A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED STRUCTURED HEALTH TEACHING PROGRAMME REGARDING PREVENTION OF COMPLICATIONS IN DIARRHOEA, AMONG MOTHERS HAVING UNDER FIVE YEARS OF AGE CHILDREN IN A SELECTED AREAS, AT BELLARY CITY, KARNATAKA.
PROFORMA FOR REGISTRATION SUBJECTS
FOR
DESSERTATION
Mrs.S.KRISHNA KUMARI
SARABESWARA COLLEGE OF NURSING,
GUGGARAHATTI, BELLARY, KARNATAKA
RAJIV GANDHI UNIVESITY OF HEALTH SCIENCES, GUGGARAHATTI, BELLARY, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FO DISSERTATION.
1. Name of the Candidate:Mrs.S.Krishna Kumari
M.Sc, [N] 1st Year,
Sharabeswara College of Nursing
Guggarahatti, Bellary.
2. Name of the Institution:Sharabeswara College of Nursing
3. Course of Study and Subject:M.Sc (N) 1st year,
Community Health Nursing
4. Date of Admission to Course:04-06-2007
5. Title of the topic:A Study to assess the effectiveness
of planned structured health teaching programme regarding prevention of complications in diarrhoea, among mothers having under five years of age children in a selected areas, at Bellary city, Karnataka.
6.Brief Resume of the intended work :
Quotation :- Shape the future of life: Healthy environments for children of today are the adults of tomorrow. They deserve to inherit a safer, fairer and healthier world. There is no task more important than safeguarding their environment.
Dr. Gro Harlem Brundtland, Director General, WHO (2003)
6.1NEED FOR THE STUDY:
Diarrhoea is one of the most important Gastrointestinal disorder in under five years of age children. Diarrhoea is ranked among the top three causes of childhood deaths in the developing countries. Diarrhoea continues to a major cause of Morbidity and Mortality world wide result in an estimated thousand deaths among children each day the highest incidents in being developing countries of the world.
Acute Diarrhoea is an attack of loose motion with sudden onset, which usually losts 3 to 7 days. Chronic Diarrhoea is a loose motion is occurring for 3 weeks or more. Diarrhoea with watery stools and visible blood in the stool is called as dysentery. Persistent diarrhoea refers to the episodes of acute diarrhoea that losts for 2 weeks or more. Most causes of acute diarrhoea are caused by infectious agents, including viral, bacterial and parasitic pathogens.
In 1-5 years of age children a child suffer from about 12 episodes of diarrhoea averagely , 4 such episodes occurring during the very first year of life. According to Suraj Gupte defined as Diarrhoea is a passage of 3 or more loose or watery motions per 24 hours resulting in excessive loss of fluid and electrolytes in stools.
Acute Diarrhoea is mostly infectious origin in peadeatric conditions. Infants and children are more frequently and severilly affected than older people.
Most of the pathogens in acute diarrhoea are spread by the faecal, oral route by contaminated food or water and spread from person to person especially where there is close contact.
The main causes for diarrhoea are :
- Younger children are more susceptibly
- Mallourished children
- Lack of clean water and insufficient under standing of hygiene contribute to contamination, over crowding and poor sanitation.
- Inadequate facilities for food preparation and refrigeration
- Concentrated formulas in food [ milk ] preparation.
Globally approximately 4 – 5 million deaths occurs as a result of diarrhoeal diseases every year. Eight out of Ten deaths are in the first 2 years of life, the most susceptible cause is for malnutrition. Approximately 4.6 million children were dying each year due to dehydration caused by the diarrhoea. Diarrhoea diseases are not confined to developing countries. In the united states there about five hundred diarrhoeal disease deaths annually over in recent ten years between the age group is one month at four years of age 80% of those deaths were in infants under 12months of age.
In India diarrhoeal diseases major health problem among children under the age of 5 years. During 2005 about 1.07 million cases of acute diarrhoeal were reported in India with 2040 deaths. About 1/3 of total hospitalize children are due to diarrhoea diseases and 17% of all deaths in paedeatric patients are due to diarrhoea. The morbidity rate in terms of diarrhoea episodes per year per child the age of 5 years is 1.7.
