Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s29
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Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. Name of the candidate and address SHERLY GEORGE (SR.) (in block letters) I YEAR M.Sc. NURSING ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE – 575 001.
2. Name of the Institution ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE – 575 001.
3. Course of Study, M. Sc. NURSING Subject PAEDIATRIC NURSING
4. Date of Admission to the course 20-05-2011
5. Title of the Topic
EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING AVAILABLE VACCINES AGAINST COMMUNICABLE DISEASES FOR CHILDREN AMONG MOTHERS, IN A SELECTED RURAL COMMUNITY AT MANGALORE
1 Introduction
“Knowledge is of no value, unless you put in to practice”(Heber J Grant)
Vaccination is probably one of the most cost effective interventions to reduce burden of childhood morbidity and mortality, provided used optimally and judiciously. Currently it is estimated that immunization saves the life of 3 million children a year but 2 million more lives could be saved by existing vaccines.1 Vaccination is a cornerstone of public health, believed to save an estimated 2-3 million lives annually. Therefore, provision of childhood immunization continuous to be an essential component in reducing morbidity and mortality worldwide. India is one of the few courtiers where universal routine childhood immunization is provided free of charge.2
Today vaccination is very essential part of children health .vaccination programme is a key step for the preventive services of children. The field of paediatric vaccination is growing and changing as new vaccines are becoming available and previous diseases are being eradicated due to the complicity and evolution of vaccine preventable diseases .A review of immunology and the principles of vaccination provide background knowledge for information pertaining to disease transmission and the current recommended vaccine schedule .The goal of vaccination is to protect the population from disease and decrease the incidence of disease and disease transmission.3
Childhood immunization require collaboration with parents, who may be anxious about immunization safety .Many parents are worried that some vaccines are not safe and may harm their baby or young child .They may ask their doctors or nurses to wait or even refuse to have the vaccines .So awareness of vaccines and its effects to all the caregivers of children or parents is an important factor to improve the health of the child. In spite of any barriers or difficulties in providing immunizations, bringing children up to date at every opportunity continuous to be essential both in preventing morbidity and mortality and in promoting worldwide eradication of vaccine preventable diseases. Protection from vaccine preventable diseases is one of the most crucial rights of children. So the parents must have the primary responsibility of getting their child fully immunized and the child must not be made to suffer if the care givers are having lack of knowledge.4
6 Brief Resume of the Intended Work
2 6.1 Need for Study
“If you have knowledge, let others light their candles at it.”(Margaret Fuller)
Approximately 2.5 million children under five years of age die every years as a result of disease that can be prevented by vaccination using currently available or new vaccines. India houses a large chunk of these unimmunized children. According to 2006 estimates, around 12 million children were not immunized; Utter Pradesh with more than 3.0 million unimmunized children tops this list.2
In India 22,616 cases of pertussis were reported in 2006. In developing countries pertussis is a major cause of infant mortality. The reported incidence for diphtheria has been 2472(partial) and 10,231 cases in the year 2006 and 2005 respectively.5 Measles is the leading cause of childhood death. Every year around 3 million cases of measles are seen and about 900,000 children die because of measles around the world .In India every 500 children die because of measles .The most worrying factor is that the vaccines coverage against measles in India is only 66% and even below 50% in many states. There are 8.8 million estimated deaths in children under 5 years of age in world wide due to haemophilus influenza in 2008. The estimated pneumococcal deaths in Indian children aged 1-5 month per 100 000 is between 100 and <300. An estimated 527,000 children aged <5 years die from rotavirus diarrhea each year, with >85% of these death occurring in low income countries of Asia and Africa.6
Protection from preventable diseases, disabilities and death through vaccination is the birth right of every child .Vaccination is the one of the most cost effective health care intervention against six killer preventable disease; poliomyelitis, tuberculosis, diphtheria, pertussis, tetanus and measles. Vaccines are immune-biological substances which produce specific protection against a given diseases. It stimulates active production of protective antibody and other immune mechanism. Vaccines are prepared from live attenuated organisms, killed organisms, toxoids, extracellular fractions or combination of these. Other vaccine preventable diseases are: hepatitis B mumps, rubella, haemophilus influenza type B (hib) infection, typhoid, meningococcal meningitis, Japanese encephalitis, influenza, pneumococcal pneumonia, chickenpox, rotavirus diarrhoea, yellow fever, cholera, malaria, hepatitis A, plague and rabies.7
