A STUDY TO DETERMINE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON RESPIRATORY INFECTIONS

AMONG MOTHERS OF UNDER FIVE CHILDREN IN A

SELECTED PEDIATRIC HOSPITAL AT BANGALORE.

M.Sc. Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

By

Mr.H.S PRADEEP KUMAR

M.Sc NURSING 1ST YEAR

+ 2011-2013

Under the Guidance of

HOD, Department of Pediatric Nursing

K.T.G College of Nursing

Hegganahalli Cross

Vishwaneedam Post

Bangalore –91

RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

Mr. H.S PRADEEP KUMAR

1st YEAR M.Sc NURSING

K.T.G COLLEGE OF NURSING,

BANGALORE

2 NAME OF THE INSTITUTION K.T.G COLLEGE OF NURING GANDHADAKAVALHEGGANAHALLI CROSSVISHWANEEDAM POST, MAGADI ROADBANGALORE-91

3 COURSE OF THE STUDY AND

SUBJECT

M.Sc. NURSING PEDIATRIC NURSING

(CHILD HEALTH NURSING)

4 DATE OF ADMISSION TO

COURSE

15-09-2009

5 TITLE OF THE STUDY

A STUDY TO DETERMINE THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON RESPIRATORY

INFECTIONS AMONG MOTHERS OF UNDER FIVE CHILDREN IN

A SELECTED PEDIATRIC HOSPITAL AT BANGALORE.

6 BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

“The childhood shows the man as morning shows the day”

Children are an embodiment of our dreams and hopes for the future.

They are wet clay in the potter’s hands; Handled with care they become something

beautiful or else they break and become discarded. They are the most vulnerable group in

the society. WHO in the year 2005 focused its activities towards children with a theme

“Healthy environment for the children”. Health is a complex phenomenon, a state of

complete physical, mental, social well-being and not merely the absence of disease or

infirmity. In spite of this broad definition, health is traditionally assessed by observing

mortality and morbidity over a period of time. Therefore the balance between physical,

mental, social well – being and the presence of disease becomes a prime indicator for

health.1

UNICEF (2005) reported that acute respiratory infectionsis one of the

leading causes of under five mortality in developing countries and is responsible for 1.9

million deaths annually. Among 42 countries in the world 90% of child mortality burden,

14 – 24% of the under five mortality burden is due to pneumonia and nearly 70% of this

pneumonia mortality occurs in Africa and south east asia regions. Most of the children

have about 4-6 attacks of respiratory infections each year. 2

WHO (2003) reported that each year in the world about 154 million

children ware born. Four million, their brief existence is marked by pain and disease and

ends in tragically and early death. Nevertheless around 2.4 million deaths among

children under the age of five are still due to vaccine preventable diseases and infections

in early life. Mortality may be greater in developing countries because of low resistance

of these children against infection. 3

About 15 million premature deaths occur each year in developing

countries among children under five years of age. Nearly 1/3rd of these deaths are caused

by acute respiratory infections, an illness that is both preventable and treatable. Acute

respiratory infectionsare one of the leading causes less than five mortality in the

developing countries, and are responsible for 1.9 million deaths annually. Among 42

countries in the world 90% of child mortality burden ,14-245 of under five mortality

burden is due to pneumonia and nearly 705 of this pneumonia mortality occurs in Asia

and south east Asia regions (Neil. M., 2006).4

WHO (2006) reported that children below 5 years of age suffer about

5 episodes of Acute Respiratory Infection per child per year, thus accounting for about

238 million attacks. Consequently, although most of the attacks are self-limiting episodes,

Acute Respiratory Infection is responsible for about 30-50% of visits to health care

facilities and for about 20-40% admissions to hospitals.5

For Respiratory Infection the primary barriers to reducing global

child mortality from Acute Respiratory Infection have been identified. Over the next 10

years a number of challenges must be met to overcome the impact of Acute Respiratory

