Proforma for Registration of Subject For

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

PINKY ANTONY

FIRST YEAR M. SC. NURSING

CHILD HEALTH NURSING

YEAR 2011-2013

PADMASHREE COLLEGE OF NURSING

GURUKRUPA LAYOUT, NAGARBHABI

BENGALURU-560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 1 NAME OF THE PINKY ANTONY CANDIDATE AND M.SC. NURSING 1ST YEAR ADDRESS PADMASHREE COLLEGE OF NURSING, GURUKRUPA LAYOUT NAGARBHABI, BENGALURU-560072

2 NAME OF THE Padmashree college of nursing Bengaluru INSTITUTION

3 COURSE OF THE STUDY 1st year M.Sc. nursing AND SUBJECT Child health nursing

4 DATE OF ADMISSION 08/06/11 TO THE COURSE

5 TITLE OF THE STUDY Effectiveness of steam inhalation with tulsi leaf and turmeric as a remedy to relieve corzya among children in selected community area, Bengaluru.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

2 “Children are unpredictable. You never know what inconsistency they're going to catch you in next.”

- ‘Franklin P. John

Children’s health reflects the National health and wealth. Today’s children are tomorrow’s citizens. A well developed child contribution to the National welfare and children are the priceless resources of the Nation. Children are an embodiment of our dreams and hopes for the future. They are the most vulnerable group in the society.1

Nearly 2 million under five children die from acute respiratory tract infection and most of the children in developing countries. The incidence of lower respiratory tract infection is high and cause 19% to27% hospitalization of children under the age of 5 year in the USA. Acute respiratory infections counted for 67% of all morbidity in India.2

Respiratory diseases are very often found in children’s especially respiratory Infections. It is one of the leading causes of mortality and mortality in young Children. India has 440 million children and about 27 million children are born each year in India. But nearly 2 million of them do not live to the age of 5. Acute respiratory infections are leading cause of child mortality (30%) in India.

WHO (2009) report stated that children below five years of age suffer about 5 episodes of ARI per child per year. ARI is responsible for about 30-40% of Visits to health care facilities and for about 20-40% admission to hospitals. The proportions of death due to respiratory infection in the community is much higher as many children die at home.3

Respiratory illnesses are common in children under 5 years of age. Most Children will develop three to eight colds or respiratory illnesses a year. This Number may even be higher in children who attend day care or are exposed to Tobacco smoke. Most cases are

mild, but about one-third of all hospitalizations In this age group are due to respiratory problems, including asthma and pneumonia.4

A cohort study was conducted on determinants of acute respiratory infection in Denmark, 2006. Data were collected on the occurrence and the clinical impact of

3 respiratory pathogen in the population. During the period of study, a total number of 571 children were observed for 118,650 days, with the determinants birth weight, breastfeeding, gender ,crowding ,passive smoking indoor pollution, and sanitary facilities were analysed .A total number of 486episodes of coughing and nasal discharge combined were recorded. The incidence of severe ARIs was reduced among breastfed infants the study suggests that crowding and communal living conditions are important determinants of ARIs. Breastfed seemed protective against sever ARI.5

The corzya (common cold) or acute nasopharyngitis is the most common respiratory infection in infants and children .In addition to the nasopharynx, the accessory paranasal sinuses and middle `ear are generally involved. The common cold (viral upper respiratory tract infection (VURTI), acute viral rhinopharyngitis, acute coryza, or cold) is a contagious, viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses(30-50%) and corona viruses (10-15%).6

As the common cold mainly affects the upper respiratory tract, i.e. the nose, throat and the wind pipe, the symptoms mainly relate to them only. A cold often starts with a "tickle" in the throat, a runny or stuffy nose and sneezing. Children with colds may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite. Cold usually takes seven to 14 days in recovery. In case of an added infection by the bacteria or complications like sinusitis, ear infection, laryngitis or bronchitis occur, the illness will be prolonged.7

The common cold is the most frequent infectious disease in humans occurs with average two to four infections in adults and six to eight in under five children’s per year. Collectively, colds, influenza, and other infections with similar symptoms are included in the diagnosis of influenza-like illness. They may also be termed upper respiratory tract infections (URTI) in which Influenza involves the lungs while the common cold does not.8

