Rajiv Gandhi University of Health Sciences s196

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTERATION OF

SUBJECTS FOR DISSERTATION

PEBY THOMAS

1 YEAR M.Sc. NURSING

CHILD HEALTH NURSING

2012-2014

HOSMAT COLLEGE OF NURSING,

80 FEET ROAD, OPPOSITE TO LAGGERE RING ROAD BRIDGE,

BANGALORE-560

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTERATION OF

SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE MS. PEBY THOMAS AND ADDRESS 1 YEAR M Sc NURSING

HOSMAT COLLEGE OF NURSING,

80 FEET ROAD, OPPOSITE TO LAGGERE RING

ROAD BRIDGE,

BANGALORE

2. NAME OF THE HOSMAT COLLEGE OF NURSING INSTITUTION

3. COURSE OF STUDY AND M.Sc. NURSING 1ST YEAR SUBJECT CHILD HEALTH NURSING 4. DATE OF ADMISSION TO COURSE 01-06-2012 “A STUDY TO ASSESS THE EFFECTIVENESS OF 5. TITLE OF THE TOPIC SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING PREVENTION OF LEAD POISIONING AMONG MOTHERS OF CHILDREN UNDER SIX YEARS OF AGE IN SELECTED RURAL COMMUNITY AREA, BENGALURU”.

5. TITLE OF THE TOPIC

“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING PREVENTION OF LEAD POISIONING AMONG MOTHERS OF CHILDREN UNDER SIX YEARS OF AGE IN SELECTED RURAL COMMUNITY AREA, BENGALURU”.

6. BRIEF RESUME OF INTENDED WORK

6.1 NEED FOR THE STUDY.

Children being an integral and more vulnerable section of our society have been one of the principal victims of all social ills, including poisoning. Children under age 6 are particularly vulnerable to lead poisoning, which is asymptomatic but can lead to dangerous neurological impairment. These are occurred because of the unawareness, ignorance and casual approach of the caregivers making their environment unsafe and unprotected.1

National surveys estimate that more than 3 million children six years of age and younger have lead poisoning. This number represents almost one out of every six children younger than age 7. In Illinosis, more than 5,000 children were found to have lead poisoning in 2008.2

Researchers conducted the study on children living in Chennai, India, on 2001 regarding Out of lead in gasoline in India, the study found that blood lead levels in children remain relatively high, with half (52.5%) of the children having a level greater than 10 milligrams. An increase of 10milligrams decreased the children’s visual score by 2.6 points and 2.9 points for the drawing subtest.3

In the May 27, 2005, morbidity and mortality weekly report (MMWR), the centers for disease control and prevention (CDC) published national data on lead poisoning. The reports states approximately 310,000 American children, the equivalent of 1.6% of children aged 1-5 have too much lead in their blood.4

3 In 2008 in New York State, 3010 children were diagnosed with lead poisoning. Children are most commonly exposed to lead by the ingestion of paint chips or dirt that is contaminated with lead.NYS has made significant progress towards reducing both the incidence and severity of childhood lead poisoning, but it remains a serious public health problem.5

According to the Centers for Disease Control and Prevention (CDC), Approximately 250,000 American children have dangerous lead levels greater than 10µg/di of blood.4

In February 1999, The George Foundation sponsored and hosted in Bangalore the largest international conference on lead poisoning prevention and treatment ever held, jointly with the World Bank, WHO, CDC, USEPA. At this conference, the result of project-lead free were announced, that revealed that over 51% of the children below the age of 12 living in major urban areas of India had unacceptability elevated levels of blood lead of 10µg/dl or more.6

Dr. Venkatesh Thuppil, Director, National Referral Centre for Lead poisoning in India, said “The future of lead’s impact on our society is alarming. With policy plan to generate 12.3giga watts of electricity from solar energy in India, we are on the verge of becoming the world capital of lead poisoning”. He observed that, the total production of new lead in the world is 6 million tons a year and workable reserves are estimated to be 85 million tons, which is less than 15 years supply.7

“Prevention is better than cure” is ideally applicable to lead poisoning in its true sense. The awareness of parents and older children alone can prevent up to 60% of the problem due to lead poisoning. Parents must educated regarding sources of lead, how lead affects the child, normal mouthing behavior for infants and toddlers, avoidance of children from exposure to lead etc. Parents must begin to teach their children at an earlyage, the danger of lead and importance of hygienic practices.8

Many death and disabling squealer following lead poisoning could be prevented if more attention were given to implementing preventive measures at home. Education on which products are highly dangerous and the giving of precautionary advice to parents would also help to reduce the incidence of lead poisoning. 9

4 According to the findings of previous studies on childhood lead poisoning, most of the poisoning occurs in children under six years of age and parental educational level has direct impact on reducing the incidence of childhood lead poisoning. So the researcher found essential to impart knowledge to mothers of children under 6 years of age regarding prevention of lead poisoning using a self instructional module.

