RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

1. NAME OF THE : Mr.SWAMY. R.T

CANDIDATE AND I YEAR M.Sc. NURSING,

ADDRESS RAJIV GANDHI COLLEGE OF

NURSING

BANGALORE- 560004.

2. NAME OF THE : RAJIV GANDHI COLLEGE OF

INSTITUTION NURSING, BANGALORE -560004.

3. COURSE OF STUDY & : I YEAR M.Sc. NURSING,

SUBJECT PAEDIATRIC NURSING.

4. DATE OF ADMISSION : 01/09/2010

5. TITLE OF THE TOPIC : “EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON

KNOWLEDGE OF DOMICILIARY

MANAGEMENT AND PREVENTION OF

UPPER RESPIRATORY TRACT

INFECTION AMONG MOTHERS OF

UNDER FIVE CHILDREN IN SELECTED

URBAN SLUMS OF BANGALORE”.

INTRODUCTION

Respiratory diseases are very often found in children’s especially respiratory

infections. It is one of the leading cause of mortality and mortality in young children.

India has 440 million children. About 27 million children are born each year in India.

But nearly 2 million of them do not live to the age of 5. Acute respiratory infections are

leading cause of child mortality (30%) in India.1

WHO report stated that children below five years of age suffer about 5 episodes of

ARI per child per year. ARI is responsible for about 30-40% of visits to health care facilities

and for about 20-40% admission to hospitals. The proportions of death due to respiratory

infection in the community is much higher as many children die at home.2

Under five children are risky population to get upper respiratory tract infection due to

lack of immune power. The need immediate and prompt treatment to prevent lower

respiratory tract infection. Upper respiratory tract infection to children includes common

cold, Rhinitis, Sinusitis, Nasopharyngitis, Epiglotitis, Laryngitis, Tracheitis,

Laryngotracheitis,. The important risk factor associated with respiratory diseases include

malnutrition, low birth weight, climatic variations, overcrowding house, air pollution, poor

ventillation and lack of environmental sanitation.

The domiciliary management of children with respiratory infection consist of

complete bed rest, increased fluid intake will help to keep throat and lining of nose moist,

saline nose drop may be used to relieve congestion and obstruction in the nose, keep away

the child from passive smoke and use of home remedies for cough and cold. Ex : Tulsi,

Honey, Zinger, Hot drinks, etc. Warm or cool steam used near the child’s bed may prevent or

relieves the laryngeal spasm and cough and essential to maintenance of warm well ventilated

environment.

The preventive measures of respiratory infections includes hygienic practices related

to personal and environmental hygiene, appropriate disposal of respiratory secretions,

isolation is infected patients, maintenance of nutritional status, immunization to be completed

as per schedule and special protection of children during weather variations to prevent cold.3

1

1. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

“To do what nobody else will do, a way that nobody else can do, in spite of all we go

through ; is to be a nurse”.

-Rawsi Williams

A study conducted on “Breast feeding and reported morbidity during infancy”.

Finding from the Southampton women’s survey. In a prospective birth cohort study

assessed the relationship between the duration of breast feeding and the prevalence of

respiratory tract infections. During the first year of life in 1764 infants. 81% of the infants

were breastfed initially, and 25% were breastfed upto 6 months. There were graded

decreases in the prevalence of respiratory symptoms between birth and 6 months as

breastfeeding duration increased. Data provides strong support for a protective role of

breast feeding against respiratory infections in infancy.4

A study conducted on “Seasonal trends of viral respiratory tract infections in the

tropics.” A retrospective survey of laboratory virus isolation. Serology and

immunofluorescence microscopy in two large general hospitals in Singapore between

September 1990 & September 1994 was carried out. Respiratory tract viral ourtbreaks

particularly among infants who required hospitalization, were found to be associated with

respiratory syncytial (RSV) infections (72%). The RSV trends were associated with

higher environmental temperature, lower humidity & higher maximal day to day

temperature variation. These data support the existence of seasonal trends of viral

Respiratory tract infections. 5

A study conducted on “Determinants of morbidity and mortality due to acute

Respiratory infections”. Acute Respiratory Infections were monitored every two weeks in

a urban community in Metro Manila, Philippines, Incidence rates were highest in infants,

3.2-4.0 per person. Followed by children 1-4 years of age, with corresponding rates of

