Work on Synopsis

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE ANNEXURE-II SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE Mr. DINESH KUMAR VARMA CANDIDATE AND I YEAR M.Sc. NURSING, N.D.R.K. ADDRESS COLLEGE OF NURSING, B.M. ROAD, 6. HASSAN, KARNATAKA. 2 NAME OF THE N.D.R.K. COLLEGE OF NURSING, INSTITUTION B.M. ROAD, HASSAN, KARNATAKA. 3 COURSE OF STUDY & MASTER OF SCIENCE IN NURSING SUBJECT (CHILD HEALTH NURSING).

4 DATE OF ADMISSION TO 04 -05- 2007 THE COURSE 5 TITLE OF THE STUDY “THE EFFECTIVENESS OF TEACHING MODULE ON KNOWLEDGE REGARDING EYE CARE AMONG THE SCHOOL AGE CHILDREN AGED BETWEEN 6-11 YEARS STUDYING AT C.K.S. SCHOOL,HASSAN, KARNATAKA”. 5.1 STATEMENT OF THE “A STUDY TO ASSESS THE PROBLEM EFFECTIVENESS OF TEACHING MODULE ON KNOWLEDGE REGARDING EYE CARE AMONG THE SCHOOL AGE CHILDREN AGED BETWEEN 6-11 YEARS STUDYING AT C.K.S. SCHOOL, HASSAN, KARNATAKA”. BRIEF RESUME OF THE INTENDED WORK.

6.1 INTRODUCTION:- “Vision is a gift from god.” “Vision is a gift to be cherished”.

Our vision is one of those wonderful gifts most of us take for granted. Eye care is essential to maintaining the health of our eyes. People with eye diseases that greatly affect their vision face many problems. They are physically hampered by impaired vision .There are many eye diseases that can be prevented or whose progression can be slowed down with proper precautions and healthy eating .Antioxidants help to prevent many diseases affecting not only the heart , immune system, cancer but also the eyes. Antioxidants include vitamin C, vitamin E, and vitamin A.

One of the greatest enemies of our eyes is the sun. Just like the skin, eyes are damaged by ultraviolet rays coming from the sun, whether it is over cast or a clear and sunny day .Even eye infections are also common among school age children , because to prevent from dust allergy. Working on the computer and watching television really can harm your vision1.

The eye is an intricate part of our body. In comparison to a car, the engine being the heart, the gas tank being the stomach, the eye would be all windows and gauges. Imagine having all the windows fogged and not being able to see. Imagine the gauges do not work and you do not know how fast you are going or how much gas is left in the tank .you would have to drive with feeling only. Without the eye you would be in the same sinking boat .The eye allows you to not only to view objects, but to view depth, color, size and every little detail .The eye functions like a camera. Light rays enter the eye through the cornea (the clear front window), pass through the pupil (the hole in the center of the iris), and then through the lens, finally reaching the retina (the film) at the back of the eye .when the light rays land on the retina, they form an upside- down image .The retina converts the image in to impulses that travel through the optic nerve to the brain, which converts them in to upright visual images. Vision is clear only if the cornea and lens correctly bend or “refract” the light rays and focus them on the retina. Blurry vision may be due to what is called a “refractive error” the failure of the cornea and lens to focus light properly2.

Vision screening in schools has a long history, the purpose of which was, and continues to be, the detection and referral for treatment of commonly occurring visual anomalies (Zaiger 2006). “Commonly occurring” is defined as a condition whose prevalence is 1 % or greater of potentially – affected population. Early detection of a vision problem can have educational and behavioral benefits, and certainly has quality of life benefits. School vision screening is distinct from school vision assessment, which is conducted when a teacher or parent refers a child to the nurse because of a suspected visual problem. Assessment is more comprehensive than screening and considers all available data in formulating a nursing diagnosis3.

