“A Study On The Effectiveness Of Structured Teaching Program On Knowledge Regarding Prevention Of Vit-A Deficiency Among Mothers Of Under Five Children In Selected Urban Community At Madhugiri With A View To Develop A Information Booklet”.

PAEDIATRIC NURSING

NAME OF THE STUDENT

MR. MAHESH KUMAR GOME

NAME OF THE GUIDE

MRS. B RUNEELA

PRINCIPAL

ACADEMIC YEAR: 2010-2011

M.Sc. NURSING FIRST YEAR

“A Study On The Effectiveness Of Structured Teaching Program On Knowledge Regarding Prevention Of Vit-A Deficiency Among Mothers Of Under Five Children In Selected Urban Community At Madhugiri With A View To Develop A Information Booklet”.

NAME OF INVESTIGATOR : MR. MAHESH KUMAR GOME

DEPARTMENT: PAEDIATRIC NURSING

HEAD OF THE DEPARTMENT: PROF. B RUNEELA

SIGNATURE :

HEAD OF THE INSTITUTE : PROF. B RUNEELA

PRINCIPAL

SIGNATURE :

Introduction:

The word vitamin was originally derived from Funk's term "vital amine." In 1912, he was referring to Christian Eijkman's discovery of an amine extracted from rice polishing that could preventberiberi. Funk's recognition of theanti-beriberifactor as vital for life was indeed accurate. Researchers have since found that vitamins are essential organic compounds that the human body cannot synthesize. Vitamins A, D, K, and E are classified as fat-soluble vitamins, whereas others are classified as water-soluble vitamins.

Vitamin Awas the first fat-soluble vitamin to be discovered. Early observations by ancient Egyptians recognized that night blindness could be treated with consumption of liver. Two independent research teams, Osborne and Mendel at Yale University and McCollum and Davis at the University of Wisconsin, simultaneously discovered vitamin A in 1913.Vitamin Ais made up of a family of compounds called the retinoid. The retinoid designation resulted from finding that vitamin A had the biologic activity of retinol, which was originally isolated from the retina.

There are essentially 3 forms of vitamin A: retinols, beta carotenes, and carotenoids. Retinol, also known as preformed vitamin A, is the most active form and is mostly found in animal sources of food. Beta carotene, also known as provitamin A, is the plant source of retinol from which mammals make two-thirds of their vitamin A. Carotenoids, the largest group of the 3, contain multiple conjugated double bonds and exist in a free alcohol or in a fatty acyl-ester form.

In the human body, retinol is the predominant form, and 11-cis-retinol is the active form. Retinol-binding protein (RBP) binds vitamin A and regulates its absorption and metabolism. Vitamin A is essential for vision (especially dark adaptation), immune response, bone growth, reproduction, the maintenance of the surface linings of the eyes, epithelial cell growth and repair, and the epithelial integrity of the respiratory, urinary, and intestinal tracts. Vitamin A is also important for embryonic development and the regulation of adult genes. It functions as an activator of gene expression by retinoid alpha-receptor transcription factor and ligand-dependent transcription factor.

Deficiency of vitamin A is found among malnourished, elderly, and chronically sick populations in the United States, but it is more prevalent in developing countries. Abnormal visual adaptation to darkness, dry skin, dry hair, broken fingernails, and decreased resistance to infections are among the first signs of vitamin A deficiency.

Problem Description

Need of the study/ Justification:

Vitamin A deficiencyis a lack ofvitamin Ain humans. It is common in developing countries but rarely seen in developed countries.Night blindnessis one of the first signs of vitamin A deficiency.Xerophthalmiaand complete blindness can also occur since Vitamin A has a major role inphototransduction. Approximately 250,000 to 500,000 malnourished children in the developing world go blind each year from a deficiency of vitamin A, approximately half of which die within a year of becoming blind. The prevalence ofnight blindnessdue to vitamin A deficiency is also high among pregnant women in many developing countries. Vitamin A deficiency also contributes tomaternal mortalityand other poor outcomes inpregnancyandlactation.

Vitamin A deficiency also diminishes the ability to fight infections. In countries where children are notimmunized, infectious diseases likemeasleshave higher fatality rates. As elucidated byDr. Alfred Sommer, even mild, subclinical deficiency can also be a problem, as it may increase children's risk of developing respiratory and diarrheal infections, decrease growth rate, slow bone development, and decrease likelihood of survival from serious illness.

