RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1.Name of the candidate and address

SANGEETA SARMA.M.Sc NURSING 1 YEARDr. SYAMALA REDDY COLLEGE OF NURSING#111/1 SGR MAIN ROAD,MUNNEKOLALA,MARATHAHALLI,BANGALORE-560037.

2.Name of the Institution Dr. Syamala Reddy college of nursing

3.Course of study and subject M.Sc nursing 1 year.Community Health Nursing.

4. Date of admission to course June – 2010

5. Title of the study A study to evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of asthma among mothers of under five children in a selected urban community at Bangalore

1

BRIEF RESUME OF INTENDED WORK :

6.0 INTRODUCTION:

“Children are the wealth of tomorrow; take care of them if you wish to have a strong India, ever ready to meet various challenges.” Jawaharlal Nehru.

Children constitute a large portion of the population in India. It has been a great

challenge to the nation to provide health, education and food to the growing children.

Children are the most vulnerable group in the society. Children’s are not only

our future, they are our present and we need to start taking their voices very seriously.

Children are priceless resource and any nation which reflects them would do so as its

perils.1

Children are tomorrow’s adults. The 21 st century belongs to them and to their

children and grand children. They and their descendants are deserved to enjoy all the

health facilities.

Every day, millions of parents seek health care for their sick children, taking

them to hospital, health centres, pharmacists, doctors and traditional healer. Each year

more than 10 million children die before they reach their fifth birthday.2

The morbidity associated with asthma is dramatic, under diagnosis and in appropriate

therapy are major contributions to asthma morbidity and mortality. The high

morbidity rates related to asthma may attributed to limited access to health care, an

inaccurate assessment of disease severity, a delay in seeking help, inadequate medical

2

treatment , non- adherence to prescribed therapy and increased allergens in the

environment.3

Respiratory tract infection is a frequent cause of acute illness in infants and

children. Many paediatric infections are seasonal cough and cold are very common in

children. However, there are some children who have frequent or persistent cough,

particularly children living in slums or overcrowded areas. The commonest cause of a

frequent or possible cough in a healthy baby is asthma.4

With increasing urbanization of the world’s population, it is predicted the

number of individuals with asthma will increase markedly worldwide. Chronic

diseases have a tremendous effect on the growth and development of children. Asthma

is the most common chronic lung disease of childhood and is the major cause of

hospitalization for children under the age of one to five.

The word asthma originates from an ancient Greek word meaning parting. It is

one of the most common chronic diseases, affecting 300 million people worldwide.

There has been a significant increase in prevalence over the last 30 years, particularly

in the West. Complex relationships between genetic and environmental factors, such

as viral infections, allergies and occupational agents, influence the origin and

progression of the disease.

Asthma is a chronic inflammatory disorder of the airway in which many

cells and cellular elements play a role, in particular, eosinophils, mast cells, T

lymphocytes, neutrophils and epithelial cells. Some patient develop structural changes

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of the airway, a process known as remodelling possibly due to ongoing inflammation

and abnormal repair processes.

Asthma may have its onset at any age, 30% children are symptomatic by one

year of age and where as 80 – 90% of asthmatic children have their first symptoms

before 4 – 5 years of age. Risk factors for occurrence of asthma in children include

poverty, black- race, maternal smoking, large families, intense allergic exposure and

respiratory infection in early childhood.

Susceptible individuals experience recurrent episodes of wheezing,

breathlessness, chest tightness and cough, particularly at night and in the early

morning. These episodes are usually associated with widespread but variable airflow

obstruction, which is often reversible and bronchial hyper responsiveness to a variety

of stimuli. Acute asthma is common medical emergency and requires prompt

assessment and treatment. Advances in the understanding of the genetic and

environment factors that account for asthma and its pathogenesis should lead to

improved management strategies.5

A study conducted in Delhi shows that the prevalence of current asthma in

children is 11.9 %, while in the past it was reported by 2.1 % while that associated

with cold by 2.4 % of children. Boys had a significant higher prevalence of current

asthma as composed to girls i.e. 12.8 % and 10.8 % respectively. It is estimated that in