Prevalence rates of mild xeropthalmia from eight states were available from the National Nutrition Monitoring Bureau (2000) and from five other survey reports in four states covering children whose ages ranged from 5 to 16 years .As these latter rates were not considered to be statewide, they were weighted by a factor of 0.75, to account for the lack of representativeness, and averaged with each stateside Multiple Indicator Cluster Surveys (MICS) prevalence rate for xeropthalmia. Rates for all states were summed and averaged to obtain a national prevalence rate for India, which was 2.8 %4.

There are some common eye problems among the school age children like blurred vision, double vision, rednessness of the eyes, stickiness of eyelids, watering white reflex in the eye, abnormal looking eye, drooping of the eyelids and squinting of the eyes5.

6.2. NEED OF THE STUDY:

India has the largest number of visually impaired persons (18 Million) in the world. Karnataka with a population of 54.4 million has a blindness prevalence of over 1.6%. The visual impairment results to about 11.4 billion losses to the nation’s Gross Net Production. The solution to this is community eye care: which is cost effective, state of art of health care is at the door step of rural India6.

The five most commonly separated sports activities with eye injuries include base ball, basket ball, swimming, bicycle and football. Playing with toys caused another 9,000 eye

injuries to children less than 14 years of age. Among the most common toys cited as causing eyes injuries were toy weapons, bicycles and balloons7. A study in Japan revealed the role of posture of children while studying in the rising trend of eye problems. An understanding of the other probable causes of abnormalities in the eye sight of school children is important in the promotion of eye care. It is noted that the viewing distance assumed by the patient is shorter than for usual reading. The right eye was also observed to be dominant and the right eye looks like turned more inwardly during near point vision. The practice brought about the loss of binocular vision and the inability to achieve smooth accommodative convergence.

Prolonged visual work at near point generally leads to a decrease in accommodative power. Examples of activities of school children that involve near point vision are reading cartoon magazines, playing cards in the dark, use of compact displays, such as the Game boy and sending and reading e-mail with a mobile phone.

Many children with myopia do not wear glasses and their visual conditions may remain undetected because of compensatory measures. The number of undiagnosed refractive errors among children is much more common than one might imagine. Symptoms like acute headache, nausea and depression, suggestive of organic brain damage are increasingly seen among school age children8.

Almost 25 percent of school age children have vision problems. Around 44% of the parents do not realize that behavioral problems can be an indication that a child’s vision is impaired9.

Many pediatric computer vision eye doctors believe that heavy computer use among children puts them at risk for early myopia .A study at the Department of Health in Taiwan, says that the percentage of first graders with myopia has increased from 12.1% to 20.4% since 1995. A similar study in Singapore found that in three years the percentage of seven to nine year olds with myopia had doubled, to 34%. Three reasons has been discussed for the

provision of eye care and for giving priority attention for the children. First of all, Children have a limited degree of self awareness, secondly they are very adaptable because they assume that what they see and how they see is normal – even if their vision is problematic and lastly, children are smaller than adults. Computer users should view the screen slightly downward, at a 15 degree angle10.

Throughout growing years, children are visually stimulated. Nothing stimulates a child’s vision more easily than a toy. Most children’s accidents occur at home, many with toys. Children spend a greet deal of time playing with their toys, usually with markers, balls, bicycle, musical instruments, jump ropes, sports equipments etc especially 7 to 10 years old children. Usually when toys are not safe it’s because they are not age appropriate11.

School children and their teachers had serious misconceptions e.g. use of kohl (a cosmetic lotion used for darkening the eyelids), medicines and eye drops keep eyes healthy. Kohl is an important source of lead and can reduce children’s intelligence even at low blood levels. Health education in schools must take in to account children’s existing knowledge of and misconceptions about various aspects of eye health .Such steps if taken could improve the relevance of eye health education to school children12.

6.3 STATEMENT OF PROBLEM:-

“A study to assess the effectiveness of teaching module on knowledge regarding eye care among the school age children aged between 6-11 years, studying at C.K.S School, Hassan, Karnataka.