Infection as the leading cause of child mortality.. Expansion of programmes to assist

families in recognizing the signs and symptoms of sever respiratory infection expansion of

home based treatment programmes. These measures will result in a marked reduction in

child deaths from Acute Respiratory Infection and other diseases 6

Family members especially the mothers have an important role in

preventive aspects and through that health promotion in their children. Pediatric nurses

are in a position to identify the mother’s knowledge. Attitude and practice towards these

challenging problems. This will enable the nurse to plan with specialized service to help

the mother to understand about common childhood diseases that will make a significant

difference in the prevalence of these diseases affecting the health of the children.6

NEED FOR THE STUDY:

Infections of the respiratory tract are perhaps the most common

human ailment, while they are a source of discomfort, disability and loss of time for most

of the adults. They become a substantial cause of morbidity and mortality in young

children The incidence of Acute Respiratory Infection is about 50 times more in

developing countries compared to the developed countries, one third of all deaths in the

first year of life. Acute Respiratory Infection accounts as the main cause for 14.3% of

deaths in infancy and 15.9% in children between 1-5 years of age in India 7

National Family Health Services statistics (2004) reported that in

India, in the states and districts with high infant and child mortality rates (about 30% of

under five deaths) acute respiratory infectionsis one of the leading causes of death. An

acute respiratory infection is also one of the major reasons for which children are brought

to the hospitals and health care facilities. Hospitals recorded statistics from states with

high infant mortality rate show that upto 13% of in patient deaths in pediatric wards is due

to acute respiratory infections. The proportion of deaths due to acute respiratory

infectionsin the community is much higher as many children die at home .The reason for

the high case fatality may be due that children are not brought to the hospitals or are

brought too late. Only 2/3rd of children are taken to a health care facility. 7

Daniel Benti, G.T.,et al (2002) in their article on Acute Respiratory

Infection in developing countries based on the WHO strategy explaining the current

approaches for case management of Acute Respiratory Infection stressed on the

importance of imparting health education to the mothers of under five children who play

an important role in observing changes in their child’s health. Therefore, providing

pertinent information to mothers about signs of major childhood illnesses like Acute

Respiratory Infection would vastly improve their ability to care for them. 8

Nanvathi et. al., (2004) reported that the work the health professionals,

nurses, must recognize the importance of educating mothers, especially in the developing

countries like India where the nurse-patient ratio is inadequate; the womenfolk can be

prepared as health providers in their own families.9

Mothers are usually the primary care providers to children. They should

essentially have the knowledge of preventive measures so that they can protect their

children from the risks of getting Acute Respiratory Infection. During her clinical

experience the investigator has come across many children below 5 years admitted with

acute bronchopneumonia. From the above studies and after going through the available

statistics, the review of literature, WHO study findings and recommendations and

prevalence of acute respiratory infectionsin the OPD attendance at Dr. Vas hospital and

Dr. Chelliah hospital, which were 65.26% and 60.16% respectively, the researcher was

motivated to conduct a study through which the knowledge of mothers can be increased

regarding Acute Respiratory Infections. This can be done by educating the mothers when

they come with the children to OPD.

The investigator therefore felt the need to find out about the mothers

knowledge, attitude and knowledge of practice regarding Acute Respiratory Infection by

an interview and on that basis give them a proper health education which would help them

to recognize the severity of the illness and make right decisions at the right time. In all

probability these women would share their knowledge to their friends, neighbors, thus

reducing occurrence of complications and death due to Acute Respiratory infections in

children so as to up healthy children for a better tomorrow.

6.2 REVIEW OF LITERATURE

INTRODUCTION

A literature review involves the systematic identification, location,

scrutiny and summary of written materials that contain information in a problem ( Polit &

Hunglar 1999).10

Review of literature helps in selecting the appropriate methodology,

developing tool, analyzing data and relating the findings from one study to another so as

to establish knowledge in a professional discipline from which valid and pertinent theories

may be developed.

Literature review was done on respiratory infections by means of

extensive survey of books, journals, internet and Medline. Research as well as non-

research literatures were reviewed to broaden the understanding and gain insight into the

problem under study.

