BRIEF RESUME OF THE INTENDED WORK

6. INTRODUCTION

Every child comes with the message that God is not yet discouraged of man.

~ Rabindranath Tagore

The child is the most precious possession of mankind, most loved and perfect in

its innocent and a child is beautiful, a source of joy and happiness, a focus of love and

care and a subject of dream for the future.

Children are one third of our population and all of our future. While we try to

teach our children all about life, our children teach us what life is all about. Receive the

children in reverence, educate them in love, and send them forth in freedom. Under five

children focus on important segment of Indian population. They contribute to the vital

human potential and impart strength to the national economy and development.

Under five children tend to establish eating habits during the first 2 to 3 years of

life. During childhood, the eating preferences and attitudes related to food habits are

established by family influences and culture. Unhealthy diets are common among lower

income families, often because of the lack of nutritious fresh fruits and vegetables and

adequate milk and protein intake. In addition, the lifestyles of homeless and migrant

children place these populations at risk for inadequate food, causing nutrient deficiencies,

developmental and growth delay, depression, hunger and behavior problem.1

Behavioral disorders are very common in childhood. Young people can have

mental, emotional, and behavioral problems that are real, painful, and costly. These

problems often called "disorders," are sources of stress for children and their families,

schools, and communities. The number of young people and their families who are

1

affected by mental, emotional, and behavioral disorders is significant. It is estimated that

as many as one in five children and adolescents may have a behavioral disorder that can

be identified and require treatment.2

It has been estimated that about 25% of children have behavioral problems and

found to be more common in nuclear families. These are not considered as disease

entities but as a symptom or group of symptoms because of faulty/disordered

development of personality of the child due to environmental maladjustments.3

Eating disorder is one of the most common behavioral problem in children. The

most common eating disorder in children are Pica, Anorexia/resistance to feeding,

Obesity, vomiting, Rumination disorders. Of all eating disorders pica is commonest

eating disorder.3

Many young kids put nonfood items in their mouths at one time or another. They

are naturally curious about their environment and might, for instance, eat some dirt out of

the sandbox. Kids with pica, however, go beyond this innocent exploration of their

surroundings. Between 10% and 30% of kids ages of 1 to 6 years have the eating disorder

pica, which is characterized by persistent and compulsive cravings (lasting 1 month or

longer) to eat nonfood items.4

The word pica comes from the Latin word for magpie, a bird known for its large

and indiscriminate appetite. Pica is an eating disorder typically defined as the persistent

eating of non nutritive substances for a period of at least one month at an age in which the

behavior is developed mentally in appropriate (>18-24 month). children with pica

frequently crave and consume nonfood items such as: dirt, clay, sand(geophagy), paint

chips, plaster, chalk, cornstarch, laundry starch(amylophagy), baking soda, coffee

grounds, cigarette ashes, burnt match heads, cigarette butts, feces, ice (pagophagy), glue,

hair, buttons, paper, sand, toothpaste, soap etc,4

2

Pica is most common in children with developmental disabilities, including

autism and mental retardation between the ages of 2 and 3. Pica also may surface in

children who have had a brain injury affecting their development. Pica may be due to

parental neglect, poor attention of caregivers, inadequate love and affection, etc. In some

societies, pica is culturally sanctioned practice and is not considered to be pathologic.

Pica may be benign or it may have life threatening consequences.5

Children with pica may have associated problems of intestinal parasitosis, lead

poisoning, vitamins and minerals deficiency. These children may have problems like

trichotillomania and trichobezoar.6

The broad range of complications arising from the various forms of pica and the

delay in accurate diagnosis may result in mild-to-life-threatening sequelae. Bezoar,

infection, intestinal obstruction, ulcerations, perforations, malnutrition, inherent toxicity,

lead poisoning, parasitic infections and dental injury.5

In most cases, pica disorder in not diagnosed until the child, adolescent, or adult

are brought into the emergency room with severe to life threatening complications

associated with non-food items. The main approach in such situations is identifying the

health emergency (whether the person is poisoned, has an intestinal blockage or

obstruction) and eliminating the problem in order to save the patient’s life and avoid

other complications. Individuals with pica require close medical monitoring throughout

their treatment and the medical team should include a physician (who evaluates and treat

the physical problems associate with pica), social worker (responsible with probable

socioeconomic issues), and mental health specialist (who will address the psychological

issues associated with the disorder).7

The main goal of the treatment is to reduce and eliminate the habit of eating non-

food items. Treatment of pica will often depend on the cause and type of pica.

