"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE ATTITUDES

AND PRACTICES OF MOTHERS REGARDING GROWTH MONITORING OF UNDER FIVES

AT SELECTED PHC, BIDAR, KARNATAKA.”

BY

JYOTHI SUPRIYA K

Synopsis submitted to the Rajiv Gandhi University of

Health Sciences, Karnataka, Bangalore.

In Partial fulfillment of the requirements for the degree of

MSc Nursing In Community Health Nursing

under the Guidance of

Mrs. VANITHA KULKARNI

Community Health Nursing,

Akkamahadevi College of Nursing, Chidri, Bidar, Karnataka.

2010

"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE ATTITUDES

AND PRACTICES OF MOTHERS REGARDING GROWTH MONITORING OF UNDER FIVES AT

SELECTED PHC, BIDAR, KARNATAKA.”

BYJYOTHI SUPRIYA K

GUIDEMRS. VANITHA KULKARNI

DEPARTMENT OF COMMUNITY HEALTH NURSINGAKKAMAHADEVI COLLEGE OF NURSING,

CHIDRI, BIDAR, KARNATAKA.

A SYNOPSIS SUBMITTED AS A PART OF PRACTICAL EXPERIENCE IN AKKAMAHADEVI COLLEGE OF

NURSING, CHIDRI, BIDAR, KARNATAKA.

2010

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESJAYANAGAR, BANGLORE, KARNATAKA.

PROFOMA FOR REGISTRATION OF SUBJECT FOR SYNOPSIS

1 NAME OF THE

CANDIDATEJYOTHI SUPRIYA KM.SC NURSING I YEARAKKAMAHADEVI COLLEGE OF NURSING, CHIDRI, BIDAR, KARNATAKA.

2. NAME OF THE INSTITUTION

AKKAMAHADEVI COLLEGE OF NURSING

3

COURSE OF THE STUDY& SUBJECT

M.SC, NURSING, COMMUNITY HEALTH NURSING.

4 DATE OF

ADMISSION23/02/2010

5TITLE OF THESUBJECT

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAM ON KNOWLEDGE ATTITUDES AND PRACTICES OF MOTHERS OF UNDER FIVES AT SELECTED PHC AREA BIDAR, KARNATAKA.”

S. NO INDEX PAGE NO6

6.1

6.2

6.3

6.4

6.5

6.6

6.7

6.8

6.9

7

7.1

7.1.1

7.1.2

7.1.3

7.2

7.1.1

7.2.2

7.2.3

7.2.4

7.2.5

7.2.6

7.2.7

7.2.8

BRIEF RESUME OF THE INTENDED WORK: NEED FOR THE STUDY:

REVIEW OF LITERATURE:

STATEMENT OF THE PROBLEM:

OBJECTIVES OF THE STUDY:

HYPOTHESIS:

OPERATIONAL DEFINITIONS:

ASSUMPTIONS:

DELIMITATIONS:

PROJECTED OUTCOME:

MATERIALS AND METHODS:

SOURCE OF DATA:

RESEARCH DESIGN:

SETTING OF THE STUDY:

POPULATION:

METHODS OF DATA COLLECTION:

SAMPLING PROCEDURE:

SAMPLE SIZE:

INCLUSION CRITERIA:

EXCLUSIVE CRITERIA:

VARIABLES:

TOOL FOR RESEARCH:

DATA COLLECTION PROCEDURE:

DATA ANALYSIS AND INTERPRETATION PLAN:

1

1 – 4

5 – 8

9

9

9

10

11

11

11

12

12

12

12

12

12

12

12

13

13

13

14-15

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6 BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study:

The word ‘growth refers to increase in the physical size of the body. It is a measure of

physical maturities, signifies an increase in size of the body and its various organs.

