Rajiv Gandhi University of Health Sciences, Karnataka,Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Address Mrs. MANJU MATHEW

1st YEAR M.Sc. NURSING

ROYAL COLLEGE OF NURSING,

7th MAIN, 1st BLOCK, UTTARAHALLI,

BANGALORE- 560 061.

2 Name of the Institution Royal College of Nursing, Bangalore

3. Course of study and subject1st Year M.Sc. Nursing, Pediatric Nursing.

4. Date of admission to course 01-06-2009.

5.Title of the Topic: “A quasi experimental study to assess the effectiveness of structured teaching programme regarding common bacterial infections in children among staff nurses working in selected pediatric hospitals in Bangalore.”

6. Brief resume of the intended work: 6.1 Need for the study6.2 Review of literature6.3 Objectives of the study6.4 Operational definitions6.5 Hypothesis of the study6.6 Assumptions6.7 Delimitations of the study6.8 Pilot study6.9 Variables

Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed

7. Materials and methods:7.1 Source of data- Data will be collected from staff nurses working in selected Pediatric hospitals in Bangalore.7.2 Methods of data collection- Structured questionnaire. 7.3 Does the study require any interventions or investigation to the patients or other human being

or animals? No 7.4 Has ethical clearance been obtained from your institution? Yes, ethical committee’s report is here with enclosed.

8. List of references Enclosed

Rajiv Gandhi University of Health Science, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Address Mrs. MANJU MATHEW

1ST YEAR M.Sc. NURSING

ROYAL COLLEGE OF NURSING

7TH MAIN ,1ST BLOCK ,

UTTARAHALLI, BANGALORE-61

2. Name of the Institution Royal College of Nursing

3. Course of study and subject 1ST year M.Sc. nursing

Pediatric Nursing

4. Date of admission to course 01/06/2009

5. Title of the Topic

“A quasi experimental study to assess the Effectiveness of Structured Teaching Programme

regarding Common Bacterial Infections in Children among Staff Nurses working in selected

Pediatric hospitals in Bangalore.”

1

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

"Viruses and bacteria are not the sole cause of infectious disease, there is something else".

Rene Dubois

Bacteria existed long before humans evolved, and bacterial diseases probably co-evolved with

each species which involuntarily hosts them. Many bacterial diseases that we see today have been

around for as long as we have, others may have developed later. In either case, for the longest time we

were not aware of the cause of infectious diseases.1

The word bacteria derived from a Greek word meaning “small staff”. Bacteria’s are unicellular

organisms that lack membrane-bound organelle. Bacteria are a few micrometers in length; bacteria have

a wide range of shapes, ranging from spheres to rods and spirals. Bacteria are ubiquitous in every habitat

on Earth, growing in soil, acidic hot springs, radioactive waste, water, and deep in the Earth's crust, as

well as in organic matter and the live bodies of plants and animals. There are typically 40 million

bacterial cells in a gram of soil and a million bacterial cells in a milliliter of fresh water; in all, there are

approximately five nonillion (5×1030) bacteria on Earth, forming much of the world's biomass.2

Bacteria were first observed by Antonie van Leeuwenhoek in 1676, using a single-lens

microscope of his own design. The name bacterium was introduced much later, by Christian Gottfried

Ehrenberg in 1838. If bacteria form a parasitic association with other organisms, they are classed as

2

pathogens. Pathogenic bacteria are a major cause of human death and disease and cause infections such

as tetanus, typhoid fever, diphtheria, syphilis, cholera, food borne illness, leprosy and tuberculosis.3

The most common bacterial infections among children are skin infections (including impetigo),

ear infections, and throat infections (strep throat). These and many other less common bacterial disorders

are treated similarly in adults and children. Other infections occur at all ages but have specific

considerations in children. Certain children are at particular risk of bacterial infections. These children

include infants younger than 2 months, children who have no spleen or who have an immune system

disorder, and children who have sickle cell disease.

