Proforma for Registration of Subject for Dissertation s3

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED BY GAYATHRI G J

1ST YEAR M.Sc NURSING

VIVEKANANDA COLLEGE OF NURSING

CHITRADURGA

RAJI GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND GAYATHRI G J ADDRESS VIVEKANANDA COLLAGE OF NURSING

CHITRADURGA-577501 KARNATAKA INDIA

2. NAME OF THE INSTITUTION VIVEKANANDA COLLAGE OF NURSING

CHITRADURGA-577501 KARNATAKA INDIA

3. COURSE OF STUDY AND SUBJECT M.Sc. NURSING 1 YEAR COMMUNITY HEALTH NURSING

4. DATE OF ADMISSION TO COURSE 10-06-2009 5. TITLE OF THE TOPIC A STUDY TO ASSESS THE IMPACT OF HEALTH EDUCATION RELATED TO PREVENTION OF WORM INFESTATION FOR MOTHERS OF UNDER FIVE CHILDREN IN RURAL COMMUNITY AT CHITRADURGA. 6. BRIEF RESUME OF THE INTENTED WORK

INTRODUCTION

Children are the most valuable asset for any society. They are the

builders of the future of any nation. “Children health – Tomorrow’s wealth”.

Children are priceless resources. In 1984, World Health day rightly spotlighted

the basic-truth indicating that we must safe guard the healthy bodies and minds

of the children. Their well being is the basic concern of every nation. A healthy

child brings happiness to the family eternal joy to the parent and thrill to the

society and hoe to the nation.

Health education is the most effective weapon to prevent and control

illness. It promotes health, prevents and reduces suffering, prolongs life with

quality with less cost. Timely healthy education provided at frequent intervals

help all individuals to achieve good healthy by their own action and effort.

Out of 843.97 mullions of population, children constitute a major

proportion of forty eight percent, who are vulnerable to infection and face high

morbidity and mortality. The morbidity rate under 0-1 year and 5-14 years ee

12.8 percent and 22.9 percent respectively increased morbidity rate among

children is due to various disorders like nutritional deficiencies, dental disorders,

anaemia, communicable diseases and warm infestations. Among all child hood disorders, common intestinal worm infestations affect the healthy of the children very much. There is a need to bring awareness regarding care, prevention and control of intestinal worm infestations. Council for International organization of medical sciences also supports the above statement1.

Worm infestation is one of the major causes of child hood malnutrition, anemia, stunted physical and mental growth, psycho-social problems and these along with repeated gastrointestinal and upper respiratory tract infection contributes to high morbidity among children and remains a major cause of high infant and child mortality in our country4.

Worms or helminthes are the organisms or parasites which live in or one the body of the host and obtain nourishment from it and are therefore called parasites. They are under-go developmental changes in the host and infect the host; parasitic diseases contribute significantly to the total morbidity in a community, particularly in the developing countries2.

Most common helminthes are roundworm, thread worm hook worm, whipworm and tape worm which are potentially pathogenic to the human beings, if these are present in sufficient number. These may cause disease in children by the following mechanisms. 1). Round worms deprive the host of the nutrients, 2). Hook worms such 0.4 ml of blood per worm per day for their food and therefore cause anemia in the host. 3). Some worms may interfere with the body functions mechanically. Thus, the round worms may cause intestinal obstruction. 4).

Reactions may occur due to toxic products of the parasites. 5). Death of the

tissues occurs in amoebiasis4.

The control measures of helminthic infestations are the construction of

borehole latrines in the rural area and the people should be encouraged to use

these instead of defecating in the open fields. This will prevent contamination of

the soil in the places adjacent to living or play area of the children with faces

containing infective forms of parasities4.

6.1 NEED FOR STUDY

The World Health Organization (WHO) estimates that infection with round

worm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and hookworms

(Ancylostoma duodenale and Necator americanus) with associated morbidity,

affect approximately 250 million, 46 million and 151 million people, respectively.