Thus, it can be measured in terms of centimeter (height) and kilograms (weight). The

word ‘development’ refers to increase in skills and function i.e., it is a measure of

functional or physiological maturation. It signifies accomplishment of mental

acquisition of skill, etc., emotional) (development of attitudes, etc.) and social

(adaption to family and society, etc.) abilities.1

“Monitoring” implies the routine continuous collection and evaluation of the

measurement which reflect the “nutritional situation.” Anthropometric measurements,

which include weight, length, height, MUAC, triceps skinfold (TSH), and date of

birth for calculation gives clues for nutritional status of the children.1

The factors influencing growth and development are Genetic inheritance, Nutrition,

Socioeconomy, Environment, Chronic diseases, Infections and Parasitoeses,

Emotional trauma, Others.1

One of the basic activities of the under-fives clinic is growth monitoring, i.e., to weigh

the child periodically at monthly intervals during the first year, every 2 months during

the second year, and every 3 months thereafter up to the age of 5 to 6 years. When the

child’s weight is plotted on the growth chart against his/her age, it gives what is

known as the growth curve. This will help the health worker to detect early onset of

growth failure.2

Most trainers of health workers agree that activities with mothers and children are the 1

most important part of health work in a community. This is because ,Women and

children make up more than half the people (up to 75%). The health needs of mothers

and children are especially great. Mothers and older children are the main providers of

care for babies and younger children, whose needs are greatest of all. 3

Mother’s Status in the Family and Nutritional Status of Their Under- Five Children.

Paper presents part of findings from a longitudinal collaborative project of UNICEF,

Kolkata and ICMR, undertaken in four demarcated villages of West Bengal during

1998-99. Present analysis aims to relate status of 450 mothers in the family with the

nutritional status of their 530 under five children. For assessing mother’s status their

education and employment levels and role in decision making were ascertained.  Role

in decision-making included control over daily household expenses, decision

regarding use of family planning and seeking permission for visit to parental house or

watching a movie. The information was collected by a social scientist by undertaking

in depth interview of mothers.  For assessing nutritional status of children height and

weight measurement were taken using standard techniques and method. Proportions

of under weight and stunting were calculated using NCHS standard, showed that

proportion of both underweight and stunting was more among children of illiterate

mothers (55.2% and 55.8 %) while comparing with children of mothers having above

primary education (41.0% and 42.9 %), employed mothers (77.4% and 80.6 %) while

comparing with children of housewives (46.8% and 47.8 %) and mother who don’t

have any control over daily family expenditure  (54.7% and 50.3%) while comparing

with children of mothers who had such control (25.6% and 30.0 %). More than 80 %

of families belonged to labour class and the differences persisted irrespective of

economic status of families. Thus the study shows that educated mothers and those 2

having control over family expenses take care of children more effectively reflected in

better nutritional status of their children, while children of poor employed mothers

suffer nutritionally. Hence there is need for some place like crèche   to take care of

children of poor working mothers during their working hours. 4

India is a third world war country. Since independence, one of the gravest problems

India is confronting with is malnutrition among under-5 children. As in other

developing nations, malnourishment is a burden on considerable percentage of

population, the most vulnerable being the youngest group of the society. About two-

third of the under-five children of our country is malnourished. Among them, 5-8%

are severely malnourished while rest fall in the group of mild or moderate

malnutrition. So it can be said that malnutrition is one of the most widespread

conditions affecting child health. The 'germ' of malnutrition 'infects' a foetus in the

intra-uterine life due to lack of sufficient antenatal care on part of the mother. The

condition deteriorates further when after birth the infant is deprived of exclusive

breast feeding or initiation of weaning is delayed.5

Weaning should be started after the age of 6 months and should contain energy rich

semi-solid food. Malnutrition makes a child susceptible to infections and delays

recovery, thus increasing mortality and morbidity. Every time an innocent child

suffers the curse of malnutrition; the responsibility goes to the mother, the family and

to the community due to their faulty or no knowledge regarding the harmful effects of

prelacteal feeding, benefits of exclusive breast feeding and initiation of proper

weaning at the correct time. It is to be realized that a million children die worldwide

each year because they are not breast fed. Several millions who survive suffer from 3

acute or chronic illness related to harmful effects of artificial feeding. These

sufferings are unnecessary and are the preventable ones by discouraging bottle

feeding and initiating efforts to bring back the breast feeding culture. On this

background, a project has been carried out under the above mentioned title, which is

discussed in detail in the pages to follow. A study like this is very much essential to

estimate graveness of the situation so that effective and adequate measures can be

taken at the individual, family, community and government levels to combat the curse

of malnourishment.5

4

6.2 Review of literature:

The related literature are presented in the following subheadings.

