الفهرس 
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Abstract
Investing in the nutrition of children has the power to trigger huge social and economic changes in countries. With the right nutrients and care early in life, a child’s brain and body are able to grow to their full potential. Children who are more developed have better life chances: they live longer and healthier lives, they do better in school, they grow into more productive adults prepared to boost a country’s economic development, and they pass good practices on to future generations.
Egypt Demographic and Health Survey (EDHS) showed that around 6 in 10 children aged 5-19 years, regardless of sex, fall within the normal body mass index range for their age. Two percent or less of children are thin or severely thin. On the other hand, one-quarter of girls aged 5-19 years are overweight, and 10percent are obese. The proportions of boys found to be overweight (25 percent) and obese (11 percent) are very similar to the levels found among girls.
The causes of nutritional problems in Egypt are interactions of many factors: most households are food insecure because of low income, high food prices and low local agricultural production, in addition to poor dietary practices due to lack of awareness, and inadequate health service provision capacities. On the other side the adoption of Western diets high in refined carbohydrates, saturated fats and sugars, as well as a more sedentary lifestyle are commonly cited as the major contributors to the increase in overweight and chronic diseases.
Good nutrition, health and education are key factors on the global agenda. None of these three factors alone, however, will sufficient to achieve social and economic development; Nutrition education is a significant factor in improving nutrition Knowledge, Attitudes and Practices (KAP) of school children, family and the community at large.
It is important to note that nutrition education is an important entry point to teaching nutrition, however, it is not the only source of nutrition knowledge. There are other entry points such as school environment, school meals, health and nutrition clubs and school gardens.
With regard to micronutrient intakes and status, the WHO identifies deficient and/or inadequate intakes of calcium, iodine, iron, and zinc as well as vitamin A, vitamin D, and folate as commonly reported by many countries in the Middle East region, particularly in children and women of childbearing age. Over one-third of the population in the region is iron deficient or anemic. About one-third of the population is at risk of iron deficiency disorders, including cognitive and functional development in early childhood.
There is an interrelationship between vitamin a and iron fortification. Animal and human studies conducted in different parts of the world by independent investigators support such a concept. It is also evident that improving vitamin A nutrition of underprivileged children living in the developing world has a positive impact on their iron and hematological status. Different types of vitamin A interventions such as fortification and supplementation can improve hemoglobin levels and biochemical indicators of iron. Thus, in regions where vitamin A supplementation is limited, this vitamin may play an important role in the etiology of iron deficiency anemia. This direct or indirect interaction of vitamin A and iron is an important phenomenon to be taken into consideration when combating iron deficiency anemia in populations.
Aim of the study: To identify the current dietary practices including risky nutritional habits among target group; the malnourished children (overweight/obesity, underweight and those who suffer from vitamin A deficiency among anemic children).To identify the rate of vitamin A deficiency among anemic children (aged 6-12 years) in Othmanya village. To improve the nutritional awareness and practices of balanced meals & food groups through focusing on the three recommended key behaviors (Manage Portions, Choose Nutritious and Varied Options, Choose to Drink Water( among target group
Study design & sample size:
Sample size: according to results of first phase assessment that was done 158 child and their mothers enrolled in the study.
Two types of study design:
First study design in first stage: formative research (Descriptive Cross Sectional)
Identification of current risky nutritional practice among malnourished children.
Second study design in second stage: is a health education for the targeted group (Community Intervention)
Selection criteria for participants
c- Inclusion criteria
All children proved to be malnourished: overweight/obesity, underweight and anemic children to test for the vitamin A deficiency will be included in the study.
d- Exclusion criteria:
If the child is under specific curative nutritional program for chronic illness.
Study implementation site:
El Othmanyia village of El Mahala district– Gharbyia governorate will be selected as site of the study implementation.
Target groups
• The target group: are the beneficiaries, school children aged (6-17years) proved to be malnourished [obese-overweight-underweight and anemic to test for vitamin A deficiency] and their mothers.
Methodology:
Phase one: Assessment and detection of current awareness and behavior within families and their children. selection of anemic children to test for vitamin A deficiency.
1- Phase two: Intervention to improve awareness of children using:
Production of educational and multimedia tools appropriate for the malnourished children and their mothers (presentations, videos, posters, educational cards) in addition to model kitchen for mothers.
Model Kitchen aiming to preparing more nutrient-rich foods and less calorie-dense foods with low levels of nutrients every day targeting those showing habits with low levels of nutrients every day.
These Sessions was twice weekly for six months for obese and underweight group and four months for vitamin A deficiency group.
The target group was divided into groups, each group will receive six sessions, and every session will contain nutritional educational messages. Any activity as per target group.
