innovation established are 60% of the world's salt is now iodized, and millions of children at every year are spared mental retardation as a result. Vitamin A supplementation is helping disease resistance in children and soon become an important measure in helping reduce maternal deaths around the world.⁵

Millions of north Korean children suffering from malnutrition. They are lacking about food, health care and medicine and they need support for physically and mental, leaving stunted and malnourished. Nearly one third of under five children suffering about stunting mainly in rural area due to food lack and chronic diarrhea due to lack of clean water to drink and sanitation. Hospitals also have short power supply and drug supply. Reporters also said that instead of food security they spend money for military, testing rockets and nuclear projects. North Korea not produce enough food to feed its 24 million people. The country suffered a famine in the mid and late 1990s said by food and agriculture organization and world food programme by last year.⁶

Report which published from Assabiyn Hospital in Sanaa, Yemen, said that every minute five children in the world died because of chronic malnutrition. Along with this half a billion children at risk for permanent damage over next fifteen years. By the report from ‘Save the children’ said the death of 2million children per year can be prevented if malnutrition is better treated. British government calculated that between 50, 000 and 100, 000 people died in Somalia last year due to famine. Most of them are children. Children were much more affected by starvation to death caused by diarrhea, pneumonia and malaria. The save the child reports that if there is not action take place to reduce malnutrition, 450 million children will be affected by 2025.⁷

A study conducted regarding the child nutrition in India, by the help of National Family Health Survey subject report which collected a national level data. They collected the data about the anthropometric measurement of height and weight of children below four years of age. This find out the level of malnutrition and effects of selected demographic and socio economic factor on child nutrition. The result says that both acute and chronic malnourishment among Indian children. About 52% of Indian children below four years of age are stunted, 54 % are under weight and 17 % are wasted. 29% of children are severely stunted, 22% are severely under weight and 3% are severely wasted. Low prevalence of wasting than stunting or underweight indicating chronic malnutrition prevalence in India. Among state Bihar and Kerala have highest and lowest prevalence of malnutrition respectively.⁸

A news letter by WHO said that 57% of childhood death and its is an important public concern in Sierra Leone. Findings got by the measurement scale ‘Standardize Measurement and Assessment of Relief and Transition’ (SMART 2010). This study shown that 959, 749(16.7 %) are under five children in the country in 2010. Where 327, 000(34.1%) are stunted growth and 180, 000 (18.7%) are under weight and 66, 000(6.9%) were wasted. Only 11% of infant breast feed exclusively. They found out many factors which influence malnutrition are lack of appropriate feeding practice due to cultural belief, illiteracy and lack of knowledge regarding nutrition. Along with this, lack of safe drinking water supply and poverty.⁹

An exploratory study conducted in Jalandhar, Panjab in 2010 about the prevalence and malnutrition among children. The main objectives of the study was to assess the prevalence and degree of malnutrition, to find out the relation of prevalence and selected variables and to prepare a pamphlet on nutritional diet. The design of the study was a non experimental exploratory approach was used. This research found that among half of children to be malnourished in which 43.8% children under first degree malnutrition 35% under second degree, 10.5% under third degree and 10.5% under fourth the degree malnourished and among this majority of female children are suffered with malnourished.¹⁰

MATERIAL AND METHODS:

Research frame work encompasses research design, variables under the study, setting of the study, population, criteria for selection of sample, sample size, sampling technique, development of tool for data collection and statistical analysis.

Research design:

The research design of the study was pre test –post test Quasi experimental with control group design.

Diagrammatic representation of the study:

E QI X Q2

C Q1 Q2

E- Experimental group.

C-Control group

Q1- Pre test assessment of malnutrition by weight and height monitoring and BMI calculation among children in both groups

X- Supplementation of HCCM for experimental group

Q2- Post test assessment by weight for height ratio (BMI ) on growth parameters among children in both group.

Variables under the study:

Independent variable was HCCM.