1. Knowledge and attitudes of mothers on growth monitoring.

2. Practices of mothers on under five growth monitoring.

3. Problems related to under fives.

1. Knowledge and attitudes of mothers on growth monitoring:

The reliability and validity of the schedule was evaluated through a 10-month

monitoring programme of 95 children, aged 2–10 months. The acceptability of the

process was evaluated by studying retention rates and by organizing focus group

discussions with participating mothers. Results are, The structured interview

‘Developmental Milestones Checklist’ consisted of 66 items covering three broad

domains of child functioning: motor, language and personal–social development. The

interview yielded scores of developmental achievements that showed high internal

consistency and excellent test–retest reliability. The results were sensitive to

maturational changes and nutritional deficiencies. In addition, acceptable retention

rates of approximately 80% were found. Participating mothers reported that they found

the procedures both acceptable and beneficial. Conclusion is Developmental

monitoring using caregiver report is a viable method to identify and monitor at-risk

children in Sub-Saharan Africa.6

It was therefore necessary to evaluate mothers’ knowledge and attitudes of these

activities. A descriptive cross-sectional study of nursing mothers and their children

attending well-baby clinics in Ibadan was designed. Two hundred and forty nursing

mothers and their children were recruited from three types of well baby clinics

5

(university teaching hospital, state maternity hospital and primary care health centers)

in the Ibadan North local government area of Oyo state, Nigeria. Interviewer-

administered questionnaire were used to obtain information from mothers about

Anthropometric measurements of the children were taken to determine ‘wasting’,

‘stunting’ and ‘underweight’. Result of the analyses showed that majority of the

mothers (74%) were married and 17% were single, 31.3% had completed primary

and/or secondary education, 16.7% had no formal education while 51.8% had tertiary

education. Timely and complete immunization was practiced by 93.8% for BCG,

80.4% for one dose, 60.4% for two doses and 49.2% for three doses of DPT and oral

polio vaccines, 53.8% for measles and 12.1% for hepatitis B. About 55% of the

mothers were currently using family planning methods. Sixty-three percent of the

children were underweight, 68% were stunted and 23% were wasted. There was no

significant relationship between mothers’ practice of CSS and nutrition of the children.

Mothers’ education was negatively correlated to ‘wasting’ in the children. This study

reaffirms the importance of female education in the practice of CSS and good

nutritional outcomes in children. Basic knowledge of child health, nutrition and related

issues should continue to be made available to women and be included in the school

curricula7.

2. Practices of the mother in under fives growth monitoring

A study was conducted on practice of mothers regarding infant feeding and nutritional

status of under-five children attending the Immunisation Clinic at the Department of

Community Medicine , N .R.S. Medical College and Hospital, Kolkata .It was a

clinic-based cross-sectional study .Data collection was done by interview of mothers

with predesigned and pretested schedules, and by examination of children. Total

6

6

number of children in the study = 55, 4. Male children = 29 (52.70%) Female children

= 26 (47.30 %) 5. 29 .27 % children were born with low -birth weight and 87.27%

children were delivered at institutions. ( 98.18% ) 90.9% .In case of 14.54% children,

Age of initiation of weaning was more than 6 months in 70.59% children. In 3.64%

children,while 29.09% children had grade-I malnutrition. 68.96% of male children

and 57.69% of female children had normal nutritional status. 71.43% . illiterate

mothers had initiated breast feeding within 24 hours of birth of their children. 57.14%

children receiving exclusive breast feeding and 57.19% children not receiving

exclusive breast feeding had a normal nutritional status.5

The present study was performed to assess, beyond socio-economic factors,

independent associations between the health and nutritional status of children under 5

years old and (1) family behavioural factors related to women with regard to child

care and (2) war-related experience by the household of hardships in Afghanistan.