3 The inadequately immunized children are mostly in rural areas and in urban slums and semi urban under privileged communities due to poor health delivery facilities and non functional health care units. Failure to immunize is important not only to the individual child, but it also has societal and global implications for limiting the spread of disease. According to epidemiological data, there has been a sharp decline in disease incidence following licensure and use of each vaccines (National Associations of Paediatrics Nurse Associates and Practitioners, NAPNAP) 2000. It is critical that health care providers know and understand incidence and squeal associated with these vaccine preventable diseases and are able to discuss the benefits and risk with parents.8
A study was conducted to investigate the knowledge of nursing mothers about vaccines preventable diseases, their causes and benefit of childhood vaccination among 69 nursing mother’s ages 21-50 years with secondary education to a self administered questionnaire .Result showed that 78.57% of mothers had identified poliomyelitis is a disease preventable by routine childhood immunization and 85.1% knew the organism. Tetanus was identified by only 5.7% and not agreed that vaccination was the best prevention against them.9
WHO estimate that haemophilus influenza type b (Hib) caused over 8 million cases of serious disease and 376,000 deaths globally in the year 2000. Hib disease had been shown to be a significant cause of mortality and morbidity in Indian children <5 years of age. Hospital based studies showed that Hib and pneumococcus were the most common cause of childhood bacterial meningitis. Measles continued to be an important cause of childhood morbidity and mortality in many states in India and between 100,000 and 160,000 children die from measles. The extremely low rates of routine immunization in large parts of the country remain a matter of serious concern .Inadequate routine administration of polio vaccine in, UP, Bihar, West Bengal and some other parts has been chiefly responsible for the delay in polio eradication from India. Sporadic outbreaks of Diphtheria and Measles have been observed in different parts in the Northern states. The gravity of the situation calls for a more vigorous approach.10
While working in the community the investigator found that there are so many children missed the opportunities of vaccination due to the inadequate knowledge of mothers and are in high risk for developing communicable diseases. So the investigator thought that if the mothers are educated well the disease can be controlled to some extent.
4 Therefore the investigator decided to undertake the study to assess the effectiveness of planned teaching programme for mothers in a selected community at Mangalore.
6.2 Review of Literature
A descriptive study under taken to assess the immunization status of children in 90 districts of the country .The WHO 30 cluster survey methodology was used. In each district a sample of 30 village/ ward was selected using probability proportional to size systematic sampling. Further in each selected village with a random start, samples of seven children in the age group of 12-23 month were selected in the form of clusters of contiguous households. The study covered about 19,000 children. The result showed that about 63% children received all the vaccine (BCG, DPT, OPV, measles) and the state of Bihar, Rajasthan UP, MP coverage’s were low and also lower for children of illiterate mothers and in small and inaccessible and tribal village.11
A community based cross sectional study using cluster sampling method was under taken in the selected parts of rural Thiruvallur district and urban Chennai to estimate the routine and the newer childhood vaccines coverage rate among children aged 12-24 months. The sample size was 202 for the rural and 205 for the urban study and the method used for data collection was interview technique. The result showed that the proportion of children aged 12-24 month who had received BCG on the day of birth and OPV–zero doses within 3 days after birth were 3% and 55.9% respectively, in both the rural and urban area. The proportion of children who had received Hepatitis B on the day of birth was 3.5% and 11% in the rural and urban areas, respectively. No significant urban rural difference was observed.12
A community based cross-sectional study was undertaken among 682 care takers of children under 5 years attending pulse polio immunization centers in East Delhi .Pre- tested semi open ended questionnaire used as a tool and the sampling technique was non randomized. The respondent was asked to record about the knowledge of routine immunization, mainly it include week day and age for routine immunization .The chi-
5 square test was used and the result shows that only 252 (37.0%) respondents correctly knew the day of routine immunization and less than half (49.1%) knew that routine immunization is done for children up to the age of 5 years. And only 39.3% were able to name at least 3 disease covered under routine immunization program.14
