Rajiv Gandi Unviersity of Health Sciences Karnataka Bangalore

RAJIVGANDHIUNIVERSITY

OF

HEALTH SCIENCES

KARNATAKA BANGALORE

PROFORMA FOR REGISTRATION OF

SUBJECTFOR DISSERTATION

GEETHA.MN.

Ist. YEAR M.Sc. NURSING

COMMUNITY HEALTH NURSING

2008 – 2010,

EASTWESTCOLLEGE OF NURSING,

BANGALORE – 10.

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES KARNATAKA BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTFOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“THE CHILDREN ARE THE FUTURE CITIZEN OF THE NATION”.

The Healthy development of children is an investment in national development and productivity. The Importance of ensuring child health, as an investment for future cannot be ignored. The developments of many countries have yielded little when this aspect has been over looked. A productive and energetic population cannot grow from unhealthy children who are chronically affected by repeated minor ailments. It is absolutely essential to protect the child’s health to build a sound foundation for the health of the nation.

In India has around 10.6 million children still die every year before reaching there fifth birthday. Most of these deaths occur due to non – availability of portable water sanitation, and health care neglected by the “illiterate parents”. There is little or no access to intellectual stimulation. All these conditions are non conductive for the growth and development of the child.1

The 80% of the diseases did not receive medical attention. Only complicated cases can be refers to the hospital to get treatment under the guidance of pediatrician. Most of the minor ailments could be remedied at home by the mother or the care giver. The minor ailments which commonly occur among under five are as follows: fever, cough, cold, diarrhea, worm infestation, eye infection, scabies, and dental carries.2

The child in the age of 2 months to 5 years of age having only fast breathing i.e., having mild pneumonia and it treated with antibiotics at health centre and cared by the mother at home. Similar care is given at home by the mother. The mother is instructed to make assessment and bring the child immediately to health centre if any dangerous sign is observed.

Secondly diarrhoeal diseases for a significant morbidity and mortality among under five children. It is estimated that there are 1.7 episodes of diarrhea for child per year in under fives. In 2005 - 2006in India, only 39% of under fives with diarrhea receive oral rehydration and continued feeding. An estimated 4,00,000 children under five die each year due to diarrhea.

Malnutrition directly or indirectly associated with more than half of all young child mortality. Studies show that 13% of under five mortality globally, and an estimated 16% in India.3

6.1 NEED FOR THE STUDY

UNICEF defines under five mortality rate, as the annual number of deaths of children age under fives, expressed as a rate per 1000 live births “More specifically it

measures the probability of dying between birth and exactly 5 yrs of age.2

At presently, India is off-track to achieving the Infant Mortality Rate as well as under five mortality Rate targets. The infant Mortality Rate for India was estimated to be 58 /1000 live birth in 2006, though this marks disparities between rural and urban areas (64 and 40 respectively), between boys and girls (56 and 61 respectively); and states (ranging from 76 in Madyapradesh to 14 in Kerala)3

The number of children in the world dying before their fifth birthday fell below 10 million, to 9.7 million. South Asia contributed to 3.1 million of under five deaths and India, 2.1 million. India therefore contributes to about 21 per cent of the global burden of child deaths.1

Each year 27 million children are born in India. Around 10% of them do not service to 5 years of age. In absolutes figures, India contributes to 25% of the over 10.6 million under five deaths occurring world wide every year

The under five mortality rate (U5MR) for India in 2006 has been estimated as 76. Although India has made progress in the reduction of child mortality, the average annual rate of reduction in U5 mortality between 1990 and 2006 has been 2.6 per cent. If India is to reach the MDG Goal of 38 by 2015, the average annual rate of reduction in the next nine years has to be about 7.6 per cent.

Worldwide 37 per cent of under-five deaths are attributed to neo-natal causes. About 75 per cent of under five deaths in India are infant deaths and about half of under five children die within four weeks of their birth.3

Health staus indicator in India shows that ,

Under five populations (2005): 127000,000

Annual number of birth (2005): 27000,000

Neonatal mortality rate per1000 live births(2004) :39

Annual number of neonatal deaths (2004) : 996000.

Infant mortality rate per 1000 live births (2005) : 56

Annual number of infant deaths (2005) : 1600,00

Under five mortality rate (2005): 74

Annual number of under five deaths (2005): 2200,000

45% of Neonatal causes contribute to under five mortality rate 45

A study conducted an evaluationof diarraheal diseases and acute respiratory infections control programmes in a Delhi slum in 2007. Effective early management at home level and health seeking behaviour in case of appearance of danger signs are key strategies in Acute respiratory infections (ARI) and Acute, Diarrheal Diseases (ADD) where majority of episodes are self-limiting and viral in origin. A Cross sectional survey was conducted in this urban slum of Trans-Yamuna, covering 1307 under-5 children. In 191 (14.6%) of 1307 children surveyed, had an attack of ARI in the preceding two week. The attach rate of Acute Diarrheal Diseases was 7.73% in the study. The result concluded that awareness of danger signs of ARI, correct home based management e.g. use of ORS, continues feeding etc., was deficient in the community.6

In India present under five mortality rates in 2006 is 76 per 1000 live births.Since this population requires mothers care increasing minor ailments so its is important to assess the existing knowledge and practice of the mothers about management of minor ailments.