About half the population in South India and 50% of school children in tribal

areas of Central India are infected with Ascaris lumbricoides, Trichuris trichiura

and /or hookworm. In the western part of Nepal, 86.7% of the pre-school

children are infected with a single geohelminth infection and 13.3% with mixed

infections. Thus, worm infestation as a public health problem needs immediate

attention from policy makers in India and other South Asian countries8.

Young children have a high infection rate and suffer with a heavy worm

burden of A. lumbicoides, Trichuris trichiura and / or schistosomes. These parasitic infections manifest themselves as reduced growth rates through impaired nutrient utilization. Consequently the children are not able to achieve their full potential in physical performance and education. Heavy hookworm burden is the major etiology for iron deficiency anemia in young children.

Parasitic infections are widely distributed throughout tropical and sub tropical areas with prevalence in some communities as high as 90 percent. The disease flourishes in rural communities with moist, shaded soil and inadequate latrines. Disposal of human faeces and the common habit of walking barefoot are important epidemiological features.

The quality of one’s life is greatly influenced by the home environment which in turn influenced by the women. As a mother she got a significant role in primary care execution to children. She plays a pivotal role in child rearing, home management besides assessment of growth and development. She is the first person who identifies the deviation from normal health. In different facets of children’s life i.e. developmental physical, intellectual and psychological, the most crucial and important influence is exerted by the mother. Mother creates a healthy environment at home to enable the children to grow in a secure and safe atmosphere. She has to ensure that the foundations needed for the health and growth of the children in early stage are not eroded. She has to regulate the behavior, attitude, outlook and living environment in a family since these are the basic factors which influences the growth of the children9.

In India, 80 percent of children population are affected by worm infestations who lives in rural areas because of poor sanitary conditions, poverty, ignorance, illiteracy and level of health education.

Studies from Nigeria and Pakistan have reported prevalence rates of 44% and 77% respectively among young children although an Ethipian study found a much lower prevalence. A relatively high prevalence of intestinal geohelminth infections in these developing countries is due to poor socio economic conditions like presence of inadequate housing, low levels of education and awareness, poor health services, inadequate sanitation, lack of access to sanitation facilities and clean drinking water8.

Preventive measures for safety of available drinking water and spreading awareness related to sanitation related behavior should be adopted to minimize the prevalence of worm infestation. Simple community based measures such as increasing public awareness about the drawbacks of open-air defecation, safe disposal of waste water and safe handling of drinking water can be used for easy and short-term results. Also, sanitation education campaigns are necessary to increase awareness of populations at risk to the relationship between deploying safe sanitation practices, sanitary conditions in general and helminthiasis8

Worm infestation remains one of the main problems of child development. This is especially a grater healthy hazard in developing countries.

Health education is the main tool for changing or modifying the health practices in improved from in the community.

The major problem of the rural community is lack of environmental sanitation and poor hygiene mainly due to lack of knowledge among mothers.

The mother does not posses basic knowledge of worm infestation, though it is a

preventable by simple measures. Hence the investigator felt that there is a

strong need to educate mothers with minimum cost, within a short time with

maximum effectiveness regarding worm infestation and its preventation

6.2 Review of Literature The studies are categorized in two decisions

 Studies related to demographic variables

 Studies related to knowledge of the mother on worm infestation

Literatures Related to Demographic Variables

Ostan I, Kilimcioglu AA, Girginkardesler N, Ozyurt BC, Limoncu ME, Ok UZ

(2007) conducted a questionnaire study to determine and compare the incidences of

intestinal parasitic infections and the socio-economic status of two near primary school

children in Manisa, a western city of Turkey. A total of 352 children were examined and

the results showed that the percentages of the students found to be infected with

intestinal parasites, were 39.6% and 13.4%. The factors which significantly increase the

incidence of intestinal parasites were uneducated and unemployed mother, lower social

status of father, living in crowded houses with insufficient indoor spaces, using the tap

water as drinking water.11 Quihui L, Valencia ME, Crompton DW, Phillips S, Hagan P, Morales G et al