6.1 NEED FOR SYUDY

3

“Hundreds of people are lining up to take tests for infections, heart and kidney problems and

dehydration”.

Julie Ferguson

The most obvious diseases caused by bacteria among children are infectious diseases. Bacteria

can cause a wide range of illnesses, from gastrointestinal upset to skin disorders to life-threatening

illnesses that require immediate attention. Dangerous bacteria that cause illness include Streptococcus

species, E. coli, and salmonella.4

Impetigo is the most common bacterial skin infection in children worldwide. Approximately 10%

of children presenting to U.S. medical clinics with skin complaints are diagnosed with this condition.

The annual incidence of impetigo in the U.K. is approximately 80/100,000 in children aged 0 to 4 years,

decreasing to approximately 50/100,000 in those aged 5 to 14 years.5

Upper respiratory tract infections are a leading cause of time lost from school. Bacteria account

for up to 25 percent of upper respiratory tract infections. Streptococcus throat is most common bacterial

infections in children and adolescents (aged 3 years to 18 years). Strep throat is called ‘strep’ throat

because the bacterium that causes belongs to Group A Streptococcus.40% of strep throats are treated

with antibiotics. The easiest place to catch strep throat is in a hospital. Hospital workers and inpatients

more likely to carry Group A Streptococcus. Children who attended day care are also at high risk of

catching bacterial infections. Other pathogens include Haemophilus influenza. Middle ear infections are

4

the most common bacterial infections in children in the United States. By the age of 3 years, two-thirds

of American children have had at least one episode of otitis media, and the other third has had three or

more episodes.

Bacterial infection of the trachea can result in inflammation, swelling, purulent secretions and

life-threatening narrowing of the upper airways, causing asphyxia and cardio-respiratory arrest. The

incidence of bacterial tracheitis, which has become now more common than epiglottis, is estimated to be

8 per million children aged 0-5 years. Children may present with a brief period of rhinorrhea, fever,

cough, sore throat and hoarse voice. Typically, the patient deteriorates rapidly, with respiratory distress,

airway compromise and toxic appearance.

Researcher had an experience while working as a staff nurse. The researcher met many children

admitted in the hospital with many complications like respiratory distress and secondary infections that

have arisen due to the ignorance of common bacterial infections by staff nurses. So, the researcher

thought of taking the task of assessing the knowledge of staff nurses who are working in paediatric

hospitals regarding common bacterial infections in children with a view to improve the knowledge.

6.2. REVIEW OF LITERATURE

5

“Literature review to the activities involved in identifying and searching for information or a

topic and developing a comprehensive picture of the state of knowledge on that topic”.

A study was conducted in Department of Pediatrics Chandigarh, India regarding nosocomial

pneumonia in a pediatric intensive care unit. Nosocomial pneumonia is the second most common

hospital acquired infection. Understanding the pattern of occurrence, and etiological agents nosocomial

infection in a pediatric intensive care unit is essential for developing effective infection control

measures. Children admitted in the pediatric intensive care unit over a period of 1 year who had

endotrachial intubation were enrolled in to the study. The result showed that in 72 children with a

median age of 3.7 years.22/72 (30.5%) developed nosocomial pneumonia. Additionally 18(39%) had

evidence of endotrachial bacterial colonization.Re intubation, prolonged duration of intubation were the

risk factor of developing nosocomial pneumonia. Overall mortality was 21 % (15/72). 7 (47%) of these

death were secondary to nosocomial pneumonia. The study concluded that reintubation, prolonged

duration of intubation were the significant factors for development of nosocomial pneumonia. So the

nurses who working in pediatric intensive care unit should have proper knowledge about developing

effective infection control measures.6

A study was conducted in Postgraduate Institute of Medical Education and Research,