3.0-

3.4 per person. The risk factors for ARI morbidity were low socioeconomic status &

age less than one year. Malnutrition and a positive culture of blood were significant risk

factors for mortality. The identified risk factors underscores the value of primary health

2

care Interventions, promotion of breast feeding and Vit-A Supplementation, as strategies

for reducing ARI mortality in developing countries. 6

A study conducted on “Etiology of acute respiratory infections in children’s in

tropical southern India”. Nasopharyngeal secretions and throat swab specimens from 809

children less than 6 years old with acute Respiratory Infections were examined for the

presence of virus of viral antigen. Blood was cultured for the presence of bacteria in

selected cases of Respiratory Infections viruses were detected in 163 (49%) of 331

children with Respiratory Infections Bacteria were isolated from 27 (18%) of the 147

children for whom blood cultures were done. 7

A study conducted on “Causes of neonatal and child mortality of India; a

nationally representative mortality survey in India.” A registrar general of India Surveyed

all deaths occured in 2001-03 in million nationally representative homes. Field staff

interviewed house hold members and completed standard questions about events that

preceded the death. There were 10,892 deaths in neonates and 12,260 in children aged 1-

59 months identified in the study. Two causes accounted for 50% of all deaths at 1-59

months. Respiratory Infections and diarrheal diseases. 8

A study conducted on “Relationship between the duration of breast feeding

and morbidity as a result of respiratory infection in the first year of life. “A study of 2602

live born children ascertained through antenatal clinics at a major tertiary Obstetric

hospital in Perth, Western Australia. Main outcome measures were hospital, doctor or

clinic visits and hospital admission for Respiratory Infection in the First year of life.

Main exposure measure were the duration of predominant breast feeding (defined as the

age other milk was introduced) and partial (any) breast feeding (defined as the age breast

feeding was stopped). Results concludes that predominant breast feeding at least six

months & partial breast feeding for upto one year may reduce the prevalence of morbidity

of Respiratory illness & infection in infancy.9

Children’s health reflects the national health and wealth. Todays children are

tomorrows citizens. A well developed child contribution to the national welfare and

children are the priceless resources of the nation. Children are an embodiment of our

dreams and hopes for the future. They are the most vulnerable group in the society.

Nearly 1.5 million under five children die from the disease of Pneumonia

each year, accounting for nearly one in five child death globally. Currently 18% of 3

under five death are due to Pneumonia.10 Acute respiratory infections counted for

67% of all morbidity in India. 11

Acute Respiratory infection (ARI) is a issue to be manage to promote health

of children. Women if educated about ARI can promote health and control or present

health and control or prevent the morbidity and mortality among underfive children.

Hence Researcher felt need to educate the mothers of underfive children

especially at urban community.

6.2 REVIEW OF LITERATURE: -

Review of literature helps to get an understanding of the subject matter. For

better understanding the topic is categories as following.

1. Brief description of upper respiratory infection

2. Related studies on Upper Respiratory Tract Infections

3.Related studies on Domiciliary management of Respiratory infections

1. Brief description of upper respiratory infection :

Acute respiratory infection is an acute infection of any part of the respiratory

tract and related structures including para nasal sinuses, middle ear and plural

cavity. It may cause inflammation of respiratory tract any where from nose to

alveoli with a wide range of combinations of symptoms and signs.

The Incidence of ARI is highest in young children, especially below 5 years of age

and decreases with the increasing age. Depending upon the site of infections of

respiratory tract, ARI can be classified as

1. Acute upper respiratory Infections.

2. Acute lower respiratory Infections.

Acute respiratory infections accounts for 20-40% of out patients and 12-35 %of

inpatients attendance in a general hospitals. Upper respiratory tract infection

including rhinitis, Nasaopharyngitis, Pharyngitis, Tonsilitis and Otitis media

constitutes 87.5% of the total episodes of Repiratory infections. The vast majority of

acute upper respiratory tract infections are cause by viruses.11

2. Related studies on Upper Respiratory Tract Infections :

A study conducted was on “ Acute respiratory diseases in case of children below

five years of age in Tripura” to determine the incidence, causes, riskfactors, morbidity

and mortality associated with Acute Respiratory infection and impact of simple case

management in children under 5 years of age. The annual attack rate per child was

4

more in urban area than in rural area. Monthly incidence of acute respiratory infection

was 23% in Urban area, 17.65% in rural area.12

A study was conducted on “ Descriptive epidemiology of acute respiratory

infection among under five children in an Urban slum area in Sunderpur, Varanasi ”

150 under five children were selected by stratified random sampling method and were

observed for 52 weeks at weekly interval to record the illness. In total 661 episodes

were observed in 5623 child-weeks of observation giving an episode rate of 6.11 per

child per year. Acute respiratory infections counted for 67% of all morbidities.

