A Study to Determine the Effectiveness of Child to Child Programme on Knowledge and Practice

A STUDY TO DETERMINE THE EFFECTIVENESS OF CHILD TO CHILD PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING FOOD AND WATER BORNE DISEASES AMONG SCHOOL CHILDREN IN A SELECTED SCHOOL IN BANGALORE.

M.Sc. Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

Mr. BIBIN JOHN

M.Sc NURSING 1ST YEAR

2009-2011

Under the Guidance of

HOD, Department of community health nursing

National college of nursing

Hegganahalli Cross

Vishwaneedam Post

Magadi Road Bangalare RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA CURRICULAM DEVELOPMENT CELL

CONFORMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Registration number :

Name of the candidate : Mr. Bibin john Address : Gandhadakaval, Hegganahalli Cross, Vishwaneedam Post, Magadi Road, B,lore-91 . Name of the institution : National College of Nursing

Course of study and subject : M.Sc Nursing in Community Health Nursing. . Date of admission to course 15-09-2009

Title of the topic : A study to determine the effectiveness of child to child programme on knowledge and practice regarding food and water borne diseases among school children in selected schools at Bangalore. Brief resume of the intended work : Attached

Signature of the student :

Guide Name : . Remarks of the guide :

Signature of the guide :

Co-guide name :

Signature of co-guide :

HOD name :

Signature of HOD :

Principal Name : Principal Mobile No Principal E-mail ID :

RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES, KARNATAKA, BANGALORE ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE Mr. BIBIN JOHN AND ADDRESS 1st YEAR M.Sc NURSING NATIONAL COLLEGE OF NURSING,

BANGALORE 2 NAME OF THE INSTITUTION NATIONAL COLLEGE OF NURING GANDHADAKAVAL HEGGANAHALLI CROSS VISHWANEEDAM POST, MAGADI ROAD BANGALORE-91

3 COURSE OF THE STUDY AND M.Sc. NURSING SUBJECT (COMMUNITY HEALTH NURSING) 4 DATE OF ADMISSION TO COURSE 15.09.2009

5. TITLE OF THE STUDY

A STUDY TO DETERMINE THE EFFECTIVENESS OF CHILD TO

CHILD PROGRAMME ON KNOWLEDGE AND PRACTICE

REGARDING FOOD AND WATER BORNE DISEASES AMONG

SCHOOL CHILDREN IN A SELECTED SCHOOL IN

BANGALORE. 6.0 BRIEF RESUME OF THE INTENDED WORK

Food and water borne diseases are the

significant health risk in the developing countries as well as in the 3 rd world especially

among poor rural communities and the most vulnerable group age groups – the young and

the old .

Food and water borne diseases are largely caused by micro organisms present

in human or animal waste (feces) finding their way in to humans via the mouth

(orally).This may happen through drinking or using contaminated water supply (water

borne diseases),but more often fecal oral diseases are spread through other routes such as

via hands,clothes,food or materials used for cooking ,eating or drinking. These disease

are infections, which means that they can spread from one person to another. High

standards of hygiene and sanitation are needed to stop the spreading of disease. There is a

saying that, infectious disease will last as long as humanity exists 1

In India almost 74% of people live in rural

areas. It is observed that because of illiteracy,ignorance,misconception and superstition

people of rural areas have developed undesirable health attitudes and practices. About 30-

50% of rural school children suffer from many morbidities like worminfestations,diarrheal

diseases, under nutrition etc,but unless there is genuine understanding about how the

disease is caused and carried, communicable disease is likely to continue because people

are not in born with hygiene knowledge. 2 Healthy child is nations pride ,hence by curtailing the

occurrence of these infectious disease of childhood, we can build up a better

generation. According to who diarrheal disease caused more than 1.7 million death in

2004 and 90% of these occurred among children. Almost 88% of the diarrheal diseases are

attributes to unsafe water supply ,inadequate sanitation and hygiene. This preventable

disease of childhood can cause a unique challenge to health care system of the country. 3

Child to child is an educational approach for

helping children to helping children to help themselves and other children to improve

health and social conditions of themselves, their families and the community.Primary

school children are more open minded and are likely to be receptive to changes in ideas

and agreeable to new information. 4

NEED FOR STUDY 6.1

According to who reports 2005, food and water borne diseases are

one of the major causes of childhood mortality and morbidity in develoloping countries.