The incidence of common cold has grown dramatically around the world in 2008. In the US there are 62 million affected with cold each year, children (6-10) a year, adult 24 and elderly one attack per year. Thus the total no of cold attack in the US per year 1 billion children miss 22 million school days a year because of the cold. Cold sufferers in the U.S alone spend $2.9 billion on over-the-counter (OTC) medications and spend nearly $400

4 million on prescription medications. Adult cold sufferers miss 150 million work days and another 126 million work days are lost when parents take off days to care for their children suffering from common cold. The total economic impact on common cold to the U.S, is in excess of $20 billion, annually.9

The home remedy for children with respiratory infection consist of complete bed rest, increased fluid intake will help to keep throat and lining of nose moist, saline nose drop may be used to relieve congestion and obstruction in the nose, keep away the child from passive smoke and use of home remedies for cough and cold. Ex: Tulsi, Honey, Zinger, Hot drinks, etc. Warm or cool steam used near the child’s bed may prevent or relieves the laryngeal spasm and cough and essential to maintenance of warm well ventilated environment.10

6.2 NEED FOR THE STUDY

Anatomically children are smaller and proportioned differently than adults. Smaller body size relative to body volume, the child’s smaller airway can be block easily by swelling or foreign bodies. In children the Eustachian tube is in more of a flat or horizontal position between the middle ear and the nasophrynx.11

The common cold is a contagious viral infection of the upper respiratory tract. A large variety of viruses are associated with common cold and that is why the body does not seem to be developing immunity against them. It commonly infects school-going children and the incidence of cold lessens with age. It is normal for a child to have cold around eight or more times a year. This is because there are hundreds of different viruses and young children are meeting each one of them for the first time.7

Rhinitis or common cold is a condition of the upper reparatory tract and can present with runny nose, congestion of the nose and throat, watering of eyes etc. Some may even cause the adenoid to swell causing a post nasal drip and blocked or stuffy nose.

5 This can be either allergic or infective, in any type of cold point to be remember that always blowing out the nose will prevent blocking of the Eustachian tube and ear pain12

The common cold is the most common types of infectious diseases. In children, it is estimated that each child in the United States experiences two to four respiratory infections annually. The morbidity of these infections is measured by an estimated 75 million physician visits per year, almost 150 million days lost from work, and more than $10 billion In costs for medical care. Serotypes of the rhinoviruses account for 20 to 30 percent of episodes of the common cold. However, the specific causes of most upper respiratory infections are undefined. Pneumonia remains an important cause of morbidity and mortality for non hospitalized adults despite the widespread use of effective antimicrobial agents.8

A study conducted on etiology of acute respiratory infections in children’s in tropical southern India. Nasopharyngeal secretions and throat swab specimens from 809 children less than 6 years old with acute Respiratory Infections were examined for the presence of virus of viral antigen. Blood was cultured for the presence of bacteria in selected cases of Respiratory Infections viruses were detected in 163 (49%) of 331 children with Respiratory Infections Bacteria were isolated from 27 (18%) of the 147 children for whom blood cultures were done.13

Normally common cold subside in less than a week’s time however, it gets complicates if there are secondary infection with other organism. The infection may spread from nose and go downwards to cause bronchiolitis.occationally child may develop meningitis following an attack of common cold, child have the symptom of high fever, with breathlessness or wheezing. Some children may complain earache following an attack of common cold. This is because the throat infection may spread into the middle ear cavity and cause a condition known as Otitis media.14

A survey conducted on Causes of neonatal and child mortality of India in India. A registrar general of India surveyed all death Occurred in 2001-03 in million nationally representative homes. Field staff interviewed House hold members and completed standard questions about events that preceded the Death. There were 10,892 deaths in neonates and 12,260 in children aged 1-59 months Identified in the study. Two causes 6 accounted for 50% of all deaths at 1-59 months. Respiratory Infections and diarrheal diseases. 15

A Descriptive study was conducted by the Lakeside Medical Centre and Hospital in2002.study shows that asthma and other respiratory ailments accounted for 50 per cent of the Emergency cases among children in hospitals. Doctors attributed only 6% of Asthma cases in children to genetic causes. Coughing and wheezing and common cold among Children, especially of school-going age is on the rise because they Inhale air that has high content of sulphur-dioxide and carbon-monoxide due to Uncontrolled vehicular emission. Which causes inflammation of the lungs. 1000 of Children need emergency help and hospital alone has treated over 2,900 such Children from January to December 2002,". The study found that while 32 %of children studying in schools located at heavy-traffic zones suffered from Respiratory problems, 11 %of those studying in schools located at low-traffic zones were affected. The incidence of respiratory ailments in Bangalore's children has risen sharply from 9 % in 1979 to 30 % in 1999.16

