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LETTER TO EDITOR  
Year : 2020  |  Volume : 45  |  Issue : 4  |  Page : 563-564
 

Rapid assessment of diet provided in public health facilities of selected districts of Madhya Pradesh


Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Date of Submission09-Jan-2020
Date of Acceptance06-Aug-2020
Date of Web Publication28-Oct-2020

Correspondence Address:
Dr. Devendra Gour
Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcm.IJCM_19_20

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How to cite this article:
Toppo M, Pal DK, Gour D, Nair AR, Verma S, Sawlani H. Rapid assessment of diet provided in public health facilities of selected districts of Madhya Pradesh. Indian J Community Med 2020;45:563-4

How to cite this URL:
Toppo M, Pal DK, Gour D, Nair AR, Verma S, Sawlani H. Rapid assessment of diet provided in public health facilities of selected districts of Madhya Pradesh. Indian J Community Med [serial online] 2020 [cited 2020 Nov 28];45:563-4. Available from: https://www.ijcm.org.in/text.asp?2020/45/4/563/299414




Sir,

Diet and lifestyle are important determinants of health of both mother and offspring, starting from the preconception period. During pregnancy and lactation, nutritional requirements increase to support fetal and infant growth and development as well as maternal metabolism and tissue development specific to reproduction.[1] The goals of hospital food service are to provide in-patients with nutritious meals for their recovery and health and to present them with a nutritional model with meals tailored to their specific health conditions. Meal consumption of in-patients is a good indicator of dietary status and satisfaction with meal service. The Ministry of health and family welfare, Government of Madhya Pradesh has also designed a diet plan[2] for the postnatal mothers delivered in the government institutes. The aim of this study was to assess the diet provided to postnatal females in public health facilities of four district hospitals of Madhya Pradesh in a 3 months' duration in 2019.

A total of three surprise visits in the four districts were completed subsequently in the spells of 3 days, 2 days and 2 days each with a gap of 7–10 days between each visit. Entire study was carried out in the duration of 3 months. Investigators visited the kitchens of the respective hospitals and the process of cooking was observed with inspection of hygienic practices followed by kitchen staffs. The availability of prescribed diet chart in kitchen and the examination of milk were done by lactometer. Knowledge assessment of kitchen staffs with in depth interview was carried out. The process of distribution of food was observed by the investigators. Quantity of each item provided in the meal to the postnatal females was done with digital weighing scale. Quality of the supplied food was examined in terms of appearance, taste, and odor of various items. In-depth interviews of the beneficiary females were taken with the help of predesigned, pretested questionnaire. The investigators visited the wards, five times in a day, i.e., at tea time, breakfast, lunch, evening tea, and dinner. The team interviewed ten randomly selected postnatal women admitted to the ward during each visit after informed verbal consent. Thus, a total of 30 females per district were observed and interviewed in all four districts during the three visits. The data thus collected were entered and analyzed into MS Excel.

Regarding availability of infrastructure in the kitchen, it was observed that adequate raw materials were available in kitchens of all the district hospitals. Exhaust fan and refrigerator were present and functioning in the kitchens of the all the district. Vegetables and fruits supplied were fresh and washed before cutting in all the kitchens of visited district hospitals. The vegetables were cut on platform except in one of the district hospitals where the cutting was done on the floor. The milk supplied in one of the district hospitals was diluted with an average lactometer reading of 23 and it was around 32 in another district hospital, which is as per the standards.

The kitchen staff was following hand washing and trimmed their nails while preparing the food. None of the kitchen staff was using aprons and caps on the first visit but henceforth in the next visits, the kitchen staff started wearing it. Tap water was the source of water supply in two district hospitals whereas hand pump and bore well water was being used in the rest two.