Majority of the episodes (88.96%) were confined to the upper respiratory tract only.

61.4% of all the episodes terminated within seven days.13

A research conducted was on “An evaluation of acute respiratory infections

control programme in a Delhi Slum”. A study conducted in this Urban slum covering

1307 under five children during 2004. 191 (14.67%) of 1307 children had on attack

of acute respiratory infection in the preceding two weeks. The common symptoms of

acute respiratory infection cases were mild running nose (78%), Cough (76.4%) and

Fever (45.4%) only 7 (4%) had fast breathing acute respiratory infections are mostly

mild/self limiting but only 16% of care takers perceived so and doctors also

prescribed medicines. Result concluded that though aware of danger signs of ARI.,

care takers were still seeking medical advices for mild cases of ARI and doctors

prescribing drugs.14

3. Related studies on Domicillary management of Respiratory infections :

A study conducted was “Evaluate the efficacy and tolerability of bovine

colostrum (pedimune) in preventing upper respiratory tract infections in children”.

605 children (1-8 years) having recurrent episodes of respiratory tract infections

received bovine colostrum (pedimune) for 12 weeks. Total number of episodes of

recurrent infections, hospitalization care, overall well being, adverse event were

assessed at evey 4 weeks. It was highly effective in the prophylactic treatment of

recurrent upper respiratory tract infections in reducing. Result concluded that

espisodes of upper respiratory tract infection reduced significantly 91.19% at the end

of therapy. 15

A Study was conducted on “Health behaviour of rural mothers to acute respiratory

infections in children in Gondar, Ethiopia”. During 1990, medial students interviewed

132 mothers with atleast 1 child younger than 5 years old living in the villages so

researcher could assess the mother’s knowledge, attitudes and practices regarding acute

5

respiratory infections (ARI) in their children. Most mothers recognized that respiratory

rate (77.3%), high fever (76.5%) and decreased feeding (62.8%) were important signs of

Pneumonia. Only 35.6% would take their child with these symptoms to a near by health

center. Other common treatments were taking the child to a traditional healer (64.4%)

and applying butter and herb to the chest via a massage at home (95.5%). Traditional

practices were the predominant interventions proposed by the mothers for mild ARI (Ex :

Cold, Sore throat and ear discharge)16

A study was conducted on “Complementary, holistic and Integrative medicine for the

common Cold”. The study review examines popular complementary, Alternative

medicine (CAM) therapies used to alleviate symptoms of the common cold in children.

Natural health products (which include herbals (Ex : Ginger, Echinacea, Eucalyptus)

honey, vitamins, homeopathic and traditional medicines) are used widely for prevention

and treatment of common cold. Study have investigated the efficiency and safety of

Echinacea in the prevention and treatment of colds in pediatric patients. The first was

randomized controlled trail (RCT) in which 430 children (ages 1 to 5 years) received on

herbal preparations containing 50 mg/ml of Echinacea and 10 mg/ml of vitamin C over a

12 week period during the winter. Children had significant reductions in the number of

illness episodes (55% reduction)17

A study conducted was on “Acute respiratory infections in children ; a study

of knowledge and practices of mothers in rural Hariyana”. 304 mothers were interviewed.

23% recognized pneumonia by fast breathing. 11.2% recognized severe pneumonia chest

indrawing and 1.3% knew the infective origin of ARI. Most were convinced about the

continuation of breast feeding, but 70% advised restricting food, the use of herbal tea in

ARI was widely prevalent. Result concluded that primary health center was the most

frequented place for treating ARI and mother-in-law was the most important person in

making management decision for the child18

6

6.3 STATEMENT OF THE PROBLEM

“Effectiveness of structured teaching programme on knowledge of

domiciliary management and prevention of upper respiratory tract infection among

mothers of under five children in selected urban slums of Bangalore”.