The investigator through her personal experience noticed that, because of mothers inadequate knowledge and poor practicing on management of minor ailments there was increased incident of mortality and morbidity and also the researcher through visualization of article, journal noticed that mothers are having inadequate knowledge on minor ailment, hence the researcher to conduct above study, to improve the knowledge and practice of mothers of under five children which in turn help to promote the health of under five children.

6.1.1CONCEPTUAL FRAME WORK.

Rosenstoch’s (1974) and Becker and Maiman’s (1975) “Health belief model” can be adopted for the present study. This theory will addresses the relationship between person’s beliefs and behaviors. It provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies.

The first component of this model involves the individual’s perception of susceptibility to an illness. The second component is the individual perception of the seriousness of the illness. The third component – the likelihood that a person will take preventive action – results from the person’s perception of the benefits and barriers to taking action. In this study it involves mothers perception of suceptibility to an minor ailment among under five children. E.g. fever, cough, cold, diarrhea. Mothers perceived the complication of the minor ailments. This perception is influenced and modified by the demographic variable (age, educational status, number of children, type of family, occupation and income) and sociopsychological variable (personality, social class and peer) perceived threats of the complication of the illness of under five and cues to action.

With the above demographic variable and cues to action it helps the mothers to take the preventive action. Hence the investigator adopted the Health belief model in this study.7

6.2 REVIEW OF RELATED LITERATURE.

The literature review was done for the present study under the following headings.

1. Literature related to mothers knowledge regarding diarrhea.
2. Literature related to mothers knowledge regarding fever.
3. Literature related to scabies. & pediculosis

Section 1 :- Literature related to mothers knowledge regarding diarrhea.

A study conducted on maternal understanding of diarrhea-related dehydration and its influence on ORS use in Indonesia (2007). Dehydration resulting from diarrhoea remaind a significant cause of death for young children in developing countries such as Indonesia, although oral rehydration solution(ORS) in effective in Preventing and treating dehydration, its use in home treatment is not widespread. This study sought to assess whether mother’s understanding of diarrhea related dehydration influenced their use of ORS in home treatment. One hundred months of children under the age of five years in rural Indonesia were surveyed using a street red Questionnaire, administered in an interview format in their homes. Only 38% of mothers surveyed could identify 201 more correct signs of dehydration significant relationship was found between maternal knowledge of current signs of dehydration & the use of ORS in home treatment. Resulting recommendation include improved health education programming for mothers of young children as well as future programme evaluation & intervention studies.8

A study conducted on mothers skills in preparing oral rehydration salt solution (2000). This was a community based thirty cluster survey, carried out in rural chittagong district, Bangladesh during 1996 with the objective to assess the skill of mothers in preparing packet ORS solution. A total of 420 mothers whose children had been suffering from acute diarrhoea were investigated. There were 377(89.8%) mothers who demonstrated the preparation of ORS & 43(10.2%) mothers nerve ever prepared the solution & were unable to demonstrate the preparation. 140(33.3%) mothers were able to demonstrate the preparation currently & the rest 237(56.4% ) demonstrated the preparation currently. The incurrect preparation was found to be associated significantly with the refusal of ORS solution by the children. Therefore, demonstration of preparation of ORS solution to the mothers should be in built in the health education package of oral rehydration therapy for diarrhoeal diseases.9

A study conducted on risk factors for development of dehydration in children aged under five who have acute watery diarrhoea. A case –control study(1998). To indentify factors for development of dehydration in under five year olds with acute watery diarrhoea. Hospital based unmatched case control study. The study included 387 cases of diarrhea having severe or moderate & 387 contorts suffering form diarrhoea & mild or no dehydration. The result showed that the study identified the significance of infancy, religion severe under nutrition , non washing of hands by mothers before preparation of food, frequency of stool >8.d frequency of vomiting >2ld history of measles in previous six months, with drawl of breast feeding during diarrhea. Withdrawal of fluids during diarrhoea & not giving ORS, HAF or both during diarrshoea, in the outcome of development of moderate of severe dehydration.10

Section 2-Literature related to the knowledge of mother regarding fever.

A study conducted on caregivers perceived treatement failure conducted in home- based management of fever among Vgandan children aged less than 5 years2006) Home based management of fever could improve prompt access to anti material medicines for african children. 978 acregivers of children between two & 59 months of age, who had reported fever within two & 59 months of age, who had reported fever within two weeks prior to the study that result shows lower caregivers perceived treatment failure (15% & 23%) or among those who used harbs(56%) under HBMF, starting treatment with in 24 hours of symptoms onset & taking treatement for the recommended three days duration was associated with a lower perceived. Treatment failure. Conversely vomiting, convulsions& any illness in the month prior to the fever episode was associated with a higher perceived treatment failure.11

A study conducted on management of child fever in the battle against malaria in Brazzaville (2002). A cross sectional study on the diagnostic & therapeutic practicesof heath staff and mothers with regard to fever was carried out in the urban area from the to the 12th of the 20th April 1997. 390 children were included in the sample. Children were aged under Five years had suffered from the fever 15 days piror of the survey & were treated at home or in a health centre C the most currently used drugs against malaria, results of the quesationnaire indicated that those symptoms best recognized by 1 moters are fever (85.8%) asthenis(79.9%) chills(21.1%) vomiting (25.1%) and diarrhoea (10.9%) chlorquine in the most used drug at home (66%) & a modicquine (67.9%) % street vendors (19.1%) management of fever requires proper traning of health staff & good communication between health personal & the target population.12

Section 3 Literature related to scabies & pediculosis.