The common cold can be treated at home and demands plenty of rest and fluid intake. Hot ginger tea and lukewarm lime water with honey are very effective in the treatment of colds and dry cough. Intake of fluids helps the immune system function properly, Hot water baths and steam inhalation is helpful and can relieve chest and nasal congestion. Two doses of a powdered mixture of tulsi seeds and ginger everyday also ensures quick healing. On other hand turmeric is proven anti inflammatory agent. Inhalation of smoke from the burning turmeric brings quick relief by causing copious nasal discharge during cold. 17

An experimental study conducted on effect on lactoferrin and curcumin (Turmeric) among preschool children in Italy2009. Oral Supplementation was examined in healthy children with recurrent respiratory Tract infections. Infection was reduced in children receiving lactoferrin and Curcumin. Result shows that lactoferrin and curcumin supplementation result Immune modulation and could be clinically beneficially .18

The tulsi or holy basil is an important symbol in the Hindu religious tradition. The holy basil is also a herbal remedy for a lot of common ailments.Tulsi, holy basil, technically known as Ocimum Tenuiflorum, is heat generating in action And useful in respiratory infections. Its anti-bacterial, anti-tubercular, anti-Asthmatic and anti-

7 inflammatory effects have been confirmed in recent times. Leaves of this plant, mixed with an equal quantity of dried ginger powder, from an excellent substitute for tea during cold and flu. This may be adding milk and Sugar three times a day.19

A double blind study was conducted on Effects of Steam Inhalation on Common Cold Symptoms .Patients were eligible for the study if they were over five year of age and had mild to moderate nasal drainage, nasal congestion and sneezing for three days or less. 32 patients with upper respiratory tract infections received active treatment with a device that delivers 40 L per minute of heated (40[degrees]C to 42[degrees]C humidified air through two exhaust nozzles. 34 patients were randomized to receive a placebo treatment of 2 L per minute of ambient air at 20[degrees]C to 24[degrees]C. Two 20-minute treatments, 60 to 90 minutes. Symptom scores for nasal congestion, nasal drainage and sneezing were obtained daily for seven days. In addition, treatment effectiveness was measured by nasal resistance rhinomanography on days 1 and 7. There was a significant difference between the symptom scores and the nasal resistance measurement among the patients who received active treatment and the patients who received placebo.20

From the personal experience of the investigator during clinical experience at Indira Gandhi hospital many children admitted with respiratory tract infection and common cold. Considering the magnitude of the problem and with a view of developing some skill to the mother of school children regarding home remedy for cold. The investigator was motivated to assess the effectiveness of steam inhalation with tulsi leaf and turmeric as a home remedy to relieve cold

6.3 Statement of the problem

A study to assess the effectiveness of steam inhalation with tulsi leaf and Turmeric as remedy to relieve coryza among children in selected Community area Bengaluru.

8 6.4 Objectives

1. To identify the pre assessment symptoms of corzya among children of control and experimental group with coryza.

2. To administer steam inhalation with tulsi leaf and turmeric for relieving coryza for experimental group. And to administer plain water steam inhalation to the control group.

3. To evaluate the effectiveness of steam inhalation with tulsi leaf and turmeric in relieving corzya by comparing the pre assessment score of experimental and control group.

4. To compare post test level of coryza between experimental and control group.

5. To associate pre and post assessment symptoms of coryza of experimental and control group with their selected demographic variable.

6.5 Operational definition:

1. Effectiveness: It refers to the reduction of coryza after administering tulsi leaf with turmeric steam inhalation to the subjects as elicited by assessment tool.

2. Coryza : It refers to the upper respiratory tract infection characterised by profuse discharge from nasal mucous membrane, sneezing and watery eyes. It is the medical name for common cold.

3. Tulsi leaf: It refers to the plant leaf contain (carvacrol) which has antibacterial property. And useful for treating common cold.

4. Turmeric: It refers to a bright yellow aromatic powder obtained from the rhizome of a plant of the ginger family which has an ant inflammatory effect.