A cross-sectional study was under taken to assess the satisfaction of the parents with the immunization services in urban slums of Lucknow district from January 2005 to April 2005 with their demographic characteristic. Among the children of age group of 12- 23 months in the urban slums using the WHO 30 cluster survey methodology and pre tested structured questionnaire. Analysis for a total of 388 respondents of completely or partially immunized children was done to assess the level of satisfaction and its determinants. The overall satisfaction was more than 90% in the respondents of both the categories of the children, however the difference between the satisfaction rates was found to be significant. Also the satisfaction with accessibility (p<0.o4) and information given by the health worker (p<0.00) differed significantly between completely and partially immunized.15
A quasi experimental study was under taken to study the effects of planned instruction on mothers knowledge, health believes and number of children receiving immunization for Diphtheria, Pertusis ,Neonatal tetanus and Polio in Sikhothtaboung district Vientiane Lao P.D.R. The study subjects were 30 mothers from Viengkhan Chansavang, and Nogteng village who had given birth with in the 4-5 week before the data collection. The experimental group received planned teaching programme and hand book, the data were collected using questionnaire. Data analysis done by mean and standard deviation, the differences in two group was analyzed by independent t’ test .Result showed that the mothers knowledge, health beliefs, after intervention between two groups were significantly different (p<.05) but the number of children receiving immunization between group were not significantly different.16
A study undertaken to obtain immunogenicity and safety data for a pentavalent combination vaccine (diphtheria, tetanus, a cellular pertussis, and inactivated polio virus Hib polysaccharide–conjugate), a prospective non comparative phase III clinical study was performed at two medical centres in India. A healthy full term infants weighing more than 2.5 kg received the vaccines (6, 10,14weeks of age) and hepatitis B Vaccines (6, 10, and 14) according to the schedule. Total 226 in of age infants were received the vaccine and
6 immunogenicity of high for each vaccine antigen. Vaccine was highly immunogenic at 6, 10, and 14 weeks of age in infants in India.17
6.3 Problem Statement
Effectiveness of Planned Teaching Programme on knowledge regarding available vaccines against communicable diseases for children among mothers in a selected rural community at Mangalore. 6.4 Objectives of the Study
1. To determine the knowledge level of mothers regarding available vaccines against Communicable diseases for children as measured by structured interview schedule.
2. To evaluate the effectiveness of planned teaching programme on knowledge regarding available vaccines against communicable diseases for children among mothers in terms of gain in mean post test knowledge score.
3. To find out the association between mean pre-test knowledge score and selected demographic variables [age of mother, education of mother, occupation of mother, number of children ,previous exposure to teaching on vaccination, type of family, income].
6.5 Operational Definitions
1. Knowledge: in this study knowledge refers to the mother’s information regarding available vaccines against communicable disease for children as it is measured by a correct response to a structured interview schedule.
2. Effectiveness: In this study effectiveness refers to the extent to which planned teaching programme on available vaccines against communicable disease for children has achieved the desired effect in improving the knowledge of the mothers as evidenced by gain in mean post test knowledge score.
3. Mother: In this study mother refers to woman who is having children between the ages of 0-16 years in selected rural community at Mangalore.
7 4. Planned Teaching Programme: In this study, planned teaching programme refers to systematically developed instructional programme designed for mothers to provide information regarding available vaccines against communicable diseases for children such as BCG, DPT, Polio, HIB, MMR, Hepatitis A and B, Varicella, Typhoid, pneumococcal, and influenza.
5. Vaccine: In this study vaccine refers to a substance which is used to stimulate the production of antibody and provide immunity against one or several diseases, prepared from the causative agent of a disease, its products, or a synthetic substitute, treated to act as an antigen without inducing the disease.
6. Communicable disease: It refers to disease that spread from person to person through different mode of transmission in cases of children belonging to the age group of 0 to 16 years.
7. Children: In these study children refers to those belonging to the age group of 0 to 16 years in a selected rural community at Mangalore.
Variables under study
1. Dependent variable: Knowledge of mother regarding available vaccines for children against communicable diseases.
2. Independent variable: Planned teaching programme on available vaccine for children against communicable diseases.
3. Extraneous variable: Age of mother, education of mother, occupation of mother, number of children, previous exposure to teaching on vaccination, type of family income.