6.4 OBJECTIVES:- Of the study is To:-

1. Identify the level of knowledge regarding eye care among the school age Children (6-11 years) during the pre -test. 2. Assess the level of knowledge regarding eye care among the school age children (6-11 years) after the administration of the teaching module. 3. Determine the level of knowledge regarding eye care among the school age children (6-

11 years) after the post-test. 4. Associate the level of knowledge regarding eye care among the school age children (6-11 years) with selected socio-demographic data.

6.5 RESEARCH HYPOTHESIS:- There will be significant difference in the level of knowledge regarding eye care among the school age children (6-11 years), who attended the teaching module (studying at C.K.S. school, Hassan, Karnataka).

6.6 ASSUMPTION: This study will: 1. Create an increased health awareness pertaining to eye care among the school age children aged between 6-11 years (studying at C.K.S school, Hassan, Karnataka). 2. Stress the importance of eye care among the school age children aged between 6-11 years (studying at C.K.S school, Hassan, Karnataka.).

6.7 OPERATIONAL DEFINITIONS:- 1. ASSESS: - To estimate about the understanding level of the school age children studying at C.K.S. school, regarding eye care. 2. EFFECTIVENESS: - It is a process which produces an intended result on knowledge among the school age children regarding eye care. 3. TEACHING MODULE:- It is an intervention to be provided to the school age children to improve their knowledge level regarding eye care. 4. KNOWLEDGE: -It refers to the understanding and awareness regarding eye care. 5. EYE CARE: - It is the care provided to the eyes in order to prevent eye problems. 6. SCHOOL AGE CHILDREN: - This is the developmental stage in children, which ranges from 6 years to 11 years of age. 7. C.K.S SCHOOL HASSAN: - C.K.S School is located at B.M road and it consists of students which range from first standard to seventh standard.

6.8 CRITERIA FOR SAMPLE SELECTION:-

6.8.1 INCLUSION CRITERIA:- 1. School age children (6th standard students) who are studying in C.K.S school Hassan. 2. School age children (6th standard students) who are willing to participate in the study. 3. School age children (6th standard students) who know to speak, read, and write in kannada and English.

6.8.2 EXCLUSION CRITERIA:-

1. Sixth standard students who are not willing to participate in the study. 2. C.K.S school children other than students of sixth standard students. 3. Students of sixth standard, studying in any school other than C.K.S school, Hassan.

6.9 PROJECTED OUT COME (SIGNIFICANCE OF THE STUDY):-

1. This study will enlighten the knowledge of school age children regarding eye care. 2. This study will promote the knowledge of school age children regarding futuristic eye care.

6.10 DELIMITATIONS: - This study is limited to:-

1. The school age children studying in C.K.S School, Hassan. 2. The students of sixth standard. 3. A sample size of 80 school age children (sixth standard). 4. A period of 4 weeks only.

6.11. CONCEPTUAL FRAME WORK

It is based on:- “General system theory”, which is given by Ludwig Van.Bertanlaffy in the year of 1968.

6.12 REVIEW OF LITERATURE

The aim of the study was to report severe visual loss caused by optic nerve avulsion (ONA) in children with door –handle trauma and the data were analyzed for cause of visual loss among 14 children (average age 8 years) at a tertiary eye care hospital in Saudi Arabia. All the 14 children had evidence of optic nerve avulsion and diagnosis was made clinically by imaging studies and confirmed histopathologically in the eyes and finally visual acuity was the light perception in one patient and no light perception in 13 patients. Recommendation of the study said that optic nerve avulsion was the common cause of visual loss in children who sustained ocular trauma caused by door- handles13.