The review has been divided under the following headings:

Section I : Literature related to respiratory infections

Section II : Literature related to studies on knowledge, attitude and

practices of respiratory infections

Section III : Literature related to studies on effectiveness of teaching

programmes respiratory infections

Section I: Literature related to respiratory infections

Park K.E (2005) stated respiratory infections may cause inflammation

of respiratory tract anywhere from nose to alveoli. Symptoms are running nose, cough,

sore throat, difficulty in breathing, ear problem and fever. Some children die due to

pneumonia which is a major complication. India, Nepal and Indonesia account for 40% of

global mortality, 90% are due to pneumonia. Risk factors include overcrowding,

pollution, fathers smoking in the house. 11

WHO, UNICEF, Center for disease control (2005) reported that for

most of the people in this world every step in their life, from infancy to old age is taken in

the twin shadows of poverty, inequity and under the double burden of sufferings and

diseases. This burden which affects the health of the world can be measured under

diseases incidence and prevalence. 12

Respiratory infections constitute a leading cause of morbidity and

mortality in children. 7, 50,000 children below 5 years of age die of respiratory infections

in India every year that is 2,200 deaths per day, 85 deaths per hour. respiratory infections

accounts for 14.3% of deaths during infancy and 15.9% of deaths during 1-5 years.

Contributing factors are low birth weight and severe malnutrition. It is caused by bacteria

and virus (Gupta M.C.et al 2008).13

WHO (2006) reported that of more than four million deaths a year from

Acute respiratory infections in the developing world quarters are linked to malnutrition

and a father quarter are associated with pulmonary complications of measles, Pertussis,

respiratory infections and AIDS. 70% of deaths from acute respiratory infections occur

before the first birthday. Respiratory infections particularly pneumonia, were the leading

cause of death accounted for an estimated 4.1 million deaths among underfive in the

developing world. They are also leading cause for disability including deafness as

sequelae of otitis media.14

Kabir, et al (2002) reported on child mortality rates in rural India. This

report is the result of special project conducted under rural health services (Ballahgarh

project). The population served by 28 village of the project was 74,007 the study

population included all children aged 0-59 months. There were 1014 underfive deaths and

17,500 live births recorded during the study period. Data analysis showed a marked

decline in mortality from 1991-2000 and respiratory infections, diarrhea, malnutrition are

the three common causes of 2/3 child deaths in the project area.15

Sulaiman, et al (2002) reported on a wide health survey in the Sultanate

of Oman. The report highlights on the risk of respiratory infections. Around 25 per cent

of the underfive children were reported to have had a cough during the two weeks before

the survey. The prevalence of respiratory infections tends to be higher among boys than

girls (26% & 24%) Age differentials indicated that children under two years of age are

likely than the older children to be the victims of respiratory infections.16

Mitra (2001) conducted a longitudinal study on respiratory infections among

rural underfive children in a village of Hoogly district West Bengal. The objectives the

studies were to determine the respiratory infections morbidity and mortality among

underfive and to some of the epidemiological factors responsible for such morbidity. Sixty

three children less than five years of age living in the village of Durgarmpur were

included in the study. The children were followed up with periodic home visits at two

weeks intervals for six months. Overall incidence density rate of respiratory infections

episodes were 19.57/100 persons - months at risk. Incidence was highest among infants.

Low socio-economic class, low birth weight, under nutrition of the child, inadequate

immunization, children not exclusively breastfed and indoor air ration were significantly

associated with increased number of respiratory infections Sepisodes.17

Sayeed, A.A, et al (2005) conducted a study to assess the respiratory

infections prevalence in children and anthropometric correlates in Saudi Arabia. 250

mothers were interviewed for one month regarding respiratory infections during the

previous two weeks in their children aged less than 2 years. Results showed more of the 7-