6.6 Assumptions
1. Mothers will have some basic knowledge regarding vaccination.
2. The level of the knowledge can be measured by a structured knowledge questionnaire.
3. Planned teaching program me is an accepted teaching strategy in improving the
8 knowledge of mothers.
4. Mothers will be interested and willing to co-operate in the study.
5. Appropriate knowledge of mothers regarding vaccines against communicable diseases will help them to protect their children.
6.7 Delimitations
The study will be delimited to mothers.
who can understand English or Kannada.
who are available during the time of data collection.
6.8 Projected outcome (Hypothesis)
The hypotheses will be tested at 0.05 level of significance
H1: The mean post test knowledge score of mothers regarding available vaccines against communicable disease for children will be significantly higher than their mean pre-test knowledge score.
H2: There will be significant association between the mean pre –test knowledge score of the mothers regarding available vaccine against communicable diseases for children and the selected demographic variables.
7. MATERIAL AND METHODS
7.1 SOURCE OF DATA
Data will be collected from mothers who are having children under the age group of 0 to 16 years in a selected community at Mangalore.
Research Approach
In this study research aims to determine the effectiveness of planned Teaching Programme on available vaccines against communicable diseases using evaluative research
9 approach.
7.1.1 Research Design
Pre-experimental one group pre-test post-test design will be used for the study.
O1 X O2
O1 – Pre-test
X – planned teaching programme
O2 – Post-test
7.1.2 Setting
The study will be conducted in a selected rural community at Mangalore, Vamanjoor is a the selected rural area which comes under Kudupu P H C which is 12 km away from the Mangalore city under the governance of Mangalore City Corporation. Kukupa P H C has 6 sub centres and the population is around 26817.
7.1.3 Population
In this study population will consist of mothers of 0-16 years of children residing in selected area Approximately 5000 people are residing in the area and around 100 mothers have the children between the age group of 0-16 years.
7.2 METHOD OF DATA COLLECTION
7.2.1 Sampling Procedure
Purposive sampling technique will be used to select the rural community and simple random sampling will be used to select the sample size
7.2.2 Sample Size
The sample for the present study consists of 60 mothers of 0-16 of children in a selected rural community at Mangalore.
7.2.3 Inclusion criteria for sampling
10 1. Mothers who have children between the age group o 0-16.
2. Mothers who are willing to participate in the study.
3. Mothers who could speak or understand Kannada / English.
4. Mothers who are present at the time of data collection.
7.2.4 Exclusion Criteria for sampling
1. Mothers who are not willing to participate in the study.
2. Mothers who cannot speak or understand Kannada/ English.
7.2.5 Instrument intended to be Used
The tool would consist of two sections.
Section I: Demographic Proforma.
Section II: Structure interview schedule to assess the knowledge of mothers of 0-16 years of children regarding available vaccines against communicable diseases.
7.2.6 Data collection method
Permission will be obtained from the concerned authority the purpose of the study will be explained to the subjects and informed consent will be taken. Pre-test will be conducted with knowledge questionnaire using structured interview schedule on available vaccination against communicable diseases this will be followed by administration of planned teaching programme on available vaccines against communicable diseases .The post test will be conducted with the same knowledge questionnaire using interview schedule after seventh day.
7.2.7 Data Analysis Plan
Based on the objectives, data analysis will be done by using descriptive and
11 inferential statistics. The findings will be presented in the form of tables and figures.
1. Demographic data will be analysed using frequency, percentage, mean and standard deviation.
2. Effectiveness of planned Teaching Programme will be analysed by using paired ‘t’ test.
3. Association between pre-test mean knowledge score and selected demographic variables will be analysed using Chi-square test.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
No investigation or intervention will be conducted on samples. However the investigator will be conducting the structured interview schedule and a planned teaching programme on available vaccines against communicable diseases .
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes. Ethical clearance will be obtained from the ethical committee of college of nursing prior to the conduction of the study. Administrative permission will be obtained from the concerned authorities. A written consent will be obtained from the samples and confidentiality will be assured.