6.2 REVIEW OF LITERATURE

Review of literature is defined as the broad comprehensive, in depth, Systematic and critical review of the scholarly publication, unpublished scholarly print materials Audio visual materials and personal communication.10

The related literature has been organized under the following

Section A –Literature related to incidence and prevalence of lead poisoning.

Section B – Literature related to knowledge of mothers on prevention of lead poisoning

Section C – Literature related to effectiveness of self instructional module.

A study was conducted on Mapping Global Environmental Lead Poisoning in Children. The authors collected data from the published literature through a Pub Med literature search and unpublished data from Blacksmith cleanup sites. The authors reviewed 1,011 studies and datasets, 120 of which met the inclusion criteria. Of 242 included populations, 57 (24%) were lead hotspots. Most of the included studies came from North America, Western Europe, The Caribbean, India, Bangladesh, South Korea, and China; few studies came from Africa, Eastern Europe, Central Asia, the Middle East, Southeast Asia, the Pacific Islands, or South America. The 57 hotspots represented more than 8,000 children, mostly in countries that have child and adult mortality rates ranging from low to high child and very high adult mortality, as defined by the World Health Organization (WHO).11

A conference conducted by The George Foundation on 8th-10th February 1999 regarding lead poisoning highlighted the results of a major blood lead survey of Indian children. The study involved the collection of approximately 22,000 samples from children, pregnant women and

5 workers in the battery and paint industries. The results for children under 12 years based on just PbB (lead in blood) data indicated that PbB was greater than 10µg/dl for 51.4% of children in India.12

A cross sectional study was conducted on 2008 in Fort Wayna, Indiana. This study was conducted to determine the prevalence of elevated blood lead levels(BLLs) among children of Burmese Refugees and potential sources of lead exposure. A case was defined as an elevated venous BLL (≥10µg/dl), prevalence was compared with all Indiana children screened. Environmental and product samples were tested for lead. The results show 14 of 197 (7.1%) children had elevated BLLs (prevalence ratio 10.7), that ranged from 10.2-29.0µg/dl. Laboratory testing identified a traditional ethnic digestive remedy, Daw Tway, containing a median 520 ppm lead.13

A study conducted on Lead Poisoning: More than a Medical problem. Medical records of 236 Newark, New Jersey children hospitalized and chelated for lead poisoning in 1977 through 1980 were reviewed to determine the progress had been made in eradicating the disease since 1972. Results show that the number of treated asymptomatic children, ages 1-6 began to rise after 1976 and was higher in 1980 than in 1972 when the Newark Lead Poisoning Prevention and Control Program first began. The increase in numbers and rates indicates that childhood lead poisoning still exists as an environmental and social problem.14

A conference conducted by The George Foundation on 8th and 10th February 1999 regarding lead poisoning highlighted the results of a major blood lead survey of Indian Children. The study involved the collection of approximately 22,000 samples from children, pregnant women and workers in the battery and paint industries. The results for children under 12 years based on just PbB (lead in Blood) data indicated that PbB was greater than 10µg/dl for 52.4% of children in India.6

A Cross sectional study on Outbreak of fatal childhood lead poisoning was conducted in villages in Northwestern, Nigeria, in May 2010. The researchers surveyed 119 family compounds. Of 463 children less than 5 years of age, 118(25%) had died in the previous year.

6 They tested 59 %( 204/345) of children less than 5 years of age, among that 97% (198/204) of children had blood lead levels(BLLs) ≥45µg/dl. 15

A 32 item questionnaire was developed by Philadelphia Department of Public Health to assess knowledge and perceptions of family care givers of children younger than age 8. 80 family caregivers were interviewed. About 61% of the sample identified eating paint chips as a cause of lead poisoning, whereas only 15% identified lead paint dust as a source of lead poisoning. Approximately 49% of the caregivers reported that they “never” or only “sometimes” perform recommended prevention activities.16

A 24-question test regarding lead poisoning and its prevention (Chicago Lead Knowledge Test) was developed. It was self-administered by a sample of 2225 parents of 0 to 6 Year old children. A 1-way analysis of variance (ANOVA) was used to determine the association. The mean Chicago Lead Knowledge Test score was 12.2 (SD, 3.7).The researchers came to the conclusion that Parents do not have much knowledge of ways to prevent childhood lead poisoning. Information from a health care provider can aid parental knowledge of demographic descriptors with test scores.17

6.3 STATEMENT OF THE PROBLEM

A study to assess the effectiveness of self instructional module on knowledge regarding prevention of lead poisoning among mothers of children under six years of age in selected rural community area , Bengaluru.

