RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Mr. E. Murugan

M. Sc Nursing First Year

Community Health Nursing

Year 2011-2012

VIVEKANANDA COLLEGE OF NURSING

CHIITRADURGA, KARNATAKA.

0

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

1. NAME OF THE CANDIDATE AND ADDRESS

Mr. E. Murugan

M.Sc (Nursing) First Year

Vivekananda College of Nursing,

Chiitradurga, Karnataka.

2. NAME OF THE INSTITUTION Vivekananda College of Nursing

3. COURSE OF THE STUDY AND SUBJECT

M. Sc (Nursing),Community Health Nursing.

4. DATE OF ADMISSION TO THE COURSE

00.00. 2011

5. TITLE OF THE STUDY

A STUDY TO ASSESS THE

KNOWLEDGE OF MOTHERS ON

EARLY DETECTION AND

PREVENTION OF FURTHER

MALNUTRITION AMONG MILD

MALNOURISHED TODDLERS OF

SELECTED URBAN SLUMS IN

CHITRADURGA DISTRICT IN VIEW

OF PROVIDING INFORMATION

BOOKLET

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

The World Health Organization (WHO) defines malnutrition as "the cellular

imbalance between the supply of nutrients and energy and the body's demand for them to

ensure growth, maintenance, and specific functions." The term protein-energy

malnutrition (PEM) applies to a group of related disorders that include marasmus,

kwashiorkor, and intermediate states of marasmus-kwashiorkor. The term marasmus is

derived from the Greek word marasmos, which means withering or wasting. Marasmus

involves inadequate intake of protein and calories and is characterized by emaciation. The

term kwashiorkor is taken from the Ga language of Ghana and means "the sickness of the

weaning". Williams first used the term in 1933, and it refers to an inadequate protein

intake with reasonable caloric (energy) intake. Edema is characteristic of kwashiorkor but

is absent in marasmus.

Malnutrition is a manmade disease which often starts in the womb and ends in the

tomb. It is a global problem especially in developing countries in even in under

privileged communities of some developed countries. This is particularly true of

developing countries where the population growth is not controlled and resources are

poor. The United Nation International Child Emergency Fund in 2005 reported that 150

million children are malnourished worldwide; millions of Indian children are equally

deprived of their rights to survival, health, nutrition, education and safe drinking water. It

is reported that 63 % of them go to bed hungry, 53% suffer from malnutrition.1

Malnutrition continues to be a major health problem in world today, particularly in

children under five years of age. Lack of food; however is not always the primary cause

for malnutrition. In many developing and underdeveloped nations, diarrhoea is a major

factor in malnutrition. Additional factors are bottle- feeding (in poor sanitary conditions)

2

inadequate knowledge of proper child care practices, parental illiteracy, economic and

political factors and simply the lack of food. The most extreme forms of malnutrition or

protein energy malnutrition are kwashiorkor and marasmus. In the United States milder

forms of protein energy malnutrition are seen, although the classic cases of marasmus and

kwashiorkor may also occur. Unlike the developing countries, where the main reason for

protein energy malnutrition is inadequate food.2

Protein energy malnutrition is a wide spread type of under nutrition among the

underprivileged in tropical and subtropical countries. It is caused by a diet that is severely

deficient in protein and contains less than adequate calories. Kwashiorkor occurs in

infants and children between 4 months and 5 years of age. Marasmus is a form of under

nutrition caused by inadequate calorie intake occurring chiefly during the first year of

life .3

Under nutrition is widely recognized as a major health problem in the developing

countries of the world. The frequency of under nutrition cannot be easily estimated from

prevalence of commonly recognized clinical syndrome of malnutrition such as marasmus

and kwashiorkor because these constitute only proverbial tip of the iceberg. Cases with

mild to moderate under- nutrition are likely to remain unrecognized because clinical

criteria for their diagnosis are imprecise and difficult to interpret accurately. Growing

children are most vulnerable to effects of under nutrition. Nutritional status of children is

an indicator of nutritional profile of the entire community.4

Nutritional status plays a vital role in the deciding the health status particularly in

children. Nutritional deficiencies give rise to various morbidities, which in turn may lead

to increased mortality. Under nutrition also is known factor closely associated with child

mortality. Nutritional status is a sensitive indicator of community health and nutrition.