2- Phase three: Evaluation phase:
Assessment of vitamin A in anemic children.
RESULTS:
In obesity group, mothers’ age ranged from 23 to 46 years with mean of 32.3±5.7. Secondary school level was the predominant educational level in both mothers and fathers (63% and 57.8%), 6.5% of mothers were illiterates and only 10.9% were university level. Most of them were housewives (86.9%). Most of mothers were married (93.5%). Most of fathers were workers (51.1%) and farmers (22.2%). Mean number of kids was 2.7± 1.
Both genders were quite equal (50% per each gender). Mean age of obese child was 10.8 ± 2.4. Mean BMI percentile was 91.9 ± 4.6 and ranged from 85.4 to 98.5. Mean WAZ score was 2.64± 1.2 improved to 1.27± 0.7. Knowledge of mothers generally improved with average of 33.3% regarding obesity. All of assessed items were found to be improved. Knowledge regarding obesity complications was found to be the most improved item when comparing it before and after intervention (from 25% to 95.4%), then knowledge about related bad habits to obesity also improved from 37% to 82.2%. then knowledge about related healthy habits to obesity also improved from 25.1% to 47.4%, then knowledge regarding meaning of obesity also improved from 34.8% to 56.5%, then knowledge regarding psychologic support to obese child also improved from 35.2% to 51.3%. There was slight improvement for risk factors and diagnosis of obesity.
Underweight is most commonly used as a composite indicator to reflect both acute and chronic under nutrition. The results of the present study indicated that mothers’ age ranged from 24 to 52 years with mean of 36.7 ± 6.1. Secondary school level was the predominant educational level in both mothers and fathers (53.8% and 63.5%), 10.3% of mothers were illiterates and only 11.5% were university level. Most of them were housewives (89.7%). Most of mothers were married (92.3%). Most of fathers were workers (48.6%) and farmers (23%). Mean number of kids was 2.7± 1.
Underweight females were 57.7% and males were 42.3%. Mean age of obese childe was 11 ± 1.9. Mean BMI percentile was 190 ± 9.3 and ranged from 1.5 to 49.4) mean WAZ score was -1.8± 0.8 and ranged from -3.09 to -1.02 improved to -0.2± 0.6. Knowledge of mothers generally improved with average of 37.3% regarding underweight. Most of assessed items (15 out of 17) were found to be improved. Knowledge regarding Number of meals found to be the most improved item when comparing it before and after intervention (from 32.1% to 92.9%), then knowledge about macaroni, rice and bread portions also improved from (35.7% to 92.9%), (41.1% to 91.1%) and (44.6% to 91.1%) correspondingly, then knowledge about complications of underweight also improved from 55.4% to 94%, then knowledge regarding Needed Factors to Manage also improved from 28.6% to 66.8% but still in need to more improvement. Meaning and diagnosis of underweight were found to be optimum (100%) before and after intervention.
The third group revealed that age of mothers of vitamin A deficiency children ranged from 25 to 49 years with mean of 33.7 ± 5.8, secondary school level was the predominant educational level in both mothers and fathers (67.6% in both genders), 5.9 % of mothers were illiterates and only 8.8% were university level, all of them were married (100%), most of fathers were workers (55.9%) and farmers (17.6%. The mean number of kids was 2.7± 1. Mean WHZ score was 0.02 1.06 and ranged from -1.17to1.04. Mean vitamin A was 35.66± 26.99 improved to 146.9± 102.8. Mean Hemoglobin was 9.77± 0.9 improved to 11.39± 0.9. Knowledge of mothers generally improved with average 75.1 in vitamin A deficiency group.
There was general significant improvement of mothers knowledge regarding vitamin A deficiency generally was after intervention with statistically significant positive change (p value equals or less than 0.0001); the overall knowledge score improved from 14.2 to be 83.5 % (with average positive change of 75%), all of assessed items (7 items) found to be improved as follows; Knowledge regarding Leafy vegetables found to be the most improved item when comparing it before and after intervention (from 20.9 % to 88.9%), then knowledge about risky dietary habits, Definition of Anemia and Vitamin A rich food also improved from (10% to 88.6%), (41% to 88%) and (5.9% to 87.6%) correspondingly, then knowledge about Symptoms and signs of Anemia also improved from 12.3% to 86.3%, then knowledge regarding Side effects of Anemia also improved from 9% to 80.3% and meaning of vitamin A deficiency found to be improved from no knowledge at all before intervention to 64.7% after intervention.
Conclusion and Recommendations:
There was an acceptable level of knowledge of mothers regarding the malnutrition of children, using different teaching and learning strategies can enhance the learning outcome and improve body mass index.