WHO initiated Diarrhoeal diseases control programme has made a significant contribution in averting deaths among children among five years of age. Diarrhoeal diseases cause a heavy economic burden on health services. Much attention has been given to acute diarrhoea and its management over the lost decade.
FAGUNDES – NETO U, DE ANDRADE JA. In 1999 - designed a study, to evaluate the clinical and epidemiological factors associated to deaths in diarrhoea. From January 1989 to December 1995 in Umberto I Hospital, Brazil. The study demonstrates that some factors such as age less than 6 months, severe malnutrition, food intolerance, lab diagnosis by conducting the stool culture indicate a high risk of death in under fives due to severe acute diarrhoea.
In Bellary [VIMS] Vijayanagara Institute of Medical Sciences Hospital in Paedeatric OPD and in patients ward under five years of age children are more from Guggarahatti with dehydration fever convulsions, Malnourished due to poor water purification and improper hygienic food, poor sanitation in environment. Children need to be physical and intellectual development. Todays competitive global economics effective education is more important ever before. So mothers can modify and broden their concept on health at children through sound health education tour preventing complications of diarrhoea.
PNI – TRO Report expresses of a quantitative study on 750 urban and 750 rural mothers of children under five years of age in Morocco. The topics covered under diarrhoeal disorders include causes, symptoms of diarrhoea, incidence, and causes of dehydration and its treatments advised for diarrhoeal disorders. The study gives the report on oral rehydration therapy included knowledge and perception of oral rehydration salts, preparation and use of oral rehydration salts, and supply sources for oral rehydration salts. The final section on media use for sources of information, covered radio, television, and news papers, sources of health advice, and attitudes toward and preferences for different sources of advice.
For this reason bringing awareness and knowledge among mothers who is having under five children by structured health teaching programme is necessary regarding prevention of complications of diarrhoea – dehydration, fever, convulsions, hypoglycemia, malnutrition, growth retardation, mental disturbances and renalfailure.
So this reason the researcher has taken the initiative to conduct study on health teaching programme regarding prevention of complications in diarrhoea among mothers who is having under five years of age children.
6.2REVIEW OF LITERATURE:
A.K.Sood, et. al 2007 – conducted study on knowledge and practices among rural mothers in Haryana. The conducted study on 108 rural mothers about child hood diarrhoea where determined by using pretested semistructure interview schedules. The common process are diarrhoea reported were eruption of teeth [67.59%], eating of mud [51.85%] worm infestatition [47.22%], change of climate [35.18%], poor personal hygiene [34.25%] and changes in diet [25.92%]. Majority [83.33%] of mothers practice food restriction during diarrhoea. 77% consulted their mother – in – laws in the first instance for treatment of diarrhoea. The home remedies tried by mothers were, isabgol husk with curd [30.55%], ghee with tea [28.70%], water boiled with mint leaves [25.92%], local ghutti [22.22%], and unripe mango juice [16.66%]. Majority of mothers [83.33%] believed that oral rehydration therapy alone, cannot treat diarrhoea.
Debuys Roessingh As, et. al 2007 – This study has conducted in France in this study they reviewed the files of all children admitted to hospital for D+hus between 1988 to 2000 [diarrhoea, haemolytic, uremic, syndrome]. They have tested in 65 children with D+hus cases. In that 16 children develop gastrointestinal complications. In conclusion the research determine the prevalence and severity of diarrhoea, and treatment needs among under five children with gastrointestinal complications of D+hus is rare but they need early surgery.
Nilambarjh, et. al 2006 – conducted a study on knowledge, attitude and practices of mothers regarding home management in Nepal on 330 children on Sunsari District. The time of home visit, after 24 hours to know the improvement in the child and also preparation the information about ORS and also its usual names in the management of dehydration due to diarrhoea. Mothers gave ORS to their children ideally [after each stool] . With correct preparation and ideal use of ORS in Sunsari District. Use of ORS definitely lowers the mortality due to dehydration, with increasing womens literacy, improving basic sanitation and health care services and raising the expected to decrease the diarrhoeal diseases morbidity and mortality.
