Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka s43
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MONIKA CHAUDHARYI YEAR M.Sc. NURSING STUDENT
Smt. NAGARATHNAMMA COLLEGE OF NURSING,
ACHARYA DR.SARVEPALLI RADHAKRISHNAN ROAD,BANGALORE – 90
2. / NAME OF THE INSTITUTION / Smt. NAGARATHNAMMA COLLEGE OF NURSING,
ACHARYA DR.SARVEPALLI RADHAKRISHNAN ROAD,BANGALORE – 90
3. / COURSE OF STUDY AND SUBJECT / I YEAR M.Sc. NURSING
CHILD HEALTH NURSING
4. / DATE OF ADMISSION TO COURSE / 30.6.2012
5. / TITLE OF THE TOPIC / EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMMME ON KNOWLEDGE REGARDING “PREVENTION OF MUMPS IN UNDERFIVE CHILDREN,” AMONG THE MOTHERS ATTENDING UNDER FIVE CLINIC OF BANGALORE RURAL PHC.
6. / BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
‘"Real knowledge, like everything else of value, is not to be obtained easily. It must be worked for, studied for, thought for, and, more that all must be prayed for."
- Unknown
Communicable diseases have in many occasions led to the death of children who could have contributed positively to the economic, social and political development of the society. It is therefore imperative for every individual and organizations to find solution to the problem of communicable diseases in the area of prevention and control, for an adage says prevention is better than cure.1
The epidemiology of mumps in India and the magnitude of the problem are still not fully appreciated. Mumps continues to occur in epidemic proportions, despite the availability of an effective vaccine. There were 301 children admitted with mumps between 1999 and 2003.2
In 2010, approximately 92% of all children had been exposed to mumps by the age of 15. In these pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 2011 when approximately 250 cases were reported for every 100,000 people.3
According to India Weekly outbreak reports 2012, there are 19 cases of mumps in Lakhisarai (Bihar), 13 cases of mumps in Thrissur (Kerala), 47 cases of mumps and 1 fatality in Osmanabad (Maharashtra), 27 cases of mumps in Bankura (West Bengal), and 93 cases of mumps in Leh (Ladakh) ( Jammu and Kashmir).4
Mumps is a moderately infectious disease caused by a virus of the paramyxovirus group. The infection is spread by airborne droplets and possibly also by urine. The first symptoms occur after an incubation period of 15-24 days (median 19 days). After a prodromal (warning signs) period of several days with non-specific flu-like symptoms of headache and fever, the classic swelling of the parotid glands (salivary glands) develops.5
Vaccination is probably one of the most cost effective intervention for infectious diseases 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.6
So awareness of vaccines and its effects to all the mothers is an important factor to improve the health of the child. So, the mothers must have the primary responsibility of getting their child fully immunized and the child must not be made to suffer if the mothers are having lack of knowledge.7 Mothers are the primary care takers of the children because usually the children depend on their mothers for fulfilling their needs the mothers play a vital role in safe guarding their children against many disease conditions especially infectious disease like viral infections. So their knowledge regarding infectious diseases and their prevention is of vital importance. 8
6.1 / NEED FOR THE STUDY
Mumps cases reported in Kerala state, India, it has hit a three year high, total of 133 cases were reported in 2012 when in comparison to 97 cases in 2011, the number of cases were increasing drastically since October. Mumps cases are known to peak in the period between January to march. The reason for the rapid spread of the disease is that swelling occurs on the child only after 2 or 3 days, in these 2 or 3 days the only symptom will be fever or cold. So the parents keep sending their child to school. This results in spread to other students. For this reason awareness campaigns were launched.9
Over 100 children have been affected by a mumps outbreak in Marashda, Egypt, with 43 cases and 70 infections reported. Officials at the ministry of health insist that this is a serious outbreak. 10
As Because of the arrival of new mumps virus genotype, Mumps has re-emerged as an infection in the developed world. Its epidemiology has changed, while mumps is easily suspected if parotitis is present, parotitis is absent in 10%-30% of symptomatic cases. Mumps is a systemic infection with a variety of extra- parotid complications.11 Although there is only one serotype of mumps virus, according to recent update by WHO (June 2012), There are currently 12 genotypes A-N.12