methods are The subjects were all children born during the previous 5 years from

1400 households in Kabul Province, Afghanistan and were selected by multistage

sampling in March 2006. A total of 2474 children from 1327 households completed

the examinations and interviews; among them, 101 children were deceased by the

time of the interview visits. Diarrhoea (32.5%) and acute respiratory infection

(41.0%) were common child health problems and both emaciation (12.4%) and linear

growth retardation (39.9%) were prevalent.(odds-ratio = 1.72; 95% confidence

interval = 1.23, 2.40), and linear growth retardation of children (odds-ratio = 1.38;

95% confidence interval = 1.01, 1.90); a lack of education of the mother (71.7%) and

child marriage of the mothers (18.3%) were associated with diarrhoea (odds-ratio =

1.84; 95% confidence interval = 1.40, 2.41; odds-ratio = 1.46; 95% confidence

interval = 1.08, 1.96, respectively).8

7

3. Problems related to under fives:

To identify under-five-year-old children with vision or ocular defect in two provinces

(Wilayats) of central Oman in 2006. Public health intervention study.Ocular

examination in Manah Wilayat was conducted by nursing staff of the primary health

center (PHC) and in Mudhaiby Wilayat was conducted by a trainee Omani

optometrist. Abnormal sized eyeball, strabismus, nystagmus and white pupil were

recorded. Visual acuity was tested by LOGMAR chart with Lea's symbols in children

>2 years of age and preferential viewing was assessed by Lea's grating paddle or

'Hiding Heidi' picture in children </=2 years age. Data was analyzed using Statistical

Package for Social Studies (SPSS 12). Among 1,520 examined children, three

children had absent eyeball bilaterally and three had unilaterally absent eyeball.

Strabismus and nystagmus were detected in 44 (2.9%) and 18 (1.2%) children

respectively. 'Hiding Heidi' test was normal in 530/537 (87%) of children. 9

This study was to assess the magnitude of under-nutrition and its correlation. This

cross-sectional study was undertaken during March–February, 2009 as part of the

baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric

dam, south-west Ethiopia. A total of 2410 under-five children were included for

anthropometric measurement and blood investigation for the diagnosis of malaria and

anemia Results Significant proportion (40.4%) of under-five children were stunted

(height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and

one tenth of the children had anemia and malaria parasite respectively. Older children

were more likely to have under-nutrition. [OR = 1.5, (95% CI: 1.1–2.0)]. Conclusion

In this study, there is no association between malaria and under-nutrition. Children

who have malaria are more likely to be anaemic. 10

8

6.3 Statement of the problem:

“A Study to assess the effectiveness of Structure Teaching Programme on

Knowledge, Attitudes and Practices of Mothers regarding Growth Monitoring of

Under fives in selected PHC, Bidar, karnataka.”

6.4 Objectives of the study

1. To asses Knowledge, Attitudes and Practices of mothers on under-fives growth

monitoring.

2. To Evaluate the effectiveness of structure teaching Program on under-five

growth monitoring

3. To determine the association between the pre-test score of and selected

demographic variables.

6.2 Hypothesis

H1 :- There will be a significant difference between knowledge, attitudes and

practices score of mothers after structure teaching program at 0.05 level of

significance.

H2 :- There will significance association between knowledge attitudes practices score

of the mothers with demographic variables.

9

6.5 Operational definitions:

1. Assessment :- Refers to the statistical measurement of knowledge of the

mothers regarding the under-fives on growth monitoring.

2. Knowledge :-Refers that it is the correct response of the mothers to the

knowledge in terms regarding growth monitoring as per the structured

interview schedule.

3. Attitude :-Refers that it is expressed opinion of the mothers towards under-

fives growth monitoring.

4. Practice :-Refers to verbal responses of the mothers to the practice items

related to growth monitoring of under-five children

5. Mother :-Refers to a women who is biological mother and is responsible

for the care of the under fives

6. Under-five :-Refers to the children below five years of age.

7. Growth monitoring :- Refers to weigh the child periodically at monthly

interval during the first year, every two months during the second year and

every three months thereafter up to the age of five years as per ICDS

standards.

