A Study to Assess the Effectiveness of Structured

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS OF SCHOOL AGE CHILDREN REGARDING FIRST AID MANAGEMENT OF DOG BITE

IN SELECTED AREA OF RAICHUR”

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

MD. MOHSIN AHMED

NAVODAYA COLLEGE OF NURSING

RAICHUR, DECEMBER-2010

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. Name of the Candidate:Mr.Md. Mohsin Ahmed

M.Sc.Nursing. 1st Year

Child Health Nursing

NavodayaCollege Of

Nursing, Raichur

2. Name of the Institute: NavodayaCollege of

Nursing. Raichur.

3. Course of Study and Subject: M.Sc.Nursing. 1st Year

Child Health Nursing

4. Date of Admission: 15-06-2010

5. Title of the Topic:

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS OF SCHOOL AGE CHILDREN REGARDING FIRST AID MANAGEMENT OF DOG BITE

IN SELECTED AREA OF RAICHUR”

6. BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study:

“While a dog may be a man’s best friend

That is not always in case of children”

Background

Rabies is a viral zoonosis, an animal disease transmissible to humans, caused by rhabdoviruses of the genus Lyssavirus. It is almost invariably fatal in humans. Rabies is widely distributed throughout the world and present in all continents. More than 99. 9 % of human deaths from rabies reported worldwide result from the bite of a rabid dog. Due to cleansing of the wound, non administration of immunoglobulin in cases of severe exposure1

Rabies is one of the oldest recognized diseases affecting humans and one of the most important zoonotic diseases in India. It has been recognized in India since the Vedic period (1500–500 BC) and is described in the ancient Indian scripture Atharvaveda, wherein Yama, the mythical God of Death, has been depicted as attended by 2 dogs as his constant companions, the emissaries of death. Rabies is endemic in India, a vast country with a population exceeding 1.02 billion and a land area of 3.2 million km2. In India, about 15 million people are bitten by animals, mostly dogs, every year and need post exposure prophylaxis. Since 1985, India has reported an estimated 25 000–30 000 human deaths from rabies annually The majority of people who die of rabies are people of poor or low-income socioeconomic status and school age children2

National Multicentric Rabies Survey, conducted in 2004 by the Association for Prevention and Control of Rabies in India in collaboration with the World Health Organization,1 is 20 565 deaths from rabies per year. Most animal bites in India (91.5%) are by dogs, of which about 60% are strays and 40% pets. The incidence of animal bites is 17.4 per 1000 population. A person is bitten every 2 seconds, and someone dies from rabies every 30 minutes. The annual number of person-days lost because of animal bites is 38 million, and the cost of post-bite treatment is about $25 million2.

Most people received the vaccine at government and municipal anti-rabies clinics. Each case required a mean of 4.4 visits for treatment, at a cost of Rs 2500/- (for the vaccine and other medicines) and a loss of 2.2 days of work In the past, a large proportion of rabies patients did not receive any vaccination, and of those who did, many did not complete the full course. In the latest survey, in 2004, only 39.5% of bite victims washed the wounds with soap and water, and about 46.9% received rabies vaccination2

The 2004 survey also revealed that about 60% of infected people resort to indigenous treatment, with local applications to the wound (36.8%) and indigenous remedies (45.3%) being . In 21st century thousands of people in India are dying from rabies, some of the medical professional bodies such as the IndianAcademy of Pediatrics and the Association for the Prevention and Control of Rabies have taken action. They have collaborated to create awareness, develop strategies suitable to the Indian situation, popularize the use of intradermal vaccination, with a view to reduce the high cost of treatment and cooperate with the government to reduce the incidence of death from rabies, with the ultimate goal of eradicating rabies from the country.3

Public health educational programs are needed to create awareness both in the medical community and in the public regarding the dangers of inadequately managed animal bites. The importance of proper wound care, post exposure vaccination with modern tissue-culture vaccine and the administration of human rabies immune globulin, The World Health Organization (WHO) in 2003 says that death due to rabid dog bites in India is increasing every year. About 17,000 people die of rabies in India every year3.