12 months children were affected with respiratory infections whose mothers were less

educated and aged 35 years or more. The study concluded that intervention strategies to

control respiratory infections in children less than 2 years of age should target less

educated mothers. 18

WHO/UNICEF (1999) estimated that respiratory infections are

responsible for 28 per cent of all deaths in children underfive years of age living in less

developed countries. In these countries 20% of babies who are born, die before they reach

five years age and 25.3% of these deaths are due to respiratory infections. Young children

and in the less developed countries have about five to seven respiratory infections in a

year, about the same number that occur in children in living countries. Mortality may be

greater in developing countries because of low resistance of children due to malnutrition,

overcrowding and poor environmental circumstances such as indoor air pollution. In

addition, infants of low birth weight, which is more common in developing countries, are

at greater risk of dying from AR%I.19

Section II: Literature related to knowledge, attitude and practices

of acute respiratory infections

Kauchali ,S. et al (2004) conducted a descriptive study on 15 mothers to

identify the local beliefs and practices around respiratory infections m South Africa. 87%

believed supernatural causes for respiratory infections and hence reluctant to seek medical

care and used traditional treatments. Proper education on good supportive home care for

respiratory infections should be imparted the study concluded.20

Simiya,De, et al (2003) conducted a KAP study regarding respiratory

infections in Kenya. 309 mothers were interviewed. Only 18% described pneumonia. No

one knew about respiratory infections caused by vaccine preventable diseases. The study

reveals that mothers had poor knowledge of respiratory infections Low knowledge and

practices on respiratory infections may result in continued high mortality in this area.

Proper educational interventions may be needed to change such re4sulte the study

concluded.21

Ray, S. K, et al (2001) in their article on some aspects of under five deaths

in urban field practice concluded that mothers ignorance on the prevention and care

aspects of respiratory infections may be contributory causes to under five deaths in urban

slums.22

Stewart. MK, et al (2000) conducted a qualitative study in Bangladesh to describe

community perceptions of signs and symptoms of respiratory infections and case

management behavior. Mothers believed respiratory infections to be an attack by evil

influences and spiritual healers were sought. Implications of this belief would have a

negative effect on the mothers to care for children with respiratory infections the study

concluded 23

Kapoor, SK. et al (2000) conducted a KAP survey based study on respiratory

infections at Delhi. 106 mothers were interviewed, 59% did not know to recognize

pneumonia and 2/3rds of them preferred not to give any treatment for respiratory

infections. Feeding practices during respiratory infections was poor. 62% said they would

stop fluids and breastfeeds. Results indicate a poor knowledge on complications of

respiratory infections and feeding practices necessitating intensive educational

programmes to mothers.24

Section III: related to effectiveness of health education programmes

McCarthy, et al (2002) had undertaken a pilot study on empowering parents

through asthma education in Canada. The purpose of this pilot study was to compare the

outcomes of parents who participated in empowering and traditional approaches to asthma

education. A quasi experimental design was selected and specific outcome that were

examined included a) knowledge b) sense of control c) ability to make decisions and

ability to provide care. The sample consisted of 57 families who participated in a multi

session education programme. Data were collected before, immediately after and 6

months following the educational intervention. Both approaches resulted with increased

knowledge and significant differences were found in parents who participated in

empowering approach.25

D'Souza (2001) conducted a quasi experimental pre test post test

controlled group study on effectiveness of intensive health educations adherence on the

treatment of tutor positive pulmonary tuberculosis patients in selected hospitals of Gujarat

The sample consisted of 60 newly diagnosed pulmonary patients above 30 years. Major

findings of the study have shown that there was a significant difference in the total health

status scores of patients after receiving the intensive health education. And there were

significantly higher knowledge scores in the post test among experimental group.

6.3

6.4

STATEMENT OF TH E PROBLEM

A study to determine the effectiveness of structured teaching programme on respiratory

infections Among mothers of under five children in a Selected pediatric hospital at

bangalore.

OBJECTIVES OF THE STUDY

The objectives of the study are:

6.5

To assess the existing knowledge of under five mothers on respiratory infections.

To study the effectiveness of knowledge of under five mothers after Structured

teaching programme on respiratory infections.

To compare pretest and post test knowledge of under five mothers.

To associate the knowledge with selected demographic variables such as

age,religion,education of the parents, type of family, number of children, area of

residence, income.