8. Structure Teaching Programme:- Structure teaching plan prepared by the

investigator to improve the knowledge attitudes and practices of mothers

regarding under five growth monitoring.

10

6.6 Assumptions

1. The mother of the under five children will have some knowledge regarding

growth monitoring.

2. They mothers may have either positive or negative attitude towards growth

monitoring of the under fives.

3. Structure teaching program will improve the knowledge, attitudes and

practices of mothers regarding growth monitoring of under fives.

6.8 Delimitations

The study is limited to the mothers,

Who have one or more than one child below 5 years of age.

Who are willing to participate.

Who will be available during data collection

6.9 Projected outcome:

The finding of the study will reveal the knowledge attitudes and practices of

the mothers which help in growth monitoring of under fives in selected PHC, Bidar,

karnataka.

11

7. MATERIALS AND METHODS:

7.1 Source of data:

7.1.1 Research design:

The research design will be for this study is one group pre-test post-test design.

7.1.2 Setting of the study

The study will be undertaken at PHC, area Manahalli, which is about 20 kilometers

from Bidar city. The populations of the PHC is 2057 (2010). The PHC has 7

subcenters. It provides promotive, preventive and curative services to the people. One

of the clinical activities of the PHC is well baby clinic which is considered every

week on Friday.

7.1.3 Population:

All mothers of under-fives in the PHC, in Bidar will be the Population of the study.

7.2 METHODS OF DATA COLLECTION:

7.2.1 Sampling procedure:

Random sampling will be the strategy that proceeds through a set of stages.

7.2.2 Sample size:

60 mothers from selected PHC in Bidar will be the sample for the study.

12

7.2.3 Inclusive criteria:

The criteria for inclusion as a sample are the following

The mothers who,

o Are in the age group of 18-40 yrs.

o Are having under five children.

o Are willing to participate in the study.

o Are available at the time of data collection.

o Are able to understand and speak kannada.

7.2.4 Exclusive criteria:

This study excludes the mothers who,

o Are not in the age group of 18-40 yrs.

o Are not having under five children.

o Are not willing to participate in the study.

o Are not able to understand and speak kannada.

7.2.5 Variables:

Dependent Variable:

Knowledge, Attitudes and Practices are the dependent variables.

Independent variable:

Structure Teaching Programme.

7.2.6 Tool for research:

The semi-structured interview schedule will be prepared.

The related literature and will be based on research problem and objectives of the

study and will be reviewed and guides are consulted for preparing the schedule.

The schedule has four segments.

Section ‘A’- Demographic Data: will Consists of questions related to demographic

data such as age, sex, religion, occupation, educational status, type of income,

distance from PHC to home.

Section ‘B’- Structured Questionnaire : will Consists of questions related knowledge,

Attitudes and practices of mothers regarding growth monitoring.

Section ‘C’- Rating Scale : will consists of questions related to importance of groeth

monitoring and measure the attitudes of mothers towards growth monitoring of under

fives. Libert scale will be used to measure the attitudes of mothers regarding growth

monitoring of under fives.

Section ‘D’- Explanation of the Tool : Knowledge section will include seventeen

items to assess the knowledge. Each item will be a multiple question with one

appropriate answer, Attitude section includes five point libert scale to assess positive

and negative attitude in terms of strongly agree, agree, undecided, disagree and

strongly disagree. For the positively worded item strongly agree refers to the

agreement of the statement .The rest will refer to the lesser degree where strongly

disagree will not be present at all at any time. Strongly agree get a score four, a score

13

14

of three for agree, two score for undecided and one for disagree and zero for strongly

disagree. The reverse will be negative answer. The practices section will have five

items to assess the practice . Each items will be multiple choice question with one

appropriate answer. The score will be one each for all questions. Thus, the total score

will be five in practice section. pre-test and post-test will be conducted.

7.2.7 Data collection Procedure:

Data will be collected by the investigator herself after obtaining written permission

from the District Health Officer, Bidar.