The objective of the study was to identify additional barriers to follow-up care after failed school vision screenings. School nurses in an urban, Mid-western public school district identified elementary school students, who had not received follow-up eye exams after failed school vision screenings. Parents of these students were interviewed during the summer to determine financial, logistical, social\family, and perceptual barriers to care. Result of this study showed that family issues, parental perceptions of vision problems, and difficulty in planning ahead were found to be significant factors. Recommendations for overcoming barriers to care were identified14.

The main aim of the study was to assess the prevalence of refractive error and related visual impairment in school aged children in the rural population of the Mahbubnagar district of Andhra Pradesh state. Random selection of village-based clusters was used to identify a sample of children 7-15 years of age and a total of 4,414 children from 4876 households was enumerated and 4074(92.3%) were examined for visual acuity; Ocular motility evaluation, retinoscopy and auto-refraction. The result revealed the prevalence of uncorrected, baseline and best corrected visual acuity of 20/40 was 2.7%, 2.6% and 0.78%, respectively and refractive error was the main cause of visual impairment in children aged between 7and 15 years in rural India. Recommendation of this study demanded for effective strategies be developed to eliminate this easily treated cause of visual impairment.15 The objective of this study was to study the relation between subjective symptoms at near and ocular accommodation in terms of the amplitude of accommodation and the relative accommodation and the purpose of this study was to discuss the diagnosis of accommodative insufficiency. There were two subsequent examinations with the interval of 1.8 years. The first examination included 72 children, 43 boys (mean age 8.1years) and 29 girls (mean age 8.3 years) and second examination included 59 of these children. Result of first examination evidenced the prevalence of at least one symptom, was 47.2% and symptoms were reported for the youngest children (8 years onwards) in second examination. The discrimination ability for the amplitude of accommodation, both monocular and binocular, was significant. Recommendation was to suggest that accommodation measurements (screening) should be performed more routinely and regularly, especially in children over 8 years of age16.

The objective of this prospective study was to evaluate different refractive cutoffs for provision of spectacles with regards to their impact on visual improvement and compliance. Population was the South African school children aged 6-19 years and the association between five proposed refractive cutoff protocols and visual improvement and spectacle compliance were examined in separate multivariate models. Result analyzed or screened 8520 children, among them 810(95%) received spectacles, of whom 636 (79%) were aged 10 to14 years. Presenting vision and improvement in vision were unassociated with subsequent spectacle wear, but girls (P<=0.0006 for all models) were more likely to be wearing glasses than boys. In the last, conclusion revealed that the lack of association between spectacle retention and either refractive error may have been due to the relatively modest degree of refractive error in this African population17.

The objective of the study was to quantify the proportion of children who have corrective lenses (glasses or contact lenses) and to evaluate the association of corrective lenses with age, gender, race/ethnicity and family income. Children 6 to 8 years of age were identified in the medical expenditure panel survey and national estimates were made of the proportion with corrective lenses. Logistic regression modeling was used to assess factors that

were associated with corrective lenses. Results showed an estimated 25.4% of the 52.6 million children between 6 and 18 years had corrective lenses and girls had greater odds than boys of having corrective lenses (odds ratio, 1.41; P<0.001) . Among families with an income > or = 200% of the federal poverty level, the odds of having corrective lenses increased with age (P, OR = 0.04) 18.

In 1992 - 94, a nation-wide survey in the Sultanate of Oman was conducted with the objective of identifying the prevalence of visual acuity loss after injury. A random selection of 6292 children from grades 1 to 6 from all primary schools in the country provided the research sample and children who failed the visual acuity screening test received a complete “On the spot” eye examination by the pediatric ophthalmologist. The result disclosed the total prevalence for loss of vision in one eye was 0.19, with 0.15% in 6 years olds and 0.25% in 12 years olds. Altogether the prevalence of traumatic monocular visual damage in the study was 0.19%. Information about trauma prevention and the need for adequate ophthalmic care should be emphasized19.