(2006) conducted a cross-sectional study in 12 rural communities in two Mexican states to assess the variety of socio-economic factors, including maternal education and employment levels, were associated with intestinal parasite infection in rural school children. A total of 507 school children were participated and the results showed the children from lower-income families and with unemployed and less educated mothers showed higher risk of intestinal parasitism. This study concludes that lower income, defecation in open areas, employment status and a lower education level of mothers were the significant factors related to these infections.12

Giray H, Keskinoglu P (2006) carried out a cross sectional and analytic study to determine the factors affecting the presence of Enterobius vermicularis in schoolchildren. There were 477 student’s specimens were collected and the mean age of children was 8.6+/-2.0 years. The results revealed that the prevalence of Enterobius vermicularis in schoolchildren was higher in slum areas, in crowded homes and in those that lacked modern sanitary facilities.13

Ulukanligil M, Seyrek A (2003) conducted a survey to analyze demographic and parasitic infections status of schoolchildren and sanitary conditions of schools in

Sanliurfa province of south-eastern Turkey. A total of 1,820 schoolchildren between 7-

14 years age were involved and the results showed the Ascaris lumbricoides was the most prevalent species and followed by Trichuris trichiura. And this study concludes that burden of parasitic infections and poor sanitation conditions constituted public health importance among to the shantytown schoolchildren.14

Edirisinghe JS. Weilgama DJ (1997) conducted a cross sectional study between the prevalence of intestinal worm infections with that of degree of soil pollution with human faeces in Sri Lanka. They had conducted 99 faecal samples by means of simple random sampling method. Through microscopic examination the study findings revealed that 77.7% were positive for at least one helminthes infestation where the soil pollution was more which was proved by soil analysis. The prevalence rate of Ascaris,

Trichiuris and Hookworm infections were 54%, 28%, and 22% respectively.15

Literatures Related to Knowledge of the Mothers Regarding Worm Infestation

Ram R, Chakraborty M, Sarkar M, Bhattacharya SK, Bhattacharya KD, Roy

M (2004) carried out a cross sectional study among 370 school going children of the

Nepali community about 5-6 years in Siliguri subdivision of Darjaling district revealed the prevalence parasitic infection to be 51.4% which 28.2% had single and multiple parasitism respectively. A significant statistical association was observed in the decrease of worm infestation rate among children with in increase in educational status of their mothers. The study was revealed that 19.73% and 18.91% of the mothers had no knowledge about mode of transmission and prevention of worm infestation respectively.16

Nematian J, Nemation E, Gholamrezanezhad A, Asgari AA (2004) conducted a study to determine the prevalence of intestinal parasitic infections in primary school children living in Tehran and their association with socio-economic factors and hygienic habits. A total of 19,209 children were examined and the results revealed that the prevalence rate of intestinal parasitic infection among the students was 18.4%. With increase in educational level of parents (especially mothers), the infection rate of children was decreased. This study concludes the low level of education and consequently poor socio-economic and hygienic conditions of families appear to be powerful determinants of infection.17

Naish S, McCarthy J, Williams GM (2004) carried out a survey on the prevalence, intensity and risk factors for soil-transmitted helminth infection was undertaken among 204 school children aged 5-9 years attending a primary school in the fishing village in Peda Jalaripet, Visakhapatnam, South India. The results revealed the predominant parasite was Ascaris lumbricoides (prevalence of 91%), followed by

Trichuris trichiura (72%) and hookworm (54%). Multivariate analysis identified parental occupation, child's age and mother's education. Children from fishing families with low levels of education of the mother had the highest intensity of a lumbricoides infection.18

Traub RJ, Robertson ID, Irwin P, Mencke N, Andrew Thompson RC (2004) conducted a descriptive study to assess the knowledge of the mothers with age, socio- economic status, house hold crowding, defecation practices in relation to the prevalence, intensity and associated risk factors for infestation with hookworm, roundworm, threadworm in Tea growing communities of Assam. They had collected