About 120 million (70%) of the worlds, 182 million stunted children aged under 5 years

live in Asia. Analysis of six longitudinal studies by World health organization’s revealed

a strong association between severity of weight for age deficits and mortality rates. About

3

54% deaths of under-five children’s in developing countries were accompanied by low

weight for age. Attempt to reduce child mortality in developing countries through

selective primary health center have focused primarily on prevention and control of

specific infectious disease.5

6.2 NEED FOR THE STUDY

Today’s healthy child is tomorrow’s better citizen. Development of healthy child is

influenced by many factors, in that nutrition is also one of the important factors that

determine health in addition to environment, genetics, socio-economic status of the

family etc. The children of under-five are most vulnerable groups who are prone to many

infectious disease, nutritional deficiencies, accidents etc. Deficiency of the nutrients such

as carbohydrates and proteins in children may have mild to moderate impact on growth

and cognitive development of the child. As the mothers are the primary care giver who

cares for their child, they should have adequate knowledge in early identification of

diseases and prevention of protein energy malnutrition.

Insufficiency of food the so-called “food-gap” appears to be chief cause of protein

energy malnutrition, which is a major health problem particularly in first years of life.

The majority of cases of protein energy malnutrition were nearly 30% are mild and

moderate cases. The incidence of protein energy malnutrition is more in preschool

children. This problem exists in all the states and the nutritional marasmus is more

frequent than kwashiorkor. 6

Growth faltering and malnutrition are highly prevalent in most South Asian

countries. Among the serious consequences, malnutrition is increased in risks of

morbidity and mortality in children as well as deficits in physical stature and lowered

cognitive measures. Childhood malnutrition in poor households has been well

documented in India, with the highest rates observed in those aged 12-23 months.

4

Countrywide National Family Health Survey II data show mean underweight prevalence

increases from 11.9% below 6 months infants to 58.4% at 12-23 months of age. The

intervention group as a whole had improved feeding practices.7

A study was conducted to assess the nutritional and immunisation status, weaning

practices and socio-economic conditions of under five children in three villages of

Bangladesh, with a total sample of 479 children aged 6-60 months (male/female,

240/239). Of all children 368 (77%) received BCG and 439 (82%) received partial or full

dose of DPT and Polio vaccines. Among children aged 13-60 months 75% received

Measles vaccine. Weaning food was started at (mean +/- SD) 8 +/- 4 months. Low

household income, parental illiteracy, small family size early or late weaning and absence

of BCG vaccination were significantly associated with severe PEM. Timely weaning,

education and promotion of essential vaccination may reduce childhood malnutrition

especially severe PEM.8

A longitudinal study was done to investigate changes in nutritional status and

morbidity over time among pre-school slum children in Pune, India for a period of two

years. Children in the age group of 0-5 years from three slums in Pune (n = 845) were

studied during this period. Measurement of weight (up to 20 g) and height (up to 0.1 cm),

morbidity (in last 7 days) and clinical assessment was undertaken once every four

months. Peak prevalence of malnutrition was observed around 18 months and shorter

period (3.5 months) of exclusive breastfeeding was probably responsible. Higher

morbidity in younger children (less than 2 years) led to deterioration of nutritional status

over time in 30% to 50% children. Shorter period of exclusive breastfeeding results in

under nutrition at an early age among slum children. Morbidity further deteriorates the

nutritional status.9

An intervention study done to evaluate a nutrition education designed to improve

infant growth and feeding practices among caregivers in 11 randomly selected and 2

purposively selected villages of south Karnataka. About 138 Infants of aged 5-11 months

5

were selected and their families were administered a monthly questionnaire on feeding

and child care behaviour. Statistically significant improvement was found in weight

velocity for female infants in the intervention group compared to non-intervention

infants. So, to conclude nutrition education and counselling were significantly associated

with increased weight velocity among girls and improved feeding behaviour among both

boys and girls.10

A National Family Health Survey report shows that 4 out of every 10 children in

the Karnataka state are undernourished, born stunted or too short for their age. About

70% of the children in the state in the age group of 6 to 59 months are anaemic. The

National Nutrition Monitoring Bureau report shows the consumption of green leafy

vegetables, roots and tubers, milk and milk related products, fats and oils is low in