Dependent variables were weight, height and weight height ratio (BMI) of children, in experimental group.

Setting of the study:

The study was conducted at two Home for children one at Aravanikkum Anbu Illam, near Thaneer pandal, Hopes, Coimbatore and second one at New Life home at Vadavalli in Coimbatore. These homes shelter 75 children, including both male and female, age ranges from 7-14 yrs.

Population:

The population comprises of all children at the age of 7-14 years staying in Home for children, who are undernourished to their age according to Harvard standard of weight for height ratio <18.

Sample Size:

The sample size was heterogeneous group of 34 children 17 in each group after pre-screening for malnutrition. Total 75 children were screened and identified, 34 children with malnutrition enrolled for study.

Sampling Technique:

Survey to identify malnutrition and Non probability purposive sampling technique was used to select the samples for the study. The researcher randomly selected the homes for experimental group in Aravenikkum Anbu Illam and control group as New Life Home.

Criteria for sample selection:

*Inclusion criteria:

· Children age ranges from 7to 14 years having low weight for height ratio BMI less than 18, who are residing at Home for Children.

· Boys and girls both were included.

· Children who were on normal diet.

*exclusion criteria:

· Children who were with appropriate weight for height.

· Children with chronic illness, under special diet.

· Children who were obese.

Development of the tool for data collection:

The researcher prepared the demographic data of children, clinical evaluation tool and Performa for standard weight and height.BMI was calculated using Harvard University of Health Services formula. The formula is (Weight in kg ÷ Height in cm ÷ Height in cm × 10, 000). According to the formula the normal BMI is more than 18.

HCCM preparation:

Content:

Milk -100ml, wheat flour-15gms, jaggery -5gms, ground nut 2 gms.

Recipe:

Boil the milk, add up the wheat flour 15gms in milk, 5gms of jiggery and ground nuts 2gms. It serve as a palatable.

Description of the tools:

The tool consists of four sections:

Section A: Demographic data of the children.

Section B: Clinical evaluation of the nutritional status of children.

Section C: Proforma for weight and height for age.

Section A: Demographic data:

The demographic data consist of base line information of children regarding age, sex and the class of study

Section B: Clinical evaluation of the nutritional status of children:

The clinical evaluation include General appearance, Skin, Hair, Eye, Mouth, Nail and Face of children authenticated by Indian Council of Medical Research

Section C: Proforma for weight –height for age:

It consist of weight and height for age in both male and female child between the age of 7 to 14 years of age the BMI ratio, according to Harvard standard.

Content validity:

The tool was submitted to experts in pediatric nursing, medicine and nutrition, and the experts opinion were included for the present study.

Procedure for data collection

The study was conducted for 6 weeks at ‘Home for children’. The researcher obtained formal permission from the concerned authority at two ‘Home for children’ at Coimbatore. Researcher maintained good rapport with the Trustee and the children, and introduced herself and explained the purpose and methods of study. Pre-test screening was done including weight and height and nutritional status of children in both homes.The weight and height ratio of (BMI) less than 18 were grouped for low nutritional status. The first preparation of HCCM was supervised by the researcher, periodical visit was done every week to the experimental group children. The children who were enrolled for HCCM supplementation were provided with HCCM twice on daily basis for 6 week. Post test was done after 6 week in both homes for children.

Statistical analysis:

The obtained growth parameters and clinical evaluation were tabulated. Appropriate descriptive and inferential statistics were computed to test the hypotheses and to achieve the set objectives for the study. Computed statistical evidence are represented in the following chapter.

RESULT:

DATA ANALYSIS AND INTERPRETATION:

This chapter deals with the description of the study subjects, classification, analysis and interpretation of data collected to evaluate the Effectiveness of HCCM on Growth Parameters among Malnourished Children at selected Home for Children at Coimbatore.

Section I:

Description of demographic profile of the malnourished children in experimental and control group.

Section II:

Description of the clinical evaluation of undernourished children.