6.4 OBJECTIVES OF THE STUDY:-

1. To assess the level of knowledge on lead poisoning among mothers of children under six years of age. 2. To develop self instructional module on prevention of lead poisoning in children 3. To assess the effectiveness of self instructional module by analyzing the pre test and post test knowledge score.

7 4. To determine the association between the pre test and post test knowledge score among mothers of Children under six years of age with selected demographic variables

6.5 OPERATIONAL DEFINITIONS:-

Effectiveness: - It refers to the gain in knowledge of mothers of children under six years of age regarding prevention of lead poisoning after providing self instructional module as measured by the instrument and evaluated by the post test knowledge scores.

Self Instructional Module: - It refers to the self contained instructional material that contain information on lead poisoning and its prevention which can be used by the mothers of children under six years of age for self learning .

Knowledge: - It refers to the level of understanding and awareness of mothers of children under six years of age regarding prevention of lead poisoning as measured by knowledge questionnaire.

Prevention: - It refers to the measures taken by the mothers of children under six years of age in avoiding the occurrence or minimizing the risk of lead poisoning.

Lead poisoning: - It is the presence of excessive level of lead in the body caused by ingestion, inhalation, or absorption of lead which will be harmful to the body.

Mothers : - Women aged between 20-45 years of age who have children under six years of age.

6.6 HYPOTHESIS :-

H1:- There will be significant increase in the knowledge scores of mothers of children under six years of age regarding prevention of lead poisoning after administering self instructional module

H2:- There will be significant association between the pretest and post test knowledge levels of mothers of children under six years of age with selected demographic variables.

8 6.7 ASSUMPTIONS:-

1) Mothers of children under six years of age may have inadequate knowledge regarding prevention of lead poisoning. 2) Self instructional module may have effectiveness in improving knowledge regarding Prevention of lead poisoning among mothers of children under six years of age.

6.8 DELIMITATION:-

The study is limited to the mothers aged between 20-45 years of age, who have children under six years of age in selected rural community area , Bengaluru.

6.9 VARIABLES:-

Dependent variable in the study is knowledge of mothers of children under six years of age regarding prevention of lead poisoning.

Independent variable in the study is self instructional module.

Attribute variable in the study are age, education, occupation, family income, religion, type of family, number of children, sources of information.

7. MATERIALS AND METHODS:-

7.1) Source of data : Data will be collected from mothers of children under six years of age in selected rural community area ,Bengaluru.

7.1. i) Research design : A pre experimental design of one group pretest post test design will be adopted to conduct the study.

9 7.1.ii) Research approach : An evaluative approach will be used in the study.

7.1. iii) Research setting : The study will be conducted in selected rural community area,Bengaluru.

7.1. iv) Population : Mothers aged between 20-45 years of age who have children under six years of age.

7.1. v) Sample size : 60 mothers of children under six years of age.

7.1.vi) Sampling technique : Non probability convenient sampling technique will be used.

7.1. vii) Sample criteria :

Inclusion criteria: The study includes

1) Mothers aged between 20-45 years of age. 2) Mothers who have children under six years of age. 3) Mothers of children under six years of age who are available during the data collection period.

Exclusion criteria: The study excludes

1)Mothers of children under six years of age who are not willing to participate in the study. 2)Mothers of children under six years of age who are unable to read and write English or Kannada.

7.2) Methods of data collection:

7.2. i) Tool for data collection : The data will be collected using Structured knowledge questionnaire. It consists of two sections:

Section A: Consists of demographic variables

10 Section B: Consists of questions on knowledge regarding lead poisoning and its prevention.

7.2. ii) Procedure for data collection : After obtaining oral consent from the participants, the investigator will collect the data from mothers by using self administered questionnaire, before and after providing self instructional module.

7.2.iii) Data Analysis Method :The data collected will be analyzed using descriptive statistics (mean, median, standard deviation) and inferential statistics (t-test, chi-square).

