RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
1)NAME AND ADDRES : MISS. RENITA PRIYA D’SOUZA
I YEAR MSC NURSING
GOVERNMENTCOLLEGE OF
NURSING, FORT, BENGALURU-2
2) NAME OF THE : GOVERNMENTCOLLEGE OF
INSTITUTION NURSING, FORT, BENGALURU-2
3) COURSE OF STUDY : I YEAR MSC NURSING
AND SUBJECT CHILD HEALTH NURSING
4) DATE OF ADMISSION : 20/ 5/ 2009
5) TITLE OF THE TOPIC : A STUDY TO EVALUATE THE
EFFECTIVENESS OF CHILD
TO CHILD PROGRAMME ON
ROAD SAFETY MEASURES
AMONG PRIMARY SCHOOL
CHILDREN AT SELECTED
SCHOOL, BENGALURU.
6) BREIF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“No Other Gift is greater than Gift of Life”
-Charaka
Life is a precious gift by God and it should be handled with care. Nursing
profession is one of the main professions responsible to care the life of people by
providing preventive, curative, promotive, restorative and rehabilitative care.
Today’s children are tomorrow’s citizens and healthy children are wealth of
nation.Children below 15 years of age make 40% of the total population of India.
Childrennot only constitute large group but they are also vulnerable groupor “special
risk group”. Death rate in children is high inIndia due to multi- causes like
communicable diseases, accidents, infections etc.1
Road traffic accidents are the common cause of death in school children. India’s
killer roads account for more deaths than anyother single cause, from terrorism to natural
deaths. Every hour 13 people die due to road, thehighest in the world. Every 10th person
who dies due to road accident is an Indian. Everyday about 250 people die in road
accidents or an astonishing 1,40,590 each year. It is estimated that road accident cause an
estimated loss of 1% of the country’s gross domestic product. In fact the Global Status Report on Road safety (GSRRS) by World health organization (WHO) says it is the low level enforcement of simple road safety measures in India, like prohibition and monitoring of drunken driving, wearing helmets, seat belts and child restraints. The mandatory use of child restraints can reduce child deaths by 35%. School
teachers should inculcate traffic safety among students and enforces traffic rules within
the school premises.2
India adopted National Health Policy for children in August in 1974 and recognized children as the “Nation’s supremely important asset”. David Morley and his colleagues in London who identified ‘The Child Power’ for spreading the health messages. ‘Child to child programme’ is based on the concept that children in schools and asfamily members need to be considered aspartners in spreading health messages as well as benefiting from. The children are educated on simple but important health topics like personal hygiene, balanced diet, immunization, accidents, first aid etc.The activities made lively by using different modalities of teaching like demonstration, role play, songs, health games etc. Each child is then asked to spread the health messages.Least that expected from these children is to spread health messages to their siblings, parents, neighbors andultimately the message spread to community.3
6.1 NEED FOR THE STUDY:
It has been estimated that 1 million deaths and 15 million Road Side Accidents
occur on roads world wide every year.Globally Road Side Accidents is 10th in South
East Asia regionand 7th leading cause of death in all age groups. According to World
Health Organization the road accidents are the 9th leading cause of death. However it is
likely to reach the number 3 by 2020.It was estimated that over 75% of RSA occur in
developing countries and accounts for only 32% of total motor vehicle fleet, which
involves 65% of pedestrians and 35% of school children.Child pedestrian injury, an
important cause of mortality and morbidity remains one of the leading causes of death in
developed and developing countries. Each year in United States approximately50
children under the age group of 15 years are killed and another 30,000 are injured in
pedestrian collisions. During last decades injuries due to RSA have risen by 300% in
Asian and African countries in contrast to 30-40% in developed countries.4 In India
highest % of Road Traffic Accidents (RTA) are seen in Mumbai .i.e. 17.6%. Bengaluru
takes 5thplace with 6.4% of RTA. 4
A study conducted by H.M.Swami, S.Puri, and V.Bhatia on Road safety
awareness and practices among school children of Chandhighar showed that 40% of
children lacked correct knowledge of traffic safety rules. Bicycle, motorcycle/scooter
and car were driven mostly by 62%, 18.5% and1.7% of school children respectively.
Some children 13.3% started driving under the age of 10 years. More than half of the
students informed that they were caught for not wearing helmets and not having valid
documents. Students who were using mobile phones while driving were 22%,
overspeeding was done by 29% and 8.3% of them consumed alcohol while driving.
Death of any school child in road traffic accident is while driving is a serious issue. But
this is certainly preventable. Parents should not allow their children to drive There is
limited literature related to accident related behavior in developing countries. The
chances of Road Side Accidents (RSA) can be averted to a large extent if school children,
are made aware of road safety measures.Road safety education is considered essential to
teach children to interact with traffic safely. Many programs, however, donot consider the
separate component skills of the road crossing tasks, the functional and behavioural
factors that may put some children at increased risk and the most beneficial methods to
transfer knowledge to improved behaviour in real- world environment.5
In child to child program childrenare consideredas very good messengers of health. At present world both the parents are working and are not able to provide complete attention to their children. So children themselves are responsible for their health and to their siblings also. Child to child program is an effective method of spreading health messages. Prof.Hugh Hawes states that “Children have vitally important part to play in the health of the community, not merely by kept healthy by adults but in passing on health messages to then to younger brothers and sisters and by jointly co-operating to become a positive force of health”. Health education to school children in their formative age is the most effective method for protection and promotion of their health.