A comfortable place will be selected, Mothers who will be comfortable and

relaxed and who have under five children. Instructions related to the tool will be

given to facilitate co-operation, Questions regarding the demographic data will be

asked first as per interview schedule followed by the item related to under five growth

monitoring. Questions will be asked as per interview schedule and Responses will be

recorded as per the options provided in interview schedule. Approximately five to ten

mothers will be interviewed per day and about twenty to thirty minutes will be spent

for each mother.

7.2.8 Data analysis and Interpretation:

Discriptional and Infrential statistics will be used for data analysis.

1. Frequency and Percentage distribution is used to assess demographic data.

2. t- Test will be used to Evaluate the Effectiveness.

3. Chi- square will be used to determine the association between pre-test and demographical variables

15

7.3 DOES THE STUDY REQUIRES ANY INVESTIGATIONS {OR}

INTERVENTION TO BE CONDUCTED ON THE PATIENT’S {OR}

ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

Yes, the study will be conducted on patients who are living in rural areas in bidar (dt)

Karnataka. Structured teaching program will be administered to the mothers regarding

under fives growth monitoring.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE IF THE STUDY REQUIRES INVESTIGATION TO

BE CONDUCTED ON PATIENTS (OR) OTHER HUMAN BEINGS.

Yes, informed consent will be obtained from the rural community authorities and

subjects, privacy, confidentiality and anonymily will be guarded scientific objectivity

of the study will be maintained with honesty and impartiality.

LIST OF REFERNCES:

1. BT Basvanthappa. Text book of Community of Health Nursing, 2nd edition,

Published by jaypee Brothers Medical publishers (P) Ltd: 2008 ; pg 563.

2. K A Park. Text book of Preventive and social Medicine, 17 th edition,

Published by M/s Banarsidas Bhanot, Jabalpur, 2003; pg 365.

3. Neelam Kumari, Text book of Community Health Nursing-I 1st edition,

Published by P.K Jain, Jalandar city, 2009; pg 227.

4. Aparna Pandey, Regional Leprosy Training and Research Institute, Lalpur,

Raipur (C.G.),

5. S. Chatterjee & S. Saha, A Study On Knowledge And Practice Of Mothers

Regarding Infant Feeding And Nutritional Status Of Under-Five Children

Attending Immunisation Clinic Of A Medical College . The Internet Journal

of Nutrition and Wellness. 2008 Volume 5 Number 1).

6. Kenya A Abubakar, P Holding, F Van de Vijver, G Bomu, and A Van Baar

Acta Paediatr, ‘ Developmental monitoring using caregiver reports in a

resource-limited setting: the case of Kilifi, 2010 February; 99(2): 291–297.

doi: 10.1111/j.1651-2227.2009.01561.x.

7. Rasaki Ajani Sanusi ,Adunni Olatokunbo Gbadamosi: Research Article: ‘Do

Mothers knowledge and practice of ‘ Child Survival strategies’ Affect the

Nutritional Status of Children? (Article)

8. BMC Public Health 2008, 8:301doi:10.1186/1471-2458-8-301.

9. Khandekar R , Al Harby S, Mohammed AJ. ‘‘ A public health intervention

study’’. Jan; 3(1):13-7.

10 Deribew A, Alemseged F, Tessema F, Sena L, Birhanu Z, et al. (2010)

Malaria and Under-Nutrition: A Community Based Study Among Under-Five

Children at Risk of Malaria, South-West Ethiopia. PLoS ONE 5(5): e10775.

doi:10.1371/journal.

Signature of the Candidate :

Remarks of the Guide :

Name &Designation of the Guide : Mrs. Vanitha Kulkarni.

M.Sc Nursing

Community Health Nursing.

Signature :

Co-Guide :

Signature :

Remarks of the chairman :

The topic is selected as there is a need to evaluate the effectiveness of structured

teaching programme on knowledge, attitudes, and practices of mothers

regarding growth monitoring of under fives.

Signature :

Remarks of the Principal :

Signature :