Karnataka. Considering that some state -run programmes, like the Integrated Child

Development Scheme (ICDS), have been on since 1975, it is surprising that the state is

still unable to address the issue of malnutrition. The ICDS programme is on in 54, 260

anganwadis in the state. Around 44 lakhs beneficiaries, including pregnant women,

lactating mothers and anganwadi workers are availing of the benefits. “With Rs. 2 per

beneficiary, it will take time to achieve complete control on malnutrition and the

government is planning to increase the amount to Rs. 4 per child beneficiary”. 11

The above findings shows that the morbidity of protein energy malnutrition is very

high in children inspite of adequate interventions were taken by the government. Hence it

shows that the community participation and mothers knowledge and the awareness

regarding further prevention of protein energy malnutrition are less, which leading causes

of morbidity. Investigator during the visit to the rural community found that most of the

mothers had inadequate knowledge regarding further prevention of protein energy

malnutrition. Hence the investigator states that adequate awareness programmes should

be conducted inorder to motivate the mothers in further of prevention of protein energy

malnutrition.

6

This study is a timely felt need, as the biblical evidence proves that there is significant

number of toddlers in developing countries are suffering with moderate and severe

malnutrition especially in different provinces of India. Hence, this study has taken up for

conducting research to determine the knowledge of mothers on degree of malnutrition

and its prevention with reference to the moderate and severe malnutrition. Also, the

information booklet may helps to enhance the level of knowledge of young children in

terms of preventing malnutrition and adopting proper feeding practices for their young

one.

6.3 STATEMENT OF THE PROBLEM

A study to assess the knowledge of mothers on early detection and prevention of further

malnutrition among mild malnourished toddlers of selected urban slums in Chitradurga

District in view of providing information booklet.

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge of mothers of mild malnourished toddler regarding

detection and prevention of further malnutrition.

2. To associate knowledge of mothers of toddler regarding early detection and

prevention of further malnutrition with selected demographic variables.

3. To prepare information guide sheet regarding early detection and prevention of

further malnutrition for mothers of toddler.

6.5 OPERATIONAL DEFINITIONS

Knowledge

7

It refers to verbal responses given by the mothers of toddler regarding early detection and

prevention of further malnutrition

Mothers:-

It refers to the mothers who have malnourished children between 1-3 years of age and

residing at selected urban slums in Chitradurga District.

Early detection:-

Mean the strategy used to prevent the second and third degree of malnutrition among

toddlers residing in urban slums. .

Prevention:-mean, avoiding the severe form of malnutrition among urban toddlers at

chitradurga slums.

Further malnutrition: Means the moderate and severe form of mal nourishment

among toddlers residing in urban slums of childurga.

Toddler

A child belong to the age group of 1-3 years suffering with mild(1st degree) malnutrition and

residing in urban slums of childrurga.

6.6 RESEARCH HYPOTHESIS

H1 – There is a significant association between knowledge of the mothers of mild

malnourished toddler with selected demographic variables mothers.

H2: There is significant lower level of knowledge among mothers of mild malnourished

toddlers.

6.7 REVIEW OF LITERATURE

8

A critical literature review is a critical assessment of the relevant literature. A

literature review discusses published information in a particular subject area within a

certain time period. A literature review can be just a simple summary of the sources. It

might give a new interpretation of old material or combine new with old interpretations,

or it might trace the intellectual progression of the field, including major debates.

Depending on the situation, the literature review may evaluate the sources and advise the

reader on the most pertinent or relevant matters.

A cross-sectional survey was conducted to assess the prevalent care and feeding

practices among children aged 6 to 18 months residing in the squatter settlements of

Karachi and to identify care and feeding practices, as well as any other underlying

factors, associated with stunting. A total of 433 mothers of eligible children were

interviewed with the use of structured questionnaires. The result of this study includes

female children nearly three times more likely to be stunted than male children.