B.p.Das, et. al 2005 – Investigated on knowledge, attitudes and practices [KAP] regarding the management of diarrhoea on drug sellers in eastern Nepal. In Nepal drug sellers often act as the first treaters. About 50 to 60% of them were unaware of uncontrolled diarrhoea and importance of ORS in its management. Only 20% of the drug sellers using along with drugs such as antimotility agents [AMA] or metronidazole. As a result of the above conferring knowledge about the ethical aspects of drugs in the management of diarrhoea.
Zhong J, et. al 2005 – Conducted study on prevention of complications in diarrhoea. Study expresses that the source of infection is the consumption of selfish [polluted by sewage] and astroviruses, caliciviruses at reoviruses can cause mini epeidemics, in families, hospital wards are potentially very dangerous to seriously ill hospital patients they also have economic consequences for fishermen and food industry. The conclusion of the study is these viruses contribute the massive mortality caused by infantile diarrhoea in developing countries are responsible for uncounted millions of deaths each year.
W.onyango – ouma, et. al 2004 – Conducted study on changing concepts of health and illness among children of primary school age in Western Kenya, with 40 primary school children aged about 10-15 years of age. Investigation underwent a 2 month intervention and were there after enrolled as health communicators in a longitudinal study for an additional period of 12 months. Data were collected before, during and after the intervention using in-depth interviews technique. More action oriental health concepts were identified and a general change from an external locus on control towards an internal locus of control was found. The study concludes that students can modify and broden their concepts of health and illness through action oriented health education.
Jose Solar Zano Giron, et. al 2004 – to studied on annual burden of diarrhoea and is associated with rotaviras [RV] in children clinics and hospitals in Honduras. The researcher data was collected of all children below 5 years old clinics and hospitals populated by the secretary of man for the period of 2000 through 2004. The result of this study shows diarrhoea is a major cause of illness among children under five Honduras and Rv is likely than most common causes. Our preliminary estimate needs to be refined so that health planners in decisions on the future use of rotavirus vaccine. A programme of hospital based surveillance for rotavirus in Honduras has been this need.
Banerjee B, et. al 2004 – conducted study on prevalence and severity of diarrhoea children under five. The problem of in under five children of with different socio economic status in an urban area of West Bengal overall prevalence of diarrhoea was 31.67% highest in over socio economic class 41% in lower economic class. After several cross sectional studying in conclusion the study suggests that low socio economic status suffer more compared to others.
Programme for national health development Ethiopia 2000 – reported that many developing countries children under 15 years of age constitute a very large proportion of its population 44.7% of which around 40% are under five and 8% are made 1 year of age. In 2000 the under five mortality rate was estimated at 166, infant and neonatal mortality rate were estimated 97 and 49 per 1000 live births. The study annual under five mortality current estimated of 146.6. The major causes under five mortality has been pneumonia 28.9% malaria 21.5% diarrhoea 6.7%. Half of ethiopias children under fives are stunded 52% with 11% were reported as wasted in 2000. The government has adopted an integrated management of child hood illnesses as his Key Strategy towards reducing under five mortality and morbidity, and promoting healthy growth and development of children. The government also focuses on key child survival interventions proven to be effect the reducing the child hood mortality
Haddock wo, et. al 1999 – conducted a research on complications related to diarrhoea hospitalizations among California children. The study shown that the African American Children have a higher rate of death from diarrhoea disease than whites. They have conducted a survey among hospitalized children with diarrhoea the age group between 28 days and 5 years. In this 185 patients has developed complications like acute renal failure, central nervous system symptoms shock or death. It this Asians were 2.4 times have had complications African Americans were not that much affected.
CHR approach 1996 – This study design an using locally available and effective in treating persistent diarrhoea, in corporated into the IMCI guidelines in over 79 countries around the world. According to this 2.2 million diarrhoeal deaths occur annually in developing countries in children under fives. This study shows that the prevalence of diarrhoea in under fives can be treated by taking oral rehydration therapy, appropriate drug therapy optimal breast feeding practices, improved nutrition access to clean water and sanitation facilities and improve personal domestic hygiene. In addition reanalysis of the efficacy of the past rotavirus vaccine trials in Peru and Brazil has demonstrated that a safe vaccine would have a significant public health impact
6.3Objectives of the study :
- To identify the demographic data
- To assess the knowledge on regarding prevention of complications in diarrhoea among mothers having under five years of age children
- To impart planned structured programme regarding prevention of complications in diarrhoea
- To evaluate the effectiveness planned structured health teaching programme among mothers having under five years of age children
- To find out the association between selected demographic characteristic and knowledge.