Vitamin A deficiency is estimated to affect approximately one third of children under the age of five around the world.[5]It is estimated to claim the lives of 670,000 children under five annually.Approximately 250,000-500,000 children in developing countries become blind each year owing to vitamin A deficiency, with the highest prevalence in Southeast Asia and Africa. According to the World Health Organization (WHO), vitamin A deficiency is under control in the United States, but in developing countries vitamin A deficiency is a significant concern.

Statement of the problem:

A study on the effectiveness of structured teaching program on knowledge regarding prevention of Vit-A deficiencyamong mothers of under five children in selected urban community at Madhugiri with a view to develop a information booklet.

Objectives of the study:

  1. To assess the pre test knowledge of mothers of under five childrenregarding Vit-A deficiency.
  2. To assess the effectiveness of structured teaching program on knowledge regarding prevention of Vit-A deficiency among mothers of under five children.
  3. To associate the knowledge of mothers regarding prevention of Vit-A deficiency with selected demographic variables.

Variables:

A variable is a concept (construct) that has been so specifically defined that precise observations and therefore measurement can be accomplished

Variables in my study are:

1knowledge of mothers of under five children regarding prevention of Vit-A deficiency

2Demographic variables:

-Age

-Sex

-education

-type of family

-No. of children

-Socio-economic status

Operational definitions:

  1. Assess: It is the activity outcome level on knowledge score of mothers.
  2. Effectiveness: It is a degree of performance and accuracy of structured teaching on prevention of Vit-A deficiency.
  3. Knowledge: It refers to the correct responses of mothers to the knowledge items in the close-ended questionnaire regarding prevention of Vit-A deficiencyas prepared by investigator.
  4. Vit-A deficiency:It refers to lack of special nutrients in daily diet which leads to a disease.
  5. Mothers: It refers to the lady who has biologically blood relation with child.
  6. Structured teaching program: It refers to set of instructions or verbal communication on prevention of Vit-A deficiency.
  7. Under five Children: it refers to the children who are below the five years of age.

Assumptions:

It is assumed that mothers have some knowledge regarding prevention of Vit-A deficiency.

It is also assumed that the knowledge of mothers regarding prevention of Vit-A deficiency will vary according to selected demographic variables.

It is assumed that all participants will answer honestly in this study.

Hypothesis:

  • RH-1. There is a significant difference between the pre test and post testknowledge after implementation of structured teaching program regarding the prevention of Vit-a deficiency among the mothers of under five children
  • RH-2. There is a significant increase in level of knowledge after implementation of structured teaching program regarding the prevention of Vit-a deficiency among the mothers of under five children
  • RH-3. There is significant association between selected demographic variables and pre test knowledge of mothersof under five children regarding the prevention of Vit-a deficiency.

Delimitations:

  1. The study is delimited to the mothers whose children are below five years of age.
  2. The data will be collected during the day time.
  3. Assessment of the knowledge will completely depends on questionnaire formed by the investigator.
  4. The study will be limited in selected areas.
  5. Period of data collection is delimited to four weeks

Conceptual framework

Conceptual model deals with concepts which are assembled together by virtue of their relevance to common theme. In this study the following concepts are assembled; knowledge, mothers, structured teaching program andunder five children.

In this model the knowledge of mothers influencing their children to avail the proper Vit-A enriched diet and the demographic variables of mothers are affecting the knowledge of them. And the knowledge ultimately influencing the nutritional status of children.

After an extensive in the review of literature, and discussion with experts, the investigator found that Ernestine Widen Bach’s (1969) Prescriptive theory is best suited to study the effectiveness of structured teaching program on knowledge regarding prevention of Vit-A deficiency among mothers of under five children

Review of literature :