Households that were food insecure with hunger were also three times more likely than

other households to have a stunted child. Hence to conclude, there is a significant

association between the child’s gender and house hold food insecurity was found and

females are more affected than males.12

A study was carried out to determine the prevalence of malnutrition in a rural

Nigerian community. Using the modified Wellcome classification, the prevalence of

protein energy malnutrition (PEM) was 20.5% the prevalence of PEM in this rural

Nigerian community may be due to the services and intervention provided by a non-

governmental organization in the community.13

A cross-sectional study was done in four selected slums kebeles (villages) of Addis

Ababa in which nutritional status of 758 children aged 6 to 36 months was examined and

stratified into malnourished and well nourished groups. Analysis of hygiene and health

seeking practices of randomly selected house hold of the two sets of children determined

practices that significantly exacerbate childhood malnutrition. The rates of immunization

9

for the malnourished (80%) and well nourished households (77.6%) were practically the

same. No significant difference was found in the prevalence of home treatment or food

withholding habits at times of diarrhea episodes between the two groups. 14

A community-based, randomized, controlled trial was done in order to explore the

effectiveness of a nutrition education package to prevent malnutrition among young

children in rural Bangladesh. A sample of 605 normal and mildly malnourished children

(6 to 9 months) had chosen in 121 community nutrition centers of the Bangladesh

Integrated Nutrition Project in four regions. The intervention group received weekly

nutrition education based on the nutrition triangle concept of UNICEF for 6 months;

whereas the control group received regular Bangladesh Integrated Nutrition Project

services and both were observed for 6 months. The result depicted, there is a significant

increase in the frequency of complementary feeding was observed in the intervention

group compared with the control group. The intervention group had a higher weight gain

than the control group after the end of the intervention (p=0.053).15

A case control study was conducted to identify the determinants of growth failure

in 12 to 24 month-old children from an urban slum community attending a day hospital,

Duncan Village, East London. A questionnaire was used to assess the direct and

underlying causes of growth failure. About 155 children were selected for the study, with

100 children in the control group and 50 children in the growth-failure group. The results

of the study shows the that underlying determinants of growth failure that were identified

in the study population seem to be related to the caring capacity, and the resultant caring

behaviours of mothers. Hence the results of this research suggest that day hospital should

focus mainly on improving the caring capacity of mothers in the study area.16

A study was conducted to estimate the prevalence of protein-energy malnutrition

with various anthropometric indices and examine its correlates in a large sample of poor

rural minority children. A total of 2019 children under 7 years of age belonging to the

Hani, Yi, Hui, Miao ethnic minority groups and the Han major group were drawn from

10

four poor rural minority countries in the Yunnan Province of China. The results of this

study shows respective prevalence of moderate and severe protein-energy malnutrition

was 15.8 and 3.1% for underweight children, 31.8 and 19.2% for stunting and 0.9 and

0.5% for suffer from malnutrition. Stunting was most common in children aged 2 years.

Boys were more likely to suffer from malnutrition. Hence to conclude that protein–

energy malnutrition is relatively high in the rural minority children of China. 17

A cross- sectional study was done to assess the nutritional status of children, aged

6 to 36 months, in Sharkia Governorate aiming for early detection of malnourished cases.

The study was carried out on 1000 children aged 6-36 months, selected by a multistage

random sample from 6 villages in two districts. Data were gathered by an interview

questionnaire to the child’s mother or care-giver at their homes. Anthropometric

measurements as height, weight, mid-arm, and head circumference and skin fold

thickness were assessed. The results of the study showed that all anthropometric

measurements were lower than normal in underweight and borderline subjects. Hence

this study reveals that there is a high prevalence of wasting, stunting and underweight

among infants and children of the studied sample in Sharkia Governorate explained by

the low socio economic status, unbalanced diet.18

A Cross-sectional study conducted to describe maternal/child characteristics

associated with important practices of feeding US infants and toddlers aged 4 to 24

months. A national random sample of mothers (n=2,515) whose infants and toddlers aged

4 to 24 months made up the Feeding Infants and Toddlers Study cohort. The results show

that mothers with a college education were significantly more likely than mothers without

a college education to initiate breastfeeding and breastfeed the child to age 6 and 12

months. Initiatives to improve infant and toddler feeding practices should focus on

assisting mothers who have less than a college education, who are unmarried, whose

child is in day care, or who are enrolled in the Special Supplemental Nutrition Program

for Women, Infants, and Children.19

11

A Data from the Demographic and Health Surveys for 5 Latin American countries

(7 data sets) were used to explore the feasibility of creating a composite feeding index

and to examine the association between feeding practices and child height-for-age Z-

scores. Bivariate analyses showed that feeding practices were strongly and significantly

associated with child Height- for –Age Z-score in all 7 data sets, especially after 12

months of age. Multiple regression analyses also revealed that better feeding practices

were more important for children. The data available in DHS can thus be used effectively

to create a composite child feeding index and to identify vulnerable groups that could be

targeted by nutrition education and behaviour change interventions.20

A study was undertaken to assess the nutritional status and feeding practices of < 5

year children among the pastoral communities of Simanjiro district, northern Tanzania.