HYPOTHESIS

The hypothesis will be tested at 0.05 level of significance.

H 1: There will be significant difference in the pre test and post test knowledge

scores of under five mothers on respiratory infections

H 2: There will be significant association between knowledge of under five

mothers and selected demographic variables such as age,religion,education.

of the parents, type of family, number of children, area of residence,

income.

6.6 OPERATIONAL DEFINITIONS:

DETERMINE In this study it refers to firmly decide on the effect of Structured teaching

programme on Respiratory infections as measured by the semi -structured questionnaire

and expressed as the post test scores of the experimental group.

EFFECTIVENESS

In this study it refers to producing the desired or intended result of structured

teaching programme on Respiratory infections as measured by the instrument and shown

by the post test scores of the experimental group.

STRUCTURED TEACHING PROGRAMME

It is a formal and specific teaching developed for mothers of under five aged

children regarding meaning, causes,transmission,clinical manifestation, prevention and

management of Respiratory infections

KNOWLEDGE

In this study it refers to the correct responses of the mothers to the knowledge

part of the questionnaire of the interview schedule and expressed as knowledge scores

ACUTE RESPIRATORY INFECTIONS:

it includes infections resulting from any part of the respiratory tract or any related

structure including paranasal sinus and middle ear as manifested by running nose, cold

and cough earache.

MOTHERSIn this study the word refers to the mothers with underfive children with Respiratory

infections

UNDERFIVE CHILDREN In this study the term refers to the children between the age group 1 to 5 years of

age.

ASSUMPTIONS

Mothers will have inadequate knowledge regarding causes, prevention and

management of respiratory infections

Structured teaching programme on respiratory infections to mothers Under five

children will promote health of a children and better prevention.

Mothers are best conveyors of health information to other mothers and to family.

DELIMITATIONS:

The study is delimited :

to mothers of under five children suffering from respiratory infections

who knows kannada or English

children between the age group of 1 to 5 years.

PROJECTED OUTCOME:

The present study will help the under five mothers to understand about the

causes, prevention and management of respiratory infections and hence it will help to

bring down the under five mortality.

MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from mothers of under five children who are

admitted in the hospital.

7.1.1 RESEARCH DESIGN

The research design adopted for this study is Quasi experimental study.

RESEARCH APPROACH

The research approach is evaluative.

7.1.2 SETTING:

The study will be conducted in K C G hospital. at Bangalore. It is 10 km away

from the College.

7.1.3 POPULATION

The population selected is mothers of under five children who are affected with

respiratory infections.

7.2 METHOD OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE

The Sampling Technique adopted for this study is purposive.

7.2.2 SAMPLE SIZE

The sample size is 60.

7.2.3 INCLUSION CRITERIA

The criteria for sample selection are mothers of under five who

Have children aged between 1 to 5 years

willing to participate in the study

know kannada or English language

7.2.4 EXCLUSION CRITERIA

Children above 5 years of age

under five children who are affected with diseases other than respiratory infections

7.2.5 INSTRUMENT INTENDED TO BE USED

SELECTION OF TOOL

This consist of three parts :

PART 1 :consist of demographic variables such as age,religion,education of the parents,

type of family, number of children, area of residence, income.

PART 2:Questionnaire will be used to assess the knowledge.25 Questions will be used.

PART 3:Structured teaching programme regarding meaning, causes, transmission,

clinical manifestation, prevention and management of respiratory infections will also be

used.

SCORING PROCEDURE

For knowledge assessment

For Answers. If answer is yes 1

If answer is no 0

SCORING INTERPRETATION Good :- 75-100%

Average :- 50-75%

Poor :- Below 50%

7.2.6 DATA COLLECTION METHOD

Prior permission will be obtained from the principal of the school before conducting the

study. Self administered questionnaire will be distributed to the children and responses

will be collected . Data will be collected from 2 to 3 samples per day. The duration will

be 4 weeks.

7.2.7 PILOT STUDY

6 samples will be selected and a study will be conducted to find out the feasibility

7.2.8 DATA ANALYSIS PLAN

The data obtained from will be analyzed in view of the objectives of the study

using analytical and inferential statistics.