Section III:

Description of degree of malnutrition in children according to IAP classification.

Section IV:

Compare the pre and post test growth parameters of malnourished children.

· Compare the pre and post test BMI of malnourished children in experimental group after HCCM.

· Comparison of pre and post test BMI among malnourished children in control group.

· Comparison of BMI among children between experimental and control group.

SECTION II:

Table 2:-Description of the clinical evaluation of malnourished children (N=17+17)

S. No	Characteristics		Experimental group(n=17)				Control group(n=17)
S. No	Characteristics		Pre test		Post test		Pre test		Post test
			F	%	f	%	f	%	f	%
1	General	Normal	1	5.88	3	17.65	4	23.53	4	23.53
		Thin	16	94.11	14	82.35	13	76.47	13	76.47
2	Skin	Normal	12	70.588	14	82.35	10	58.82	10	58.82
		Poor turgor	4	23.53	3	17.65	4	23.53	4	23.53
		Pallor	1	5.882	0	0	3	17.65	3	17.65
3	Hair	Normal	10	58.82	13	76.47	4	23.53	7	41.18
		Dry	1	5.88	1	5.88	0	0	0	0
		Pluggable	5	29.41	1	5.88	11	64.71	9	52.94
		Thin	1	5.882	2	11.76	2	11.76	1	5.88
4	Eye	Conjunctiva Normal Pallor	4 13	23.53 76.47	6 11	35.29 64.70	17 0	100 0	4 13	23.53 76.47
		Vision Normal Dull vision	17 0	100 0	17 0	100 0	17 0	100 0	17 0	100 0
5	Mouth	Gums Normal Pale	4 13	23.53 76.47	5 12	29.41 70.58	14 3	82.35 17.65	16 1	94.12 5.88
		Lips Normal	17	100	17	100	17	100	17	100
		Teeth Normal Dental carries	13 4	76.47 23.53	13 4	76.47 23.53	12 5	70.59 29.41	12 5	70.59 29.41
		Tongue Normal Pale	2 15	11.76 88.24	3 14	17.64 82.35	0 17	0 100	5 12	29.41 70.59
6	Nail	Normal	16	94.12	16	94.12	16	94.12	16	94.12
		Brittle	1	5.88	1	5.88	1	5.88	1	5.88
7	Face	Normal	17	100	17	100	17	100	17	100
5	Mouth	Gums Normal Pale	4 13	23.53 76.47	5 12	29.41 70.58	14 3	82.35 17.65	16 1	94.12 5.88
		Lips Normal	17	100	17	100	17	100	17	100
		Teeth Normal Dental carries	13 4	76.47 23.53	13 4	76.47 23.53	12 5	70.59 29.41	12 5	70.59 29.41
		Tongue Normal Pale	2 15	11.76 88.24	3 14	17.64 82.35	0 17	0 100	5 12	29.41 70.59
6	Nail	Normal	16	94.12	16	94.12	16	94.12	16	94.12
		Brittle	1	5.88	1	5.88	1	5.88	1	5.88
7	Face	Normal	17	100	17	100	17	100	17	100

Table 2 shows the description of the clinical evaluation of undernourished children of both experimental and control group. From this table it is clear that the general appearance has improved from 5.88 percentage in the pre test to 17.65 percentage in the post test for the experimental group while it remains same for the control group.

SECTION:-III Description of degree of malnutrition in children according to IAP.

Fig 1: Degree of malnutrition in children in pre Experimental group.

Fig 2: Degree of malnutrition in children in post experimental group.

SECTION –IV: Comparison of pre and post HCCM growth parameters of malnourished children

Table 3:- Compare the pre and post test BMI of malnourished children in experimental group.

BMI

Mean (x)

‘t’ value

Pre test

13.22

0.93

2.803*

Post test

13.67

0.92

S=significant *p<0.05

Table: 3 shows that the computed ‘t’ value for BMI of malnourished children in the experimental group before and after intervention was 2.803 (p<0.05). It reveals that there was a significant weight gain after the HCCM supplementation.