6.4 OBJECTIVES OF THE STUDY

To assess pre-test knowledge of mothers of under five children on

domiciliary

management and prevention of upper respiratory tract infection.

To assess the post test knowledge of mothers of under five children on

domiciliary management and prevention of upper respiratory tract infection.

To find out the effectiveness of structured teaching programme regarding

knowledge on domiciliary management and prevention of upper respiratory

tract infection among mothers of under five children’s.

To find the association between pre-test knowledge scores of mothers of under

five children’s with selected demographic variables.

6.5 HYPOTHESIS

H1 There is a significant gain in post-test knowledge scores compared to the

pre-test knowledge scores of mothers of under five children’s.

H2 There is a significant association between pre-test knowledge scores with

selected demographic variables.

6.6 OPERATIONAL DEFINITIONS

Effectiveness : Refers to gain in knowledge as determined by the significant

differences between Pre-test & Post-test knowledge scores.

Structured teaching programme : refers to a planned and organized teaching

programme on upper respiratory tract infections and its management and prevention.

Knowledge : Refers to information regarding upper respiratory tract infections and

its management and prevention.

Upper respiratory tract infection : Refers to infections of upper respiratory tract

infections which includes Rhinitis, Sinusitis, Nasopharyngitis, Pharyngitis,

Epiglottitis, Laryngitis, Tracheitis in under five children

Domiciliary management : Refers to care of under five children suffers with upper

respiratory tract infections by home remedies.using tulasi, ginger, honey, hot

7

drinks.etc..

Prevention : Refers to the measures taken to decrease the incidence and limit the

progression of respiratory infection

Mothers of under five children : Refers to woman having children of under five

years of age group.

7 MATERIALS AND METHODS

7.1 SOURCE OF DATA : Data will be collecting from mothers of

Under five children in selected slums of

Bangalore.

7.2 METHOD OF COLLECTION : The data will be collecting using

OF DATA structured knowledge questionnaire.

7.2.1 STUDY SUBJECTS : Mothers of under five children’s in

Selected slums of Bangalore

7.2.2

a) INCLUSION CRITERIA : 1. Mothers who are present

at the time of data collection.

1. Mothers who read and write

Kannada

2. Mothers who have under five children.

b) EXCLUSION CRITERIA : 1. Mothers who are already been

exposed to educational

programmes.

1. Mothers who illiterate

2. Mother who have children more than 5 years of age.

7.2.3 RESEARCH DESIGN : One group pre-test and post-test design.

7.2.4 SETTING : Selected Urban slums of Bangalore.

7.2.5 SAMPLING TECHNIQUE : Convenient Sampling

7.2.6 SAMPLE SIZE : 60 Mothers

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7.2.7 TOOL OF THE RESERCH : Structured questionnaire will be

constructed into two parts :

Part – A consist of Demographic data.

Part-B Knowledge questionarrie

regarding Domiciliary management and

prevention of upper respiratory tract

infection.

7.2.8 COLLECTION OF DATA : After obtaining informed consent from

the participants, the investigator will

collect data by using structured

qustionnaire to assess the knowledge

before and after structured teaching

programme.

7.2.9 METHOD OF DATA : 1. The investigator will use appropriate

ANALYSIS AND descriptive and inferential statistics

PRESENTATION Like means, median, standard deviation,

mean Percentage and inferential

statistics namely paired t-test and

Chi-square test to analyze the data.

2. The analyzed data will be presented

in the form of tables and graphs

where ever necessary.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS

TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS ? IF

SO PEASE DESCRIBE BRIEFLY.

Yes, the study will be conducted on mothers of under five children regarding

Domiciliary management and prevention of upper respiratory tract infection.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION CASE OF 7.3 ?

9

1. Yes, ethical clearance has been obtained from the concerned authority of

institution.

2. Informed consent will be obtained from the participants prior to the study.

3. Privacy, confidentially and anonymity will be guarded.

4. Scientific objectivity of the study will be maintained with honesty and impartiality.

5. Permission will be obtained from the research committee of the Rajiv gandhi

college of nursing.

8. LIST OF REFERENCES :

1.www.America.cry.org.statistics/ situation of children- child statistics

underprivileged.

2. Sherene G. Edwin, effect of planned teaching programe on knowledge, Attitude on

practice of ARI among mothers, Shakuntala college of nursing, Trichy, the nursing

journal of India, TNAI, Nov 2009, Vol C.No. 11.