Medications may help reduce the abnormal eating behavior, if pica occurs as part of a

developmental disorder such as mental retardation. 7

3

Management of pica involves behavioral, environmental, and family educational

approaches. Other successful treatments include associating the pica behavior with bad

consequences or punishment (mild aversion therapy) followed by positive reinforcement

for eating the right foods.8

4

6.1 NEED FOR STUDY

Children always need special care to survive and thrive. Child health is greatly

depending upon family health. Good health of these precious members of society should

be ensured as prime importance in all countries. As said by Karl Meninger “what is done

to children, they will do to the society.” Children are the wealth of tomorrow.

A child is the unique individual, he or she is not a miniature adult, not a little man

or women. The child health care concerned with preventive, curative and rehabilitative

care of children. Disease pattern and management of childhood illness are different than

adult and they need special care to survive and thrive.6

In India about 35% of populations were children. They have a special place in the

lives of the people, but a large number of children become a cause of sorrow because of

illness and ultimate death. Pica is one of the Most Dangerous Eating Disorder especially

among small children. Children eat certain ingredients like lead, it is very poisonous and

can damage the stomach linings and may even kill. Other non-food items also contain

harmful chemicals that may not only poison but also result in other very serious health

conditions like intestinal obstruction,constipation, ulcerations, perforations, and iron and

zinc-deficiency anemia, electrolyte metabolic disorders, tooth wear, hypokalemia.6

Researchers has estimated that 33% of children ingest more than 10 grams of soil

1 or 2 days a year. The soil ingestion rate reported by their parents was 3% for 6-month-

old children, 30% for 12 month-old children, 31% for 18-month-old children.9

Pica occurs throughout the world. Pica is a widespread practice in western Kenya,

southern Africa, and India. Pica has been reported in Australia, Canada, Israel, Iran,

Uganda, Wales, Turkey, and Jamaica. In some countries, Uganda for example, soil is

available for purchase for the purpose of ingestion. Pica is reported to be problematic in

70% of the provinces in Turkey.9

5

The true incidence of pica is not known but it is estimated to be 75% in infants,

15% in two-three year old toddlers and 10-33% among the institutionalized mentally

retarded children.9

According to the Agency for Health care Research and Quality (AHRQ) finds

that eating disorder called pica has sharply increased by 93% from 1999 to 2009.

Hospital stays with a diagnosis of pica increased 41 percent from 1999–2000 to 2005–

2006.9

In United states pica behavior is seen more often in young children than adults,

between 10 and 32% of children (1-6yrs) have these behaviors. Worldwide Morbidity

and Mortality rate is high due to pica behavior are related to the following types of

ingestion: Ingestion of poisons, Exposure to infectious agents, gastrointestinal effects,

direct nutritional effect, dental effects.9

The Nationwide the rate of pica is increased from 964 to 1,862 over the past ten

years. Over 30% of child hospitalizations with pica in 2009 had autism spectrum

disorders.9

A prospective study was undertaken at a pediatric clinic at Jammu. The main

objective of the study was to observe the various aspects of clinical profile of pica among

children. The study sample includes 200 children (18 months to 10 years) visiting

pediatric clinic with history of pica. The study results show that 64% of children

belonged to 2-4 years, 32% of mothers gave direct history of pica with presenting

complaints were cough (30%), pain abdomen (34%), poor appetite (26%), increased

pallor (19%), diarrhea (17%), vomiting (12%), abdominal fullness (11%), generalized

weakness (8%), passage of stool (7%), family history for pica was positive in 44%

children, 46% had poor nutritional status, intestinal parasites 63%. The study concluded

that cough, pain abdomen, poor appetite, increasing pallor, abdominal fullness etc are the

presenting features of pica in children.11

6

The study was conducted by Department of psychiatry,National Institute of

Mental Health and Neurosciences, Banglore. The sample include 2064 children aged 0-