The main objective of this study was to determine the knowledge among primary school teachers about the nature of visual problems (including refractive errors) among their pupils. Qualitative research methods used were individual interviews, questionnaires and focus group discussions. Sixteen interviews and 16 questions for teachers were conducted followed by four focus group discussions with other teachers of primary section in two government and two private schools. The information collected from the three sources was used to triangulate the data; there by strengthening its trustworthiness. Results revealed that discoloration of eyes is a sign of eye diseases and therefore children with eye pain and decreased vision should be referred to a hospital20.

7. MATERIAL AND METHODS OF STUDY

7.1 SOURCES OF DATA: -

Data will be collected from school age children (6th Standard) Studying at C.K.S. School, Hassan.

7.2 METHODS OF COLLECTING THE DATA:-

7.2.1. RESEARCH DESIGN:- A quasi-experimental study is planned for the research study with randomization but there is no control group.

Group of 80 students of 6th standard Pre-test Intervention Post -test

studying at C.K.S. School, Hassan

E 01 X 02 KEY: - E= Experimental group

01= Pre-test knowledge about eye care X= Planned teaching module regarding eye care.

02= Post-test knowledge about eye care among school age children after the administration of planned teaching module.

7.2.2. RESEARCH SETTING:-

C.K.S. School, which is situated behind Bhanu Theatre at B.M. Road, Hassan, is a English medium school and was started in 1970. It is regulated under the auspices of Boovanahally Chanakeshwara Swami vidya samsthe. This school has a principal and other teaching staffs. It has 7 standards from 1st standard to 7th standard and consists of 400 students. I have selected 6th standard students for my study because it has 106 students in 2 different sections. The playground of the school is very rough and therefore students are prone to get eye injuries while playing, so I selected the topic of my study regarding the knowledge of students about eye care.

7.2.3. POPULATION: - All the students of 6th standard studying at C.K.S. School, B.M. Road, Hassan.

7.2.4. SAMPLE: - 80 students of 6th standard class studying at C.K.S. School, Hassan.

7.2.5. SAMPLING TECHNIQUE: - Probability sampling technique is used in which simple random sampling for the selection of subjects will be followed.

7.2.6. COLLECTION OF DATA: - Interview method is planned for collection of data by using a semi-structured questionnaire. 8. VARIABLES: - a. Independent Variable: Planned teaching module for 6th standard students studying at C.K.S. School, Hassan. b. Dependent Variable:- Knowledge regarding eye care among school age children.

9. PLAN FOR DATA ANALYSIS: - a. Descriptive statistics: - The descriptive statistics analysis includes percentage, frequency, mean, Standard deviation for the 6th standard C.K.S students regarding eye care for school age children. b. Inferential statistics: - It includes independent “t” test and paired “t” test with Chi-square and “ANOVA” test for the assessment of knowledge and to associate the socio-demographic variables. And Mc. Newman’s test may also be utilized in the inferential statistics.

10. PILOT STUDY: - 10% of the population is planned for the pilot study during the month of April 2008.

11. ETHICAL CONSIDERATION: - It includes- 1. Does the study require any interventions to be conducted on 6th standard students? ---Yes. Informed consent will be obtained from the respondents. 2. Has ethical clearance being obtained from your institution? --- Yes. Ethical clearance has been obtained from the institution. 3. Has the consent taken from the school authorities? --- Yes. Consent has been taken from the school.