Face-to-face interviews with the sampled mothers were conducted using a semi-

structured questionnaire. Anthropometric measurements using weight-for-age criterion

were employed to assess the nutritional status. The study showed that 31% of the children

were undernourished, some 6% of them severely malnourished, children 2 - 3 years old

were the more affected. An educated mother was less likely to have an undernourished

child, while a child from a teenage mother was more likely to be undernourished. Small

size of a household was in favour of nutrition status. There is a great need to undertake

interventions through community education to rescue the situation in Simanjiro district.21

A study to assess Breastfeeding and mixed feeding practices in Malawi , 160

caregivers of children (6 to 48 months of age) were asked to recall the child's age at

introduction of 19 common early infant foods, who decided to introduce the food, and

why. The heights and weights of the 160 children were measured. About 67% of the

children were given food in their first month, and only 4% of the children were

exclusively breastfed for 6 months. Promoters of exclusive breastfeeding should target

their messages to appropriate decision makers and consider targeting foods that are most

harmful to child growth.22

12

A literature search was conducted to examine the effectiveness of rehabilitating

severely malnourished children in the community in nonemergency situations at various

centres with or without provision of food, for the period 1980-2005. Effectiveness was

defined as mortality of less than 5% and an average weight gain of at least 5 g/kg/day.

Thirty-three studies of community-based rehabilitation were examined and summarized.

Eleven (33%) programs were considered effective. None of the programs operating

within routine health systems without external assistance was effective. Hence to

conclude, with careful planning and resources, all four delivery systems can be effective.

It is unlikely that a single delivery system would suit all situations worldwide. 23

A cross-sectional study on nutritional status of indigenous children aged up to 6

years was undertaken in the Resguardo Embera-Katio, in Tierralta in the Province of

Cordoba, located in northern Colombia. The weight-, height and cephalic perimeter were

assessed for each of 272 children under six years of age. Nutritional parameters were

surveyed in 194 homes; fecal samples of 172 children were examined for evidence of

intestinal- parasites. Prevalence of moderate and severe chronic malnutrition was found

in 63.6% of the children's; 8.8% was categorized with slight and moderate acute

malnutrition. The prevalence of chronic malnutrition in this place high, reflecting the

adverse nutritional and economic conditions in which they live.24

A cluster randomized trial was used to compare two World Vision programmes for

maternal and child health and nutrition, which included a behavior change and

communication component: a preventive model, targeting all children aged 6-23 months;

and a recuperative model, targeting underweight children aged 6-60 months. Clusters of

communities (n=20) were paired on access to services and other factors and were

randomly assigned to each model. Using two cross-sectional surveys, it was tested the

differences in under nutrition in children aged 12-41 months (roughly 1500 children per

survey). The findings of the study includes there were no differences between programme

groups at baseline. At follow-up, stunting, underweight, and wasting were 4-6 percentage

points lower in preventive than in recuperative communities. Hence to conclude that the

13

preventive programme was more effective for the reduction of childhood under nutrition

than the traditional recuperative model.25

A cross-sectional study was conducted to assess child-care practices and the

nutritional status of infants and young children with the aim of improving feeding

practices and child nutritional status undertaken in urban Dar-es-Salaam, Tanzania. The

study involved 100 randomly selected mothers of children 6 to 24 months old from

households in Ilala Municipality. Data were collected by a structured questionnaire; spot-

check observations, and anthropometric measurements. The prevalence rates of stunting,

underweight, wasting, and morbidity were 43%, 22%, 3%, and 80%, respectively. The

prevalence rates of chronic malnutrition and morbidity are high, and child-feeding

practices are inadequate in this urban population. Maternal employment and educational

characteristics constrain good child-care practices, and alternative caregivers are taking a

more important role in child care as mothers join the work force. 26

A case control study was done to determine socio-economic risk factors for severe

protein energy malnutrition among children aged 0-60 months in Mulago Referral and