  1. Payne LG,Koski KG,et all conducted a study on Benefit of vitamin A supplementation on ascarisreinfection is less evident in stunted children. They conclude the common coexistence of vitamin A deficiency and Ascaris infection in preschool children in developing countries, and despite the widespread use of vitamin A supplements, remarkably little is understood about the impact of vitamin A supplementation on this gastrointestinal nematode. The Ministry of Health of Panama recently initiated a vitamin A supplementation program in rural indigenous populations. We took advantage of this initiative to assess the benefit of 200,000 IU (60 mg retinol) vitamin A on reinfection with Ascaris following deworming. Baseline stool exams, anthropometry, and socio-economic data were collected for 328 preschool children from 12-60 mo of age (106 supplemented within previous 3 mo and 222 unsupplemented within previous 6 mo). All children were dewormed with albendazole, and reinfection levels were monitored 3 and 5 mo later. Baseline prevalence of Ascaris was 79.5%. Stepwise regression showed that Ascaris intensity was lower in Vit A-supplemented children at baseline and 3 mo after deworming, but not after 5 mo. As 61% of the children were stunted, the impact of supplementation on Ascarisreinfection was examined separately for stunted and children of normal height. Prevalence and intensity of Ascaris at baseline and 3 mo after deworming were lower in children of normal height, but in stunted children the benefit was restricted to those who were dewormed within 6 wk of supplementation. Our study provides evidence that combined vitamin A supplementation and deworming reduces Ascarisreinfection in children living in areas of chronic parasitosis, but that the duration of the benefit is less in stunted children.
  1. West KP Jr conducted a study on Extent of vitamin A deficiency among preschool children and women of reproductive age.Knowledge of the extent of vitamin A (VA) deficiency (D) is critical for identifying high-risk populations and mobilizing resources for prevention. Yet, all estimates are necessarily imperfect, often based on assumptions in the absence of data. In 1995, the World Health Organization estimated 254 million children to be VA-deficient and 2.8 million to have xerophthalmia. Subsequently, estimates were changed to 75-140 million and 3.3 million, respectively. Although both sets are consistent with a problem of enormous magnitude, the discrepancies also created uncertainty. The present analysis indicates there are approximately 127 million and 4.4 million preschool children with VAD (serum retinol < 0.70 micro mol/L or displaying abnormal impression cytology) and xerophthalmia, respectively. More than 7.2 million pregnant women in the developing world are VA-deficient (serum or breast-milk vitamin A concentrations < 0.70 micro mol/L), and another 13.5 million have low VA status (0.70-1.05 micro mol/L); >6 million women develop night blindness (XN) during pregnancy annually. Roughly 45% of VA-deficient and xerophthalmic children and pregnant women with low-to-deficient VA status live in South and Southeast Asia. These regions harbor >60% of all cases of maternal XN, three fourths of whom seem to live in India. Africa accounts for 25-35% of the global cases of child and maternal VAD; about 10% of all deficient persons live in the eastern Mediterranean region, 5-15% live in the Western Pacific and approximately 5% live in the Region of the Americas. VA prophylaxis seems to be preventing the number of deficient preschool children from increasing while probably reducing rates of blindness and mortality. Greater effort is needed to assess and prevent VAD and its disorders, particularly among pregnant and lactating women.
  2. De Pee S,West CE conducted a study on Dietary carotenoids and their role in combating vitamin A deficiency with a objective o evaluate the evidence that carotene-rich fruits and vegetables can overcome vitamin A deficiency. The result of the study was that the Increased intake of fruits and vegetables has been shown to be related to improved vitamin A status in many cross-sectional, case-control and community-based studies, but this does not prove causality of the relationship. Many experimental studies indicating a positive effect of fruits and vegetables can be criticized for their poor experimental design while recent experimental studies have found no effect of vegetables on vitamin A status. Thus, it is too early to draw firm conclusions about the role of carotene-rich fruits and vegetables in overcoming vitamin A deficiency. Bioavailability of dietary carotenoids and their conversion to retinol are influenced by the following factors: Species of carotene; molecular Linkage; Amount of carotene in a meal; Matrix in which the carotenoid is incorporated; Absorption modifiers; Nutrient status of the host; Genetic factors; Host-related factors and Interactions (SLAMANGHI). Studies are required to quantify the impact of these factors, especially of the matrix, host-related factors and absorption modifiers.