A study conducted on prevalence of pediculosis and scabies in preschool nursery children of afyon Turkey(2006). scabies & pediculosis are ubiquitous, contagious and debilitalign parasite dermatoses. The tendency of high prevalence of pediculosis & scabies among school & Preschool age children had prompted us to conduct a head louse and scabies prevalence survey among pre school nursery children in our district. A school based, cross-sectional study was performed, with 134 children chosen for evaluation. The infestation was found in 14 (1.2%) of 134 children, 9 (0.8%) of with pediculosis capitis and 5 (0.4%) with scabies we found that infestation were wore frequent in children with mothers whose education leads were low. This indicates that necessity of an improvement in the economic & socio cultural status of the community & the promotion of hygiene concepts & practices in order to improve health of preschool age children.13

6.3. STATEMENT OF THE PROBLEM.

A study to assess the knowledge and practice on management of minor ailments among mothers of under five children at Hesaraghatta in Bangalore.

6.4.OBJECTIVES OF THE STUDY

1)To assess the level of knowledge on management of minor ailments among mothers of under five children

2)To assess the level of practice on management of minor ailments among mothers of under five children

3)To correlate the level of knowledge andthe level of practice on management of minor ailments among the mothers of under five children.

4)To associate the knowledge on management of minor ailments among mothers of under five children with the demographic variables

5)To associate the practice on management of minor ailments among mothers of under five children with the demographic variables

6.5.OPERATIONAL DEFINITION:

Knowledge: It refers to mothers awareness in relation to meaning, causes,

Signs and symptoms , prevention and treatment in the

management of minor ailments

Practice: It is an act of doing day to day activity to managing the minor ailment of under

five children

Mother: A person who has given biological birth to a child and have under five children.

Minor ailments: Minor ailments or disorders commonly found in children which are not

often serious in nature.

Fever:Elevation of body temperature above the normal level.

Common cold :It is acute inflammation of the nasal cavity characterized by

running nose and sneezing.

Cough :It is the voluntary reflex forceful expulsion of air from the lungs.

Scabies:a contagious skin diseases caused by itchmite characterized by papule

vesiclewith itching.

Dental caries : Dental problem caused by inadequate oral hygiene.

Worm infestation :Parasite invasion in to elementary tract.

Diarrhea: Rapid movements of faecal matter through the intestine,regulating in

poor absorption of water nutrition elements and productivity.

Under five children : The children who are the age group of under five year

6.6.ASSUMPTION OF THE STUDY.

The mothers of under five may have inadequate knowledge and

Poor practice regarding management of minor ailments.

6.7 HYPOTHESES.

H01:There is no significant difference between knowledge and practice

on management of minor ailments among mothers of under five children.

H02: There is no significant association with the level of knowledge of

mothers of under five children with selected demographic variables.

H03: There is no significant association with the level of practice of mothers

of under five children with selected demographic variables.

6.8 INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria

-The mothers having under five children

-The mother who are willing to participate in the study

-The mothers who could speak kannada or English

-The mothers who are present at the time of data collection

Exclusion criteria

- The mothers having under five children suffering from acute disorder

- The mother who are working

6.9DELIMITATION

The study is delimited to all mothers of under five children at Hesaragatta during the acodemic year 2009.

7. MATERIAL AND METHODS:

7.1: Sources of data: The data will be collected from mothers of under five children.

7.2:Method of data collection : Structured questionaire and observational checklist.

a) Research design: Survey design.

b) Setting: Community setting Hasaragatta at Bangalore district.

c) Population: Mothers of under five children.

d) Sampling technique:Simple random sampling.

e) Sample size:100 mothers of under five children

f) Tool : Structured questionnaire and observational check list

g) Method of data analysis and presentation :

The analysis will be done by using descriptive and inferential statistics.

h) Duration of data collection: 6 to 8 weeks

i) Variables:

- Study variables: Knowledge and practice of mothers of under five children

- Extraneous variables: Mothersage, educationalstatus, occupation, income, level of

honorarium and experience of motherhood.

j) Projected outcome: This study helps the community health nurse to identify the mothersknowledge regarding management of common minor ailments and it will also helps in reducing the mortality and morbidity rate of under five children and we can improve the mothers knowledge and practice methods regarding management of minor ailments.

7.3DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON THE PATIENT OR OTHER HUMAN BEING OR ANIMALS ?