16 years were selected by stratified random sampling from urban middle class, urban

slum and rural areas at Banglore. The screening stage was followed by a detailed

evaluation stage. The results indicated a prevalence rate of 12.5% among children aged 0-

16 years. The morbidity among 0-3 year old children was 13.8% with the most common

diagnosis being Pica and Behavior disorder.12

Some studies shows that pica has been associated with iron deficiency, zinc

deficiency, geophagia, mental deficiency, develop mental delay & a family history of

pica. Complications of pica includes abdominal problems (sometimes necessitating

surgery) ,lead poisoning, hypokalemia, hyperkalemia, mercury poisoning, phosphorus,

intoxication and dental injury. The study concluded that pica is an under diagnosed

problem that can be cause by a variety of disorders and lead to, serious complications.13

The researcher during her experience has also found that mothers had lack of

knowledge regarding prevention and management of pica. So the researcher felt the need

to assess the knowledge among mothers of under five children and to impart planned

teaching programme to improve the mothers knowledge.

7

6.2 REVIEW OF LITERATURE

A review of literature is essential aspect of scientific research. It involves the

systematic identification, location, scrutinizing and summary of the written materials that

contain information on research.

Review of literature is sectioned under following heading:

I. Studies related to general information about pica.

II. Studies related to complications of pica.

III. Studies related to prevention and management of pica.

IV. Studies related to structured teaching programme.

SECTION –A–STUDIES RELATED TO GENERAL INFORMATION ABOUT

PICA:

A longitudinal study was conducted by Egerton University, Department of

environmental Science, Egerton, Kenya. The main objective of this study was to

investigate whether earth eating within the home environment by children is a risk factor

for diarrhoeal disease. The study included that 350 households having children aged

below 5 years. The result of the study shows that 37% of index children ingest earth less

than handful and 12% ingest a lot. The study concluded that earth eating is a risk factor

for diarrheoa in the home environment.14

8

A prospective study was undertaken at a pediatric clinic at Jammu. The main

objective of the study was to observe the various aspects of clinical profile of pica among

children. The study sample includes 200 children (18 months to 10 years) visiting

pediatric clinic with history of pica. The study concluded that cough, pain abdomen, poor

appetite, increasing pallor, abdominal fullness etc are the presenting features of pica in

children.11

A study was conducted to determine the association between specific forms of

pica and toxocariasis and elevated blood lead in children. The sample include 100

children aged 1-6 years in Allegheny country, Pennsylvania,US. The study results shows

that significant associations were found between 1.feces, soil, or grass pica and toxocara

infection; 2.paint or plaster pica and elevated blood lead, 3.dogowenership and toxocara

infection. The study concluded that significant associations were found between specific

forms of pica and toxocariasis and elevated blood lead in children.15

A study was conducted to analyse the association of pica with iron-defiency

anemia among 2 year old children conducted by Dipartimentodi Pediatria, ospedale civile

di Arzignano, Vicenza, India. The study concluded that a case of pica in Indian child,

affected by a serious ferropenic anemia.16

A study was conducted regarding the frequency and riskfactors for intestinal

parasitic infection in underfive children. A study sample includes 269 children

underfives. The parasitic detection was confirmed by formalin ethyl acetate concentration

method. Results of the study shows 185 (68.8%) children had parasitic infection.

Majority of children 144(53.5%) were among 4-5 years of age. Only 40% children were

not found to wash hands with soap after using the toilet, eating mud/pica was present

48%. The study concluded that frequency of intestinal parasitic infection was found to be

high among children under 5 years, major contributory factors were pica and lack of hand

washing.17

9

A retrospective observational study was conducted by Sickle cell center,

children’s Hospital of Michigan.USA .the main objective of study is to determine the

prevalence of pica and its characteristics among children with sickle cell disease. The

sample includes 480 children who visited the center. The study results shows that

134(33.9%) of reported pica, ingested items included paper, foam and powders. The

study concluded that prevalence of pica is high in children with sickle cell anemia.18