Chandigarh, India regarding the effect of interrupted 5-day training of neonatal and childhood illness on

the knowledge and skills of primary health care workers. A 5 day training package was developed and

administered in Haryana state. Improvement the knowledge and skills of 50 primary health care workers

following the interrupted 5day training was compared with that of 35 primary health care workers after

the conventional 8-day training package. The average score increased significantly from 46.3-74.6 in

6

8day training and from 40.0-73.2 in 5day training. Average skills score for respiratory problems

increased from 38-57 in 8day training. Average counseling skill score also rose from 42-89 in 8 day and

from 37-70 in 5 day training. The study concluded that proper training of health care workers will

improve the quality of management of neonatal childhood illness.7

A cross sectional study was conducted in Maulana Azad Medical College, New Delhi, regarding

knowledge of general public and health professionals about tetanus immunization. They done a cross

sectional study at a perfect health mela and all the government allopathic health agencies in Delhi. Result

showed that the knowledge of tetanus immunization was poor among general public as well as health

care providers. The knowledge of tetanus immunization schedule for adults was poor though it was

comparatively better for pregnant females, but only 75% of doctors and 51.1% of nursing personnel

correctly knew the immunization schedule against tetanus in children. The study concluded that there is

a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of

tetanus are followed properly and unnecessary repeated immunization are avoided.8

A study was conducted in National Institute of Communicable Diseases, Delhi. India regarding

diphtheria is declining but continues to kill many children. In 1997,of 143 clinically suspected cases

admitted to hospital 45(32%) died. All the deaths and 92 %( 131/143) of cases occurred in children

below 10 years of age. Only 12% cases had received one or more doses of DPT. Mortality rate were

significantly higher in young (p=0.03) and unvaccinated (p=0.01) children. The study concluded that

importance of improved vaccine coverage and early diagnosis will reduce mortality rate of children with

diphtheria in Delhi.9

7

A study was conducted in Public Health Services in United State regarding nosocomial

septicemia and meningitis in neonates. Most of these infections were caused by multiple antibiotic

resistant gram negative enteric bacteria, staphylococcus aureus. Risk for nosocomial infection was

related primarily to factors which enhance infant contact with these bacteria in combination with those

poorly defined determinants of bacterial virulence and host defense. Control measures for preventions of

these infections are aimed at decreasing the neonates contact with the outbreak strains, improvement in

hand washing practices and equipment sterilization processes.10

A study was conducted in John’s Hopkins University School of Nursing, Baltimore regarding

hand washing practices and resistance and density of bacterial hand flora. The hand washing practices

and bacterial flora of 62 pediatric staff members were studied. Hand washing followed patient contact

29.3% of the time (204/697 contacts).Mean duration was 14.5 seconds, and significant differences in

practices were found by unit. Mean count of colony formed units was log10 5.87+/-0.41,with significant

differences in effect of hand washing on counts of colony forming units. Significant differences were

also found by unit and by staff position with regard to species isolated and antimicrobial resistance of

isolates. The study concluded that a more efficacious and use of antimicrobial agent in hand washing is

more effective for preventing bacterial infections.11

A study was conducted in Aga Khan Health Service, Pakistan regarding management of child

hood pneumonia. Acute respiratory infections mostly pneumonia, are one of the leading causes of death

in young children, accounting for 28% of child hood mortality. The research and technical development

efforts made in the last 15 years which contributed to improving the effectiveness of the case

management strategy to reduce mortality from pneumonia in children. Clinical studies provided the