Table 4: Comparison of pre and post test mean BMI among malnourished children in control group.

BMI

Mean (x)

‘t’ value

Pre test

14.18

0.78

2.39*

Post test

13.94

0.87

S=significant *p<0.05

Table 5 shows that the observed‘ t’ value in the control group was 2.39, which was significant at 0.05 level. It shows that there was a significant reduction in the BMI of the children in post test.

Fig 3: Mean BMI among malnourished children in Experimental group

Fig 4; -Mean BMI among malnourished children in the Control group

Table 5: Comparison of BMI among children between experimental and control group in posttest.

BMI

Mean(x)

‘t’ value

Experimental

13.67

0.92

0.878(NS)

Control

13.94

0.87

NS=Not Significant

As shown in the table 5:- the observed‘ t’ value in the posttest experimental and control group after the HCCM supplementation was 0.878, which was not significant at any level. It shows that there was no significant relation between the BMI of the children in the experimental and control group.

Fig 5: BMI among children between experimental and control group after the HCCM.

DISCUSSION, SUMMARY, CONCLUSION:

This chapter deals with discussion, summary and conclusions drawn. Our national wealth is our children.Nutrition play an important role in the wealth of our country.

DISCUSSION:

The present study was to assess the Effectiveness of HCCM on Growth Parameters among Malnourished Children at selected Home for Children at Coimbatore. The study was conducted in two different homes for children, one from Aravenikkum Anbu Illam near Thaneer pandal, Hopes and second one from New Life home, Vadavalli, Coimbatore. Nutritional assessment was done and then selected the malnourished children according to the Harvard standardized calculation. Equal number of children were selected for experimental and control group, 17 for each group. Majority of the children were in the age group of 7-10 years, in the experimental group 70.58 percentage and control group 58.82 percentage.

The first objective of the study was to monitor the height, weight, calculate BMI and clinical evaluation of Nutritional status of children in experimental and control group.

Weight and Height monitored, calculated the BMI and clinical evaluation of nutritional status were observed in experimental and control group at Home for Children. After the clinical evaluation total of 34 children were identified with prevalence of malnutrition. The mean value of pretest BMI among experimental group was 13.22 and control group was 14.18.The clinical evaluation reveals that 94.11percentage children in experimental group and 76.47percentage of children in control group were thin in general appearance. The demographic characteristics of the children in experimental group show that 12 (70.58%) malnourished children belong to the age group 7 -10 years and remaining 5(29.41%) were 10-14 years age 13(76.47%) were male and 4(23.52%) were female. In the control group, 10(58.82%) were included in the age group of 7- 10 years and 7(41.17%) were in 10-14years. In the case of sex about 5(29.41%) were female and 12(70.58%) were male.

A study conducted by Fagundes Ulysses about the nutritional status of Indian children supported the result of the present study. The main objectives of the study was to evaluate nutritional status and estimate body composition of Indian children by using z- score by weight for height index and compared it with standard values. The study resulted that Indian’s body compositions enhance good nutritional status among studied population.¹¹

The second objective of the study was to evaluate the effectiveness of HCCM on Growth Parameters in Experimental group.

The present study reveals that the mean difference in the pre and post BMI of malnourished children in experimental group is significant with ‘t’ 2.803 ( p<0.05 ).The mean pre and post test BMI on malnourished children in experimental 13.67 and control group were13.94. It is evident that there is an increase in the weight of the malnourished children in the experimental group.

Ramachandran Anup. et al., 2010. conducted a study regarding locally made read- to – use therapeutic food for treatment of malnutrition. It is a randomized controlled trial. The main objective is to evaluate the effectiveness of a locally made ready – to – use therapeutic food (RUTF ) in decreasing mild to moderate malnutrition. the results are the mean (SD) weight gain at 3 months was higher in the RUTF group: RUTF (n=51):0.54kg; (SE=0.05; 95%Cl=0.44-0.65) versus HCCM (n=45): 0.38kg (SE=0.06; 95%Cl=0.25-0.51), p=0.047.The weight gain per kilogram of body weight was directly proportional to the severity of malnutrition, supports present study results post test weight gain 13.67 at p<0.05. ¹²

The third objective of the study was to compare the post test Growth Parameters of children among both groups.