3. Parul Datta, Respiratory diseases, Paediatric nursing, Second edition, 2009,

P-273- 275

4. Fisk CM, Crozier SR, Inskip HM, Godfrey KM, Cooper C, Roberts GC, Robinson

SM, Breastfeeding and reported morbidity during infancy MRC Epidemiology

Resource Centre, University of Southampton, UK, Maternal Child Nutrition,

2011 Jan P. 61-70

5 FT Chew, S. Doraisigham, A.E. Ling and B.W. Lee, Seasonal trends of Viral

respiratory tract infection in the tropics, Department of Pediatrics, National

University of Singapore, Epidemiological Infection, 1998 August. P. 121-128

6.TE Tupasi, MA Velmonte, Determinants of morbidity and mortality due to

acute respiratory infections, Philippines, The journal of infections. 1988

7. TJ John, T. Cherian, MC Steinhoff, Etiology of acute respiratory infections in

children in tropical, South India, Reviews of infections 1991.

8. Bassain DG, Kumar R, Awasthi S., Morris SK, Paul VK, Ram U. Black RE, Jhap,

Causes of neonatal and child mortality in India, Centre for Global health research, Li

Ka Shing knowledge Institute, University of Toronto, Canada, 2010 Nov. P. 1853-60

10

9. WH Oddy, PD Sly, NH de klerk, LI Landau, GE Kendall, PG Host, FJ Stanley,

Breast feeding and respiratory morbidity in infancy, Telethon Institute of child Health

Research, Western Australia, 19 Sep 2002. P 224-228

10. www.child.info.org/statistics by area/child survival and health.

11. Sharma A.K., Reddu D.C. Dwivedi R.R. Descriptive epidemiology of acute

respiratory infection among under five children in an urban slum area, University

college of medicine, Delhi, Indian journal of public health, 1999 Oct. P 156-159

12. Neemisha Jain, R. Lodha, S.K. Kabra, India Journal of pediatrics Vol. 68 Pg.No.

1135-1138.

13. Debsk, Acute respiratory disease survey in Tripura incase of children below five

years of age, Department of Paediatrics, IGM hospital Agartala, Journal Indian

Medical association, 1998 April P. 111-116

14. Gupta N, Jain SK. Ratnesh, Chawla V., Venkatesh S., an evaluation of diarrheal

diseases and acute respiratory infections control programmes in Delhi Slum, division

of reproductive health and nutrition, Indian council of medical research, Newdelhi,

Indian journal pediatric, 2007 May P.471-476.

15. Kamlesh patel, Rajiv Rana, Pedimune in recurrent respiratory infection. The

Indian express, Mumbai, Indian journal paediatric, 2006 P. 585-591

16. Teka T, Dagnew M., Health behaviour of rural mothers to acute respiratory

infections in children in Gondar, Ethiopia, Departmentof paediatrics, Gondar college

of Medical Sciences East African medical Jounral, Oct 1995, P.No. 623-625

17. Cecilia Bukutre, Christophe Le, Sunita Vohra, Complementary, Holistic and

integrative medicine, Amerian academy of pediatric, 2008, P e66 - e71.

18. Sarini N.K., Gaur D.R. Saini V., Lal S., Acute respiratory infections in children,

a study of knowledge and practices of mothers, department of SPM, Medical college,

Medical college, Rohtak, Haryana, Journal communicable diseases, 1992 Jun,

P.75-77

11

9. SIGNATURE OF THE :

CANDIDATE

10 REMARKS OF THE GUIDE : ARI is the leading cause of death among

children hence education helps in

enhancing the knowledge of mother, study

can be proceeded.

11 NAME AND DESIGNATION

11.1 GUIDE : Prof .(Mrs). Susan Shaila Abharam

Professor in pediatric nursing

Rajiv Gandhi College of nursing Bangalore

11.2 SIGNATURE :

11.3 CO-GUIDE(IF ANY) :

11.4 SIGNATURE :

11.5 HEAD OF THE :

DEPARTMENT

Prof .(Mrs). Susan Shaila Abharam

Professor in pediatric nursing 11.6 SIGNATURE :

12 REMARKS OF THE :

PRINCIPAL

Study is feasible to conduct among

children since child mortality and

morbidity can be prevented among

children

12.1 SIGNATURE :

12