OPERATIONAL DEFINITIONS:
Effectiveness:
- Evaluate the result of planned teaching programme on prevention of complications in diarrhoea
Planned structured teaching programme:
- A systamtically planned teaching strategy designed to provide information regarding prevention of complications in diarrhoea.
Prevention:
- To prevent the occurance of diarrhoea complications in under five years of age children
Complication:
- Consequences of diarrhoea are complex and difficult. In diarrhoea the child may have the complications like dehydration over hydration, fever, convulsions, hypoglycemia, malnutrition, growth retardation, mental disturbances and renal failure.
Diarrhoea:
- A condition with frequent fluid faeces.
7.Material and methods :
7.1Source of Data:
- Mothers having under five years of age children.
- Methods of collection of Data:
- Inclusion and Exclusion Criteria:
Inclusion Criteria:* Mothers having under Five years of
age children in Guggarahatti, Bellary city
* People who can understand, read and write English, Kannada and Telugu language.
Exclusion Criteria:* Mothers who are not physically and
Mentally healthy
* Mothers who are not having the interest
* Mothers who are absent at the time of data
collection
* Mothers who are not having under five
years of age children.
7.2.2 Research Design * Quasi experimental Study adopted with Pre and Post test design.
7.2.3Setting:* The study to be conducted in Guggarahatti.
It is situated at 5 Kms distance from
Bellary in Karnataka state with 5000
Population.
7.2.4Sampling Technique:* The random sampling technique will be
planed to collect data from who fulfilled
inclusion criteria laid down for selection at sample and available during period at data
collection .
7.2.5Sampling Size :* 100, mothers residing in the area having
under five years of age children in
Guggarahatti, Bellary, Karnataka.
7.2.6Tools of the Research: *Structured interview scheduled with simple
questionnaire consist demographic data and
knowledge regarding diarrhoea and its
prevention of complications
7.2.7Collection of Data:* Data collection planned by the convinience
at subject. Duration of main study is
planned for the period of one month.
7.2.8Method of Data* The data analysis was planned according
analysis to the objectives of the study, by using
descriptive statistics and inferential
statistics presented in the form of tables
and Graphs.
7.3DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE.
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HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
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8.LIST OF REFERENCES:
BOOKS:
- K park, Preventive and social medicine, 19th edition, 2007, Jabalpur, page No: 182 –186
- Whaley and Wongs, Essentials of paedeatric madicine, –1st edition, Harcourt private Ltd., Publishers 2001, Page No: 806 - 808
- Basanthappa B.T., Community health nursing, 2003, New Delhi Page No: 194 to 196.
- Suraj Gupte, the short text book of paedeatrics, 9th edition, Jaypee brothers, medical publishers, New Delhi, 2001, Page No: 325 to 328.
- Paruldatta, Paedeatric Nursing, 1st edition, New Delhi, Page No: 286 to 288.
- Donna .L. Wong Marilyl Hocken Berry Eaton, the text book of paedeatric Nursing, 6th edition, Harcourt Private Limited publishers, 2001, page No: 288 to 300.
Journal & Articles:
- American Journal of Tropical medicine
- Scientific world Journals 2005
- A Journal of rural health 2007
- A Journal of Community health nursing volume 12 page No: 25 to 27
- A Journal of Paedeatric Gastroentrology and Nutrician January 1996
- Eastern Mediterranean health Journal volume 2 1996 Page No: 102 to 106
- The integrated management of child hood illness – Article in French 2004 Page No: 137 to 142
- Diarrhoea management among under fives – Indian article 2004 Page No: 255 to 260
- A journal of knowledge and practices among rural mothers 2007.
- Health education research volume 19, 2004 Page No: 326 to 329.
- A knowledge attitude and practices survey of water and sanitation 2002.
Websites:
9.Signature of the Candidate: S. Krishna kumari
10. Remarks of the Guide : The study is feasible and I forward it for acceptance.