12. LIST OF REFERENCES (VANCOUVER STYLE)

1 www. eye care source. com. (www.pubmed.com). 2 Larry K. Wan, O.D et.al. Children and computer vision syndrome. Visual screening of adjusted adolescents, the journal of behavioral optometry,1999,volume-10. 3 Zaiger,Timmerck, et.al. National Association of school nurses ,Inc, Maryland and American Association of Pediatric Opthalmology And Stribismus,2001,page no-821- 1130. nasn @nasn.org. 4 Rahmatullah, Gupte et.al. National Nutrition Monitoring Burea. Arvind Comprehensive Eye Surgery, 2000 , page no-98-128. 5 E.Engenie Hartman, Velma Dobson et.al. Common vision and eye problems. American Academy of Pediatrics, nov. 2000, volume-106, page no.-1105-1116. www.pubmed.com. 6 National Control For Blindness Control Programe, Tubichanrai Family et.al. Community eye care at Sankara eye foundation- USA and AKKA world Canada conference, sept.2006. Web health care centre.com. 7 Harris P. Ajournal of learning related visual problems in Baltimore city : A long term program, 2002, publication no. APPIP 98-0026, volume-33, page no.-75-115. 8 Tatyama, Marumoto T et.al. Significant correction between school myopia and postural parameters of students while studying. International journal of industrial ergonomics,23.1999.Paga no.-33-39. 9 American Optometric Associations. Amarican Eye – Q Survey-2007. Children computer vision statistics. College of optometrists in vision department.www.pubmed.com. 10 Larry K Wan, Roper starch survey, US census. American Optometric Association, 2001.Volume-1. 11 Gretchyn Bailey. Toys and eye safety. Journal of pediatric ophthalmology and strabismus, 2001.volume-37, no.2. 12 Khabir Ahmad, Mohammad Amankhan et.al. Perception of eye health in schools in Pakistan. BMC ophthalmol, march 2006; 6:8.doi:1471-2415-6-8.

13 Chaudhary IA, Shamsi FA, et.al. Optic nerve avulsion from door-handle trauma in children. King khalid eye specialist hospital, Riyadh, kingdom of Saudi Arabia. July 2006; 90(7). Page no.-844-846. 14 Linda S. Kimel,RN,MS. Lack of follow-up exams after failed school vision screenings : An investigation of contributing factors. The journal of school nursing,Britain,april 2007,volume:22,issue;3,page no. :156-162. 15 Dandona R, Dandona L, et.al. Refractive error in children in a rural population in India. International centre for advancement of rural eye care, L.V. Prasad eye institute,Hyderabad, India,march 2002; 43(3), page no.615-622. 16 Bertil Sterner, Martin Gellerstedt, et.al. Accomodation and the relationship to subjective symptoms with near work for young school children. Department of ophthalmology at Goteborg university, Sweden, march 2006, volume 26, issue:2, page no.-148-155. 17 Congdon N, Patel N, et.al. The association between refractive cutoffs for spectacle provision and visual improvement among school aged children in South Africa. Chinese university of Hong Kong, Hong Kong. 25 june 2007. PMID: 17591673. 18 Kemper AR, Bruckman D, et.al. Prevalence and distribution of corrective lenses among school age children. The child health education and research unit in university of Michigan,Ann Arbor, USA. Optom vis sci. 2004 jan; 81(1) , page no.-7-10. 19 Joan Lithander, Hussain Al Kindiz, et.al. Loss of visual acuity due to eye injuries among school children in the Sultnate of Oman. Department of ophthalmology and child health, Sultanate of Oman, 1999 : 77, page no.-697-699. 20 Mohammad Saeed khan. Knowledge in eye care among school age children.Layton Rahmatulla Benevolent trust eye hospital, Quetta, Pakistan. Community eye health > v.18 (53); march 2005, page no.-81-82.

13 Signature of the Candidate Mr. DINESH KUMAR VARMA 14 Remarks of the guide A SIGNIFICANT TOPIC RELATED TO

THE VISION OF THE SCHOOL AGE

CHILDREN STUDYING IN THE

URBAN SCHOOLS WHICH IS A

SEGMENT OF SCHOOL HEALTH

PROGRAM. 15 Name and Designation Dr. W .INDIRA M.Sc, Ph.D H.O.D OF

CHILD HEALTH NURSING

DEPARTMENT 15.1 Guide Dr. W .INDIRA

15.2 Signature

15.3 Head of department Dr. W .INDIRA

15.4 Signature

16 Remarks of the principal FORWARDED FOR APPROVAL

16.1 Signature