8

rational for improving the sensitivity and specificity of pneumonia, and enhancing the therapeutic

efficacy of home treatment. A socio cultural knowledge about family practices regarding pneumonia and

acute respiratory infection in children was built up and provided effective communication between

health workers and families about home care of children with acute respiratory infections. Health system

research focused on methods for surveillance of bacterial drug resistance and evaluating the control

programmes. The study concluded that proper management of child hood pneumonia will reduce

mortality rate in children.12

A study was conducted in Department of Pediatrics, Australia regarding pediatric nurse’s

knowledge, attitudes and factors influencing fever management and the predictors of their intensions to

administer paracetmol to febrile child.51 pediatric nurses participated in the study. A self report

temperature is often unrelated to illness severity. Attitudes towards febrile convulsion were highlighted;

by belief that antipyretic do not prevent initial febrile convulsions. Nurses reported strong intension to

administer paracetmol. The study concluded that fever management is an integral aspect of pediatric

nursing. The fever management of nurses knowledge must improve, their positive attitudes enhanced and

negative attitudes challenged.13

A study was conducted in Department of Pediatrics, Burundi regarding knowledge and practices

of physicians and nursing personnel about respiratory infections in children. A survey was under taken in

1993 including 9 paediatricians,27 general practitioners and 58 nurses .a questionnaire including 15 main

items was used . The result showed that a poor understanding of risk factors in 62% of population,

especially among general practitioners and nurses. Clinically 79% were able to make a proper diagnosis

of pneumonia. The duration of antimicrobial therapy was unnecessarily long for 49.4%. 70.5% of the

9

population considered the state of their knowledge and practices to be sufficient, 93.6% indicated that

specific training in this field would be useful. The study concluded that training is needed for health care

workers at all levels specifically in the management and prevention of acute respiratory infection in

children.14

A study was conducted in Herberpur Christian Hospital, India regarding immunization status of

children under 7 years in the Vikas Nagar area. Immunization has played a major part in reducing

childhood mortality so knowledge of vaccine coverage and reasons for poor uptake is essential for

achievement of immunity. A total of 470 families were visited. Age range of children included 9 months

to 6 years. The result showed that over all primary immunization rate was 77.2%,children receiving the

first booster was 73% and children receiving the second booster was 58.4%.Measels was the most

frequently omitted vaccination. The study concluded that poor education was the most frequent reason

for failure of vaccine, so the nurses should provide expanded programme of immunization, and will have

important implications for areas with similar cultural demographics.15

A study was conducted in children’s hospital USA regarding nursing care of child with

neutropenic enterocolitis. Neutropenic enterocolitis is a serious complication in neutropenic children.

The pathophysiology of neutropenic enterocolitis is not completely understood but involvement of

neutropenic, mucosal barrier damage and infection resulting a necrotizing process of the bowel wall. The

outcome for the child with neutropenic enterocolitis has improved with better diagnostic imaging

techniques and antibiotics. Most children can be successfully managed with broad-spectrum antibiotics

10

and supportive care. The study concluded that nursing care of neutropenic enterocolitis children requires

knowledge of the disease process, excellent clinical assessment skills and a well family centered

approach.16

A study was conducted by school of medicine, national yang Ming university Taipei, Taiwan

antibiotic prescribing for children with nasophryngitis, upper respiratory infection and bronchitis who

have health professional parents. This study investigated whether children having health professionals as

parents, a group whose parents are expected to have more medical knowledge and are less likely than

other children to receive and are less likely than other children to receive antibiotics for common colds,

upper respiratory infections and acute bronchitis. A total of 53733 episodes of samples were analyzed.

The study found that after adjusting for characteristics of children with physicians (odds ratio0.50: 95%

confidence interval ((1) 0.36-0.68) or a pharmacist (odds ratio 0.69: 95%, confidence interval 0.52-0.91)

as a parent less likely to receive antibiotic prescriptions. The like hood of receiving antibiotics for the

children of nurses was similar to that for children in the comparison group. This study supports that

better parental education does help to reduce the frequency of injudicious antibiotic prescribing. Medical

knowledge alone may not fully reduce the overdose of antibiotics.17

A study was conducted in Spain, regarding the vaccination coverage in children under 16 years

of age. A transverse study by interviewing parents was made. Children were distributed into three groups

A(0-4 years of age), B(5-9 years of age) and C(10-16 years of age). Their results showed a correct global

vaccination coverage rate of 58.4%. The correct vaccination coverage rate 94.5% in group A, 74.7% in

B, and 30.8% in group C. the correct coverage for specific vaccination was measles 74.6%, rubella 69%,

mumps 63.1%, diphtheria – tetanus – pertussis and polio 67.6%. This coverage was also greater in the

11

younger children of those parents interviewed 94.8% thought that vaccines were good for health.