A study conducted by G.Mishra to evaluate the effectiveness of child to child programme. He used the children as the messengers of pulse polio immunization in the slums of Mumbai for motivating people to participate in the immunization campaigns. He formed group of 50 children between age group of 10 to 12 years from the nearby area in the slum. A doctor and 2 primary health workers conducted training for these children on different aspects of polio and benefits of immunization. Each child was asked to teach other children in the group. Each child was allotted 30 families and assigned to get the children below 5 years to nearest immunization centre. All the eligible children from 150 families were immunized achieving a 100% response for immunization among the children covered by child to child group, thus demonstrating success of programme.3
Above study and many other studies demonstrated that the child to child programme is not only effective but inexpensive and more suitable for teaching the children. And also studies have shown that the children lack the knowledge of road safety measures. Children are active, creative and interested to explore the world. In this process they are neglecting their safety.Road traffic accidents constitutes 26% of injuries and 40% of hospitalization in children at Bengaluru city.4 Making aware of road safety measures to them is effective in reducing accidents in children. As prevention and educating the people is an important function, nurses can teach the students regarding road safety measures and can help in reducing child mortality and morbidity rates to some extent. Hence the investigator felt that there is need to conduct the study on effectiveness of child to child programme on road safety measures. Teaching the children of selected primary school may help them to improve their knowledge on road safety measures and may help them to prevent accidents.
6.2 REVIEW OF LITERATURE:
1)Reviews related to road traffic accidents.
2)Reviews related to road safety measures
3)Reviews related to child-to child programme.
Reviews related to road traffic accidents:
A descriptive survey was conducted to estimate the burdenof traffic injuries among children and adolescents inurban South Asia in the year 2008. This study selected 26studies for review and data extraction out of 1505published articles. Data from the studies pooled to calculate the proportion and characteristics of child and adolescent RTI,regional RTI incidence and mortality rates,and an estimates of the burden of disease caused by these injuries through the use of the healthy life years lost (HeaLY) composite measures. Their findings showed that the majority of injuries occurred in males (67-80%) and the most frequent age group injured was between ages 0 and 9 representing 40% of cases. Children and adolescents represent an average of 22% of all those with RTI whom seek care. Children and adolescents represented an average of 13% of all RTI deaths. Regional RTI incidence rate was calculated at 880/100,000urban persons aged 0 to 19. Mortality due RTI was at 17 deaths per 1 lakh urban persons aged 0 to 19 in South Asia. Burden of disease was calculated 16 HeaLYs per1,000 general population from Road Traffic Mortality alone. With disability data added, then 27.7 Healy per 1,000 general populations are lost from road traffic injuries in South Asia.6
A study was conducted in Australia in 2008on the increasing problem of motorcycle injuries in children and adolescents. The objective of the study was to quantify an anecdotally apparent increase in motorcycle related injuries in children and adolescents .Retrospective analysis of pediatric motorcycle injuries (1july2000-30 June 2004) from statewide emergency department database in Victoria hospital and Royal children hospital Melbourne. The study had shown that the average rise in 9.6% of motorcycle accidents among children below 16 years. About a quarter of motorcycle injuries occurred in children below 10 years. The median hospital stays were for 3 days. So they concluded that the motorcycle injuries were increasing in children and adolescents. Researchers suggested that there is an urgent need for coordinated legislative changes and education efforts to decrease motorcycle injuries in children.7
A study was conducted on Epidemiology of Road traffic Injuries in Delhi in 2008. Among 30,554 populations, there were 680 traffic injuries with IR 22.3/1,000 population. Of the total injuries, 69% occurred in the age group of 15-35 and males were 4 times more affected than females. The business group had higher incidence (IR 44.0) followed by the service group (IR40.1) and the labor group (IR 28.9). The annual incidence was highest among people 6th to 8th class education level (5.3), followed by graduates (3.6). Limbs (62.2%) were the most affected part followed by head injury (11.2%). Superficial injuries were most common (47.4%), followed by fractures (20.7%), crushinjuries (14.1%) and concealed injuries (12.4%). 19.3% injuries occurred during recreational activities. Majority of the injured victims (19.4%) were administered treatment within 6 hours while 70.0% availed treatment within 1 hour of injury. Majority of injured victims took treatment from nearby private clinic (44.4%), followed by treatment from government hospitals (26.8%) and private hospitals(16.0%). Outpatient treatment was required by 47.1%; 5.9% were hospitalized. 9% of patients were critically ill due to injuries 1.8% had to be operated upon, and 1.3% had to be admitted to intensive care units (ICU).The result of this study suggests the need for large prospective studies that would assist various organizations to set and plan preventive programmes.8
Reviews related to road safety measures:
A study was conducted in 2007 on Road safety education: Spatial decentering and subjective or objective picture processing in France.This study examined children’s ability to analyze pictures of a risky situation, both in relation to the characteristics of the pictures and in relation to the centering/decentering process of cognitive development. Sixty children aged 6,9 or 11 years were given an objective or subjective version of a story about a risky situation involving road crossing and were asked to reconstruct it by putting six pictures in chronological order . The type of picture series objective or subjective had a different effect on the children’s understanding and performance according to the age. The older children were better at ordering the pictures but on the subjective version only. The picture –version effect on planning time was decreased with age: only the younger children took more time to start touching the pictures. On one hand it is concluded that for the youngest children objective representations are essential to analyzing pictures showing a risk, whereas oldest children will profit more from subjective view.9
An experimental study was conducted in 2006 in Australia on teaching young children to cross road safely. A targeted and practical training program using asimulated road environment has been developed and evaluated amongst primary school children using a randomized controlled trial. Significant reduction in proportionally incorrect road crossing responses were found immediately after training (56%) and one- month post training (47%) by the case group compared with pre-training responses, and relative to any changes in responses of the control group. The beneficial effects were greater for younger children, females, children with less well developed perceptual and cognitive skills and, those with little traffic exposure. The result of the study showed that the child pedestrians can be made to cross the road safely by training them.10
A study was conducted in Switzerlandon safety education of pedestrians for injury prevention. The objective of the study was to quantify the safety education to the pedestrians. Systemic review of randomized controlled trials of safety education programmes for pedestrian of all ages was done. They conducted sessions on safety measures to 15 groups were 14 groups included children and one group was institutionalized adults. The samples were observed for the behaviour during crossing the road. The effect of pedestrian education on behaviour varied considerably. Researchers concluded that the pedestrian safety education can change observed road crossing behaviour.11
Reviews related to child-to child approach:
An evaluative study was conducted in 2007to evaluate the effectiveness of child-to-child programme onprevention ofvitamin A deficiency among high school children in selected government schools of Bangalore. An evaluatory approach with pretest and post test was used .Purposive sampling was used to select 200 samples. Pretest was conducted to the samples and 20 ‘change agents’ were selected based on the high pretest scores and the interest of the children and the planned teaching program on prevention of deficiency of vitamin A was conducted to them and they were asked to teach their peers. Pretest knowledge score was (29.4%) and it was increased to (88.54%) on post test. So she found child- to- child programme is effective on prevention of Vitamin A deficiency.12
A quasi- experimentalstudy wasconducted in 2005 to evaluate the effectiveness of child-to child approach through role play on prevention of worm infestation in selected school in Bangalore. An evaluatory approach with pretest and post test design was used. Convenient sampling technique was used. Sample sizes of 30, 4th standard school children were selected. A structured interview schedule was conducted. Child to child programme was conducted through role play. There was significant difference between pretest and post-test results about prevention of worm infestation. The major finding of the study revealed that 16 were males and 14 were females belong to normal height and weight according to age having majority parents income below RS.1000. Majority families 23(76.65) were using toilet and most of them26(86.7%) had prior knowledge about worm infestation. The results indicated that child-to-child programme through role play on prevention of worm infestation in school children is effective.13
A study was conducted in Government primary school of Mastmaradi and Shindoli village of Belgaum district of Karnataka in 2001 to assess the impact of child to child programme in increasing the knowledge, change in attitude and practice with respect to diarrhea among rural school children. Researcher selected the 6th standard 54 students of Mastmaradi primary school as the study group and 6th standard 54 students of Shindoli primary school as control group. Pretest was conducted to the both the study and control group through pre-designed questionnaire to know their knowledge, attitude and practice regarding diarrhea .Once a week child to child session(total 12) were conducted for the study group students. During these sessions students were taught about causes, signs, symptoms, prevention and treatment of diarrhea. Lectures songs, games experiments and demonstration were the different teaching techniques used for study group. No such sessions were conducted to the control group. Post test was conducted to the both the groups. Overall improvement was seen in the knowledge of the study group was improved, pretest mean score was 1.44 and post test mean score was 23.57. Whereas pretest mean score of control group was 4.04 and post test mean was 3.20.Study has shown that the child to child programme has resulted in significant improvement in the knowledge, development of positive attitudes and healthy practices among study group students. Therefore child to child programme was effective.14
STATEMENT OF THE PROBLEM:
A STUDY TO EVALUATE THE EFFECTIVENESS OF CHILD TO CHILD PROGRAMME ON ROAD SAFETY MEASURES AMONG PRIMARY SCHOOL CHILDREN AT SELECTED SCHOOL, BENGALURU.
6.3 OBJECTIVES OF THE STUDY :
- To assess the knowledge of children regarding road safety measures.
- To conduct child to child programme on road safety measures.
- To evaluate the effectiveness of child to child programme on road safety measures.
- To find association between post test knowledge scores on road safety measures and selected demographic variables.
6.3.1HYPOTHESIS:
H1 – The mean post test knowledge scores will be significantly higher than pretest