List of References
1. Thacker N. Immunization program me in India needed a revamp. Journal of Indian Paediatrics 2007 Oct; 17:44(1).
2. D’Lugoff MI, Schalla KM. Vaccine verification guide :Demystifying Childhood Immuizations for inpatients and other Nurses. Paediatric Nursing 2000 Jan- Feb;26(1):69.
3. Paulson PR, Hammer AL. Paediatric Immunization Update 2002. Paediatric Nursing 2002 Mar-Apr;28(2):173.
4. Mathew JL. Evidence-Based Options to improve Routine Immunization. Indian Paediatrics 2009 Nov 17;993.
5. Shishshtha A, Vipin MV. Routine immunization in India : A Reappraisal of the
12 system and its performance. Indian Paediatrics 2009 Nov 17;991-10.
6. Chitkara AJ, Kukreja S, Shah RC. Pertussis and Diphtheria Immunization. Indian Paediatrics 2008 Sep 17;45(7):723-5.
7. Park K. Essentials of community Health Nursing. 20th ed. Jabalpur: M/s. Banarsidas Bhanot Publishers; 2009.
8. Srivasthva RN. Make Routine Immunization Compulsory. Indian Paediatrics 2007 Nov;44(3):848.
9. http;//adc.bmj.com/cont/95//6/el.11. Abstract. Knowledge of mothers about vaccines preventable diseases.
10. Kant L. NTAGI Subcommittee Recommendations on Haemopilus influenza Type b(Hib) Vaccine Introduction in India. Indian Paediatric Journal 2009 Nov;46(9):45.
11. Singh P, Yadav RJ. Immunization status of children of India. Indian Paediatrics 2000 Nov; 37:1194-5.
12. Kuruvilla TA, Bridgitte A. Timing of zero dose of OPV, first dose of Hepatitis B and BCG vaccines. Indian Paediatrics Journal 2009 Nov;46:1013-4.
13. Bose A , Dubey AP, Gandi D, Pandit A, Raghu M.B, Raghupathy P, Rao MIS, Verghese VP, Datta SK, Bock HL. Safety and reactogenicity of a low –dose Diphtheria-Pertusis-Tetanus-A cellular Pertussis Vaccine in pre-school children. Indian Paediatrics 2007 Jun;44:421-2.
14. Sharma R, Bhasin S. Routine immunization- Do people know About it? A study among caretakers of children attending pulse polio In East Delhi. Indian Journal of Community Medicine 2008 Jan;33:31-2.
15. Nath B, Singh JV, Awasthi S, Bushan V, Singh KS, Kumar V. Parents satisfaction with Immunization services in urban slums of Lucknow District. Indian Journal of Paediatrics May 2009;76:479-80.
16. Kamphoxay, Phommathansy K,Wichencharoen, Apawan N. The effects of planned instruction on mothers knowledge, health believes, and Number of children receiving immunization in Sikothtaboung district Vientiane Lao P.D.R. [online].
13 Available from: URL:http://www.grad.mahidol.ac.th/grad/research abstract.
17. Dutta AK, Varghese VP, Pemde HK, Mathew LG, Ortiz E. Immunogenicity and safety of a pentavalent Diphtheria ,Tetanus ,A cellular Pertussis, Inactivated polio virus, Haemophilus influenza Type b Conjugate combination vaccine with hepatitis B vaccine. Indian Paediatrics 2009;46(12):975-6.
18. Phadke MA, Bhargava I, Dhaigude P, Bagade A, Biniwale MA, Kurlekar SU. Efficacy of two dose measles vaccination in a community setting. Indian Paediatrics 1998 Aug;35:723-4.
8. Signature of the Candidate
9. Remarks of the Guide
Name and Designation of (in block letters)
10.1 Guide MRS. JTOTHI PRAMEELA MARTIS ASSISTANT PROFESSOR ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE.575001
14 10.2 Signature
10.3 Co-guide (if any)
10.4 Signature
11. 11.1 Head of the Department MRS. JTOTHI PRAMEELA MARTIS ASSISTANT PROFESSOR ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE.575001
11.2 Signature
12. 12.1 Remarks of the Chairman and Principal
12.2 Signature
15