Delhi one out of every five children has at least one episode of wheezing.6

A study undertaken at Chennai shows that 39 % of parents accepted a diagnosis

of asthma of which three know exactly what asthma means. Perception that asthma is

contagious was observed by 26 % and 35 % believed asthma to be a hereditary

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disease and 62 % of parents administered oral beta agonist medication at home before

proceeding to hospital, but majority used them as cough medications. Only 13 were

administering aerosol therapy at home. Nearly one third of parents opined that the

disease might remit with advancing age.7

Health education on asthma adds to the awareness of people and generates

interest in the prevention of those diseases. It also helps in motivating people to

participate in universal immunization programme. Health education is instrumental in

controlling indoor air pollution and discouraging smoking in living rooms and

congested areas.8

The overall awareness among mothers with regard to their rights, duties and

responsibility would strengthen the health care services in society. Since mothers can

make anything possible, provided they should be educated and given action plan. As a

mother is the 1st teacher of the child, she has to take a key role in the prevention of

asthma.

6.1 NEED FOR THE STUDY:

Allergic respiratory disorders in particular asthma are increasing in the

developed and developing countries and pose a serious global health problem and

economic burden. Recognising the problem in children is very essential since the

spectrum of presentation is variable and multiple for proper management. Under

diagnosis is very common and under treatment is equally common.

5

The increased prevalence and severity of asthma in the metropolitan city

correlates any economic growth from industrialisation should focus on control of

pollution simultaneously.3

There has been an inexorable rise in the number of asthma cases and

respiratory illnesses, especially in industrialized countries over the last 30 – 40 years.

Asthma is a respiratory disease involving inflammation of the airway and reversible

symptoms of bronchospasm. Along with New Zealand, Australia, Ireland, the United

Kingdom (UK ) has one of the highest prevalence rates of asthmas in the World .

Around 8 million people in the UK are currently diagnosed asthmatic. It is the most

common chronic childhood disease, with one in eight children suffering from it.9

There is no cure for asthma, but asthma can be managed with proper

prevention and treatment. Asthma has a genetic component. If only one parent has

asthma, chances are one in three that each child will have asthma. If both parents have

asthma, it is much more likely (seven in ten) that their children will have asthma.10

WHO estimates that 300 million people currently suffers from asthma. In 2009

asthma caused 250,000 deaths globally. Asthma is the most common chronic disease

among children. It is a public health problem not just for high income countries; it

occurs in all countries regardless of the level of development. Most asthma related

deaths occurs in low- and lower middle income countries. Asthma is under diagnosed

and under treated. It created substantial burden to individuals and families and often

restricted individual’s activity for a long life time.11

The prevalence of asthma has increased continuously since 1970s, and now

affects an estimated 4 to 7% of the people worldwide. Childhood Asthma varies

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widely from country to country. At the age of six to seven years, the prevalence

ranges from 4 to 32%. The same range holds good for ages 13 and 14. UK has the

highest prevalence of severe Asthma in the world. It has also increased the number of

preventable hospital emergency visits and admissions. It is a leading cause of

hospitalization for children. Childhood Asthma has multifactor causation.

Geographical location, environmental, racial, as well as factors related to behaviours

and life-styles are associated with the disease.12

In the United States, asthma is the most common cause of childhood

emergency department visits, hospitalizations and missed school days, accounting

annually for 867,000 emergency department visits, 166,000 hospitalizations and 10.1

million school days lost. In the United States in 2000, asthma was responsible for 223

childhood deaths, a disparity in asthma outcomes links high rates of asthma

hospitalization and death with poverty, ethnic minorities and urban living. In the past

2 decades African- American compared to white children had 2 to 4 times more

emergency department visits, hospitalizations, and deaths due to asthma. For ethnic

minority asthmatics living in US “inner- city” low income communities, a combition

of biologic environmental, economic and psychological risk factors is believed to

increase the likelihood of severe asthma exacerbation. In the US it affects over 8.6

million children and it has the highest prevalence among children between 5 and 17

years old.

Based on information collected by the National Center for Health Statistics of

the Center for Disease control and prevention in 2002, 8.9 million children (12.2 %)

had been diagnosed with asthma in their lifetime and 4.2 million children (5.8 %) had

an asthma attack in the preceding 12 months indicative of current disease. Boys (14%

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Vs 10 % girls) and children in poor families (16 % Vs 10 % not poor) are more likely

to have asthma. Although asthma prevalence is higher in black Vs non- black US

children (17.7 % Vs 11.1 % ratio) prevalence difference cannot fully account for

disparity in asthma outcomes.