A study reveals that in India lead based paints were found in the homes of

three children whose blood lead level were 40mcg/dl. In a study on dust lead

levels in Delhi, homes had dust with lead level of 31%. Lead in house hold dust

is dangerous to children who ingest lead from playing close to the ground and

having frequent hand to mouth contact and who ingest soil . The study concluded that

ingestion of soil leads to lead poisoning in children.19

SECTION –B– STUDIES RELATED TO COMPLICATIONS OF PICA:

A study was conducted in Turkey regarding assessment of heavy metal

bioavailability in contaminated soil. Nine trace analytes (As,Ba,Cd,Cr,Cu,Mn,Ni,Pb and

Zn) were determined. The results showed that high As,Ba,Pb,Zn,Cd concentrations were

found in there soils. The amounts ingested by pica behavior of children at all rate of

10g/day. The study concluded that young children who ingest soil are at greater risk

developing inherent toxicity.20

A study was performed on Low plasma zinc and iron in pica among children. The

main objective of the study is to determine role of trace elements in causation of pica

with specific reference to zinc and iron we studied plasma levels of iron (Fe), Zinc (Zn),

calcium (Ca) and magnesium (Mg) and blood lead (Pb) levels by atomic absorption

spectrophotometer. The sample includes 31 children with pica (pica group) and 60

controls matched for age, sex and nutrition (Control Group) in an observational case and

control study in the settings of outpatient clinic of a tertiary care, teaching hospital. The

10

study results shows that the plasma Fe level (mean ±SD) in children with pica (42.7 ±9.2)

mg/dl) was about 20% lower than that in controls (51.5 ±10.0 mg/dl, p<0.001). Plasma

Zn levels in the pica group (60 ±4.4 mg/dl) was about 45% lower than those in controls

(110.2±8.5 mg/dl, p<0.001). Correlation of Zn and Fe levels with pica-related

variables such as age at onset, duration and frequency and number of inedible objects

ingested was not significant. The study concluded that hypozincemia with low iron levels

may be the possible cause of pica and contradict the contention that low levels of plasma

Zn and Fe could be an effect of pica.21

A descriptive study was conducted by Interdepartmental Medical Center

Casanova. The main objective of this study is to evaluate pica's prevalence for

hospitalized patients. Secondary objectives are to describe clinical characteristics,

complications and outcome upon the different therapeutic approaches. The sample

includes 943 hospitalized patients at a selected time period, 31 distinct substances have

been identified in our study. The study results show a high incidence of surgical

complications, essentially gastro-intestinal, Respiratory complication and infectious

complications are seen most. The study concluded that Pica's evolution often implies

severe complications, which are sometimes life threatening in spite of a well-conducted

treatment.22

A study was conducted by Klinikum Remscheid Gmbh, Medizinishe klinik at

central Europe and Germany regarding effects of amylophagia among young children.

The sample includes children aged between 2-6 years having the habit of amylophagia.

The result of the study shows that pica for starch associated with severe iron deficiency

anemia in Germany. The study concluded that iron-deficiency anemia and less often

potassium and zinc deficiency are the main complications of an excessive starch or clay

ingestion, followed by gastrointestinal obstructions due to gastroliths or impaction.23

11

A study was conducted by Rhode Island Poison Control Center (RIPCC) Island.

The main objective of the study is to characterize risk factors for outcomes associated

with ingestion of cigarettes and cigarette butts among children. The sample includes 146

children aged < or = 6 years. According to Rhode Island Health Interview survey reports

that ingestion of cigarettes and cigarettes butts by children occurred more frequently in

households where smoking was permitted in the presence of children and where

cigarettes and cigarette wastes were accessible to children. The study concluded that

ingestion of cigarettes and cigarettes butts by children results in minor toxic effect.24

A study was conducted by Department of Pediatric Surgery, King`s College

Hospital, Denmark hill, London, UK regarding pica and non –nutrient material. The

study sample includes 9-year–old child with the history of persistent ingestion of Blu-

tack (a common household putty-like adhesive). The case is reported with an extensive

and complicated surgical history. The study concluded that ingestion of persistent blu-

tack will leads to acute intestinal obstruction.25

A study reveals that lead can still be found in contaminated soil, household dust,

drinking water, lead-glazed pottery and some metal jewelry. Eating food or swallowing

or touching dirt that contains lead can cause many health problems. It can also make

children irritable and affect their ability to concentrate and remember. Lead is especially

dangerous for children. A child who swallows large amounts of leaded dust or soil or

paint chips may develop anemia, severe stomachache, muscle weakness and brain

damage. Even low levels of lead are linked to lower IQ score.26

A study was carried out on Acuphagia and Hyalophagia in India. In this case

young female child is admitted to the emergency department with the history of

acuphagia (consumption of sharp objects), hyalophagia (consumption of glass materials).