The mean BMI of experimental posttest was 13.67 and control group was 13.94, which is not significant at p<0.05. HCCM has improved nutritional status of children in experimental group and BMI gained t value is 2.803, p<0.05 was significant but statically weight gain among group is not shown difference.

SUMMARY:

Nurse as an important part of health care system, as a health care provider it is one of the main focus is to meet the nutritional requirement of the children. India is one of the developing country who facing the problem of malnutrition in children Keeping this point of view, the researcher has conducted the study. The study was conducted to assess the effectiveness of High Calorie Cereal Milk (HCCM) on Growth Parameters among Malnourished Children at selected ‘Home for Children’ at Coimbatore. The following objectives were formulated.

1. Monitor height, weight calculate BMI and clinical evaluation of Nutritional status of children in experimental and control group.

2. Evaluate the effectiveness of HCCM on Growth Parameters in Experimental group.

3. Compare the post test Growth Parameters of children among both groups.

The study was based on the Pender’s health promotion model, in his theory he explained about the individual characteristics, behavior specific cognitions and affect and behavior outcome. The study design was pre test –post test experimental design. The content validity of the tool was obtained from various medicine, nutrition and nursing experts. The prepared tool for data collection consists of demographic data of malnourished children, clinical evaluation of nutritional status, height, weight and BMI of children according to Harvard standard and demonstration about the preparation of HCCM. The study was conducted in two home for children, experimental group and control group. The nutritional screening include assessment of anthropometric parameters like height and weight was done in children at both ‘Home for Children’.The normal and obese children were excluded and only malnourished children included in the study.Explained and demonstrated about the recipe for HCCM.Clinical evaluation and anthropometric parameters of the malnourished children were assessed by the same tool after 4 weeks. Based on the objectives and hypothesis, the data were analyzed using both descriptive and inferential statistics. The present study proved the formulated hypothesis that there was some significant difference in the nutritional status and weight gain after HCCM supplementation, H1 accepted and H2 rejected when compare with experimental and control group.

MAJOR FINDINGS OF THE STUDY:

The major findings of the study are as follows;

· The nutritional screening of the children in the pretest in experimental group by IAP classification of nutrition reveals that 35percentage were having Ist degree malnutrition and 41percentage had IInd degree malnutrition

· The nutritional screening of the experimental group by IAP classification after HCCM supplementation reveals that, children in the IInd degree malnutrition 6 percentage at pretest get reduced degree of malnutrition to 35 percentage after the HCCM supplementation.

· The clinical evaluation of the undernourished children before and after the HCCM supplementation in the experimental group were the general appearance in the post test group having17.65 percentage improved from the pre test 5.88 percentage. At the same time in the control group, same rate in pre and post test.

· The computed‘t’ value for BMI of malnourished children in the experimental group before and after intervention was 2.803 (p<0.05). It reveals that there was a significant weight gain after the HCCM supplementation

· The observed‘ t’ value in the control group was 2.39, which was significant at 0.05 level. It shows that there was a significant reduction in the BMI of the children in post test.

· The observed‘ t’ value in the posttest experimental and control group after the HCCM supplementation was 0.878, which was not significant at any level. It shows that there was no significant relation between the BMI of the children in the experimental and control group.

CONCLUSION:

The following conclusion were drawn from the study;

· HCCM has improved nutritional status of children in experimental group and BMI gain t value, is 2.803 p<0.05 is significant but statically weight gain among group shown that an increase in weight in experimental group.

· The posttest mean value 13.94, pretest mean was 14.18 in control group shows reduction in weight.