Worldwide, asthma appears to be increased in prevalence, despite considerable

improvement in management and pharmacopoeia to treat asthma. Numerous studies

conducted in different countries, including the US, have reported an increase in

asthma prevalence of about 50 % per decade. Globally, childhood asthma prevalence

varies widely in different locales. A large International survey study of asthma

prevalence in 56 countries (International Study of Asthma and allergies in childhood)

found a wide range in asthma prevalence from 1.6 to 36.8 %. Furthermore, asthma

prevalence correlated well with reported allergies rhinoconjunctivites and atopic

eczema prevalence. Asthma seems particularly common in modern metropolitan

locales and is strongly linked with other allergic conditions. In contrast, children

living in rural areas of developing countries and farming countries are less likely to

develop asthma and allergy.

Approximately 80 % of all asthmatics report disease onset prior to 5 years of

age. Of all young children who experience recurrent recurrent wheezing, however,

only a minority will go on to have persistent asthma in later childhood.13

According to American Academy of Allergy asthma and Immunology,

approximately 34.1 million Americans have been diagnosed with asthma by a health

professional during their life time. The prevalence of asthma increased 75 % from

1980- 1994. Asthma rates in children under the age of 5 have increased more than 60

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% from 1980 – 1994. It is estimated that number of people with asthma will asthma

will grow by more than 100 million by 2025. Asthma accounts for approximately

500,000 hospitalization each year. In 2006, asthma prevalence was 20.1 % higher in

African American than in whites. In 2005, 8.9 % children in the US currently had

asthma. Nearly 4 million children have an asthma attack in the previously year.

Asthma accounts for 217,000 emergency room visits and 10.5 % million physician

office visits every year.14

A study was conducted on the global epidemiology of asthma in children at

Wellington. Recently most studies reported that asthma prevalence has increased in

recent decades. The best indication of what is now happening globally will be

provided by phase III of the ISAAC. Some individuals ISAAC centers in Western

countries have already reported no increase or even a decrease in asthma prevalence

over the last 10 years. The package of changes in the intrauterine and infant

environment occurring with westernisation is causing increased susceptibility to the

development of asthma. The findings show that global comparison of asthma

prevalence and assessment of time will continue to play a major role in this process.15

In India, the estimated burden of asthma is believed to be more than 15 million.

There was a constant and variable increase in asthma prevalence worldwide in the last

two decades and the same is being observed in India.12

A survey reports that, there was a low prevalence of asthma (1- 3.3 % ) in the

children of Lucknow, Ludhiana and Punjab, while in Delhi the prevalence of asthma

was 11..6.16

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The study about prevalence of asthma revels that, childhood asthma at 13- 14

years of age was lower than in younger children. Researcher in the field opined that

higher prevalence of asthma in the younger age group was consistent with the

believed concept of “Children growing out of allergic diseases.”17

Different Indian studies, reveals that urban and male predominance with wide

inter- regional variation in prevalence, with a wide variation (4 – 20 %) and increase

in mortality in younger age groups. Environmental factors, including increase

exposure to pollution, tobacco smoke, and sedentary life style were identified for

asthma.12

In a recent landmark Indian study, the researchers found a consistent

association between being exposed to, and having experienced domestic violence, and

childhood asthma prevalence in India. In an age- stratified analysis, a strong

association was observed in age groups 5, 5- 14, 15- 24 and 25- 44 years. Stress

induced mechanisms, partially captured through violence and social circumstances

may be a missing link in furthering our understanding of social disparities in asthma.18

Other studies have also reported higher incidence of psychological adaptation

problem in children with asthma, particularly severe asthma, than children in the

general population. This has been ascribed to adverse developmental impact of having

a chronic health problem, increased demands on the family and dysfunctional familial

interactional patterns.19

A study was conducted on prevalence of asthma in urban and rural children in

Tamil Nadu. A total of 584 children from Chennai and 271 children from 25 villages

around Chennai participated in the study. Total 855 children were studied, the overall

prevalence of diagnosed asthma was 22 % of urban and 9 % of rural children reported

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breathing difficulty at any time in the past, urban children reported recent wheeze

more often than rural. The findings suggest that further studies are needed to confirm

the difference in the prevalence between urban and rural children and also to identify

possible cause that could account for the higher prevalence of asthma in Tamil

Nadu.20

A hospital based study was conducted on 20000 children in Bangalore, India.