On diagnosis the results shows that young female with impacted bunch of bangles in

thestomach and few in the small and large bowel, who was completely asymptomatic,

needed gastrotomy with enterotomy for complete and successful retrieval of glass

bangles. The study concluded that acuphagia and hyalophagia may cause complication

12

like impaction, leading to intestinal obstruction, ulceration, perforation and bleeding, thus

needs surgical exploration.27

SECTION –C – STUDIES RELATED TO PREVENTION AND MANAGEMENT

OF PICA.

A study was conducted regarding prevention of pica. The main objective of this

study is to control pica by components of an over correction procedure among children.

The study results that one of the components, oral hygiene, could eliminate pica by 2

retarded subjects when used alone. Although oral hygiene was the most effective

component, each of other components, tidying and personal hygiene, did decrease pica.

The study concluded that effective implementation of oral hygiene procedure will

decrease pica among children.28

A descriptive and longitudinal study is presented detailing the development of an

effective integrated approach to the treatment of pica. The subject was a mentally

retarded male whose history of life-threatening pica resulted in 37 surgeries for the

removal of foreign objects. Etiological explanations for the behavior are considered and

their role in generating elements of treatment are described. Results indicated that pica

was eliminated by: (a) directing the subject to engage in other behaviors, (b) encouraging

developmental progress through environmental exploration and trusting relationships,

and (c) analysis of and responsiveness to the subject's cues concerning the maladaptive

behavior.29

In this study, behavior modification procedures were used to eliminate pica in

three young children with lead poisoning. Three kinds of procedures were used: (1)

discriminate training, in which the subject was taught to recognize that paint and several

objects were not edible; (2) reinforcement for the absence of pica; and (3) overcorrection

for the occurence of pica. The study concluded that Pica was eliminated in all three

subjects.30

13

A comparative study was conducted regarding suppression of pica among

mentally retarded children. In this study an alternating treatments design was used to

measure the differential effects of over correction and physical restraint procedures in the

treatment of pica. The study concluded that both procedures reduced the occurrence of

pica and physical restraint was clinically more effective in terms of immediate response

reduction.31

A study shows that intervention for children with pica typically involves parental

education regarding the hazards of eating nonfood substances, increased social and

environmental stimulation, closer supervision, & behavior therapy for persistent cases.

The latter involves differential reinforcement (eg; food treats) for incompatible behaviors

(eg; playing with toys) as well as overcorrection (eg; brushing the tongue & teeth with

mouth wash contingent on eating nonfood substances).32

A study manipulated two parameters of response blocking to reduce pica: (a) the

criteria for initiating the procedure (either earlier or later in the response chain) and (b)

the distance from which the procedure was initiated. Results suggested that response

blocking may be effective only when implemented early in the chain and with near-

perfect consistency. Further, additional treatment components may be required to

eliminate all pica attempts.33

A study is performed by Using Food Aversion to Decrease Severe Pica by a Child

with Autism. The study sample include 4 –year –old boy with autism. The participant

was suffering from digestive complications due to the ingestion of plastic from a variety

of toys. The intervention was initially conducted in the child's preschool classroom

during instructional periods and was systematically generalized to the entire preschool

classroom, and eventually to both classrooms within the preschool and across 25

teachers. The study result shows that success of the intervention in decreasing pica was

enhanced by its achievement in not reducing interactions with toys. The study concluded

that food aversion was effective in reducing of plastic pica by a 4-year- old boy with

autism.34

14

SECTION –D- STUDIES RELATED TO STRUCTURED TEACHING

PROGRAMME

A study was conducted by Lehigh University, western Michigan university on

developmental disabilities aged between (1-5) years. In this study the participants were