Teaching Hospital, Kampala, Uganda. About 66 severely malnourished children were

matched, for age and sex, with 66 well nourished controls and socio-economic,

demographic, health facility utilization and feeding practices were compared between two

groups. The results includes severe protein energy malnutrition was associated with

young age of the caretaker (P=0.005), living in mud house, lack of breast feeding, failure

to complete immunization etc. On conclusion, there seems to be a strong association

between severe malnutrition and some indicators of poverty, lack of breast feeding and

failure to complete immunisation.27

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

14

Mothers of mild malnourished toddler residing at selected urban slums in Chitradurga

District

7.2 METHOD OF DATA COLLECTION

i. Research design

Descriptive correlation design will be adopted for the study

ii. Variables

Variables under study:-

- Knowledg of mothers regarding malnutrition.

-Different sociodemographic variables of mothers

-Information booklet on preventive strategy of further malnutrition.

iii. Setting

Chitradurga has got 20 urban notified slums. This study will be taken up in a few selected

urban slum.

iv. Population

All the Mothers of toddler with mild malnutrition in selected urban slums at Chitradurga

District

v. Sample

mothers who will accomplish the inclusive criteria will be considered as the sample and

the sample size is 60.

vi. Criteria for sample selection

15

Inclusion criteria:-

The study includes,

1. Mothers who have toddler with mild malnutrition

2. Mothers of toddler with mild malnutrition who can read and understand Kannada.

3. Mothers of toddler with mild malnutrition who are residing in the selected urban slums

of Chitradurga District

4. The mothers will be included for the study, after the brief antrapometric

measurements of their toddlers, only in the case wherein their child belong to the

mild malnutrition.

Exclusion criteria:-

The study excludes,

1. Mothers of toddler with mild malnutrition who are not willing to participate in the study

2. Mothers of toddler with mild malnutrition who are not available at the time of data collection.

vii. Sampling technique

Non probability convenient sampling technique

viii. Tool for data collection

The tool consists of the following sections

Section - A

It consist of a structured knowledge questionnaire for collecting demographic such as

Age (in years), education, occupation, type of family and income, type of food.

Section - B

16

It consists of a structured knowledge questionnaire on further prevention of malnutrition.

ix. Method of data collection

Formal permission will be obtained from respective authorities. The investigator will

be selecting the sample from selected urban slums of Chitradurga District by using

convenient sampling technique. After obtaining the informed consent from the samples

and assuring them about the confidentiality of the information, the investigator will use

the structured questionnaires to assess the knowledge regarding further prevention of

malnutrition.

The duration of the study is planned for the period of 4 - 6 weeks.

x. Plan for data analysis

The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics:-

Frequency and percentage distribution will be used to study the demographic variables

of the mothers of toddler with malnutrition.

Frequency, percentage distribution, means and median, standard deviation will be used to

assess the knowledge regarding further prevention of malnutrition among mothers of

toddler with malnutrition in selected urban slums of Chitradurga District.

Inferential statistics:-

Fischer’s exact probability test and Chi-square test will be used to associate

knowledge of the sample with that of the selected demographic variables.

xi. Projected Outcome

17

1. After the study the investigator will come to know about the level of knowledge

of mothers of toddler with malnutrition regarding further prevention of

malnutrition.

2. The investigator will know the association between the knowledge of mothers of

toddler with selected demographic variables.

7.3. Does the study require any investigations or Interventions to the patients or other human beings?

No, there is no active manipulation on the subject involved.

7.4 Has ethical clearance been obtained from your institution?

Ethical clearance will be obtained from the concerned authority and informed consent

will be obtained from samples. Confidentiality and privacy of data will be maintained.

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18

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09. Signature of the candidate :

10. Remarks of guide :

22

11.1 Name and designation of the guide:

11.2 Signature :

11.3 Co-guide :

11.4 Signature :

11.5 Head of the department :

11.6 Signature :

12.1 Remarks of the principal :

12.2 Signature :

23