328 fecal samples by convenient sampling method and mother’s knowledge was assessed by questionnaire method. Results showed that the children of mother with lack of knowledge, low socio-economic status, over crowding of house holds, poor defecation practices were suffering with one or another type of worm infestation that is more than 85 per cent children of the mothers with high knowledge socio-economic status and good hygienic practices.19

Rita Abbi, Paral Christian, Sunder Gujral, Tara Gopal Das (2002) conducted a survey on the effect of mother’s work status on their children’s nutrition at Chandapur district, Maharastra. The children were under the risk of developing the aneamia, worm infestation and vitamin A deficiency. Data collected from 1990 rural children one to six years of age. The risk of developing anemia and Vitamin A deficiency were 1.4 & 1.5 respectively. The child of working women were under the risk of getting worm infestation and diarrheoa were higher in those whose mothers were worked.20

Rao VG, Yadav R, Bhondeley MK, Das S (2002) conducted a descriptive study to assess the knowledge of the mother on school children of Gond Tribal community in Kundam block of Jaipur district Madya Pradesh. The mothers knowledge was assessed by means of interview method and the mothers who were un aware of worm infestations were suffered from anemia due to worm infestations.21

Vasundara MK, Harish BN (1998) conducted a study on I.C.D.S survey on 52

Anaganwadi community workers and 156 mothers of I.C.D.S beneficiary children implemented at Nelamangala at Bangalore. In order to ascertain the practice of mother in managing diarrhoea. The result were applied to improving the health education. The result of the AWW’s survey showed that 96.16% AWW’s had education up to high school 69.2% weighed the children correctly and 53.84% plotted growth chart. The mother response indicates 51.92 illiterates 86.53% were aware of the growth monitoring, 84.09% mother need health education on worm infestation, 3.84% suggested for worm infestation.22

Edirisinghe JS, Weilgama DJ (1997) conducted a cross sectional study between the prevalence of intestinal worm infections with that of degree of soil pollution with human faeces in Sri Lanka. They had conducted 99 faecal samples by means of simple random sampling method. Through microscopic examination the study findings revealed that 77.7% were positive for at least one helminthes infestation where the soil pollution was more which was proved by soil analysis. The prevalence rate of Ascaris,

Trichiuris and Hookworm infections were 54%, 28%, and 22% respectively.23

De Silya NR, Jayapani YP, de Silya HJ (1996) conducted a study to find out the knowledge level of the mothers in selected slum areas of Sri Lanka. They administered questionnaire to the mother regarding worm infestation. It was proved that the prevalence of worm infestation was more in children of less educated mothers that is 81.0%.24

Rousham EK (1994) conducted a comparative study on 150 mothers of two rural areas of Bangladesh to examine the knowledge regarding the helmenthic infestation in relation to the use of health facilities and treatment seeking behavior. A questionnaire was administered regarding helimenthic infestations. The results shown that al most all respondents worm to be the cause of bad health habits high percentage of mothers had obtained de-worming treatment for their children. But there were differences in mothers description of the causes and prevention of worm infestation. It was concluded that mothers of one area had more exposure to health education and the biomedical knowledge of worm infestation when compared to the other due to

social and cultural constraint.25

All these studies have shown that there is a greater prevalence of worm

infestations in children and there is lesser knowledge of mothers regarding causes,

spread of infection, complications, care and prevention of worm infestations. If mothers

have adequate knowledge about worm infestations, they can prevent this problem in

their children to maximum extent. So there is a greater need for assess mothers

knowledge, attitude and practice continuously to keep up the child’s health. STATEMENT OF PROBLEM

A STUDY TO ASSESS THE IMPACT OF HEALTH EDUCATION RELATED TO

PREVENTION OF WORM INFESTATION FOR MOTHERS OF UNDER FIVE CHILDREN IN

RURAL COMMUNITY AT CHITRADURGA. 6.3 OBJECTIVES OF STUDY

 To prepare and implement health education regarding prevention of

worm infestation for mothers of under five children.

 To determine the impact of health education regarding prevention of

worm infestation through post test.