aged between (1-5) years. In this study the participants were taught to exchange inedible

items for edible in selected settings. Findings showed that the intervention resulted in

reductions in pica for both participants. The study concluded that by teaching children to

exchange inedible items for edible items will reduce pica in children.35

A study was conducted by Millican and Lourie, they suggested that educational

intervention in which mothers of children with pica were adviced of the health hazards

inherentin the disorder and encouraged to spend more time with their children & to

discourage their ingestion of non food items. They also reported that the lessening of

social & environmental deprivation in the lives of children with pica resulted in a

diminishment of symtomatology & suggested psychotherapy for older children with

persistent pica.36

15

STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of Planned Teaching Programme regarding

prevention and management of Pica among the mothers of under five children in

selected rural areas at Kolar Dist. Karnataka.”

6.3 OBJECTIVES OF THE STUDY:

1. To assess the existing level of knowledge of the mothers of under five children

regarding prevention and management of pica.

2. To determine the effectiveness of planned teaching programme on prevention

and management of pica.

3. To find association between pre-test knowledge scores with selected

demographic variables.

6.4OPERATIONAL DEFINITIONS:

1. ASSESS:

Refers to the process used to identify the level of knowledge regarding

prevention and management of pica among mothers of under five children in rural

areas.

2. EFFECTIVENESS:

In this study it refers to significant gain in knowledge scores among

mothers of under five children regarding prevention and management of pica by

comparing the pretest and post test scores.

16

3. KNOWLEDGE:

This study it refers to the awareness of mothers regarding prevention and

management of pica among under five children which is elicited by using a

planned knowledge questionnaire on pica.

4. PLANNED TEACHING PROGRAMME:

In this study, it refers to systematically developed instructional method

and teaching aids designed to impact information regarding prevention and

management of pica.

5. MOTHERS: Mothers who have under-five children.

6. UNDER FIVE CHILDREN: Children in the age group of 2 to 5 years.

7. PICA: Pica is the persistent craving and compulsive eating of nonfood substances

such as dirt, clay, chalk, glue, ice, starch, hair, paint chips, plaster, cornstarch,

laundry starch etc,

6.5 ASSUMPTIONS:

The mother may have some basic knowledge regarding pica and its preventive

measures.

Planned teaching program may enhance knowledge regarding prevention of pica

among the mothers of under five children.

17

6.6 HYPOTHESIS:

H1: There will be significant difference between pre-test and post test knowledge

scores of mothers regarding prevention and management of pica.

H2: There will be significant association between post-test knowledge scores

regarding prevention and management of pica among mothers of underfive

children with their demographic variables.

6.7 VARIABLES:

Dependent variable – knowledge of mothers of under five children regarding

prevention and management of pica.

Independent variable – Planned Teaching Programme regarding prevention and

management of Pica among the mothers of under five children.

Attributed variable – Age of mother, parity, education, occupation, monthly

family income, religion, age of the child, source of health information.

7.0 MATERIALS & METHODS :

7.1 SOURCE OF DATA :

Data will be collected from mothers of under five children from selected rural

areas of Kolar.

7.2 METHODOLOGY :

7.2.1 RESEARCH APPROACH: Evaluatory approach.

18

7.2.2 RESEARCH DESIGN:

Pre experimental design (one group pre test and post test design).

7.2.3 SETTING:

The study will be conducted in the rural areas that are Mudhuvathi, which is 6

Kms and Guluganji Gurki which is 10 Kms away from the Pavan College.

7.2.4 POPULATION: Mothers of under five children at kolar district.

7.2.5 SAMPLE:

Mothers of under five children in selected rural areas at Kolar District that is

Mudhuvathi and Guluganji Gurki.

7.2.6 SAMPLE SIZE: 60 Mothers of under five children.

7.2.7 SAMPLING TECHNIQUE: Non probabality Convenient sampling technique.

7.2.8 SAMPLING CRITERIA

INCLUSION CRITERIA

o Mothers who are permanent residence of the selected rural areas.

o Mothers who have under five children.

o Mothers who are willing to participate in the study.

o Mothers who can understand Kannada or English.