India already has the word's highest number of dog-bites, 17.6 million annually. It also accounts for 80 percent of the world's rabies cases according to the Association for Prevention and Control of Rabies in India (APCRI). In Bangalore, 45 percent of dog-bite victims are slum children playing on streets in low-income .4

Deaths due to dog bites are few within BBMP (Bahrut Bangalore Mahanagra Palike) limits, says the report by the Directorate of Health & Family Welfare Services (communicable diseases department). According to the report, two deaths each were reported in 2008 and 2009 within BBMP limits. Elsewhere in the state, there were 59 deaths in 2007, 29 in 2008 and 10 in 2009. This is due to lack of awareness about rabies vaccinations. As per data of RIMS (Raichur Institute of Medical Science).Reported Dog bite cases from the year January 2009 to December 2009 are 3086 and from the year January 2010 to November 2010 are 1516. Majority of dog bites cases are found in children victims are from slums..5

6.2 Review of literature

The review of literature helps to ascertain what is already known in relation to a problem of interest. It provides a basic for future investigation and justify the need for replication6

A study was conducted in pune, Maharashtra in order to determine the profile

of Management of animal bite cases among rural populationin district Pune, three

Primary Health Centers (PHCs) were selected randomly and patients attending with

animal bites during the month of study period were enrolledfor the study. The results

reported that all animal bitecases (451) were due to dog biteand 61.4% were reported

to be bitten by pet dogs. Immediate care like washing of woundwith soap and water

was practiced by only 23.5%.The study concluded that management of animal bites

cases among rural population needs health education regarding dog bite management

in home.7

A retrospective chart review was conducted by University of Washington School of medicine, USA to evaluate children less than 16 years of age who had dog bite injuries that resulted in hospitalization or death to determine the typical characteristics of the children, the dogs, and the injuries suffered.Three large city hospitals and forty cases were selected and hospitalization data included total length of stay, need for intensive care, Injury Severity Score, the nature and extent of the injuries, procedures performed, complications, and outcome. The results reported that the average hospital stay was 6 days (SD = 5), and 12 (30%) patients required a stay in the intensive care unit. Injuries to the face, head, and neck area were most common (82%). Major surgical procedures included craniotomy, exploration of the neck or abdomen, ocular procedures, and repair of fractures. The study concluded that severe dog bites in children occur most frequently in those younger than 5 years old and involve the head and neck. Large dogs that are familiar to the child are usually involved. Young children should be closely supervised when around any dog.8

A retrospective study was conducted by department of paediatric surgery in South Africa to perform an analysis of dog bite in community in order to develop preventive strategies. The results reported that a total of 2025 dog bite injuries were sustained by the 1871 children and majority of injuries (n=1626, 80%) were classified as minor, Children less than six years of age were more likely to sustain injuries to the head, face or neck (n=421, 49%), whereas children greater than six years of age more commonly received injuries to the thigh or leg (n=560, 48%). The most frequent injuries were superficial lacerations and only 38 (2%) of children required major surgery. The study concluded that health practitioners should actively contribute to responsible dog ownership and provide evidence based dog bite preventions.9

A Multicentric study was conducted by National institute of communicable diseases in Delhi, Hyderabad, Raipur with the objective of assessing of knowledge, attitude, belief and practices about animal bites and rabies in the general community. A sample of 1129 persons in the age group of 18 to 80 years were interviewed. Data was collected by using a interview Performa. The results reported that (68.7%) people had heard about rabies, (60.7%) of cases associates rabies with dog biteonly knowledge about appropriate wound toilet was found to be inadequate, (31.9%) people felt that washing the wound with soap and water was the best option , application of indigenous products like chillies (11.4%), turmeric (5.6%), lime (6.8%), kerosene oil (2.3%), herbal paste (4.2%) was suggested along with the visit to medicine practioner (1.5%) as part of the bite wound management. The results also reported that multiple reasons like negligence and ignorance 354 (31.4%), fear of multiple painful injections 365 (32.3%), expensive treatment 169 (15%), and long course requiring daily visits to anti rabies clinics 73(6.5%) were cited as reasons for non-compliance of treatment. The study concluded that there is a need to create awareness amongst the masses regarding epidemiology of the disease and merits of prompt and appropriate post exposure through enhanced IEC ( Information and electronic communication) activities.10