5. Steam inhalation with tulsi leaf and turmeric: it refers to inhalation of warm moist air into mucous membrane and respiratory tract by adding tulsi leaf (15- 20) and half spoon of turmeric powder into the boiling water.

6. Children: it refers to children with the age group of 6-12 years, who are residing in selected rural community area having symptom of corzya. 9 6.6 Assumption:

1. The symptoms of corzya usually experienced by children’s can be relieved by many alternative therapies in which steam inhalation with tulsi and turmeric will be more effective than plane steam inhalation.

2. Use of tulsi leaf with turmeric in steam inhalation may reduce coryza in upper respiratory tract infection in children since it is having an anti inflammatory effect.

6.7 Hypothesis

H1: There will be a significant difference between the pre and post test assessment on symptoms of corzya between the experimental and control group.

H2: There will be a significant difference between the post assessment on symptoms of corzya among the experimental group and control group.

H3: There will be a significant association on pre and post assessment symptoms of children with corzya on experimental and control group with their selected demographic variable.

10 6.8 Review of literature

Review of literature is defined as the broad comprehensive, in depth, systematic and critical review of the scholarly publication, unpublished scholarly print materials, audiovisual materials and personal communication.

An important expect of literature review is to make sure what is already done in relation to the problem of interest and contribution make new knowledge, insight and general scholarship of the researchers.

The related literature has been organized under the following heading:

1. Literature related to incidence of corzya (common cold)

2. Literature related to effectiveness of steam inhalation to relieve corzya

11 3. Literature related to effectiveness of tulsi and turmeric as a home remedy for relieving corzya

1. Review of literature related to incidence of common cold.

A cohort study was conducted on weather rhinitis is a predictor for childhood school asthma. In Germany. The Study included 1314 healthy children. They were followed from birth to the age of 5 years with regular questionnaires and interviews. Specific IgE levels were measured at yearly intervals. Airway hyper responsiveness was assessed at 7 years. Allergic rhinitis until the age of 5 years was found to be a predictor for developing wheezing between the ages of 5 and13 years. In this group of children, 41.5% of all new cases of wheezing occurred among children with preceding allergic rhinitis. The first manifestation of allergic rhinitis occurs in preschool children in whom it is a predictor for Subsequent wheezing onset. Preschool children with rhinitis might thus benefit from early assessment of allergy sensitization to identify the children at high risk of wheezing.21

A descriptive study was conducted about symptom profile of common colds in school- aged children (2008). 81 subjects were taken under study, Signs and symptoms of a common cold reported in young children are those perceived by caretakers. Objective signs include cough, fever, and sneezing. Subjective symptoms include nasal congestion, feverishness, headache, and sore throat. Pre-printed diary sheets listing common signs and symptoms, were kept for School-aged children for 10 days after onset of a cold. Nasopharyngeal aspirates were analyzed for respiratory viruses and potential bacterial pathogens. Result of out of 81 colds studied; the most common signs were cough and sneezing, although the most common symptoms were nasal congestion and runny nose. Other symptoms, including feverishness and headache, were each reported in 15% of children at onset. The majority of children (73%) continued to be symptomatic 10 days after onset. Rhinovirus was detected in 46%.22

12 A descriptive study was conducted on epidemiology of acute respiratory infection among fewer than five children in an urban slum area in Sunderpur, Varanasi. 150 under five children were selected by stratified random sampling method and were observed for 52 weeks at weekly interval to record the illness. In total 661 episodes were observed in 5623 child-weeks of observation giving an episode rate of 6.11 per child per year. Acute respiratory infections counted for 67% of all morbidities. Majority of the episodes (88.96%) were confined to the upper respiratory tract only. 61.4% of all the episodes terminated within seven days.23 An experimental study conducted on community based intervention for acute respiratory tract infection and diarrhoea in Nepal 2010. Intervention are based on research were designed to train and engage community health volunteer to implement a community based control programme in Nepal with the advent of IMCI strategy. The proportion of diarrhoea and acute respiratory infection case were significantly lower in district with interventions. Case fatality due to acute respiratory tract infection and diarrhoea case across the country showed a significant trend toward a decrease from 2004-2007.24 A comparative study was conducted childhood deaths due to ARI in Africa 2002. It was estimated that globally ARI causes 1.9 million (95 % CI, 1.6 million To 2.2 million) deaths annually of children under five, 794,000 (40%) of which Occur in Africa). In countries where the under-five childhood mortality rate is 50 per 1,000, as in most of Sub-Saharan Africa (UNICEF 1996, ),ARI is Estimated to be responsible for 23 % of deaths, compared with only 15% of Deaths in countries where the under-five mortality rate is 10 per 1,000 / year. In The indigenous South African population of black people from 1968 to 1973, a Corrected estimate of 22.5 %of the under-five mortality of 40 per 1,000 was attributed to ARI, compared with 1980–85, when, with an under-five mortality Rate of 17.3 per 1,000, the proportion of deaths due to ARI decreased to 17.7 %). Similarly, ARI was linked to a high proportion (21 to 24%) of deaths in other African countries, where the under-five mortality rate ranged between 35 and 63 per 1,000 children during the 1990s). 25