The study reveals a prevalence of asthma from 1979, 1984, 1989, 1994 and 1999 is 9

%, 10.5%, 18.5%, 24.5% and 29.5%. The increased prevalence, co-relate well with

demographic changes of the city (Genetic predisposition is one of the factors in the

children for the increased prevalence urbanisation, air pollution and environmental

tobacco smoke contributes more frequently) like increase in numbers of industries,

increased density of population from migration of rural population in search of jobs

and increased number of automobiles to commute resulting in pollution.

A study reports that asthma may have its onset at any age: 26.3 % of patients

are symptomatic by one tear of age, 1 to 5 years 51.4 %, over 5 years 22.3 %. It was

observed that in 77.7 % the asthma begins in children less than five years and the

male to female ratio is 64 % to 36 % on par with various other studies.

According to International Conference on Health Care Delivery for Asthma,

shows that the obstacles to asthma care in India are the costs of care and medications,

the socio economic disparity within the country, use of multiple language, cultural

issues and the common use of alternative remedies.3

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The birth of an infant is a highly significant event that alters the behaviour of

both mother and father. Some of the predominant factors affecting parenting are the

age of the parents, chronic illness of the child and quality of the parental relationship,

the amount of previous experience with child rearing parental support system and the

effects of stress on parent behaviour.

The Investigator felt that the study on the effectiveness of structured teaching

programme on knowledge regarding prevention of asthma would improve the health

practices of mothers of under five children. This study will benefit the mothers of

under five children to take measures in order to prevent asthma among children. Thus

the community health nurse can protect the community from asthma and reduce the

burden of health problems of under five children.

6.2. REVIEW OF LITERATURE:

Asthma is the most common chronic childhood illness about half of all cases of

asthma develop before the age of 10 and about 80 % develop symptoms below age 5.

Asthma in children is highly associated with allergens, family history of asthma,

dietary habits which commonly include more fast foods and less fruits, vegetables,

fibres, minerals, children spreading more time indoor watching television, playing

video games or using computers are therefore overexposed to indoor allergens.21.

The literature of review has been arranged in the following order:-

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1. Studies related to Causes / Triggers of asthma.

2. Studies related to Clinical features of asthma.

3. Studies related to Management of asthma.

4. Studies related to Prevention of asthma.

5. Studies related to knowledge regarding asthma.

1. Studies related to Causes / Triggers of asthma

A study was conducted on socio- economical conditions as risk factors for

asthma in children aged 4- 5 years in Norway. A questionnaire was given to

parents in connection with the ordinary child control of 4- 5 years old children, in

Vestfold Country, Norway. In addition to the question “Has the child at present or

ever had asthma?” a number of medical and socioeconomic background sectors

were registered. Out of 2,430 parents, 1,913 (79 %) responded. Of the 163

(cumulative prevalence 8.7 %) children with confirmed asthma, 19 did not use any

medication and were regard as having outgrown their asthma. Several background

factors were significantly associated with asthma in a logistic regression analysis:

few rooms at home, psychosocial problems, fever more than three times during the

previous year, reaction to food and mother or father with chronic disease. The

findings indicate that socio- economic background factors are associated with

asthma in children in addition to other known risk factors.22

A study was conducted on childhood asthma and exposure to traffic and

nitrogen dioxide in USA. The study examined the association between traffic

related pollution and childhood asthma in 2008 children. Study subjects were

randomly selected. Life time history of doctor diagnosed asthma was associated

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with outdoor nitrogen dioxide , the ratio was 183 per increased of 1 in IQR is

exposure, also observed increased asthma associated with closer residential

distance to free way is 189 per IQR and outdoor pollution from free way is 2.22

per IQR . The results indicate that respiratory health in children is adversely

affected by local exposure to outdoor nitrogen dioxide, or other free way related

pollutants.23

A study was undertaken on environmental chemical hazards and child health

at Port Alegre. Around 85,000 synthetic chemicals are produced to day and 2,800

of them are mass produced. There has been a growing chemical. Children have a

greater exposure to environmental pollutant than adults, because their metabolic

needs and behaviours put them at special risk. The findings suggested that

screening of risk situation using tools such as environmental history has been

stimulated along side the greatest commitment of paediatrics towards measures

that can reduce the exposure of children to environmental chemicals.24

2. Studies related to clinical features of asthma.

A cross- sectional survey was conducted to compare physical activity

and physical self- concepts between children with and without asthma in Taiwan.