According to “The Hindu National Newspaper” Incidences of infectious disease mumps are increasing in the city every year In the hospital of Bangalore there were 265 cases of mumps in 2000, this went down to 177 and 132 in 2001and 2002 respectively. In 2003, there were 275 cases and in 2004, it was 274. The incidences of these three infections continue to increase despite a vaccine to protect against them. This is mainly because the vaccines are expensive.13 Inspite of MMR vaccine; there are cases of mumps detected in India. According to India Weekly Outbreak reports 2012, Mumps in Belgaun (25 cases, Karnataka). Mumps in Chitradurga (10 cases, Karnataka), Mumps in Bangalore (46 cases, Karnataka). 14
In 2009 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. 2012, the Centers for Disease Control and Prevention (CDC) reported 751 cases of mumps nationwide, or, in other words, about one case for every five million people.14
Mumps primarily affects young children, with increased incidence in winter and spring. This study is intended to highlight the increased number of mumps cases in children attending tertiary care centre in Nepal, so as to decrease the disease occurrence and disease burden. 15
Mumps outbreaks are likely caused by factors including incomplete protection following vaccination, waning of immunity, and intensive crowding. Mumps currently affects mainly people who were vaccinated more than 10 years ago. Outbreak response concentrates on surveillance, outbreak investigations, disease awareness, and provision of catch up vaccination to unvaccinated or incompletely vaccinated children. Adequate surveillance, important for building evidence for possible changes in mumps vaccination recommendations, depends on recognizing mumps and its complications.12
Mumps can cause major complications, particularly in male, in whom complications can result in sterility if not treated properly. CNS involvement - 15% of clinical cases like meningitis 50% to 60% of patients. , Orchitis - 20%-50% in post-pubertal males, Pancreatitis - 2%-5%, Deafness - 1/20,000 (80%), Oophoritis (ovarian inflammation) occurs in 5% of post pubertal females. Other less common complications of mumps include arthralgia, arthritis, and nephritis. An average of one death from mumps per year was reported during 1999-2010.16
Children in rural areas in India die due to infectious and communicable diseases. This study was carried out to know the immunization status, nutritional status and to assess the levels of the mother’s knowledge regarding immunization and nutritional diet. The findings reveals, For those mothers who were well aware of the immunization and nutritional programmes, the children’s height and weight were well correlated against the mothers who were not aware of these programmes, whose children’s height and weight did not show significant correlation. The results showed that 16% of the children were under malnutrition.17
The result of a study on level of mother’s knowledge shows that the mother’s knowledge of child health related matters is deficient. It is the responsibility of health care personnel to disseminate information on child health matters among mothers in the community.18
A descriptive study was conducted to determine the relationship between the literacy status and immunization coverage among 100 mothers of school going children. The analysis revealed a fairly low immunization coverage (<33%) for all vaccines and it was found that literacy status of mothers had a significant influence on the immunization level. Lack of awareness and motivation was cited as the main reason for non-immunization.19
While working in the community the investigator found that there are so many children missed the opportunities of vaccination and some children contracted the condition despite vaccination hence, the investigator decided to undertake the study to assess the effectiveness of structured teaching programme for mothers in a selected area at Bangalore.20
6.2. / REVIEW OF LITERATURE
Using a cross-sectional design, 790 HSS of Manipal University, Manipal, India, answered a questionnaire and provided a blood sample which was tested for specific IgG antibodies to measles, mumps, rubella and varicella by ELISA (Enzygnost).The study group was comprised of medical (53.9%), nursing (16.6%), and allied health (29.5%) students. Among the overall group (n = 790), the prevalence of serological susceptibility to measles, mumps, rubella, and varicella were 9.5%, 32.0%, 16.6%, and 25.8%, respectively. Among the subgroup of vaccinated subjects, susceptibility to measles, mumps, rubella, and varicella were 7.9%, 34.7%, 10.7%, and 35.2%, respectively.21