A descriptive study was conducted by the lakeside medical centre and hospital In Bangalore on incidence of asthma and cough and cold among children in 2003. Nearly 7-8 lakh children (50%) suffering from, coughing, cold, wheezing and other respiratory ailment due to alarming air pollution level. Common cold and Coughing and wheezing among children, especially of the school going age due to Inhalation of polluted air.1000children needs emergency help, and over 2,900 such Children treated in this

13 hospital alone. The incidence of respiratory ailments in Bangalore’s children has risen sharply from 9% in 1980 to 30% in 2000. 17

A Cohort study was conducted on determinants of acute respiratory infection in Denmark, 2006. Data were collected on the occurrence and the clinical impact of Respiratory pathogen in the population. During the period of study, a total Number of 571 children was observed for 118,650 days, with the determinants Birth weight, breast feeding gender, crowding passive smoking, indoor pollution, and sanitary facilities were analysed. A total number of 486 episodes of coughing and nasal discharge combined were recorded. The incidence of severe ARIs was reduced among breastfed infants. The study suggests that crowding and communal Living conditions are important determinants of ARIs. Breastfed seemed protective against sever ARI.5

2. Literature related to effectiveness of steam inhalation to relieve corzya.

A true experimental study was conducted on effectiveness of steam inhalation on nasal patency and on nasal symptom in Cleveland (Ohio) clinic foundation. 62 Patients were studied with the common cold by a double -blind randomized, Placebo-controlled clinical trial. Treatment requires consisted of two 20- minutes Sessions, during which the patient inhaled saturated, hot (42 degree to44 degree C) Air through the nose. The subjective response was recorded by each patient during the week following treatment on a daily symptom score card. Nasal Patency was determined before treatment, the following day, and 1 week later by Measuring peak nasal expiratory and inspiratory air flow. Steam inhalation Resulted in alleviation of cold symptoms and increased nasal patency a significantly higher percentage of patients in the actively treated group than in the placebo-treated group.26

A double-blind randomized study was conducted on the efficacy of steam Inhalation in the treatment of common cold in children. The criteria for inclusion Was patient who was over 5 year age and had mild to moderate nasal Discharge, nasal congestion and sneezing for 3 day or less.32 patient with Respiratory infection receive active treatment with a devise that deliver 40L per Minute of heated (40(degree)C to 42(degree)C to 42(degree)C humidified air Through two exhaust nozzles.34 patient were randomized to receive a placebo Treatment of 2 L per minute of ambient air at 20(degree)C to 24 (degree)C two 20 Minute treatment 60-90 minute. Subjective symptom scores for nasal Congestion, nasal drainage and sneezing were obtained daily for7 days. A Significant 14 difference were noted in the symptom scores and the nasal resistance Measurement between the patients who received active treatment and the patients who received placebo.27

3. Literature related to effectiveness of tulsi and turmeric as a home

remedy for relieving corzya.