They recruited 120 children with mild and moderate asthma from three paediatric

asthma clinic in Taiwan and 309 non- asthmatic children from four elementary

schools in Taiwan’s three largest cities. The study results showed that asthma was

the primary factor determining vigorous physical self – concept, especially in

terms of endurance, obesity and strength. No statistically significant relationships

were noted between asthma and gender in terms of effects on physical activity and

physical self concept. The study concluded that asthma interferes with children’s

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ability to participate in vigorous physical activity but not in moderate to vigorous

physical activity. Gender determines primary differences in physical self concept.

Appropriate exercise recommendations are necessary to encourage children with

asthma to engage in vigorous physical activity for normal growth.25

A study was conducted on wheeze and urban variation in South Asia.

Urban South Asia is characterized by narrow streets, heavy traffic, visible haze,

unplanned city architecture and the use of kerosene or wood burning stoves at

home. The study aim to compare the prevalence of asthma between 2 South Asian

cities i.e. Galle and Chandigarh. The validated ISAAC questionnaire was used for

the study. Out of 1814 distributed questionnaire 95 % were completed correctly

and returned. The prevalence rate for Wheezing in Galle is 28.7 %, higher than

Chandigarh 12.5 %. The findings suggested that there is a higher prevalence of

wheeze in children who are living in an old fashioned and congested city than in a

clear and modern city in South Asia.26

4. Studies related to Management of asthma:

A study was conducted on medical management of asthma and folk

medicine in a Hispanic community. The objective of the study is to describe beliefs

about asthma and asthma treatment in a Hispanic (Dominican – American)

community to determine how alternative belief systems affect compliance with

medical regimens. So 25 mothers of children with asthma were interviewed in

homes, in their primary language, Spanish. Mother were questioned about their

beliefs regarding their asthma aetiology, treatment, prevention of acute episodes

and use of prescribed medicines for the prevention of asthma, instead they

15

substitute folk remedies called “ Zumos ” . The home remedies were derived from

their folk beliefs about health and illness, 60 % thought that their child did not

have asthma in the absence of an acute episode, 88 % said that medications are

over used in their country and that physician hale infection from them.27

5. Studies related to Prevention of asthma:

A study was conducted on women who eat apple and fish while pregnancy may

provide significant protection to their baby against developing asthma, respiratory –

related allergy symptoms and eczema. Nearly 2,000 pregnant women in the

Netherland and Scotland was participated in this study. The study result showed that

children whose mothers ate more than 4 apple per week while pregnancy were 37 %

less likely to experience wheezing and 53 % less likely to have doctor confirmed

asthma, compared to mothers who ate 1 or no apple per week while pregnant.28

A study was conducted on childhood asthma prevention in Australia. The

objective of the study was to test house dust mite avoidance and dietary fatty acid

modification, implemented throughout the first 5 years of life, as interventions to

prevent asthma and allergic diseases. They have taken new borns with a family

history of asthma alternatively and randomized them, separately to HDM avoidance

or control and to dietary modification or control. At the age 5 years, they were

assessed for asthma and eczema and had skin prick tests for atopy. 616 children are

selected randomly and 516 (84 %) were evaluated at the age 5 years. The HDM

avoidance intervention resulted in a 61 % reduction in HDM allergens concentration

(mg/ g dust) in the child’s bed but no difference in the prevalence of asthma, wheeze

or atopy. The prevalence of eczema was higher in the active HDM avoidance groups

(26 % Vs 19 %). The ratio of V- 6 to V-3 fatty acids in plasma was lower in the active