7.3) Does the study require any investigation to be conducted on the patient or other human beings or animals?

Yes, the study will be conducted among mothers of children under six years of age regarding prevention of lead poisoning.

7.4) Has the ethical clearance obtained from your institution?

Yes, ethical clearance is obtained from the institution.

11 8. REFERENCES :-

1) Utpal Kant Singh, Layland.F.C, Rajniti Prasad, Shivani Singh. Poisoning in Children. 3rd Edition. New Delhi.Jaypee Brothers Medical Publishers Pvt.Ltd[2006 Jan 1]:53- 56.Available from: http://books.google.co.in/books/about/Poisoning_in_Children.

2) http://www.idph.state.il.us/public.hb,nblead.htm. (Accessed on 20-11-2012)

3) Jared Wodley. Lead exposure decrease children’s hand eye coordination.University of Michigan-News service. Published on 30-04-2011. Available from. http://ns.umich.edu/new/releases/8524

4) www.afhh.org/hps/leaddocs/hps-lead-BLL-data-factsheet.htm. (Accessed on 22- 11-2012)

5) Gould.E. Childhood Lead Poisoning. Conservative Estimates of The Social and Economic Benefits of Lead Hazard Control. Environmental Health Perspectives. July. 117(7):1162- 1167.

6) http://www.tgfworld.org/lead.htm. (Accessed on 17-11-2012)

7) Dr.Venkatesh Thuppil.India Becoming Capital of Lead Poisoning .IBN Live. Express News Service. April 24, 2012.Available from: http://ibnlive.in.com/news/india-becoming- capital-of-lead-poisoning/251528-62-132.html.

8) Gupta Piyush. Essential Pediatric Nursing. 2nd ed. New Delhi: CBS Publishers and Distributers; 2006:349-350.

9) Chan T.Y. Childhood Poisoning-the scope of prevention. Veterinary and Human Toxicology. 1998 Dec. 40(6): 361-363.Available from: http://www.ncbi.nlm.nih.gov/pubmed/9830699.

10) Polit D.F, Beak C.T. Nursing Principles And Method. 7th edition. Wolters Kluwer pvt.Ltd. New Delhi.pg.88-89

12 11) Alison L.Clune, Henry Falk, Anne .M.Ricderer. Department of Environmental Health. Environ Health Perspect. 2009 July. 117(7): 1162-1167 12) Myke Van Alphen. Conference on Lead Poisoning in India, Bangalore. The George Foundation. February 1999. Available from:http://www.lead.org.au/lanv7n1/L71-2.html 13) Mathew D.Ritchey. Epidemic intelligence service. Centers for Disease Control And Prevention. Lead Poisoning Among Burmese Refugee Children, Indiana.SAGE Journals February1, 2012; 129: e392-e399. Available from: http://cpj.sagepub.com/content/50/7/648.abstract .

14)Foster J D, Louria D M, Stinson L. Influence of documented lead poisoning on Environmental modification programs in Newark, New Jersy. Arch Environ -Health 1979 Sep-Oct; 34(5): 368-71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/496435.

15) Carrie A Dooyema, Antonio Neri, Yi-Chan, Lo and et al. Outbreak of fatal childhood Lead poisoning related to artisanal gold mining in Northwestern Nigeria. Environmental Health Perspectives. 01-04-2012. 120(4):601-607. Available from: http://www.ncbi.nim.nih.gov/pmc/articles/pmc3339453 .

16)Irene Mahon R.N. Caregiver’s knowledge and perceptions of preventing childhood lead poisoning. PHN Public Health Nursing [5 May 2007]; 14(3): 169-182. Available from: http://onlinelibrary.wiley.com .

17)Mehta S, Binns H J. What do parents know about lead poisoning? The Chicago Lead Knowledge Test. Pediatric Practice Research Group. Arch Pediatr Adolesc Med.1998Dec; 152(12):1213.Available from: http://www.ncbi.nlm.nih.gov/pubmed/9856 .

13 1. SIGNATURE OF CANDIDATE :

2. REMARKS OF THE GUIDE :

3. NAME & DESIGNATION OF

3.1. GUIDE :

3.2. SIGNATURE :

3.3. CO-GUIDE (IF ANY) :

3.4. SIGNATURE :

3.5. HEAD OF THE DEPARTMENT :

3.6. SIGNATURE :

4.1. REMARKS OF THE PRINCIPAL :

4.2. SIGNATURE :