19

EXCLUSION CRETERIA

o Mothers who are not available during the study.

o Mothers who are not willing to participate in the study.

o Mothers who are not able to understand Kannada or English.

7.2.9 DELIMITATIONS :

The data collection period is de limited to 6 weeks.

The study is delimited to 60 sample.

The setting is limited to selected rural areas in Kolar.

7.2.10 TOOL:

A structured interview schedule will be used to assess the knowledge regarding

prevention and management of pica among mothers of under five children.

DESCRIPTION OF TOOLS : It consists of 2 sections

SECTION A : DEMOGRAPHIC DATA

It consists of demographic variable like age of the mother, parity, education,

occupation, monthly family income, religion, age of the child, source of health

information.

SECTION B : It consists of structured knowledge questionnaire regarding prevention

and management of pica among mothers of under five children.

20

7.2.11 METHOD OF DATA COLLECTION :

Planned interview schedule will be used to assess the knowledge among mothers

of under five children regarding prevention and management pica.

7.2.12 DATA ANALYSIS & INTERPRETATION :

The researcher will use descriptive & inferential statistics such as frequency,

percentage, standard deviation, paired “t” test, chi – square test, for data analysis & data

will be interpreted in the forms of tables, diagrams and graphs.

7.3 DOES THE STUDY REQUIRES ANY INVESTIGATION OR

INTERVINTION TO BE CONDUCTED FOR PATIENTS OR OTHER

WOMEN OR ANIMALS IF SO BRIEFLY :

Yes, the study will be conducted among mothers of under five children In a

selected rural areas of the Kolar district.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM

CONCERNED AUTHORITIES

Prior to the study, the permission will be obtained from the concerned authorities

to conduct the study in a selected rural areas at Kolar District & also from research

committee of Pavan college of nursing. The purpose of the study will be explained to the

mothers of under five children. In selected rural areas, scientific objectives of the study

will be maintained with honesty & impartially.

21

8. LIST OF REFERENCES:

1. Wong’s. Essentials of pediatric nursing. 8th Edition. Mosby publications P, 2-3.

2. www.minddisorders.com

3. Anil Kaushik.Behaviral Disorders in Childhood Current Medical Journal of

India.October 2009. Volume 15. No 7. P, 15-18.

4. Cynthia R Ellis, MD; Cheifdi Caroly Pataki Eating Disorder, Pica June 4, 2009

5. www.encyclopedia.com

6. Parul Datta, Pediatric nursing. 2 nd Edition. Jaypee publications P1, 190

7. www.omnimedicalsearch.com/.../pica-disorder-introduction.html 7th sep2010

8. Wong`s Nursing care of infants & children 7 th edition, Mosby publications P,

1422-1423.

9. www.atsdr.cdc.gov/child /com.

10.Dr.B.T Basavanthappa, Text book of pediatric child nursing,New-Delhi,

Ahuja book company pvt. Ltd; 1st Edition 2205. P.331

11. Ravinder K. Gupta, Ritu Gupta Clinical Profile of Pica in Childhood volume 7

No,2, April-June 2005

12.Srinath S, Girimaji SC, Gururaj G, Seshadri S, Subbakrishna DK, Bhola

P, Kumar N Epidemiological study of child & adolescent psychiatric disorders

in Bangalore, India Indian Journal 2005 July.

22

13. Federman DG, Kirsner RS, Federman GS Pica:are you hungry for the facts

2008 Apr;61(4):207-9.

14. Shivoga WA, Mothuri WN. Geophagia as a risk factor for diarrhea.2009 mar

1;3(2):94-8

15. Glickman LT, Chaudry IU, Costantino J,Clack FB, Cypess RH Pica patterns,

toxocariasis, and elevated blood lead in children. 2008 Jan;30(1);77-80.

16. Vanin E, Urso L Meneghetti S,Mescoli G, Marcazzo L Pica and iron-

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9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF:

11.1 GUIDE:

11.2 SIGNATURE:

11.3 C0-GUIDE:

11.4 SIGNATURE:

11.5 HEAD OF THE DEPARTMENT:

11.6 SIGNATURE:

12.

12.1 REMARKS OF THE PRINCIPAL:

12.2 SIGNATURE:

26