PROFORMA FOR REGESTRATION OF SUBJECT FOR DISSERTATION
MR. MATHEW ISSAC
1ST YEAR M.Sc NURSING
COMMUNITY HEALTH NURSING
YEAR 2011-2013
PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT, NAGARBHAVI
BANGALORE-560072
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. Mathew Issac1st year M. Sc. Nursing
Padmashree College Of Nursing
No. 23, 80 Feet Road
Gurukrupa Layout, Nagarbhavi
Bangalore - 560072
2 / NAME OF THE INSTITUTION / Padmashree College of Nursing
Bangalore
3 / COURSE OF THE STUDY AND SUBJECT / 1st year M.Sc Nursing
Community Health Nursing
4 / DATE OF ADMISSION / 28-10-11
5 / TITLE OF THE STUDY / A study to assess the effectiveness of structured teaching program on knowledge and practices among mothers of preschool children on prevention of vitamin A deficiency diseases in a selected rural area, Bangalore.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Under five children are one among vulnerable population”
Health care of under five children has been markedly changed in developed countries. There is a change in the view of children from, “Miniature adults” to “Unique individual” with special needs and qualities, the under five children has prime importance, as the mortality and morbidity are higher in this group, due to vitamin deficiency disorders. Under five children focus on important segment of the Indian population. They contribute to the vital human potential and impart strength to the national economy and development.1
The word “vitamin” means life. Vitamins are substances essential for the maintenance of normal metabolic functions they are required for the metabolism of carbohydrates, fats and proteins. Vitamins are widely used as dietary supplements. Even though vitamin supplements are of no demonstrated value for healthy infants, child adolescents or adults who is consuming an adequate and varied diet.2
According to 2009 statistical report by WHO more than 254 million children suffer from vitamin deficiency world wide in each year, 20-40 million children suffer from mild vitamin-A deficiency and three million children from severe deficiency. World health organization estimates that 100 to 140 million children under the age of five may be living with dangerously low vitamin-stores. More than four million children are world wide exhibit sign of severe deficiency. In Karnataka 0.3% of children are suffering from vitamin deficiency.3
Vitamin A is essential for eye health and the proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths.4
Vitamin A deficiency (VAD) is a major nutritional concern in poor societies, especially in lower income countries. Its presence as a public health problem is assessed by measuring the prevalence of deficiency in a population, represented by specific biochemical and clinical indicators of status. The main underlying cause of VAD as a public health problem is a diet that is chronically insufficient in vitamin A that can lead to lower body stores and fail to meet physiologic needs. Deficiency of sufficient duration or severity can lead to disorders that are common in vitamin A deficient populations such as xerophthalmia, the leading cause of preventable childhood blindness, anaemia, and weakened host resistance to infection, which can increase the severity of infectious diseases and risk of death.5
Vitamin-A deficiency is seen more commonly in under five children (1-5 yrs). Vitamin-A deficiency affect the eyes. It causes “xeropthalmia” which is characterized by series of clinical signs. These are include- Night blindness, Conjuctival xerosis, Bitot-spot, Corneal ulceration, Karatomalacia and Corneal scar. Dietary deficiency of vitamin-A most commonly and importantly affects the eyes, and it can lead to blindness. Xerophthalmia, meaning drying of eyes (from the Greek word Xerox, meaning dry) is the term now used to cover the eye manifestations resulting from vitamin-A deficiency.6
A poor diet and infection frequently coexist and interact in populations where VAD is widespread. In such settings, VAD can increase the severity of infection which, in turn, can reduce intake and accelerate body losses of vitamin A to exacerbate deficiency. The prevalence and severity of xerophthalmia, anaemia and the (less-measurable) “vicious cycle” between VAD and infection in vulnerable groups represent the most compelling consequences of VAD and underlie its significance as a public health problem around the world.5
6.2 NEED FOR STUDY:
During the first year after birth, breast milk from a well nourished mother provide all vitamins that an infants needs, since 12% of the children (1-5yrs) constitutes a valuable and much neglected population of our country education and health status of children of a nation is a highly reliable index of health of its population, under five children suffer from major health problem of them is vitamin deficiency disorders and the reason are overcrowding, unhygienic products, poor environmental health, poor education or lack of knowledge in mothers and poor nutrition.7