An Explorative study was conducted on effectiveness of turmeric in respiratory Allergy, in developed countries. Attempts to develop effective control measures For allergy and asthma resulted in the exploration of alternate medicines including Herbal remedies traditionally used in old world countries. Turmeric is known for Its multiple health restoring properties, and has been used in treating several Diseases including several respiratory disorders. The active component of Turmeric is curcumin, a polyphenolic phytochemical, with anti-inflammatory, Antiamyloid, antiseptic, antitumor, and ant oxidative properties. Curcumin was reported to have anti allergic properties with inhibitory effect on histamine release from mast cells. The effectiveness of curcumin in allergy and asthma has been further investigated using a murine model of allergy. The results indicate a marked inhibition of allergic response in body .28

A study was conducted on safety and anti inflammatory activities of turmeric-in Department of California (2002). The subject were selected randomized placebo, 25subject used 8000 mg of turmeric (curcumin) per day for 3 month and another Trials using 1125-2500 mg curcumin per day, and no toxicity found from Curcumin. The result shows that curcumin have anti inflammatory activity. It has been used via oral administration for the common cold and other inflammatory disease.29

An Experimental study was conducted on immune modulation by lactoferrin and Curcumin (turmeric) in children with recurrent respiratory infections in 2009 Italy. The subject was healthy children with recurrent respiratory tract infections. . Infections were reduced in children receiving LC. Immunologic analyses showed That LC supplementation resulted in a significant skewing of CD8+T lymphocytes Maturation. LC supplementation results in immune modulation and could be clinically beneficial in respiratory tract infection.30

An Experimental study conducted on Effectiveness of tulsi in respiratory Infection on August12, 2009. Tulsi leaves are boiled in water and the essence is given to children and adults who suffer from flu and common cold, tulsi is found to improve the body's defense mechanisms against viruses in general and its Effectiveness has been vouched for in its

15 ability to act against the virus causing Flu and common cold. Tulsi can control swine flu and it should be taken in fresh Form. Juice or paste of at least 20-25 medium sized leaves should be consumed twice a day on an empty stomach. This increases the resistance of the body and, Thereby reduces the chances of inviting flu, and common cold31

An Experimental study conducted on effectiveness of tulsi leaf as a home remedy for relieving cold among school children in Kerala. A decoction using tulsi leaf and dry ginger with touch of jaggery and flavored by tea, given to the Children. Result shows that children after consuming decoction, children reduce Symptom of cold. As tulsi contain carvacol which contain anti inflammatory Effect is effective for relieving cold.32

A Descriptive study was conducted on Complementary, holistic and Integrative medicine for the common Cold. The study review examines popular complementary, Alternative medicine (CAM) therapies used to alleviate symptoms of the common cold in children. Natural health products (which include herbals (Ex: tulsi, turmeric, Ginger, Echinacea, Eucalyptus) honey, vitamins, homeopathic and traditional medicines) are used widely for prevention and treatment of common cold. Study has investigated the efficiency and safety of Echinacea in the prevention and treatment of colds in pediatric patients. The first was randomized controlled trail (RCT) in which 430 children (ages 1 to 5 years) received on herbal preparations containing 50 mg/ml of Echinacea and 10 mg/ml of vitamin C over a 12 week period during the winter. Children had significant reductions in the number of illness episodes (55% reduction).33

A Descriptive study was conducted on synopsis of turmeric’s healing properties in southern Asia. Turmeric is a Dried and ground root of the Curcuma longa plant. The common turmeric, beside its use as a spice, turmeric is also used as a skin conditioner and as an ingredient in many home based medicines. In Southern Asia, turmeric is used as an ingredient to cure common colds, and to treat skin bruises. Previously, scientific Research has been conducted to establish the antiseptic properties of turmeric oils against a variety of bacteria in the present study; the antiseptic property of turmeric roots has been studied against a specific strain of Escherichia coli.34

A comparative study was conducted about current and futures therapeutic approaches to the common cold, investigators have strived to elucidate the pathogenesis, and hence a treatment, for the common cold. Therapy has been tried with a variety of agents, ranging from anecdotal folk remedies, to well-designed medications. Measures primarily directed to relieve the symptoms of the common cold, rather than specific antimicrobial agents, are the current main stay of therapy. Millions of patients would

16 benefit from an easy-to-perform diagnostic test and specific therapy that works quickly, shortening the duration of illness and preventing further spread of infection.35

7 MATERIAL AND METHODS 17 7.1 Source of data

The data will be collected from children with corzya residing in selected rural community area Bengaluru.

7.2 Method of data collection

I Research design

The research design selected for the study is a true experimental –repeated measures design.

II. Research variable:

Dependent variable: In this study the dependent variable is corzya.

Independent variable: In this study the independent variable is steam inhalation with tulsi leaf and turmeric.

Demographic variable

In this study the demographic variable include Mother’s Religion, education status, occupation, type of family and Child’s Age, gender, duration of illness, history of other illness

III. Setting:

The study will be conducted is in selected rural community area Bengaluru.