ACKNOWLEDGEMENT:

I thank our chairman, Dr. Nalla G. Palaniswamy M.D and our managing Trustee, Dr. Thavamani D. Palaniswamy for the opportunity to pursue my studies in this institution.

I am aknowledge to our Principal, Prof. Dr. S. Madhavi, M.Sc(N), Ph.D., for her valuable guidance and support for the successful completion of the study.

I am greatly indebted to my research guide to DR. N. Rajendiran., M.A. (App.Psy)., Ph.D., Professor in Psychology & Psychologist, Kovai Medical Center and Hospital, for his constant, expert guidance, critical statistical advises, valuable suggestions and for his willingness to help at all times whenever needed.

I take immense pleasure in thanking my medical guide Dr. P. S. Chandrasekar, MBBS, MRCP, D.C.H (London), Consultant Paediatrician & Neonatologist, Kovai Medical Center and Hospital, Coimbatore-14 for his guidance and direction for this study.

My deepest gratitude is to Prof. Sivagami Ramanathan, M.Sc. (N), Vice-Principal, KMCH College of Nursing, for her support and concern throughout the study.

I am highly express my heartfelt and deepest gratitude to our Head of the Department and my research guide Prof. Ms. Mariammal Pappu M.Sc (N)., for her constant supervision, tremendous support and guidance.I am really thankful to her for the willingness to clarify my doubts at any time. I am grateful to her for her valuable suggestions, constant encouragement and critical comments at every stage which motivated me towards the successful completion of this study timely.

I am grateful for the support of my speciality teachers, Prof. Mrs. N. B. Mahalakshmi M.Sc.(N), Prof. Mrs. V. Vijayalakshmi M.Sc (N) and Mrs. K. Kalaimani M.Sc (N) lecturer.

I thank our chief librarian Mr. Damodharan, the assistant librarians and computer operators for their help in search of reference.

I wish to express my sincere thanks to all the children who were involve in the way for my project.

In my daily work I have been blessed with a friendly and cheerful group of people. Finally, yet importantly, I would like to express my heartfelt thanks to my beloved parents for their blessings and encouragement, and my classmates, friends and seniors for their help and wishes for the successful completion of this project.

REFERENCE:

1. Sandip Kumar Ray. evidence-based preventive interventions for targeting undernutrition in the indian context. Indian journal of public health. 2011; 55(1) :1-6

2. Alwan Ala. Online nutrition initiative to help protect lives and health of million of children. Nightingale Nursing Times. 2011; 7:6

3. VenemanAnn. Malnutrition kills 10 children every minute says UN: A review available from http://www.independent.co.uk/news/world/politics

4. Hindu news paper.jan10, 2010; Available from http://issues and concern.blogspot.in/2012/03/month-in-perspective.html

5. Carol Bellamy.1998; Available from http://www.unicef.org/sowc/archive

6. Save The Children. 2012; Retrieve from http://www.un.org/sg/statements

7. KhaledAbdulla. 2012; Retrieved from http://www.thestar.com/news/world.

8. Norman Luther, et al. National Family Health Survey Subject Reports. 1999; Number 14. Retrievefrom http://scholarspace.manoa.hawaii.edu/bitstream/handle

9. Hannah Yakson. WHO Nutrition Officer Nutrition Surveillance. 2011; 1.

10. Vibha.Malnutrition in children.Nightingale Nursing Times. 2010; 7

11. Ulysses Fagundes, et al. Evaluation of the nutritional status of Indian children from Alto Xingu, Brazil.journal de pediatria.2002; 78(5):383-8

12. Ramachandran A.et al. Locally Made Ready –to-Use Therapeutic Food for Treatment of Malnutrition :A Randomized Controlled Trial.Indian Pediatrics. 2010. (l47).

Received on 04.09.2018 Modified on 01.11.2018

Asian J. Nursing Education and Research. 2019; 9(1):75-83.

DOI: 10.5958/2349-2996.2019.00015.6