A cross sectional study was carried by anti rabies clinic of sasoon hospital puneto determine the profile of animal bites cases. Data was collected using questionnaire. A total 250 cases were included in and the male female ratio was 1.98: 1. The results showed that children in the age group 0-14 years were the victims in 132 (52.8%) cases, dog bite (94.4% ) cases, cat (2.4%), Jackal (1.2%), mongoose (1.2%), monkey (0.4%) and horse (0.4%). The report also showed that the wound was washed with soap and water in only 3.6% of cases. 64.8% of the bites were on the lower extremity and 63.2% of cases reported within 24 hours of the bite. Of the 247 cases administered Beta Propio Lactone (BPL) inactivated vaccine only 18.8% did not have any local reaction and 58.3% had one or more systemic reaction. The study concluded that a three pronged strategy has been recommended to reduce the burden of morbidity and mortality associated with rabies.11

An electronic hospital database was conducted to examine the hospital incidence, hospital

charges, and characteristics of dog bite injuries among children by age group and

hospitalization status and who were treated at health care system to guide prevention

programme and policies. Demographics, injury information, hospital admission status,

length of status, hospital charges and payer source of all patients younger than 18 years

who were treated for dog bites from 1999 to 2006 were collected. the results showed that

during 8 years, 1,347 children younger than 18 years were treated for dog bites, the

majority were treated and released from the emergency department (91%), (4.9%)

requiring inpatient admission, the median length of stay was 2 day, victims were

frequently male (56.9%) and <8 years (55.2%). The study concluded that Dog bite visits

comprised 1.5% of all pediatric injuries and majority (91%) of all dog bite visits were

treated and released from the emergency department. and age less than 5 years increased

the odds of being admitted as an inpatient (OR, 3.3).12

A randomized controlled trids was conducted to evaluate the effectiveness of educational

interventions in population under 20 years old for preventing dog bites. The results

reported that the intervention group showed less inappropriate behavior when observed

in the presence of dog after a 30 minute educational intervention and also an increase in

knowledge and in caution after an information programme. The study concluded that

educating children who are less then 10 years old in school settings could improve their

knowledge, attitude and behavior towards dogs and there is a need for high quality

studies that measure dog bite rates as an outcome.13

6.3 Statement of the Problem:

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS OF SCHOOL AGE CHILDREN REGARDING FIRST AID MANAGEMENT OF DOG BITE

IN SELECTED AREA OF RAICHUR”

6.4 Objectives of the study

1To assess the knowledge of mothers of school age children regarding first aid management ofdog bite

2To implement structured teaching programme regarding first aid management of dog bite

3To determine the effectiveness of structured teaching programme in terms of gain post test knowledge

4To find out the Association between knowledge of mothers and school age children with selected variables (age, parents educational status, occupation, source of knowledge prior information and first aid management of dog bite

6.5 HYPOTHESIS

H1: There will be a significant Association between pre test and post test knowledge scores of mothers of school age children regarding first aid management of dog bite

H2: There will be a significant relationship between knowledge of mothers of school age children with the selected variables(age, parents educational status, source of knowledge, prior information and first aid management of dog bite

6.6 OPERATIONAL DEFINITIONS

EFFECTIVENESS: it is defined as significant gain in knowledge of mothers of school age children and first aid management as evidenced by pretest and post test scores

STRUCTURED TEACHING PROGRAMME: It refers to systematically developed instruction designed for a group of mothers of school age children to provide information regarding first aid managementof dog bite

KNOWLEDGE OF MOTHERS:The level of understanding of mothers of school age childrenregarding first aid management of dog bite in selected area of Raichur.