IV. Population

18 In this study the population comprised of all children (6-12 years) residing in selected rural community Bengaluru having symptoms of corzya.

V. Sample size

Children who are fulfilling the inclusion criteria will be selected as samples. The sample size will be 80 school children’s.

VI. Criteria for selection of samples

Inclusion criteria:

The study include the children who are

1. With corzya residing in selected community area of Bengaluru.

2. Having symptom of corzya for the past two days

3. In the age group of 6-12 years.

Exclusion criteria:

The study excludes the children who are

1. Not willing to participate in the study.

2. Having corzya with other medical disorders.

VII. Sampling technique

The data will be collected using probability simple random sampling technique. 19 Lottery method will be adopted for selection of sample.

VIII. Tool for data collection:

Section A; It includes demographic variable of Mother’s religion, education, occupation, type of family and Child’s age, gender, duration of illness, history of other illness.

Section B:

Non observational checklist is use to assess the symptom of corzya.

Section C:

Steam inhalation with tulsi and turmeric.

IX. Method of Data collection procedure:

After obtaining the permission from the concern authority, to conduct study in selected community area the researcher will selected 80 children’s on the basis of inclusion criteria by probability simple random technique .The data collection will be done in three phases.

Phase I: Pre assessment of coryza among children of experimental and control group will be done with the help of assessment tool.

PhaseII: Then the investigator will administer steam inhalation with tulsi leaf and turmeric as a remedy for relieving corzya for experimental group and plain steam inhalation for control group for three days.

20 PhaseIII: The investigator will assess the post test assessment of corzya among children of control and experimental group to evaluate the effectiveness of steam inhalation with tulsi leaf and turmeric in relieving corzya with the help of assessment tool.

Duration of study is : 4-6 weeks

X. Plan for data analysis:

Numerical data obtained from the sample will be organized and analysed with the use of both descriptive and inferential statistics. Master coding sheet will be prepared based on the numerical data obtained from the sample.

Descriptive statistics

Frequency, percentage distribution will be used to study the demographic variable regarding children with corzya.

b). Inferential statistics

Paired “t’ test will be used to assess pretest and post test level of corzya of experimental and control group.

Chi square test will be used to find out the association between pre test and post test level of corzya of experimental and control group.

 Level of significance will be set at 0.05 to interpret the hypothesis and finding.

 Analysed data will be represented in the form of tables, graph and figures.

21 XI. Projected outcome:

As the investigator has planned for interventional steam inhalation programme among children with corzya there will be improvement in the post test symptoms of corzya in experimental group.

7.3 Does the study require as investigator to be conducted on patient or animals? If so please describe

Yes, with prior consent the sample the study will be conducted in selected Rural Community area at Bengaluru. The study will require intervention in the Form of steam inhalation intervention only. No other intervention which will Cause any harm to the subject.

7.4 Has ethical clearance obtained from your institution?

Yes, the permission will be obtained from concerned authority and the study subject.

 Privacy, confidentiality and anonymity will be guarded

 Scientific objectivity of the study will be maintained with honest and impartiality

 Ethical clearance certificate has been enclosed for the verification

22 23 24 8. LIST OF REFERENCES

1. Sharma AK Reddu Dc. Dwivedi R.R Descriptive epidemiology of acute respiratory infection among under five children in an urban slum area, University College of public health 1999; Oct: 156-159

2. Children with acute respiratory infection. Available from: www.viriology.com/content /6/1/155

3. Sherene. G Edwin, effect of planned teaching programme on knowledge, attitude on practice of ARI among mothers, Shakuntala college of nursing, Trichy, the nursing journal of India TNAI-2009; Nov: e ;11

4. Health Care Survey 2010: Available from: http://www.aanma.org/publication/special- pubs.

5. Determinants of acute respiratory infection. skej by University hospital viborg hospital Aarhus Denmark. Available from: Ines@ dadnet.dk.