16

diet group (5.8 Vs 7.4). However, the prevalence of asthma, wheezing or atopy did

not differ between the diet groups.29

6. Studies related to knowledge regarding asthma :

A study was conducted on asthma knowledge and behaviour among mothers

of asthmatic children in Aseer, South- east Saudi Arabia. During the study period

171 mothers of asthmatic children were interviewed and enrolled in the study. The

mother’s ages ranged from 22 to 45 years with a mean of 33.9 years. Illiterate

mothers were 17.5 % and the rest were educated. Only 28.7 % were working. The

study revealed that the least known information among mothers was the

complications of asthma. Breathing exercise during asthma attacks were the least

practised behaviour. In a multivariate analysis, significant risk factors for poor

knowledge and behaviour among mothers were female sex of the child, illiterate

mothers are young age of mother. More education is needed to help the mothers of

asthmatic children and acquire the necessary knowledge and practices to care for

their children.30

A study was conducted on parent education and guided self management of

asthma and wheezing in the pre- school child in Leicester. 101 child were

randomized into control group and received pre- school asthma booklet, written

guided self management plan and two 20 minute structured educational sessions

between a specialist respiratory nurse and the parent and child subjects were

assessed at 3,6 and 12 months. The results shows that the introduction of an

educational package and a written guided self management plan to the parents

reduces morbidity, over the subsequent 12 month.31

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STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of structured teaching programme on

knowledge regarding prevention of asthma among mothers of under five children in

a selected urban community at Bangalore.

6.3. OBJECTIVE:

1. To assess the level of knowledge among mothers of under five children

regarding prevention of asthma before structured teaching programme.

2. To evaluate the effectiveness of structured teaching programme on prevention of

asthma among mothers of under five children.

3. To determine the relationship between selected socio- demographic variables and

the level of knowledge among mothers of under five children regarding

prevention of asthma.

HYPOTHESIS:

H1 : There is a significant difference between the pre-test & post test knowledge level

of the mothers he of under five children regarding prevention of asthma.

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H2 : There is a significant relationship between the selected socio- demographic

variables and the level of knowledge of the mothers of under five children regarding

prevention of asthma.

OPERATIONAL DEFINITION:

EVALUATE: It refers to the statistical measurement regarding the knowledge on

prevention of asthma as observed from scores obtained on self administered

questionnaire.

EFFECTIVENESS: It refers to the improvement seen in terms of knowledge of

mothers of under five children regarding prevention of asthma after structured

teaching programme measured using structured self administered questionnaire.

KNOWLEDGE: It refers to the awareness of the mothers of under five children

regarding prevention of asthma.

STRUCTURED TEACHING PROGRAMME: It refers to a systematically planned

teaching activity to provide information about prevention of asthma through lecture

and flash card.

MOTHERS OF UNDERFIVE CHILDREN: It refers to the mothers, who are

having children between the age of 0 – 5 years.

ASTHMA: Asthma is a common chronic inflammatory disease of the airway.

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ASSUMPTION:

Mothers of under five children have some knowledge regarding prevention of

asthma.

Knowledge levels of mothers of under five children vary from individual to

individual.

Socio demographic variables influence the knowledge level of mothers of

under five children regarding prevention of asthma.

Mass media influences the knowledge level of mothers of under five children

regarding prevention of asthma.

7.0. MATERIAL AND METHODS:

7.1. SOURCES OF DATA: Mothers of under five children residing at a

selected urban community at Bangalore.

7.2. METHOD OF COLLECTION OF DATA:

RESEARCH APPROACH: Quasi experimental approach.

RESEARCH DESIGN: One group pre-test & post test design only.

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SETTING: A selected urban community at Bangalore.

VARIABLE UNDER STUDY:

In this study there are two variables such as dependent variable

and independent variable.

DEPENDENT VARIABLE:

In present study dependent variable is the knowledge of mothers

regarding prevention of asthma among under five children.

INDEPENDENT VARIABLE:

In this independent variable is considered as structured teaching

programme.

POPULATION: Target population for the study is the mothers of under five

children in a selected urban community at Bangalore.

SAMPLE: Mothers of under five children.

SAMPLE SIZE: 80 mothers of under five children in a selected urban

community at Bangalore.

SAMPLE TECHNIQUE : Convenience sampling terchnique.