Salient findings regarding the supply of food items in various districts:

  • Morning tea was supplied in less quantity in all the districts
  • Quantity of milk being served was not maintained in two of the district hospitals
  • Milk was not being served during the evening time in two of the district hospitals according to diet chart
  • Fruits was not being provided in one of the district hospitals
  • Namkeen Daliya and salad during lunch was not being provided in two of the district hospitals
  • Tomato chutney was being provided in one of the district hospital.


Regarding quality of the food, all food items supplied at the selected districts had appearance that meets the expectations along with pleasant odor and fine taste. Laddoo and tomato chutney had bad consistency leading to low consumption rate. In contrast to this, Ferreira et al.[3] observed that almost 45% patients reported that meal lack flavor and almost 15% reported that the meals smell unpleasant. About 83.3% of the mothers were aware regarding the provision of free meals following delivery in hospitals before coming to the hospital. 81.6% of the females were aware regarding the extra nutritional needs following delivery.

Only 60.4% females consumed the meal supplied to them themselves without sharing with someone. 75.7% of the females ate food on the bed, while 19.3% sat on the floor. 55.4% did not wash their hands before meals. All females agreed that they receive meals at hospitals after delivery, and 96.6% of them were satisfied with the meals provided whereas 98.3% agreed that the meals satisfied their hunger. None of them ever found any adulterant in the supplied food. These finding ere consistent with studies done in the past by Qadri et al.[4] in Haryana.

The average percentage of consumption of various items was found to be adequate (50%–80%) in all the hospitals, except for certain items such as roti, daliya, poha, and salad. The reasons for low consumption can be low cultural acceptance and local culinary preferences.

Two district hospitals did not provide any utensils and only three District Hospital (DH) provided five meals per day.

None of the beneficiaries' complained about delay in serving food in any of the district hospitals.


   Operational Barriers Top


  • In one DH, the kitchen was a separate room connected to hospital by an uncovered passage which would lead to contamination of food during the distribution
  • In two districts, there was inadequate staff for the kitchen
  • There was only one food serving trolley for food distribution
  • The slope outside the kitchen was broken and it was difficult to carry the trolley downwards
  • There were no lids on containers of raw materials, the salt was kept in the open packet and vegetables and fruits were kept in the open.



   Recommendations Top


  1. Dedicated and trained staff for cooking should be recruited
  2. Thalis should be made available for the distribution of meals, if not available, serving trolley with tight fitting lids should be used
  3. Postnatal women should be counseled about the nutritional requirement and encouraged to consume the food served
  4. Vegetable servings should be strictly adhered to according to the diet schedule to avoid monotony in the food served
  5. All kitchen staff should adhere to strict hygienic measures by wearing gloves, aprons, and caps while preparation, cooking, and distribution of food
  6. The raw materials should be available as per the diet chart provided by the National Health Mission (NHM)-Madhya Pradesh (MP)
  7. Food should be served at bedside and the relatives should be asked to step outside the ward to ensure that it will be consumed by the beneficiaries only
  8. Diet should be planned keeping in mind the geographical area and the habits of the people residing in that particular area.


Financial support and sponsorship

This study supported by the NHM-MP, Government of Madhya Pradesh.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Picciano MF. Pregnancy and lactation: Physiological adjustments, nutritional requirements and the role of dietary supplements. J Nutr 2003;133:1997S-2002S.  Back to cited text no. 1
    
2.
Ramachandran P. The double burden of malnutrition in India. FAO, Rome,2006; pp. 99-160.  Back to cited text no. 2
    
3.
Ferreira D, Guimarães TG, Marcadenti A. Acceptance of hospital diets and nutritional status among inpatients with cancer. Einstein (Sao Paulo) 2013;11:41-6.  Back to cited text no. 3
    
4.
Qadri SS, Pathak R, Singh M, Ahluwalia SK, Saini S, Garg PK. An assessment of patients satisfaction with services obtained from a tertiary care hospital in rural Haryana. Int J Collab Res Intern Med Public Health 2012;4.  Back to cited text no. 4
    




 

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