6. Child statistics under privileged. Available from www. America cry.org.statistics /situat- ion of children.

7. The common cold. Indian journal of paediatrics. Available from: http: //www. in. peep- lo .com/search.

8. Machair, Dr.Trisha etal, the common cold retrieved 2009;sept. Available from: http://www.bbc.co.UK/health/conditions.

25 9. Incidence of common cold. Available from: http:// www.org.patient/app2009;02635/4

10. Parul dutta. Paediatric nursing. 2nd edition .Jaypee brother. 2009;273-275

11. Emergency medical services for children. Available from: http;//www.nap.edu/ : 41-42.

12. Rhinitis or common cold. 2011.02 November. Available from: http / / www .sujarogya.- wordpress.com.

13. T J. John, T. Cherian, me Steinhoff. Etiolgy of acute respiratory infection in children in tropical, south India, review of infection 1991.

14. Remedies for common cold. Available from: http://www.my child hea.net/infant running.

15. Awash S, Bassoon DG, Kumar R, Paul UK, Causes of neonatal and child mortality in India, centre for global health research ilka shing knowledge institute, university of Toronto Canada. 2010November:1853 ;60

16. India Bangalore kids pay the price for pollution. News ACR weekly newsletter vol-02 2003; 17.

17. Natural common cold home remedies 8th February 2008. Available from: http;//www.home remedies –for you.com/remedy common cold html.

26 18. Immune modulation by lactoferin and curcumin. Department of pediatric L Sacco hospital University of Milan Italy.2009 April –June; 23(2); 119-23.

19. Dr. Murali Manohar chirumamilla MD (Ayurveda) guideline & Ayurvedic remedies 06-2011June .Avaliable from: http:// [email protected]

20. Effectiveness of steam inhalation. American Journal of orolaryngology. (8)(3 ; ( 149-53).

21. Rochat MK. et al. (2010); Mosby Allergic rhinitis as a predictor for wheezing onset in school –age children. American Academy Of Allergy, Asthma and Immunology.

22. Pappas DE et al (2008) symptom profile of common colds in school age children.Pediatric Infect Dis J.2008; Jan: 27(1): 8-11.

23. Debsk, Acute respiratory disease survey in Tripura incase of children below five years of age, Department of Pediatrics. IGM hospital Agartala. Journal Indian Medical association. 1998; April : 111-116

24. Ghimire M, Pradhan YV.maskey MK. community base intervention.WHO-2010; March:88(3)216-21.

25. Madhisa Kiugman KP, Acute respiratory infection. 2006; disease and mortality in Sub Sahara Africa 2nd edition Washington- DC –Chapter -11.

27 26. Ophir D Elady. Effectiveness of steam inhalation. American Journal of orolaryngology (8)(3);149-53

27. Effectiveness of inhaling heated vapour on symptom of the cold. Department of paediatrics. Cleveland clinic foundation. OH 44195-5045 JAMA-1990; August: 22- 29:264(8):989-91.

28. MI/Waukee WI, research work on curcumin asthma allergy, Allergy and immunology division. Department of paediatric medical college of Wisconsin USA.

29. Mary Ann Libert inc. Journal of alternative and complementary medicine vol-9- 1-2003; November: 161-168.

30. Immune modulation by lactoferri and curcumin in children’s with respiratory. Department of paediatric L-Saco hospital university of MI/an Italy-2009; 23(2)(119-23)

31. Effectiveness of tulsi in respiratory infection. New nation Bangladesh 2009;August: Available from: http://www.holy basil.com/3050/html

32. Effectiveness of tulsi as a home remedy for relieving cold.2008; Jan: Available from: http://kitchenmishmash blogs pot.com/chukku kapi-kerala herbal coffee home html.

33. Cecilia Bukutre, Christophe Le, Sunita Vohra.Complementary, Holistic and integrative medicine, American academy of pediatrics. 2008; e 66 – e 71.

28 34. Turmeric as an effective antiseptic against E. coli: Available from: http;//knoll.googles .com/k/

35. Mossad SB. (1998) Current and future therapeutic approaches to the common cold Arch paediatric. 1998; Jan: 5(1): 9-14.

29 9.Signature of the candidate :

10.Remark of the guide : The study will be appropriate feasible and relevant

to enhance the knowledge in the field of paediatric speciality

11.Name and designation of, :

11.1. Guide : Mrs. Arockia Mary, Professor and

HOD of Paediatric nursing

30 11.2. Signature and seal :

11.3. Head of the department : Mrs. Arockia Mary,Professor

11.4. Signature and seal :

11.5. Co Guide :

11.6. Signature and seal :

12.1 Remarks of the principal : This study is relevant appropriate to the field of nursing and speciality chosen

12.2 Signature and seal :