The duration of the presence of maternal mumps antibodies in a prospective cohort study is presented. Immunoglobulin G against mumps was portioned with a commercial ELISA test (Euroimmun anti-mumps Virus AT ELISA, Germany) on samples from 213 mother–child pairs at seven time points between pregnancy and 12months of age. Non-linear mixed models were used to model maternal antibody decay in infants. The model-based median time to loss of antibodies was 3.6months. The median child-specific time to loss of antibodies in children of naturally immune women (3.8months) and children of vaccinated women (2.4months) differed significantly (p = 0.025). The log antibody level of the mother and the log birth weight were correlated with the duration of maternal antibodies in infants (p < 0.0001). Children of vaccinated women loose maternal mumps antibodies significantly earlier in life compared to children of naturally infected women. If early administration (<12months) of the combined measles, mumps, and rubella vaccine is needed, maternal mumps antibodies are not expected to interfere with infant humoral vaccine responses.22
Comparative prospective or retrospective trials assessing the effects of the MMR vaccine compared to placebo, do nothing or a combination of measles, mumps and rubella antigens on healthy individuals up to 15 years of age. We included five randomized controlled trials (RCTs), one controlled clinical trial (CCT), 27 cohort studies, 17 case-control studies, five time-series trials, one case cross-over trial, two ecological studies, six self controlled case series studies involving in all about 14,700,000 children and assessing effectiveness and safety of MMR vaccine. Effectiveness of at least one dose of MMR in preventing clinical mumps in children is estimated to be between 69% and 81% for the vaccine prepared with Jeryl Lynn mumps strain and between 70% and 75% for the vaccine containing the Urabe strain. Vaccination with MMR containing the Urabe strain has demonstrated to be 73% effective in preventing secondary mumps cases. 23
A retrospective cohort study was conducted among the students in four elementary schools and their siblings. The vast majority (98%, 95% CI 96-99%) of the cases occurred among the unvaccinated children. The attack rates across the four schools varied widely, which could be expected in light of the major differences in vaccination coverage. For the subgroup of unvaccinated children, the attack rates also varied across the schools with the rates much higher for those children with a connection to the orthodox protestant schools A and B than for those children with a connection to schools C and D (p < 0.05). Furthermore, 59% (109/186) of the cases among the students at school A and 53% (68/128) of the cases among the students at school B could be classified as possibly secondary cases of mumps (i.e., onset of symptoms one incubation period past the infectious period of another case in the same grade, thus in the third week following onset of symptoms of the other case). Using the same definition, there were no possibly secondary cases at schools C and D. Almost half of the respondents (47%, 95% CI 45-50%) reported clinical signs of mumps.24
This was a prospective study done in Civil Service Hospital of Nepal over a period of 2 years from November 2009 to October2011. All children less than 14years of age with symptoms of fever and parotid swelling were included in the study group. A detailed history pertaining to the disease was taken, Children were asked to follow up either after 5 days or in case of noticing any signs and symptoms of complication. There were total 113 cases diagnosed clinically as mumps of which there were 71 males (62.83%) and 42 females (37.16%) with the peak incidence of disease in the month of March and September with 22 cases (19.46%) in each month. The increase incidence was seen in 4-6 years of age with 58 cases (51.32%). There were 70 patients (61.94%) that had history of exposure to mumps infection. There were large number of children with mumps and none of them were vaccinated. Child can be prevented from the infection by vaccination and thus avoiding possible sufferings and complications. Thus they recommend the use of mumps vaccination in Routine immunization programme.25