Vitamin-A deficiency is a major public health problem those most deficiency countries. In children, Vitamin-A deficiency disorder is the leading cause of preventable visual impairment and blindness. Vitamin-A was estimated to affect between 75 and 254 million preschool children each year. In a recent meta-analysis conducted by West 127.2 million preschool-aged children were vitamin A–deficient; this figure represents 25% of preschool-aged children in developing countries and in one developed country experiencing social conflict. Estimated 250,000–500,000 vitamin- A deficient children become blind every year, and about half of them die within a year of becoming blind vitamin-A deficiency significantly increases the risk of severe illness and death from common childhood infections, particularly diarrhoeal diseases and measles. It was estimated that worldwide, vitamin-A deficiency may be responsible for as many as 1.3–2.5 million deaths annually.8
A survey of blind school students in Nine Indian states revealed that 18.6% of the blindness was due to vitamin-A deficiency and another 3.2% due to measles which precipitates vitamin-A deficiency. On the other hand, vitamin-A deficiency contributed to only 5.5% of the childhood blindness in a population-based survey in West Godavari district of Andhra Pradesh. The magnitude of childhood blindness due to vitamin-A deficiency probably varies considerably in different parts of India. This may be related to variations in socioeconomic status. Vitamin-A deficiency also contributes to child mortality, which can be reduced with vitamin-A supplementation.9
In Karnataka (2007) the stages of xerophthalmia in Rural areas are, Night-blindness 2.9%,Conjuctival-xerosis 25.1%,Bitot-spot 8.8% in Urban areas, Night-blindness 1.1%,Conjuctival-xerosis 18.9% and Bitot-spot 5.2%.10
Eyes are windows for the human being through which they are able to utilize the entire glory of the nature. This vision can be affected by many factors such as-faulty practices malnutrition, infection and refractive errors. The vitamin-A deficiency is the major cause of disturbances in vision during preschool age. Vitamin-A is essential nutrient that play an important role in vision. Inadequate dietary intake of vitamin-A is the primary cause of vitamin-A deficiency. Low fat content of diet is also an important contributory factor. The consumption of animal foods that contain performed vitamin-A is very low because of cost.11
The Researcher during his experience has also found that mothers had lack of knowledge regarding prevention of selected vitamin A deficiency disorders. So investigator felt the need to assess the mother’s knowledge regarding prevention of selected vitamin A deficiency disorders in preschool children and to impart structured teaching programme to improve the mothers knowledge.
6.3 STATEMENT OF PROBLEM
A study to assess the effectiveness of structured teaching program on knowledge and practices among mothers of preschool children on prevention of vitamin A deficiency diseases in a selected rural area, Bangalore.
6.4 OBJECTIVES
1. To explore the knowledge and practices among mothers of pre-school children regarding prevention of vitamin A deficiency diseases.
2. To assess the effectiveness of structured teaching program on knowledge and practices on prevention of vitamin A deficiency diseases.
3. To correlate the knowledge and practices on prevention of vitamin A deficiency diseases among mothers of preschool children.
4. To associate the pre-test knowledge and practices on prevention of vitamin A deficiency diseases among mothers of preschool children with their selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
1. Assess: It is the activity to estimate the outcome of teaching program on prevention of vitamin A deficiency diseases.
2. Effectiveness: It refers to significant increase in the level of knowledge and practices among mothers of preschool children regarding prevention of vitamin A deficiency diseases.
3. Structured Teaching Program: It refers to systematically developed instruction with teaching aids designed for mothers of preschool children regarding prevention of vitamin A deficiency diseases by using A.V aids such as charts, video of vitamin A deficiency diseases, flash cards and posters.
4. Knowledge: It refers to number of correct responds received from the mothers of preschool children regarding prevention of vitamin A deficiency.
5. Practices: It refers to the practices that are followed by mothers of preschool children to prevent vitamin A deficiency among pre-school children such as eye care, dietary management, vitamin A prophylaxis, cooking habits.
6. Mothers: This refers to women who are having their own children in the age group of three to five years and are residing in selected rural area.
