Rajivgandhi University of the Health Sciences, Karnataka

RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES, KARNATAKA. BANGALORE

PROFORMA FOR REGISTRTION OF SUBJECT FOR DESSERTATION

01 NAME OF THE CANDIDATE AND MS.LAKSHMIDEVI.B ADDRESS Ist YEAR M.ScNURSING RAJEEV COLLEGE OF NURSING HASSAN.

02 NAME OF THE INSTITUTION RAJEEV COLLEGE OF NURSING . KR PURAM, HASSAN

03 COURSE OF THE STUDY AND M.Sc NURSING IstYEAR SUBJECT CHILD HEALTH NURSING

04 DATE OF ADDMISSION TO MAY 15TH 2007 COURSE

05 TITLE OF THE STUDY EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON PREVENTION OF GASTROENTERITIS

06 STATEMENT OF THE PROBLEM A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME TO MOTHERS OF UNDERFIVE CHILDRENS ON KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF GASTROENTIRITIS IN SELECTED SLUM AREA AT HASSAN 6. BREIF RESUME OF INTEDED WORK

6. INTTRODUCTION:

“THIS THE MIND THAT MAKES THE BODY RICH”1

Children are vulnerable group of society. Mothers are here on earth to take care of the children . over the past decades, peadiatric acute gastroentiritis has been the study of considerable world wide attention and effort. Gastroenteritis means inflammation of the lining of the stomach and intestainal mucosa. Rotavirus is the most common cause of severe gastroenteritis in young children world wide. Rotavirus has been long been recognized as a leading cause of acute diarrheal disease in young children throughout both the developed and developing world. The debilitating nature of rotavirus is reflected in that an estimated one- third of all diarrheal pediatric hospital admissions globally can be attributed to this viral agent. The actual number of rotavirus infection with associated diarrhea is probably much greater because severity appears diminished resulting from immunologic tolerance evolving from repeat exposures.2

Rotavirus infection is generally characterized by vomiting, fever and watery diarrhea with incubation ranging from 24to 72hrs. severe debilitating diarrheal disease and associated fatalities are frequently attributed to this enteric viral pathogens. Particularly in developing countries. Where young children are often already immunologically compromised, example poor nutritional status, person to person transmission is principally via fecal oral contamination and exposure while seasonality implicating colder month has been recognized in more temperature climates occurrence in tropical regions is year round. This investigation promoted by anecdotal diarrheal outbreak reports Kupang, West timor, Indonasia was designed to provide recognition of evidence of epidemic occurrence via trend analysis, associated etiology, affected population and community impact and determinants contribution to transmission.3

Bacterial gastroenteritis is a leading cause of morbidity and mortality world wide. Epidemiologic investigations indicate that in less than 36% of cases where diarrhea appears to be an infectious etiology ,no agent can be recovered . This suggest that there is still a number of new bacterial and viral enter pathogens yet to be discovered or proven to be causes of gastroenteritis . This review shows that the present information in medical literature for a number gram negative bacterial belonging to five separate families implicated as causes of infectious gastroenteritis .4

A study conducted on costs of community –acquired pediatric rotavirus gastroenteritis in seven European countries , a prospective epidemiologic study of acute gastroenteritis in children less than 5 years of age in selected areas of Belgium, France, German, Italy, Spain, Sweden and the united kingdom we calculated the average cost per episode of confirmed rotavirus gastroenteritis in primary care, emergency department and hospital settings. The result shows that total society cost (including direct medical, direct non-medical and indirect cost ) Per episode of gastroenteritis ranged from 166 euros to 473 euros in primary care setting, from 334 euros to 770 euros in emergency setting, from 1525 euros to 2101 euros hospital setting. The study conclude that rotavirus gastroenteritis in cure considerable resource utilization all healthcare setting and substantial cost for national health care payers families of patients and employers. Routine rotavirus prevention in children could be significantly reduce the health and economic burden of pediatric rotavirus gastroenteritis.5

A study was conducted on incidence impact on the family and cost of Gastroentritis among 3-5 years old children in South Austrlia(2006). This study shows that the incidence of community Gastroenteritis among 3-5 year children was 5.53 episodes per child year .This conclude that the incidence of community Gastroenteritis among 3-5 year children in South population high and need to beprevention of Gastrenteritis through improve the mothers knowledge and practice.6 A study conducted Acute gastroenteritis: does mother's knowledge of the disease reduce admission of children under two years of age(2004). shows that There was statistical association between patient admission with acute diarrhea and poor social-economic conditions (p = 0.01);a study conclude that study disclosed association between admission of children under two years of age with gastroenteritis and poor social-economic conditions.7

6.2 NEED FOR THE STUDY :

.Worldwide approximately 500 million children are suffers which gastroenteritis each year and 20% of all deaths of children are due to gastroentiritis in rural area.8

A study conducted on Burden of disease and molecular epidemiology of group A rotavirus infections(2007) in India. Rotavirus is the major cause of severe dehydrating diarrhea in young children worldwide.Considerable research has been carried out on rotavirus disease in India. This review collated data from 46 epidemiological studies to determine rotavirus positivity rates and genotypes of infecting rotavirus strains from various settings in India.Studies on diarrhea presenting to hospitals, neonatal rotavirus infections, symptomatic and a symptomatic infections in the community and nosocomial enteric infections were included. Rotavirus positivity rates varied greatly between different settings - diarrhoea hospitalizations (20%), neonatal infections (35%), symptomatic and asymptomatic infections in the community (15.1% and 6.3% respectively) and nosocomial enteric infections (22.5%).9 A study conducted on gastroenteritis hospitalization in Newzeland children under 3 years of age (2006). . The aim of the study is to describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalization rates of this illness in this Newzeland children under 3 years of age. Methods are children under 3 years of age with acute diarrhea admitted to 1of 8 study hospital between one may 1998 and 30 April 2000 were surveyed. This study shows that estimated national hospitalization rate for Rotavirus in children under 3 years of age 634per 100000 in Newzeland rotavirus result in 1 in 52 children being hospitalized by 3 years of age. This study conclude that rotavirus gastroenteritis is an important preventable cause of hospitalization in Newzeland children.10

A study was conducted on peadric burden of Gastroenteritis diseases in Europe (2006).This sudy shows that burden of Gastroenteritis diseases in < 5 years old childen Europe .An estimated 7200-7700 hospitalizatin for community acquried Rotavirus disease occurred in annually 23 million under five living in Europe .The study concluded that concludes that to evaluate the impact and effectiveness of rotavirus gastroenteritis prevention programme in Europe, additional epidemiological studies will be critical desirable.11

A study was conducted on incidence ofGastroenteritis of among young Indian children(2004).Gastroenteritis climing over 3million young lives in the world every year , is the second biggest killer of children in developing countries using data 1300 children in rural India under the age of 3 years.12

Rotavirus is the most important cause of severe life threatiatening Gastroenterits (2003) in India. children accounting for 20%-70% of hospitalization of children world wide in India incidence of Rotavirus Gastroenteritis from 5%-70% . Early diagnosis is essential for effective treatment and is aprerequsite for the prevention and control of potential out break .the aim of study was to determine the incidence of rotovirus infection in children below five years.13

A study was conducted on prospective evaluation of community acquired gastroenteritis in pediatric impact and disease burden of rotavirus infection(2001). shows that the incidence of community acquired gastroenteritis was4.67 per 100 children per year and of rotavirus positive gastroenteritis 1.33 per 100 children per year . Study conclude that rotavirus is a relevant cause community acquired gastroenteritis in children aged 4 years and younger treated by pediatrician. The data can be used as basis for developing strategies to prevent infection.14 . A study conducted on prevelance of rotavirus dirrhoea among hospitalised children (1999) in pune India. Shows that in developing countries, gastroenteritis leads to an estimaed 600,000 to 870,00deaths each year , acccounting for 20-25%of all deaths due to diarrhoea and 6% of alldeaths among children under5 year of age 2.Iin India 20-30% hospitalised cases of dirrhoea are due to rotovirus . This study reports the prevelance of Rotovirus gastroentiritis among hospitalised childrens and its association with risk factors such as age ,sex and seasonlity on the rotavirus diarrhoea have been reported.15

A study conducted on rotovirus gastroentiritis impact on young children,their families and the health care system(1997)in Sydney. The study design is cross-sectional descriptive survey setting is new children’s hospital ( Royal Alexander hospital for children ) Sydney, new south wales, 15th July to 4th October 1996. Participants children age under 3 year attending the emergency department with acute diarrhea as the presenting symptom (1997). This study results that 188 children with confirmed rotovirus infection 78% were aged 7-24 months and 82% visited atleast one other health care worker ,usually a general practioner. Sevenity (37%of 188)were admitted to hospital 33 of these (47%) were aged 13-24 months. This study reveals that rotovirus gastroentiritis has significant impact on young children,their families and the health care system. Prevention of severe disease through improve the level 16 of knowledge and practice of mothers.

Area there is a lack of health education and knowledge awareness among mothers of under five children.Investigator during the posting found that may mothers are admitted their children to hospital with gastroenteritis . So investigator felt that if the mothers understood about gastroenteritis and its prevention it may reduce incidence rate, reducing complication and mortality rate among under five children and also it may increase the knowledge and practice toward the prevention among mothers. Hence the investigator felt the need to prepare structured teaching programme to educative the knowledge of mothers regarding gastroenteritis and its prevention.

6.3 STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME TO MOTHERS OF UNDERFIVE CHILDREN ON KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF GASTROENTIRITIS IN SELECTED AREAS AT HASSAN

6.4 OBJECTIVE : 1. To Assess the level of knowledge and practice of mother on prevention of gastroenteritis before giving structured teaching programme.

2.To Evaluate the level of knowledge and practice of mother on prevention of gastroenteritis after giving structured teaching programme

3.To compare the pre and post test knowledge score of mothers of under five children

4.To Associate the post test level of knowledge and practice of mothers of under five children on prevention of Gastroenteritis with selected demographic variables.

6.5 HYPOTHESIS:

There will be a significant difference between pre test and post test knowledge score and practice score of mothers of under five children on prevention of gastroenteritis.

6.6 ASSUMPTIONS:

1.Mothers of under five children knowledge will influence the prevention of gastroenteritis

2. Structured teaching programme will improve the knowledge and practice of mothers of under five children on prevention of gastroenteritis.

6.7 OPERATIONAL DEFINITION

1.ASSESS:

It is a statically measure on knowledge and practice on prevention of gastroenteritis among mothers of under five children

2.EFFECTIVENESS:

It is defined as significant increase in level of knowledge and practice of mothers of under five children which is measured from the responses of pretest and post test after the planned teaching programme.

3. PLANNED TEACHING PROGRAMME : It is systematically prepared teaching programme for mothers about the definition , causes, & prevention of gastroenteritis 4. KNOWLEDGE Ability to recall the instruction given in the planned teaching programme and respond towards questionnaires.

5. PRACTICE: It is activity towards the mothers of under five children of prevention of gastroenteritis.

6. GASTROENTERITIS : Gastroenteritis means inflammation of the lining of stomach and intestine

7. UNDERFIVE CHILDRENS : The children age group between 0-5 years

8.SLUM AREA MOTHERS: A Group of mothers living in slum area

6.8 CRITERIA FOR SELECTION OF SAMPLES :

1.INCLUSIVE CRITERIA:

1.Mothers of under five children age between 1-5 years

2.Who are willing to participate

3..Mothers of under five children living in penshanmola area.

2.EXCLUSIVE CRITERIA:

1.Mothers who are not having underfive children.

2.Mothers who are not willing to participate

3.Mothers who are not residing in penshanmola village at Hassan.

4.Mothers who are not available during the collection of data

6.9 DELIMITATIONS OF STUDY : 1.Study limited only to penshanmola mothers of under five children’s living in slum area.

2 Study limited to 4-6 weeks of duration

3.Sample size limited to 60

4Study design limited to pre experimental study

6.10SIGNIFICANCE OF THE STUDY:

This explores the knowledge through Structured teaching programme on gastroenteritis in future according to their living condition

6.11 CONCEPTUAL FRAME WORK :Wedenberg Theory

6.12 REVIEW OF LITERATURE:

Literature review is a standard requisition of scientific research. It means reading and writing the pertinent information of the attempt in research topic to understand better about the proposed topic. It also supports and explains why the proposed topics taken for research and avoid unnecessary duplication, explore the feasibility and illuminate way to new research.17

A study conducted on Economic and health burden of rotavirus gastroenteritis for 2003 birth cohort in Latin American & carbben countries (2007).An economic model was constructed using epidemiological data from published articles, national health administration studies and country specific cost estimates. The model estimated the rotavirus outcomes for the 2003 birth cohort during first 5 years of life.This study shows that estimated that gastroenteritis would result in an average of 246 output visits 24 hospitalization ,0.6 deaths .this study conclude that rotavirus gastroenteritis is likely to the result in substantial diseases .18

A study conducted on epidemiology and characterization of rotavirus gastroenteritis in Malaysia (2006). . the aim of study was tom determine the proportion of hospitalization for diarrhea attributable to rotavirus among children under five years of age and to estimate the disease burden of rotavirus diarrhea Malaysia.a cross sectional study conducted on children 0-59 months of age admitted for acute gastroenteritis Kuala Lumpur hospital or Hospital Umum Sarwak were surveyed. The study shows the highest rate of rotavirus associated diarrhea was among children age 6-17 months accounting for 55% of rotavirus. This study conclude that rotavirus was responsible for 38% of hospitalization for gastroenteritis it was most common in 6-17 months.19 Consumption of untreated tank rain water and gastroenteritis among young children (2006)in South Australia. A cohort study of 10164 to 6 years old children who drank rain water or treated mains water in rural South Australia was under taken in 1999. This study result that the incidence of gastroenteritis among children 3.8 – 5.3 episodes per child year. But most episodes (60%) lasted just one day. No increase in odds of gastroenteritis was observed among children who drank rain water compared with treated mains water. The adjusted odd ratio for gastroenteritis associated with rain water consumption compared with the mains consumption was 0.84 (95% confidence interval 0.63 – 1.13). This study conclude that gastroenteritis was found to be significant cause of morbidity among young children. Young children who work regular consumers of tank rain water, were at no greater odds of gastroenteritis than those who drank treated public mains water. 20

A study conducted on Gastroenterits prevention through food safety education in Gujarath India(2004).This study shows that Improvement in the practice of hand-washing and avoidance of feeding leftovers to children was seen. There was reduction in the microbial load in the hand rinse samples of both mothers and children. This study conclude that effective change agents and food safety education was successful in bringing about a positive behavior modification in mothers.21

A study conducted on Maternal knowledge ,attitude and practices towasds Diarrhea in rural Maharastra ,India (2001). The method is 75 mothers of under 5 children participated in this study. They were interviewed by an interviewer using pre-designed and pre-tested questionnaire. This study shows that nearly half of the mothers were not practicing adequate hand washing.this study conclude that the maternal knowledge towards the dirrhea was inadequate in the population studied and there was actual and desired practices.22.

A study conducted knowledge and practice of mother about infants gastroenteritis episodes in Soudhi Arbia (2000). . This study subject included 300 million (150 from sulaimanira pediatric hospital and 150 from maternal child hospital) with diarrheal episodes during the study period selected by systematic random sampling. Data was collected via a structured open ended poilet tested modified questionnaire filled in trained Arabic speaking research assistants who interviewed mothers about diarrheal aspects of their infants, assessed their knowledge and practice concerning diarrheal disease in children as well as collecting the necessary sociodemographicaL character tics of the mothers and infants themselves. This study shows that mothers knowledge about many aspects of gastroenteritis was grossly deficient but tends to increase with increasing age, education level, and birth order. Mothers practices were better but still deficient and sources of information about gastroenteritis was mostly from non health professionals. This study concludes that intervention strategies to control under five gastroenteritis episodes needs to be through an integrated approach aiming at boosting mothers knowledge and improving their concerning gastroenteritis.23 . .

A study conducted on Maternal knowledge on risk behavioral practices and it's association with diarrhea in a rural community of West Bengal, India (1998). This study shows that Risk of gastroenteritis amongst children of mothers having risk practice without knowledge as compared to those who utilized their knowledge to avoid risk practice was found significantly higher (p < or = 0.005) except for bottle feeding (p = 0.330). The results of this study indicate that children can be protected significantly from gastroenteritis if mothers' gastroenteritis behaviors can be altered through educational intervention.24

7. MATERIALS AND METHODS OF STUDY:

7.1 SOURCE OF DATA: The data will be collected from the mothers of under five children aged between 0-5 years.

7.2RESEARCH DESIGN: A Pre experimental research design with pre test and post test with Which includes manipulation .

Pretest Interventions Post test

GROUP Mothersof underfive O1 X O2 children at selected area in Hassan

keywords

O1 -Pretest on knowledge and practice of prevention of gastroenteritis among mothers.  - Planned Intervention [Structured teaching programme] on knowledge and practice of prevention of gastroenteritis among mothers. . O2 - Posttest on knowledge and practice of prevention of gastroenteritis among mothers.

7.2 METHOD OF DATA COLLECTION:

Data will be collected with Structured Interview Schedule.

The Structured Interview Schedule consists of three parts.

Section A: Semi Structured Questionnaire seeks information about Demographic Data. Section B: Structured Questionnaire seeks information about mothers knowledge of prevention of gastroenteritis in children Section C: Structured Questionnaire seeks information about mothers of gastroenteritis in children.

SAMPLING PROCEDURE:

Population: All mothers of penshanmola.

Sample: Mothers of underfive children in. penshanmola.

Sample size: Sample comprises to 60 mothers of underfive children.

Sample technique: Non-Probability convenient sampling is felt to be suitable for the study

Setting: The study will be conducted in slum area penshanmola at Hassan.

Pilot study: Pilot study is planned with the 10% of population

8. VARIABLES:

8.1 Independent variable : planned teaching programme on Prevention of gastroenteritis.

8.2 Dependent variable: knowledge and practice of prevention of gastroenteritis among mothers of under five children .

9. ETHICAL CONSIDERATION:

1. Does the study require any intervention to be conducted on mothers of underfive children? Yes 2. Has ethical clearance being obtained from your institution? Yes

3. Has consent taken from primary health center authorities Yes

10. LIST OF REFERENCES:

1. WWW.Google.co.in 2. Albert MJ, Sonearto V,Bishop RF,Epideomilogy of rotavirus diarrhea in Yogyakarta, Indonasia, as revealed by electrophoresis of genome RNA. J Clin Microbiol 16:731-733. Barnes GL, Uren E, et.al.etiology acute gastroenteritis in hospitalized children in Melbourne ,Australia .J Clin Microbiol.1998 36:133-138. 3.Parashar UD, Bresee JS, Gentsch JR, et.al. Rotavirus emergency infect Dis. 1998 4:561-570 4. Ref, Janda J Michael ,Abbolt, Sharon L.Reviews in Medical Microbiology. Jan 2006 ;17(1):27-37. 5.Giaquinto C, Van Damme P et.al. cost of community acquired pediatric rotavirus gastroenteritis in 7 european countries. J Infect Dis.2007 May;195 Suppl 1;536-544 6. Heyworth JS, Jardine A, Glonek G, Maynard EJ. Incidence, impact on the family and cost of gastroenteritis among 3-5 years old children in South Australia. J Gasterol hepatol. 2006 Aug; 21(8):1320-5. 7. Vander lei LC, Silva GA. Acute diarrhea: does mother's knowledge of the disease reduce admission of children under two years of age. . Rev Assoc Med Bras. 2004 Jul-Sep;50(3):276-81. 8. .Donna L, Wong Marily Hockenberry –Eaton, Wilson, Winkelstein, Schwartz.Wongs Essential of Pediatric Nursing .sixth Edition Published at 2002.page number 883. 9. Sasirekha Ramani & Gagandeep Kang .Burden of disease & molecular epidemiology of group A rotavirus infections in India. Ind ian J Med Res 125, May 2007, pp 619-632. 10. . Grimwork RE , Huang QS, Cohet C, Gosling IA, Hook SM, Teele Dw, Pinnock Re, Nicholson WR,Graham DA, Farrek AP Leadbitter P,Lennon DR. Rotavirus hospitalization in Newzealand children under three years of age. J Peadiair child health . 2006 April ;42(4): 196-23. 11. . The Peadiatric Rotavirus European committee (protect).Epidemol. infect . 2006oct; 134(5): 908-16 12. Grimwork RE , Huang QS, Cohet C, Gosling IA, Hook SM, Teele Dw, Pinnock Re, Nicholson WR,Graham DA, Farrek AP Leadbitter P,Lennon DR. Rotavirus hospitalization in Newzealand children under three years of age. J Peadiair child health . 2006 April ;42(4): 196-23. 13. Anil.C, Phukan, Dilip K patgiri, Jagadish mahanta.Rotavirus associated with acute diarrhea in hospitalized children in Dibrugarh,North east India. J pathol microbiology 2003; 46(2):274-278. 14.Fruhwirth M,Karmaus W, Moli-Schler I, Brosis,Mutz I .Aprospective Evaluation o f communityacquired gastroenteritis in peadiatric practices ; impact and diseases burde of rotavirus infection . Arch Dis child.2001 may; 84(%):393-7 . 15.Kelkar, Shobhana D, Purohit, Sudha G, Simna, K Vijaya.prevelance of ritavirus diarrhea among hospitasalized children in Pune , India.Indian Journal of Medical Research ,1999 April. 16. Liddle,Burgess MA, Gilbert Gl, Hanson RM, MC Intyre PB, Bishop Rf,Ferson MJ.Rotavirus gastroenteritis impact on young children ,their families and health care system .Med.Jaugt.1997 sep 15;167(6):307-7. 17. Denise.F.Pilot. Cherryl Tataro Beck. Nursing Research Principles & Methods. 200; 7 th edition : 88-91.

18.Rheinagans RD,Constenla D,Antil L, Innis BL,Breuer T. Economic and health burden of rotavirus gastroenteritis for 2003 birth cohort in Latin American & carbben countries.Rev Panam Salud Publica.2007 Apr ;(4):192- 204. 19. . Hung LC, Wong SL, Chan LG, Rosli, Ng AN,Bresee JS .epidemology and strain characterization of rotavirus diarrhea in Malaysia .Int J Infect Dis.2006 Nov; 10(6):470-4 20. , Giaquinto C, Van Damme P et.al. cost of community acquired pediatric rotavirus gastroenteritis in 7 european countries. J Infect Dis.2007 May;195 Suppl 1;536-544.

21. Sheth M Obrah M. Diarrhea prevention through food safety education. . India J Pediatr. 2004 Oct;71(10):879-82 .22.Dalta V,John R,Sing VP, Chaturvedi P.Knowledge .attitude and practices towards diarrhea in rural Maharastra.Inian J Peadiatric 2001 Dec;68(12):1153. 23. MoawedcSa, Saeed AA.Knowledge and practice of mothers about infants diarrhel episodes in Saudi Arbia.Saudi Med J.2000 Dec; 21(12):1147-51. 24 . Ghosh S, Sengupta PG, Gupta DN, Mondal SK, Goswami M, Bhattacharya SK, Sircar BK Maternal knowledge on risk behavioral practices and it's association with diarrhea in a rural community of West Bengal, India. J Commun Dis. 1998 Dec;30(4):251-5.