Information about vaccinations was received from pediatrics in 31.3% of the cases and from nurses in

24.8% with the majority of the cases classifying the information as sufficient. The study concluded that

the vaccination coverage found in children up to 4 years old was very suitable, but it was worse in old

children.18

A study was conducted in Ghent University Ghent Belgium regarding nurse’s knowledge of

evidence based guidelines for the preventions of surgical site infection in children. The aim of study was

the development of an evaluation tool and subsequent evaluation of intensive care unit nurses knowledge

of the surgical site infections and preventions. After assessment of its face and content validity the test

was used in a survey among 809 intensive care unite nurses. Based on the test results and an item

analysis were performed. Face and content validity were achieved for 9 out of 10 items of the

questionnaire. Form the survey; they collected 650 questionnaires (response rate 80.3%). The item

difficulty ranging from 0.1-0.5 for eight questions, while one question had a value of 0.02

discriminative values ranging from 0.27-0.53 and values for the quality of the response alternatives

between 0.1 and 0.7. The nurses mean score on the knowledge test was 29%. The study concluded that

opportunities exist to improve intensive care unite nurses knowledge about surgical site infection

prevention recommendations. Current guidelines should support their ongoing training and education.19

A study was conducted in Children’s Medical Centre in Israel, regarding physicians, nurses and

parents attitudes to and knowledge about fever in early childhood. A total of 2059 questionnaires was

completed by the three groups. The most of the responds believed that fever is a helpful bodily

mechanism of the body. Regarding antipyretic medication 92.3% of the physicians and 84% of the

12

nurses would start treatment for a fever of 38 to 40 0C whereas 38.8% of parents would do so for a fever

of 37 to 38 0C. Febrile seizure served as reason for antipyretic treatment for 34.3% of the nurses and

20% of the patients. Study concluded that fear of brain damage due to fever was noted in almost twice as

many nurses as physicians. Parents and some nurses consider fever a risk factor for serious morbidity.20

.

6.3 OBJECTIVES OF THE STUDY

1. To assess the knowledge of staff nurses regarding common bacterial infection in children in

selected pediatric hospitals.

2. To develop and conduct a structured teaching programme to the staff nurses in selected pediatric

hospitals regarding common bacterial infections in children.

3. To assess the effectiveness of structured teaching programme on common bacterial infections in

children by a post test.

4. To compare pre and post test knowledge scores on common bacterial infections in children.

13

5. To find out the association between the knowledge scores of staff nurses regarding common

bacterial infections in children and selected demographic variables.

6.4. OPERATIONAL DEFINITIONS

1. ASSESS: Assess refers to the process of critical analysis and valuation or judgments of the status or

quality of a particular condition or situation.

2. EFFECTIVENESS: Effectiveness is a measure of the ability of a program, project or task to produce a

specific desired effect or result can be qualitatively measured.

3. STRUCTURED TEACHING PROGRAMME: It is a structured systematic information, instruction or

training given to a person or group.

4. BACTERIAL INFECTION: Invasion of harmful bacteria in the body and causing infectious diseases like

Impetigo, Ear infections, Strep throat, Pneumonia, Diphtheria and Nasophryngitis.

5. CHILDREN: A young person of either sex, especially one between 0-12 years of age.

6. STAFF NURSE: Is a person who has successfully completed diploma in general nursing and midwifery

course which is recognised by Indian nursing council and registered in the state nursing council.