DOG BITE: A bite caused by dog is called dog bite

FIRST AID: First aid is a procedure done for a dog bitten child prior to the hospital or anti rabies clinics

In this study first aid refers to immediate measures to prevent dog bite complications.

COMMON SITES OF DOG BITE INJURIES: it refers to dog bite injuries among school children in this study following common sites

1. Face
2. Neck
3. Scalp
4. Buttocks
5. Scrotum
6. Hands and lower extremities

7 MATERIALS AND METHODS

7.1 SOURCES OF DATA

DESIGN:one group pretest and post test quasi experimental design is adapted for the present study

O1XO2

SETTING OF THE STUDY: Raichur is one of the backward districts, situated in northern Karnataka, it as an area of 60square kilometers and it consist of 5 towns and 300 villages total population of Raichur is1669762 with 15 revenue wards and 35 election wards and ward number 21 is harijan ward and urban community center is selected for studies, it has area of 796, 86 sectors and population of 19745 out of which 9743 are males 10002 Are females including children

POPULATION: The population included in this study is mothers of school age children who are borne for the dog bite, the population of present study comprises of the entire mothers of school age children

SAMPLE SIZE: The sample size of this study comprises of 30 mothers of school age children

SAMPLING TECHNIQUE: Sampling refers to the study process of selecting a portion of the population to represent the entire population. In this study convenient sampling technique will be used to select the samples.

Ahouse to house survey will be done to identify the families with school age children from each street

INCLUSIVE CRITERIA

The study includes the mother

Who are?

1Having school age children

2Willing to participate in the study

3Available at the time of data collection

4Residing in Harijan ward

EXCLUSION CRITERIA

The study excludes the mothers

Who are not?

1Mentally ill individuals

2Willing to participate in the study

3Available at the time of data collection

4Residing in Harijan ward

SELECTED VARIABLES

DEPENDENT VARIABLES: Knowledge of mothers regarding first aid management of dog bite in school age children

INDEPENDENT VARIABLES: Structured teaching programme on first aid management of dog bite in mothers of school age children

EXTRANEOUS VARIABLES:

AGE: Age of the sample is categorized as

a.18-20 years

b.21-22 years

c.23-24 years

d.25-26 years

e.26 years and above

RELIGION: Religion of the sample is categorized as

1. Hindu
2. Muslim
3. Christian
4. Others

EDUCATIONAL BACKGROUND

1. Primary education
2. Secondary education
3. Higher education
4. Diploma
5. Graduation
6. Post graduation

OCCUPATION

1. Working women
2. House wife

PREVIOUS KNOWLEDGE

1. Yes
2. No

SOURCE OF KNOWLEDGE

1. Television
2. Radio
3. News paper
4. Magazines
5. Others

7.2METHOD OF DATA COLLECTION

DATA COLLECTION INSTRUMENTS

A structured interview schedule will be developed and used for collecting the data. It consists of two parts namely part I and part II. Part I deals with socio –demographic data and Part II represents the knowledge related items on first aid management of dog bite for mothers of school age children.

DATA COLLECTION METHOD

After obtaining the prior permission from the significant authorities and consent from the subjects, the Investigator will assess the knowledge of mothers of school age children regarding first aid management of dog bite by using a structured interviewing schedule and then interviewer structured teaching programme. Again the Investigator will assess the effectiveness of structured teaching programme by post test after a gap of 7 days depending on the convenience of the sample

PLAN FOR DATA ANALYSIS

a)Frequencies and percentage will be used to summarize the sample characteristic and item analysis

b)Mean, standard deviation and paired t-test will be used to calculate the effectiveness of structured teaching programme

c)Chi square value will be computed to find out the relationship between knowledge and selected variables I.e.(age, parents educational status, occupation, sources of knowledge, prior information of first aid).

7.3 PROJECTED OUTCOME