7. Preschool children: This refers to children in the age group of three to five years who are residing in selected rural area.
8. Prevention: It refers to the promotion of constructive lifestyle and norms that discourage the vitamin A deficiency diseases among preschool children.
9. Vitamin A deficiency: It refers to the blood serum vitamins A that are below a defined range (30 - 95 µg/dL) due to failure in intake of sufficient amount of vitamin A or beta carotene.
6.6 ASSUMPTIONS
Ø The mothers may have inadequate knowledge regarding prevention of vitamin A deficiency diseases.
Ø The adequate knowledge and healthy practices of mothers regarding prevention of vitamin A deficiency diseases may lead to good vision.
Ø The selected variables have influence on mothers knowledge and practices regarding prevention of vitamin A deficiency diseases.
6.7 HYPOTHESIS
H1:- There will be significant differences between pre and post test of mothers of preschool children regarding prevention of vitamin A deficiency diseases.
H2:- There will be a significant relationship between pre and post test knowledge of mothers of preschool children on prevention of vitamin A deficiency diseases.
H3:- There will be significant association between pre knowledge and practices of mothers of preschool children regarding prevention of vitamin A deficiency diseases.
6.8 REVIEW OF LITURATURE:
The term literature review refers to the activities involved in identifying and searching information on a topic and developing an understanding of the state of knowledge on topic. Also review of literature is a written summery of the state and the art of a research problem. Literature review is an essential step in the whole process of research. Therefore the researcher has reviewed literature with regard to the problem by referring books, journals, thesis, etc.
In this study the relevant literature reviewed has been organized and presented under the following headings.
1. Studies related to etiology & risk factors on vitamin-A deficiencies.
2. Studies related to manifestation, Treatment and Prevention of vitamin-A deficiencies.
3. Studies related to Lack of knowledge and the effectiveness of structured teaching programme on selected vitamin-A deficiencies.
1. Studies related to etiology & risk factors on vitamin-A deficiencies.
A cross sectional study was conducted to determine the risk factors of xeropthalmia among preschool children at primary centre (Bihar), in rural India. 4,205 preschool children were samples of the study. The outcomes were risk factors of xerophthalmia, nearly socioeconomic status and a history of repeated diarrhoea, measles, passing worm in stool and respiratory tract infection. The result indicate that the socio economic status of families, a history of passing round worm in stool and diarrhoea were important antecedent risk factors in vitamin-A deficient in preschool children.12
A study was conducted on Drumstical leaves as a source of vitamin-A in ICDS-SEP, An integrated approach was adopted in this study. This included comprehensive training sessions for the staff of the ICDS and non government organization (NGO) involved in the SF preparations. Prior to the acceptability trails, the data were elicited on the socioeconomic profile and knowledge about vitamin-A, of 60 children of 1-5 years of age attending two aganwadi centers of the ICDS. The results indicates that integration of nutrition communication along with the introduction of unconventional Dehydrated Drumstick leaves (DDL), into the ICDS-SF, was feasible and can be endeavored for a longer duration in the existing national programme.13
A study was conducted among under five children on dietary xerophthalmia in Jimma town, south west Ethiopia to assess patients knowledge about children need for plants sources of vitamin-A intake. The objective of the study was to estimate the prevalence of xerophthalmia and to forward appropriate recommendations. Eight hundred and thirty one children between the ages of six to 59 months were sample of the study. The result of study showed that only eighty percent of the children were getting green vegetables, fruits and carrots once a weekly or more. The major reasons given for not including green vegetables, fruits and carrots in the diet were “can not afford” (39%) ”not available” (33%) and child too young (16). Thus it was recommended that periodic vitamin-A supplementation, preferably combined with immunization, should be a priority action and parents need to be educated about vitamin-A deficiency and its prevention.14
A study was conducted to investigate risk for sub clinical vitamin-A deficiency among under six years of age in urban slums of Nagpur, India. The current study recognized a significant association between female gender, ill-literate mother, lower socio economic status, more than two children of under five years of age at home, under nutrition, history of Diarrhoea, Measles, Acute respiratory tract infection and sub clinical vitamin-A deficiency on univariate analysis.15