The plan of data analysis is as follows:-

Frequencies and percentage of distribution will be used to analyze the

demographic data.

Mean, Median and Mode , Standard Deviation is used for accessing the

knowledge score

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

YES, Ethical clearance will be been obtained from the research committee

of K.T.G college of nursing.

Consent will be taken from the hospital and permission will be taken from

the study subjects before the collection of data.

8.0 LIST OF REFERENCES

1. Ghai,O.P. (2000). Essentials of pediatrics. 5th Edition. Interprint publishers. Delhi.

2. UNICEF Statistics.Retrieved from the internet on 9.04.2006.

3. World health organization.(2002) .State of child health, world health report

Geneva.

4. Neil ,M.&Graham.(2001).The epidemiology of respiratory infections in children:a

global perspective.Epidemiological reviews,12(2):18-24.

5. World health organization. (2005) .WHO for the current year, Update from

internet. Retrieved on 9.03.2006.

6. U.S Coalition for child survival – Progress since 1990 Summit – a report – (2000).

7. Saini, N.K, &Saini, V. (1999). respiratory infections in children. Journal of

communicable diseases, 24(2): 75-79.

8. Daniel ,Benti .G.T., &Lee, Seema ,khadebwal. (2000). respiratory infections in

developing countries. A Review article. Journal of public health. 25(6): 48-51.

9. Nanvethi Patwrespiratory infections,A.K., & Sachdev,HPS.(1998).Frontiers in

social Pediatrics.1st edition Jaypee publishers.Delhi.

10. Polit, D.F,& Hunglar, B.P. (1999). Nursing Research, principles and methods. J.B

lippicott company Philadelphia

11. Park, J.E. (2004).Text book of preventive and social Medicine.17th Edition.

Banarsi das publishers. Delhi.

12. UNEP / UNICEF / WHO (2005), World health status. world health report,

Geneva.

13. Suraj ,Gupta.(2003).The short text book of pediatrics .9th edition.Jaypee medical

pubishers.Delhi.

14. World health organization.(2001) .Information Kit, Geneva.

15. Kabir,Z.,Long,J.(2002).Child mortality rates in rural India an experience from

Ballargh project.Tropical Pediatrics.48,178.

16. Sulaiman, S.M., Riyami, A., Earriers, S.,& Ebrahim, G.J. (2002) Omon family

health survey. Journal of tropical Paediatrics, vol 47(27).

17. Mitra, N.K. (2001).Longitudinal study on respiratory infections among underfives.

Indian Journal of community medicine, Vol. XXVI No.1(8)

18. Sayeed,A.A.&Bani,A.A. (2000).Prevalence and correlates of respiratory infections

in children less than two years of age. Saudi Medical Journal.219120:1152-1156

19. World health organization. (2000). Child Mortality rates, world health report,

Geneva.

20. Kauchali. S., &Rollins, N. (2004). Maternal perceptions of respiratory infections

in under 5 in Africa Tropical .Retrieved on November 2005 from NCBI Enterez

data base.

21. Simiyre, D.E,& Ndauti, R.W. (2003). Mothers KAP regarding respiratory

infections Sin Kenya. East African Medical Journal. 80 (6) : 303 – 307

22. Ray,S.K.,&Chaudrespiratory infections,M.(2001).Some aspects of two under five

deaths in urban field practice.A Letter.Indian Journal of Maternal – Child

Health,3(1):23-25.

23. Stewart,M.K.&Chakraborthy,J.(2000). respiratory infections in rural

Bangladesh.Medical Anthropology,15(4):377-394.

24. Kapoor.S.K.,&Reddaiah, V.P.(2000), Knowledge, attitude and practices regarding

respiratory infections. 57 (4) : 533-535,

25. Mccarthy, M.J., Herbert, R., &Brimacombe, M.(2002) Empowering parents

through asthma education. Journal of pediatric nursing, 28, 5(465

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3CO-GUIDE

11.4SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THE PRINCIPAL

12.2 SIGNATURE