  1. DeMaeyer EM conducted a portion of The WHO programme of prevention and control of vitamin A deficiency, xerophthalmia and nutritional blindness. He analyzed that the vast extent and the world wide distribution of vitamin A deficiency is discussed. Its epidemiology is reviewed and sources of vitamin A in diets recorded, along with the high requirements of children. Strategy for prevention is described under three headings--short, medium and long term steps. Strategies in many countries received notice. Conservative estimates project over 500,000 cases/year of new active corneal lesions and 6-7 million cases of noncornealxerophthalmia attributable to vitamin A deficiency on a worldwide basis. Vitamin A deficiency affects growth, the differentiation of epithelial tissues, and immune competence. The most dramatic impact, however, is on the eye and includes night blindness, xerosis of the conjunctiva and cornea, and ultimately corneal ulceration and necrosis of the cornea. Vitamin A deficiency occurs when body stores are exhausted and supply fails to meet the body's requirements, either because there is a dietary insufficiency, requirements are increased, or intestinal absorption, transport and metabolism are impaired as a result of conditions such as diarrhea. Vitamin A deficiency is the single most frequent cause of blindness among preschool children in developing countries. The younger the child, the more severe is the disease and the higher the risk that corneal destruction will be followed by death. The most important step in preventing vitamin A deficiency is ensuring that children's diets include adequate amounts of carotene containing cereals, tubers, vegetables, and fruits. An overall strategy designed to prevent and control vitamin A deficiency, xerophthalmia, and nutritional blindness may be defined in terms of action taken in the short, medium, and long term. A short-term, emergency measure includes the administration to vulnerable groups of single, large doses of vitamin A on a periodic basis. In the medium-term, the fortification of a dietary vehicle (e.g., sugar or monosodium glutamate) with vitamin A can be initiated. Increased dietary intake of vitamin A through home gardening and nutrition education programs comprises the longterm solution to this problem. The World Health Organization plans to launch a 10-year program of support to countries where vitamin A deficiency is a significant public health problem.
  2. Humphrey JH,West KP Jr,sommera conducted a study on vitamin a deficiency and attributable mortality among under-5-year-olds.He estimated that estimates of the prevalence in developing countries of physiologically significant vitamin A deficiency and the number of attributable deaths. The WHO classification of countries by the severity and extent of xerophthalmia was used to categorize developing countries by likely risk of subclinical vitamin A deficiency. Using vital statistics compiled by UNICEF, we derived population figures and mortality rates for under-5-year-olds. The findings of vitamin A supplementation trials were applied to populations at-risk of endemic vitamin A deficiency to estimate the potential impact of improved vitamin A nutriture in reducing mortality during preschool years. Worldwide, over 124 million children are estimated to be vitamin A deficient. Improved vitamin A nutriture would be expected to prevent approximately 1-2 million deaths annually among children aged 1-4 years. An additional 0.25-0.5 million deaths may be averted if improved vitamin A nutriture can be achieved during the latter half of infancy. Improved vitamin A nutriture alone could prevent 1.3-2.5 million of the nearly 8 million late infancy and preschool-age child deaths that occur each year in the highest-risk developing countries.
  3. West KP Jr Extent of vitamin A deficiency among preschool children and women of reproductive age.He analyzed thatknowledge of the extent of vitamin A (VA) deficiency (D) is critical for identifying high-risk populations and mobilizing resources for prevention. Yet, all estimates are necessarily imperfect, often based on assumptions in the absence of data. In 1995, the World Health Organization estimated 254 million children to be VA-deficient and 2.8 million to have xerophthalmia. Subsequently, estimates were changed to 75-140 million and 3.3 million, respectively. Although both sets are consistent with a problem of enormous magnitude, the discrepancies also created uncertainty. The present analysis indicates there are approximately 127 million and 4.4 million preschool children with VAD (serum retinol < 0.70 micro mol/L or displaying abnormal impression cytology) and xerophthalmia, respectively. More than 7.2 million pregnant women in the developing world are VA-deficient (serum or breast-milk vitamin A concentrations < 0.70 micro mol/L), and another 13.5 million have low VA status (0.70-1.05 micro mol/L); >6 million women develop night blindness (XN) during pregnancy annually. Roughly 45% of VA-deficient and xerophthalmic children and pregnant women with low-to-deficient VA status live in South and Southeast Asia. These regions harbor >60% of all cases of maternal XN, three fourths of whom seem to live in India. Africa accounts for 25-35% of the global cases of child and maternal VAD; about 10% of all deficient persons live in the eastern Mediterranean region, 5-15% live in the Western Pacific and approximately 5% live in the Region of the Americas. VA prophylaxis seems to be preventing the number of deficient preschool children from increasing while probably reducing rates of blindness and mortality. Greater effort is needed to assess and prevent VAD and its disorders, particularly among pregnant and lactating women.

Methodology: