METHODOLOGY

The chapter ‘Research Methodology’ presents a precise picture of the

research procedure followed systematically during the course of investigation,
analysis and preparation of manuscript. The detail research methodology
adopted for the study including the methods, tools and techniques, study area
and procedures followed in the selections of samples, collection of data and
interpretation of data analysis has been described in this chapter. Chapter II i.e.
Methodology is categorized into following subheadings,
2.1) Research Setting
2.2) Research Design
2.3) Subjects
2.4) Method of Data Collection
2.5) Statistical Analysis

2.1) Research Setting:

The Kolhapur district is the southernmost district of Maharashtra. Its

headquarters is at Kolhapur which is an ancient city. The geographical area of
the Kolhapur district is 7685 sq. kms. The population density of the district is 457
persons per square kilometers. The urban density is 1804 and the rural density is
327. Kolhapur or as it seems to have been formerly called Karveer, is probably
one of the oldest religious and trade centers in western India. Kolhapur has one
of the highest per-capita incomes for a city in India. Trade is mostly dependent on
farming of cash crops like sugarcane, the metal industry with important inputs
from textiles and mining. The population of Kolhapur district was 3515,413 as per
the 2001 census. The population of Karveer tehsil was 906,866 as per the 2001
census. The population of the Kolhapur Municipal area is distributed as follows
according to the religious they profess; Hindus- 7,18,223; Muslims-1,16,232;
Jains-9,609; Christians-5,538; Zoroastrians-125; Buddhists-57,014; Sikhs-125.
The majority of Muslims in the district, probably over 90 per cent, can be
classified under the three family names Saiyads, Pathans and Shaikhs. There
are very few families of Mughals.
The study was undertaken in Kolhapur city. The subjects were selected from
five different Muslim affluent areas such as Akbar Mohalla, Maner mal,
Laxmipuri, Rajarampuri and Slum area near Nilgiri Apartment situated in
Kolhapur city of Karveer tehsil in Kolhapur district of western Konkan zone of
Maharashtra state. The area of the study was selected by using the purposive
random design method. The area in Kolhapur city, where the population of
Muslim community is abundant was taken into account.

2.2) Research Design:

 This was descriptive study. The subjects enrolled in the study were from
Muslim families, fasting during month of Ramzan. The research is an endeavor to
discover intellectual and practical answers to problems through the application of
scientific methods to the knowable universe. The research design includes an
outline of what the investigator wants to do, writing the hypothesis of data.
Keeping these guidelines in view, specific objectives were set to provide basis for
investigation. In the light of objectives, a questionnaire was structured and
modified after testing in pilot study. Techniques of investigation and tools were
used as per given procedures. The statistical procedures were decided to
analyze the obtained data for testing their significancy.

2.3) Subjects:

2.3.1) Sampling Procedure:

 Purposive sampling techniques were used to select the respondents for the
study. The respondents were intentionally included and mostly governed by the
convenience of the interviewer. Volunteers were intentionally incorporated in the
study who furnishes the inclusion criteria.

2.3.2) Selection of Sample:

For the study, twenty five Muslim families were selected by a purposive
sampling technique. The inclusion criterion was, the subjects should be healthy
and fasting during entire month of Ramzan.

2.4) Method of Data Collection:

 Field data was collected with the help of direct observation and
questionnaire method. The self structured questionnaire was devised to evaluate
the nutritional status of Muslim families during entire Ramzan period. The
questionnaire was prepared in English medium and then translated to local
language to fit into the understanding level of respondents. Then the
questionnaires were filled up by asking questions to respondents and by
observing them.

2.4.1) Questionnaire:
The structured questionnaire is divided into two parameters i.e. general
information and specific information.
2.4.1.1) General Information:
The study was conducted by collecting data through questionnaire method.
The general information was collected on following aspects.
a) Age:
Age was recorded by asking the respondent. For accuracy age was
crosschecked by asking questions regarding birth date and local events.

b) Types of Family:
Family is a group of biologically related individuals living together, sharing
food from the same kitchen. Types of family were nuclear, joint or extended.
Nuclear family includes parents and their children only. Joint family is one which
consists of grandparents, parents, uncles, aunts and their children. Extended
family consists of family members same as joint family along with other relatives
for e.g. maternal uncles or aunts, first cousins or second cousins etc.

c) Family Size:
 Size of the family and income of the family have direct influence on the
standard of living of the family. As per the family welfare slogan an ideal family
should include not more than two children and thus a family would consist of four
members in total, keeping this in mind family size were divided into three groups
in this study.
1. Small family – When total family members are four or less.
2. Medium family – When total family members are five to eight.
3. Large family – When total family members are more than eight.

d) Educational Status:
The educational status of a population is positively associated with
nutritional status of community. The extent of literacy closely associated with rate
of poverty, malnutrition, ill health, infant and child mortality rate. The education
status was classified into five groups in this study.
 1. Primary level – First to fourth pass.
2. Secondary level – Fifth to seventh pass.
3. High school level – Eighth to Tenth pass.
4. Higher secondary level – XII pass.
5. Graduate level – Graduated

e) Economic Status:
The economic status determines the purchasing power, standard of living,
health and nutritional status of a community. It is also an important factor in
seeking health care. The economic status was assessed by considering annual
income and classified according to ration card system.
Table 2.1: Classification of socio economic status according to ration card
Sr. Type of Criteria
No Ration Card
.
1 Yellow Ration Card
a) Antyodaya Poorest families from
families amongst the BPL
families.
b) Below Families having their
Poverty line income equal to or less
than Rs. 15,000 per
annum.
2 Saffron Ration a) Families having
 ` card (Above their income Rs.
poverty line) 15,000 to 1 lakh.
b) Families having
irrigated land less than
4 Hectare
c) Families not having
four wheeler vehicle
(except taxi)
3 White Ration a) Families having
card (High their annual income
income group) more than Rs. 1 Lakh.
b) Families having
more than 4 hectre
irrigated land.
c) Families having four
wheeler vehicles.
Source- TPDS system
f) Occupation:
Occupation refers to respondent’s family engaged in such work, which gives
more than 80 per cent of total family income. By interviewing the respondents,
the types of occupations in which they are into, were recorded.

2.4.1.2) Specific Information:

The specific information related to the evaluation of nutritional status of the
members in Muslim families was collected by using different tools and
techniques.
a) Dietary Intake Pattern:
A Systematic enquiry of the food supplies and food consumption of
individuals and population groups is called as ‘Diet survey’. Dietary assessment
was conducted with the help of diet surveys. Accurate information on dietary
patterns of communities helps in assessing the nutritional status of people but
also for determining the relationship between nutrient intakes and deficiency
diseases among them.
Dietary assessment was carried out by asking questions regarding diet
history such as degree of vegetarianism, number of meals consumed, dietary
pattern, type of meal preferred, special foods during Ramzan fasting and food
fallacies, if any, followed during Ramzan fasting. Food frequency method and 24
hours dietary recall were taken to assess the dietary intake pattern of the Muslim
families.

b) Food Frequency Pattern:

Food frequency method consists of asking individuals (by interview or
questionnaire) how often (daily, monthly, weekly et.) specific foods are eaten.
This was then used as an index of diet pattern of population groups. The
underlying principle of food frequency method is that average long term diet for
example, intake over weeks, months or years, is the conceptually important
exposure rather than intake on a few specific days. This method helps to give
more crude information relating to an extended period of time.
The food frequency questionnaires consisting a list of foods or food groups
and a frequency response section to report how often each food was eaten, were
devised and filled by interviewing respondents.
2.4.2) Tools and Techniques:
a) 24 hours dietary recall:
The 24 hours dietary recall is commonly used method in large nutritional
surveys to collect dietary intake data of individuals. This method is useful in
compiling information on the kinds of foods eaten, the frequency of their
consumption, perceptions of the community about foods, attitudes towards
different types of foods and the special foods consumed during particular
conditions like pregnancy or lactation or fasting etc.
In the method, the individuals were asked to recall in as much detail as
possible. The food intake for the 24 hours was recorded in the structured
questionnaire. The type of food consumed, amount of food type of food
preparation method used, time of food consumption and other details related to
food intake were asked and recorded. However, while conducting the survey,
both the respondent and the housewife (or the person who cooks the food for the
whole family) was contacted. The dietary intakes were assessed in terms of
cooked food with the help of standardized cup measures appropriate for the local
conditions. These standardized cups, spoons etc. were used to help the
respondent to easily recall the quantities of food consumed. Thus for the purpose
of calculation, individual cooked intakes were converted into raw amounts of
each food item by standardized recipe method. The 24 hours dietary recall was
taken for subsequent three days and means of each ingredient was taken as 24
hours dietary recall.
From the raw ingredients amounts, the nutritive value of each food item was
calculated by using the nutritive values given by Gopalan et al. (2007). It was
compared with recommended Dietary Allowances (R. D. A.) of nutrients for those
of specific age groups. Along with nutritive value amount of each food group was
calculated and recorded and compared with Balanced Dietary Allowance
(B.D.A.).

b) Anthropometric Measurements:
Anthropometry is an important tool in the study and understanding of human
biological variability, including, of course morphological variations as a
universally applicable noninvasive and inexpensive methods (WHO, 1995).
Anthropometric data have varied uses in public health including the assessment
of nutritional status.
Anthropometric measurements such as height (cm), weight (kg), body mass
index (kg/m2), skin fold thickness (mm), Arm circumference (cm), wrist
circumference (cm) and mid arm muscle circumference (cm) were recorded
which were indicators of nutritional status by using standard formulas given by
Jelliffe (1966).

1) Weight (kg):
Body weight is the most widely used and the simplest reproducible
anthropometric measurement for the evaluation of nutritional status of
individuals. Body weight is a composite of all body constituents like body water,
minerals, fat, protein, bone etc. and indicates the body mass. The body weight
was measured by using weighing scale. The body weights were taken as far as
possible with minimal clothing, without shoes and without holding any support. It
was measured in triplicates and averages were calculated.

2) Height (cm):
Length or height is a very reliable measure that reflects the total increase in
size of the individual up to the moment it is determined. The height of an
individual is influenced by both genetic (hereditary) and environmental factors.
An individual’s maximum growth potential is determined by hereditary factors, but
when there is appropriate environment- optimal nutrition and good health care,
an individual can achieve his / her maximum height. Standing height was
measured by using measuring tape. Height was taken without shoes with the
subject standing erect on a flat surface, with the arms hanging naturally at the
sides. The head held comfortably erect and height was marked with the help of
pencil on wall above head in the sagittal plane (central part of head). All the
height measurements were taken in triplicates and their averages were
calculated.

3) Body Mass Index (B.M.I.):

Body mass index is also termed as Quetelets index. This ratio eliminates
dependence on frame size and provides the most useful method of measuring
obesity in populations. BMI can be calculated from the following equation.

Weight (kg)
BMI =
Height (m2)

By this method, various grades of obesity, normal and underweight can be

known. Weight status according to BMI range is shown in table.
Table 2.2: Classification of Body Mass Index
Weight Status BMI range
Underweight < 18.5
Normal 18.5 to 24.9
Pre obese 25 to 29.9
Obesity (Grade I) 30 to 34.9
Obesity (Grade II) 35.39.9
Obesity (Grade III) 40 and above
Source: WHO (1995)

4) Skin Fold Thickness (mm):

The adipose tissue is distributed over a large number of sites in the body.
The thickness of fat at various sites of the body has good correlation with
measures of body fat. Fat distribution in and around the body varies with age,
sex, physiological, nutritional and health status and ethnicity. Of all the measures
of fatness, fat fold at triceps is considered to be the simplest and most feasible in
community surveys.
Fat fold at triceps was taken at the midpoint of arm. The measurement was
made with the arm hanging loosely by the side. The fat fold parallel to the long
axis was picked up between thumb and forefinger of left hand without including
any underlying muscle and the measurement was taken with the skin fold
calipers. But one of the important factors to be considered while selecting the
calipers is that the pinch area should be 20-40 mm2 with an accuracy of 0.1 mm
and should exert a constant pressure of about 10gm/mm2. All the height
measurements were taken in triplicates and their averages were calculated.

5) Arm Circumference (cm):

Arm circumference or Mid Upper Arm Circumference is a useful indicator of
nutritional status of individuals and communities. Circumferences of mid upper
arm and calf are recognized to indicate the status of muscle development in the
body. The measurements of arm circumference correlate well with weight, body
mass index and clinical signs of protein energy malnutrition. When measured
along with fat fold at triceps, MUAC, in addition, can be used to calculate mid arm
muscle circumference (fat free arm circumference)
The arm circumference has measured with flexible fibre glass tape up to
0.1cm. It was taken on the left arm while hanging freely by the side, at its mid
point. The midpoint of the left upper arm was measured by taking first the length
of the upper arm - between acromion process of scapula and the tip of ulna - by
flexing the forearm at right angles. The midpoint was marked at half the length
with a skin marking pencil / ball pen. The fiberglass tape was placed at the
midpoint gently but firmly without disturbing the contours of the arm in any way.
All the height measurements were taken in triplicates and their averages were
calculated.

6) Wrist Circumference (cm):

Measurements of wrist circumference combined with arm circumference,
can be used to estimate Mid Arm Muscle circumference (MAMC).
The wrist circumference was measured with flexible fibre glass tape up to
0.1cm. It was taken on the left hand wrist and recorded.

7) Mid Arm Muscle Circumference (MAMC):

The mid arm muscle circumference or bone free muscle area, is a good
indicator of lean body mass and thus an individual’s skeletal protein reserves.
The MAMC is important in evaluating possible protein energy malnutrition as a
result of chronic illness, stress, an eating disorder, or an inadequate diet.
 The mid arm muscle circumference is calculated by subtracting wrist
circumference from arm circumference as shown below.
Mid Arm Muscle Circumference (MAMC) = Arm circumference – wrist
circumference.

c) Clinical Assessment:
Clinical examination is an essential feature of all nutritional survey since their
ultimate objective is to assess levels of health of individuals or of population
groups in relation to the food they consume. It is also the simplest and the most
practical method of ascertaining the nutritional status of a group of individuals.
Clinical assessment was carried out by interviewer only in a good light. By
direct observation and interview method, clinical examination was conducted.
Clinical signs related to Ramzan fasting such as lack of appetite, lethargy,
tiredness, frequent headaches, frequent infections, breathlessness, giddiness,
dehydration, bowel and bladder disturbances, indigestion and hyperacidity were
observed and recorded.
The assessment of nutritional status of Muslim families was conducted in
three phases i.e. Phase I (3 days before Ramzan), Phase II (entire month of
Ramzan) and Phase III (7 days after Ramzan). The variations in nutritional status
during these three phases were recorded.

A) Phase I (3 days before Ramzan):

In this phase general information was asked and recorded. Anthropometric
measurements were taken, clinical history was collected and questionnaire
containing food frequency and 24 hours dietary recall was filled up by interview
method.

B) Phase II (Entire period of Ramzan):

 In this phase, in each week of Ramzan all the information regarding food
frequency, 24 hours dietary recall and clinical history were taken. All the
anthropometric measurements were taken and recorded. The variations
observed in different weeks of entire Ramzan month were collected and
analysed statistically for its significance.

C) Phase III (7 days after Ramzan):

In this phase information regarding food frequency, 24 hours dietary recall
and clinical history were recorded. Anthropometric measurements were taken
and recorded in the questionnaire.
The study was carried out from 20th August, 2009 to 28th September, 2009.
So the total intervention period was about of 40 days for this project.

2.5) Statistical Analysis:

 For the statistical analysis of data, SPSS (Statistical Package for social
Sciences) was used. SPSS is one of the leading desktop statistical packages. It
is an ideal companion to the database and spread sheet, combining many of
their features, as well as, adding it’s own specialized functions. Various statistical
methods were employed in this study, based on the nature of data and the type
of information collected. The following statistical relevant applications given by
Gomez and Gomez (1984) were applied on the data collected during the entire
study.

1) Percentage:
Simple comparisons were made on the basis of percentage calculation.

2) Mean:
 Mean is widely used in measure of central tendency. The arithmetic average
of a distribution is known as its mean. The mean of a set of observation or
measures was obtained by dividing the sum of all values by the total number
values. It is used to know the centre of gravity of sample.

3) Standard Deviation (S. D.)

The measures of central tendency are very useful in describing the nature of
a distribution of measures, but they do not give the researcher a complete picture
of the data. So, the measures of variability are used to describe how the scores
tend to be distributed. The most popular measure of variability is standard
Deviation (S. D.), which was used for calculation of high statistics such as
variance, coefficient of correlation, standard score, standard error etc.

4) t-test
 The t-test is the commonly used parametric test. It was used for testing the
significance of difference between the means of two small samples. Fisher
provided the formula for testing the difference between the means of
independent small samples.