Central bureau of health intelligence (CBHI) 2002 report shows that among all reported

communicable diseases 29% shared by diarrheal diseases. Data collected by the CBHI

ministry of health and family welfare, shows that in 2003,there were 10.5 million cases of

diarrhoea with 4079 deaths ,in the same year there were 2893 cholera cases. India belongs

to high endemic country of enteric fever , there were total 535665 enteric fever cases in

2004.Recent surveillance studies from India have shown that the incidence rate of enteric

Fever may peak as early as 1-5 years of age. It is a national embarrassment that after Nigeria, India contributes second largest number of polio cases in the world. In 2004 there were 136 and 1267 wild polio cases in India and whole world respectively. 5

Food and water borne diseases in children are widely

prevalent in many developing countries especially in tropical and subtropical regions.

Young children are especially at risk because of their hand to mouth activity and

uncontrollable fecalhabits and are more likely to suffer from its pathological consequences.

WHO and world bank estimated that around 5 lakh

populations in India die due to diarrhea. Community level study conducted jointly by

WHO and UNICEF ,which was published in planning commissions. India assessment report 2002,shows that every child below 5 years of age has 2 -3 episodes of diarrhea every year. It means many hundred million cases of diarrhea occur every year and only a small l percentage of diarrheal diseases are reported. According to witttel programme for

appropriate technology in health (PATH) estimated 1,25,000 Indian children die each

year from rotavirus diarrhoea.According to the planning commission report (2005) “to

advocate the development of water supply and sanitation infrastructure and increased

efficiency within the sector ,health authorities will need to improve their information

base. “This can be achieved by linking disease surveillance with environmental

surveillance programmes by strengthening research capacities on epidemiology of water

related diseases and economic analyses, and by improving information management and

communications capabilities holds and nations economy as well . 6

Each episodes of diarrhea costs households level economic loss

includes cost of treatment, wage loss during sickness period. Loss of working days affects the productivity of the nation. On the other hand, spends on treatment government spends

on treatment of sick and providing other supportive services, which incurred huge

expenditure. According to government of India, these all adds up to rs 6700 crore

annually(i.e approximately rs 60 per head per year).

Health education to school children in their

formative ageis the most effective method for protection and promotion of their health.

Healtheducation in school children can be carried out in different ways and settings.

Approaching every individual in the rural area is Herculean task with poor sustainability.

Mass media and other teaching methods have their limitations. Under these circumstances

child- to –child programme offers most cost effective strategy to approach the communities and families. Through this method it is possible to improve the health and

nutrition awareness of the people ,change their attitude and help them to implement basic

health principles in practice. 7

Innovative approaches to education for health are essential to gain the

interest,support,involvement and commitment of students. The communication of health

messages is a central component of the child to child programme.This communication

occurs largely between groups where the message is transferred from a group of children

to group of respondents. This method is less stressful and more effective approach of

health education.Richard lansdown,in his article on child to child programme reported

thatchild is an approach to health education which encourages children to care for

themselves, younger children and members of their education and to work together to

improve their education and health care .

The recent studies and statistics throws the light that water borne diseases is an important problem in this contemporary epoch and more childrens are affected

with this diseases.This is mainly due to unhealthy environment and poor knowledge

among the parents and health workers regarding the disease condition.So it is evident that

children’s especially are vulnerable to this disease condition and through teaching

programme the mortality and morbidity rate can be controlled and prevented to a great

extent. So the investigator is very much interested in doing this topic.

REVIEW OF LITERATURE

6.2 INTRODUCTION

Review of literature is a key step in the research process. The typical purpose

of analyzing a review of existing literature is to generate questions and to identify what is

known and what is unknown about the topic. The major goals of review of literature are to

develop a strong knowledge base to carry out research and non research scholalarly

activity.

The review has been divided under the following headings:

(a)Studies related to food and water borne diseases

(b) Studies related to effectiveness of school health programme.

(c) Studies related to child-to-child programme STUDIES RELATED TO FOOD AND WATER BORNE DISEASES

A study was conducted on diarrhoeal prevention in high schools

through the use of safe water and hygiene intervention Teachers taught students about

safe water and hygiene safe water storage vessels were placed between classrooms. Two

large water tanks for hand washing were positioned by the kitchen and latrines. The

vessels were filled daily with water, which was treated with bleach and monitored.

Clinicvisits for diarrhoea peaked during January through march in 2004 ,at 130 and in

2005 72, but in 2006,after the project implantation only 15 diarrhoeal episodes were

recorded. The project saved the school about 549 dollars per student per year.8

A study was conducted to identify the incidence and some environmental and behavioral of water borne diseases. The survey conducted among 6285 persons living in 1090 households .The incidence of diarrhoea was higher among under five children of age (60.2/1000) than among adults .Dysentery was present in

13.1% of cases. Water was stored in open buckets kept on the floor without a paddle to draw it in 70.5% of the house holds 68.9% adults were using public latrines. And 22.9% defecated in open fields. Only 20.8% of children used latrines. Hand washing after defecation was practiced by 96.2% while 76.5% washed their hands before meals.

Although this survey documented substantial improvement in sources of water supply and hand washing practices, the unsafe house hold storage of water and defecation by children in fields and drains remain problematic. 9 A study was conducted to know the hand washing behaviors

Of adolescent students in seven selected schools in turkey. According to self reported

behaviors and attitudes, soap and water were used in 99.2% of hand washes. The average

duration of soap washes was 41.8+-39.1 sec.Overall 42.4%of adolescents had proper

basichand wash in multivariate analysis female sex,living at home ,high knowledge level

andschool were associated with high basic hand wash. In addition to this the presence of

some complaints about toilets in school affected proper basic hand wash. The results

showedthat adolescent have limited knowledge about indications of hand washing and

someproblems advising influenced hand washing .The study recommended that in order

to increase compliance ,problems should be solved and lessons about hand washing and

communicable diseases should be given.10

A study was conducted on food safety knowledge

.perceptions and behaviors among middle school students in Pennsylvania in 2006. The samples consist of 178 seventh and eighth grade students from 4 schools in central

Pennsylvania .base line questionnaire administered in class that assessed the background characterstics,knowledge,behaviour,and perceptions related to food safety. Independent samples t test tested differences between genders in bivariate correlation analysis explored associations among knowledge,behaviour,and perceptions(p<0.05).food safety knowledge was 7.2+-1.6 of a maximum 10 points perceived self efficacy of a foot borne illness were high, but perceived susceptibility was low. Girls scored higher on the self efficacy and severity scale (p<0.01) and severity with knowledge (p<0.01) one fifth reported taking risks in food handling and one fifth reported having been sick because of something they ate .the results showed that there is a disconnection between middle school students food safety knowledge.11

STUDIES RELATED TO SCHOOL HEALTH PROGRAME

A study Was conducted to know the effectiveness of hand washing program

on absenteeism in elementary schools in 2004.among 290 selected students from 5 schools

each test classroom had an alcohol based hand gel and received an educational programme.data on absenteeism was collected for 3months .the result showed that the number of absenteeism was 50% lower in the test group than the control group. 12

A study was conducted on a cluster randomized controlled trial evaluating the effect of hand washing promotion programme in china in 2007.87 schools were selected randomly to usual practices, slandered intervention. in control schools, children experienced a median 2 episodes of absence per 100 students per week. in standard intervention schools ,there were a median 1.2 episodes (p=0.08) and 1.9 days (p=0.14) of absence per 100 students weeks. Children in expanded intervention school experienced a medium 1.2 episodes (p=0.08) and 1.9 days (p=0.14) of absence per 100 students per week.

Children in expanded intervention schools experienced a medium 1.2 episodes (p=0.003) of absence per student weeks. The results showed that provision of a large scale hand washing programme and soap was associated with significantly reduced absenteeism.13

STUDIES RELATED TO CHILD TO CHILD PROGRAMME

A study was conducted to evaluate the effectiveness of child to childprogramme on knowledge regarding sex and sex related issues in a selected school

in Bhopal in2006.the research approach selected was evaluative. The sampling technique was purposive and sample size was 10 change agents and peer groups. The tool comprised of structured questionnaire. The pre test knowledge scores range between 29.2

% to 43.3 % and post test knowledge scoresrange between 65.3 % to 88.4 %.the gain in knowledge scores range between 25.6% to 4.5 %.theresult showed that the post test knowledge was greater than the pre test knowledge in every section

of child to child programme. 14

A study was conducted to evaluate the effectiveness of child to childprogrammein rural Jamaica in 2004 about the concept of environmental and personnel hygiene. A childprogramme was carried out in fourth and fifth grade students of six rural schools.423 students and 90mothers and guardians from four of the project school were evaluated and compared with 199 children and 47 parents from 2 control schools. The project children showed higher knowledge in the topic at the end of the year. They also improved their practices at home.15

A study was conducted to assess the impact of child to child programme on knowledge,attitude,practice regarding diarrhea among rural school children in Belgaum district in Karnataka .The subjects included sixth grade students of primary schools. The study group and the sixth grade students as control group pre tested pre designed

questionnaire was administered to study as the Control group students to know their

knowledge, attitude and practice prior to starting of the programme.Once a week one hour

child to child session were conducted for the study group students. The result of the study

showed that child to child programme had made a significant improvement in the

knowledge, change in attitude and practice of the study group students after the

intervention when compared to control group students. 2

STATEMENT OF PROBLEM: “A study to determine the effectiveness of child to child

programme on knowledge and practice regarding food and water borne diseases

among school children in a selected school at Bangalore”.

OBJECTIVES OF THE STUDY

The objectives of the study are:

 To assess the existing knowledge of school children regarding food and water borne diseases. 6.4

 To asses the practices of . school children regarding prevention and management of

food and water borne diseases.

 To compare the knowledge and practice of school children regarding food and

water borne diseases.

 To evaluate the effect of child to child programme on knowledge and practice

regarding food and water borne diseases. .

 To associate the knowledge and practice with selected demographic variables such

as age,religion,education of the parents, type of family, area of residence.

HYPOTHESIS

The hypothesis will be tested at 0.05 level of significance.

 H 1: There will be significant difference in the pre test and post test knowledge

scores of school children receiving child to child programme.  H 2: There will be significant correlation between knowledgw and practice of 6.5 school childrens regarding food and water borne diseases.

 H 3: There will be significant association between knowledge of school children

and selected demographic variables such as age,religion,education.

Of the parents, type of family, area of residence.

OPERATIONAL DEFINITIONS:

DETERMINE  In this study it refers to firmly decide on the effect of child to child programme

on water borne diseases as measured by the semi –structured questionnaire and

expressed as the post test scores of the experimental group

EFFECTIVENESS  In this study it refers to producing the desired or intended result of child to child

programme on water borne diseases as measured by the instrument and shown by

the post test scores of the experimental group.

CHILD TO CHILD PROGRAMME It is a programme through which the children (6 -12 years)

learnsabouthealthinactiveandmeaningfulways,throughgames,stories,songs,dramas,puppets,

folk dances and role plays.and through this programme the child will be able to pass

messages to other siblings,parents,neighours thereby effectively improving health status of the community.

KNOWLEDGE

 In this study it refers to the correct responses of the children to the knowledge part of the questionnaire of the interview schedule and expressed as knowledge scores

PRACTICES

 It refers to responses of children to a practice questionnaires regarding activities performed by them for prevention and management of food and water borne diseases.

SCHOOL CHILDREN

Those children between 10-11 years of age,studying in 4 th standard of a selected rural school.

FOOD AND WATER BORNE DISEASES

The diseases which are transmitted through food source and water sources

(Typhoid,Hepatitis A ,Polio,Diarrhoeal diseases,Worm infestations,Cholera,dysentery and food poisioning)

ASSUMPTIONS

 Adequate information about food and water borne diseases can be provided

through child to child programme.

 Knowledge level will be improved.

 They will follow preventive measures 6.7 DELIMITATIONS:

The study is delimited :

 Children who are willing to participate in the study.

 who knows kannada or English.

 children of the age group 10-11 years. .

6.8 PROJECTED OUTCOME:  The present study will help the school children to understand about the

causes, prevention and management of food and water borne diseases.

MATERIALS AND METHODS

SOURCE OF DATA

6.9  The data will be collected from rural school children who are studying in 4 th grade.

7.0 RESEARCH DESIGN

7.1  The research design adopted for this study is pre experimental study. One group pre

test and post test control group.

RESEARCH APPROACH

 The research approach is evaluative. SETTING: 7.1.1  The study will be conducted in S.V Sunrise school Bangalore .

POPULATION

 The population selected are school children who are studying in 4 th grade.

METHOD OF DATA COLLECTION

7.1.3 SAMPLING PROCEDURE

 The Sampling Technique adopted for this study is purposive.

SAMPLE SIZE 7.2  The sample size is 60. 7.2.1 INCLUSION CRITERIA

The criteria for sample selection are mothers of under five who

 Students of 4 th grade both boys and girls.

 willing to participate in the study 7.2.2  students who are present on the day data collection.

7.2.3 EXCLUSION CRITERIA

 Children who are studying in other grades.

 Students who are sick on the day of data collllection.

7.2.4 INSTRUMENT INTENDED TO BE USED

SELECTION OF TOOL

This consist of three parts :

PART 1 :consist of demographic variables such as age,religion,education of the parents,

7.2.5 type of family, area of residence.

PART 2:Questionnaire will be used to assess the knowledge.25 Questions will be used.

PART 3: Questionnaire will be used to assess the practice.25 Questions will be used

SCORING PROCEDURE

For knowledge and practice assessment

For Answers. If answer is yes 1

If answer is no 0 SCORING INTERPRETATION

Good :- 75-100% Average :- 50-75% Poor :- Below 50% HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

YES, Ethical clearance will be been obtained from the research committee of National college of nursing.

Consent will be taken from the hospital and permission will be taken from the study subjects before the collection of data. 7.4

LIST OF REFERENCES

1. Blackburn, B.G,Craun, G.F,Yoder J.S .”survillence of water borne disesease”.the

American journal;2004 july 17(46):58.

2. walvekar p.r,naik v.a,wantamutte a.s.”impact of child to child programme on knowledge,attitude and practice regarding diarrhoea among rural school children”.the 8.0 Indian journal of public health;2006 february 31(2):45

3. World Health Organisation ”life in 21st century, a vision for all”;2004.

4 . dongre a.r,desmukh p.r,thaware.p “the impact of school health programme on personel

hygiene”.the Indian journal of community medicine;2006.31 (1):81-82.

5. world health organization “hygiene in food services and masss catering

establishments”;2005.

6. world health organization “guidelines for cholera control”;2003.

7. richard.l “dialogue on diarrhoea”.indian journal of nursing;2004,60:2-3.

8. miggele.j,ombeki.s,ayalo”diarrhoeal prevention in schools through the use of safe water

And hygiene intervention”the American journal of tropical medicine;2003 march 76

(6):1166-1173.

9. lal.p,bansal a.k “incidence of diarrhoea and rin s.s,elated environmental factors”the

Indian journal on public health;2001.29 (2):71-72.

10.yelein s.s , altin.s “hand washing and adolescents”.the American journal of tropical

medicine and hygiene;2001. 70 (5):997-999. 11. happala.i,probart.c “food and safety knowledge”the journal of nutrition education and

behavior,;2004,36 (2):71-76.

12.gninam, et al “the effect of a comprehensive hand washing programme on absenteesm

in elementary schools”the American journal of infection contro;2002,30:217-220.

13.bowen.a long.t “the effect of hand washing promotion programmes in primary

schools”the who bulletin ;2004,,66:627-636.

14.thaneja .r “use of ctc to evaluate knowledge regarding sex education in selected

schools”.the Indian journal of holistic nursing 2006 14(2):12-14.

15.jennifer knight,grantham “the effectiveness of ctc programme”the American journal of

Pediatrics;2002,6:66-68.