CRITERIA FOR SELECTION OF SAMPLE:

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INCLUSION CRITERIA:

a) Mothers of under five children who are willing to participate in the study.

b) Mothers of under five children who can be able to speak and communicate in

Hindi and English.

EXCLUSION CRITERIA:

a) Mothers of asthmatic children.

b) Mothers of under five children who have mental illness.

SELECTION AND DEVELOPMENT OF TOOL:

SELECTION OF TOOL: A structured interview schedule is selected for the study.

DEVELOPMENT OF THE TOOL: The questionnaire is prepared in English in the

following two sections:

Section 1: It consists of socio- demographic data like age, education, occupation,

monthly income etc.

Section 2: Closed ended questionnaire on knowledge of the mothers of under five

children regarding prevention of asthma.

22

The entire question has 4 options where as one will be the correct answer

and other 3 will be the wrong answers.

Validity of tool will be ascertained in consultation with guide and other

experts from various fields like nursing, paediatricians.

DATA COLLECTION PROCEDURE:

The study will be conducted in a selected urban community at Bangalore. An

extensive survey will be done to identify the mothers of under five children who

are meeting the inclusion criteria. Then oral consent is obtained from the subjects

for the study, 80 mothers of under five children will be selected through

convenience sampling technique. A structured interview schedule is prepared to

collect the relevant information before and after teaching regarding prevention of

asthma. The duration of the data collection will be 4 weeks. Per day, the data will

be collected from 4 to 5 mothers of under five children.

PLAN FOR DATA ANALYSIS:

The collected data will be analyzed using descriptive & inferential statistics. The

plan for data analysis is as follows:

Organizing the data on a master sheet of computer.

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Analysis of the demographic characteristics of the sample by using

descriptive inferential statistics like frequency distribution, percentage,

mean and standard deviation.

Analysis of the data by using inferential statistics like t- test & Chi-

square test.

Representation of data in tables & graphs.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER

HUMAN OR ANIMALS?

No .Only structured interview will be used for data collection. No other

invasive or laboratory procedure will be conducted on the samples.

7.4. HAS ETHICAL CLARANCE BEEN OBTAINED?

Yes

Ethical consent is obtained from Kadugudi PHC

Bangalore.

Confidentiality & anonymity of subjects will be

maintained. Consent will be taken from adults before conducting the study.

8. LIST OF REFERENCES:

1 Http /en. Wikipedia. org./ wiki / Jawaharlal –Nehru

2 IMCI, Integrated Management of childhood illness.

www.childinfo.org/eddb/imci/index.htm.

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3 H Paramesh. Epidemiology of Asthma in India. Indian Journal of Paediatric.

Vol 69 .2002 April. 309- 312 pp.

4 The Lippincott. Manual of nursing practice. 7th edition, Jaypee Brothers

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5 N C Thomson, G Vallance. Asthma/ Intrinsic/ Encyclopaedia of Respiratory

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6 Chhabra SK, Gupta CK, Chhabra P, Rajpal S. Risk factors for development of

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Immunol, 1999, Nov, 83 (5) .385 – 390 pp.

7 Shivbalan S, Balasubramanian S, Anandnathan K. What do parents of

Asthmatic Children Know about asthma? Indian Journal of Chest disease

allied Science, 2005 April, 47 ( 2 ) .81-87 pp.

8 Shay D. K, Study on asthma among mothers of under five children. Indian

Journal of Paediatrics, 2004, 22 (1), 48-50 pp.

9 Richardson G, Eick S and Jones R. How is the indoor environment related to

asthma? Literature Review. Journal of Advanced Nursing, 2005 Jan, 52

(3) .328- 339 pp.

10 Asthma Allergies AAFA, Education Advocacy Research .2001 04 16, 46pp.

11 WHO fact Sheet, No 307, 2008 May.

12 Ranabir Pal, Sanjay Dahal, Shrayan Pal, Prevalence of bronchial asthma in

Indian children. Indian Journal of Community Medicine .2009, Vol 34, Issue

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27

9. Signature of Candidate

10. Remarks of the Guide

11. Name and Designation

11.1 Guide

11.2 Signature

11.3 Co-guide

11.4 Signature

11.5 Head of the Department

28

11.6 Signature

12 12.1 Remarks of the Chairman and Principal

12.2 Signature

29