 To identify the association between different socio demographic variables

of mothers with their knowledge on prevention of worm infestation.

6.3.1 OPERATIONAL DEFINITIONS :

Mothers of Under Five Children : mother’s belong to age between 20-35

years and who are having at least one under five child.

Health Education : Refers to a planned set of educational activities implemented in sequence of mothers of under five children on prevention of

worm infestation.

Worm Infestations : Worms are the parasites which live in or on the body of

the host, obtain nourishment from it and infect the host.

Prevention : The measure to be taken at Health Education programme of

prevention of worm infectation.

Impact : Gain in knowledge of mothers of under five childrens as determind by

significant difference between pre and post test scores.

6.3.2 ASSUMPTIONS: Rural mothers will have poor level of knowledge

regarding causes and prevention of worm infestations among young children. 6.3.3 WORKING HYPOTHESIS : Rural mothers will have significantly lower

level of knowledge regarding causes and prevention of worm infestations in

children. 6.3.4 SELECTED VARIABLES :

Dependent Variable: Knowledge of mothers of under-five children regarding worm

infestations.

Independent Variables : Health education on Prevention of worm infestation for mother of

under-five children 7. MATERIALS AND METHODS

7.1 Source of Data : The data will be collected from mothers of under five children of selected in rural community residing in

Palavvanahally sub center Chitradurga through

interviews schedule. 7.2 Method of data collection

7.2.1 Definition of the study : Investigator will develop an interview schedule to assess the knowledge of mothers regarding worm

subject infestations.

7.2.2 SAMPLING CRITERIA

(a) Inclusion Criteria :  The study includes the mothers who were :

 The mothers those who have under five children.

 Able to understand kannada or English.

 Available at the time of data collection.

Willing to participate in the study.

(b) Exclusion Criteria :  Mothers having children of more than five years.  Mothers of under five children who are not

available at the time of data collection.

 Mothers of under five children who are not willing

to participate in study 7.2.3 Research Setting : The study will be conducted at a Palavvanahally sub centere near Chitradurga . 8. LIST OF REFERENCE

1. Park, J.E. K.Park ‘Parks’ Text Book of Preventive and Social Medicine.

New Delhi, Banarsidas Bharat Publishers 2002.

2. Dorothy Marlow’s, “Textbook of Pediatric Nursing” 6th ed. Philadelphia :

W.B. Saunder’s publications; 1988.

3. B.T. Basavanthappa; community health nursing, second edition,

J.P.brothers medical publishers Pvt. Ltd., 2008.

4. Ananthakrishna S, Nalini P & Pani S.P; Intestinal geohelminthiasis in the

developing world, national Med j of India 1991; Vol 10, No.2.

5. Crompton DWT : gastrointestinal Nematodes – Ascaris, hookworm,

trichuris, and Enterobius. Topley and Microbiology and Microbial Infections

1998; Vol 5-Parasitology : 561-580.

6. Wani S A, Ahamad F, Zargar S A, Ahamad Z, Ahamad P, Tak H

PREVELANCE of intestinal parasites and associated with risk factors

among school children in Srinagar city Kashmir India.

J Parasital.2007dec;93(6):1541-3

7. Traub RJ, Robert son ID, Irwin P, Mencke N, Andrew Thompson RC The

prevalence associated with geohelminth infection in Tea growing

communities Assam, India. Trop Med Int Health. 2004 Jun, 9(6): 688-701. 8. Awasthi S, verma T, kotecha PV, Venkatesh V, Joshi V, Roy S,

prevalence and risk factors associated with worm infestation in pre-school

children (6-23 months) in selected blocks and Indian J. Med Sci 2008;

62:484-91.

9. Balan, K Mother: The Guardian of family Health. Social Welfare 1989 : 3-

Savioli L; Mott KE; Yu SH intestinal worms. World Health. 1996 Jul-Aug;

49 (4) : 28.

10. Khuroo M.S : Ascaris gastroenterol Clin North Am 1996 Sep; 25 (3) 553-

11 Ostan I, Kilimcioglu AA, Girginkardesler N, Ozyurt BC, Limoncu ME, Ok

UZ. Health inequities: lower socio-economic conditions and higher incidences

of intestinal parasites. BMC Public Health 2007 Nov 27; 7(147): 342.

12 Quihui L, Valencia ME, Crompton DW, Phillips S, Hagan P, Morales G et

al. Role of the employment status and education of mothers in the prevalence

of intestinal parasitic infections in Mexican rural school children. BMC Public

Health 2006 Sep 6; 6: 225.

13 Giray H, Keskinoglu P. The prevalence of Enterobius vermicularis in

school children and affecting factors. Turkiye Parazitol Derg 2006; 30(2): 99-

14 Ulukanligil M, Seyrek A. Demand patasitic infection statuofschool children

and saniconditions of schools in Sanliurfa. Turkey. BMC Public Health 2003

Sep 3; 3: 29. 15 Edirisinghe JS. Weilgama DJ. Soil contamination with geohelminth ova in

tea plantation in Ceylon. Med J 1997 Dec: 42(4): 167-72.

16 Ram, Chakraborty A, Sarakar M, Bhattachary SK, Bhattachary KD, Roy

M. A study among Nepali children in the district of Darjeeling. Journal of

Indian Medical Association 2004; 102(7): 349-52.

17 Nematian J, Nemation E, Gholamrezanezhad A, Asgari AA. Prevalence of

intestinal parasitic infections and their relation with socio-economic factors

and hygienic habits in Tehran primary school students. Acta Trop 2004 Nov-

Dec; 92(3): 179-86.

18 Naish S, McCarthy J, Williams GM. Prevalence, intensity and risk factors

for soil transmitted helminth infection in a South Indian fishing village. Acta

Trop 2004 Jul; 91(2): 177-87.

19 Traub RJ, Robertson ID, Irwin P, Mencke N, Andrew Thompson RC. The

prevalence associated with geohelminth infection in tea growing communities,

Assam, India. Trop Med Int Health 2004 Jun; 9(6): 688-701.

20 Rita Abbi, Parul Christian, Sundar Gujaral, Tara Gopal Das. Mother’ work

status on their children. Journal of Indian Medical Association 2002; 97(7):

200-23.

21 Rao VG, Yadav R, Bhondeley MK, Das S. Worm infestation and anemia in

tribal pre- school children of Madhya Pradesh. J Commun Dis 2002; 34(2):

22 Vasundara MK, Harish BN. Nutrition health education through I.C.D.S.

Indian journal of Maternal Child Health 1993; 4(1): 25-6.

23 Edirisinghe JS. Weilgama DJ. Soil contamination with geohelminth ova in

tea plantation in Ceylon. Med J 1997 Dec: 42 (4): 167-72. 24 De Silya NR, Jayapani YP, de Silya HJ. Socio-economic & behavioral

affecting the prevalence of geohelminths in pre-school children. South East

Asian J Trop Med Public Health 1996 Mar: 27(1): 36-42.

25 Rousham EK. Perceptions & treatment of intestinal worms in local

differences in knowledge, Bangladesh. Soc Sci & Med 1994 Oct: 39(8): 1063-

9. SIGNATURE OF THE CANDIDATE

10 REMARKS OF THE GUIDE Worm infestation among under five

children is quite common and its

prevention is very essential. This can

be achieved by enhancing the

preventive knowledge among

mothers of under five children. .

Hence this study is taken up.

11 NAME AND DESIGNATION Mrs.ShobhaM.Wagmare,

Asst.Prof. 11.1 GUIDE Mrs.Shobha M.Wagmare

11.2 SIGNATURE

11.3 CO-GUIDE Prof/ Dr. Venkatesh Reddy 11.4 SIGNATURE

11.5 HEAD OF THE INSTITUTION Prof.S.R.Gajendra Singh

11.6 SIGNATURE

12 REMARKS OF THE CHAIRMAN

AND PRINCIPAL 12.1 SIGNATURE