6.5. HYPOTHESIS OF THE STUDY

H1 :- There will be statistically significant association between pre and post test knowledge scores of the staff

nurses regarding common bacterial infections in children.

14

H2 :- There will be statistically significant association between knowledge regarding common bacterial

infections and years of experience.

6.6. ASSUMPTIONS

1. Staff nurses may possess some knowledge regarding common bacterial infections in children.

2. Staff nurses knowledge regarding common bacterial infection can be measured by using a

structured questionnaire.

3. Staff nurses knowledge regarding common bacterial infections in children can be improved by

administrating a structured teaching programme.

4. Effectiveness of structured teaching programme can be assessed by a post test.

6.7. DELIMITATIONS OF THE STUDY

1. The study is limited to staff nurses who have completed Diploma in General Nursing and

Midwifery course, recognized by Indian Nursing Council and registered in State Nursing

Council.

2 .The study is limited to staff nurses working in selected paediatric hospitals in Bangalore.

3. The study is limited to staff nurses who are between the age group of 22-50 years.

15

6.8. PILOT STUDY

The study will be conducted with 6 samples. The purpose to conduct the pilot study is to find out

the feasibility for conducting the study and design on plan of statistical analysis.

6.9. VARIABLE

Variables are qualities, properties or characteristics of a person, things or situation that change or

vary.

Dependent variable: Knowledge level of staff nurses regarding common bacterial infections in

children.

Independent variable: Age, Gender, General educational status, presently working ward, years of

experience and course attended regarding common bacterial infections.

7.0. MATERIAL AND METHODS

7.1 SOURCE OF DATA

16

The data will be collected from staff nurses who are working in selected pediatric hospitals in

Bangalore.

7.1.1 RESEARCH DESIGN

Quasi experimental design

The research design adopted for this study is quasi experimental in nature. One group pre test post test

design

7.1.2 RESEARCH APPROACH

Evaluative research approach

7.1.3. SETTING OF THE STUDY

The study will be conducted at selected pediatric hospitals in Bangalore.

7.1.4. POPULATION

All staff nurses who meet inclusion criteria and are working in selected pediatric hospitals in Bangalore.

17

7.2. METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE)

The data collection procedure will be carried out for a period of one month. This study will be

conducted after obtaining permission from the concerned authorities. The investigator will collect data

from staff nurses by using a structured questionnaire, before and after a structured teaching programme.

Data collection instrument consists of the following sections:

Section A : Demographic data.

Section B : Questions related to assess the level of knowledge regarding common bacterial infections

in children.

7.2.1. SAMPLING TECHNIQUE

Sampling technique adopted for the selection of sample is non probability convenience

sampling.

7.2.2. SAMPLE SIZE

The sample consists of 60 staff nurses working in selected pediatric hospitals in Bangalore.

SAMPLING CRITERIA

7.2.3. INCLUSION CRITERIA

18

1. Nurses who are working in selected pediatric hospitals in Bangalore.

2. Nurses who are willing to participate in the study.

3. Nurses who are between the age group of 22-50 years.

4. Nurses who are available at the time of study.

5. Nurses who have undergone Diploma in General nursing and Midwifery course which is

recognized by Indian Nursing Council and registered in the State Nursing Council.

7.2.4. EXCLUSION CRITERIA

1. Nurses who are working in hospitals other than pediatric hospitals.

2. Nurses who are not available at the time of study

3. Nurses who are not willing to participate in the study.

4. Nurses who have already attended the pilot study.

5. Nurses who are ANM, graduates and post graduates in nursing.

6. Nurses who have more than 50 years of age.

7.2.5. TOOL FOR DATA COLLECTION

Structured questionnaire is used to collect the data from the staff nurses who are working in

selected pediatric hospitals in Bangalore.

7.2.6. DATA ANALYSIS METHOD

19

The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics: Frequency and percentage will be used for analysis of demographic data

and mean, mean percentage and standard deviation will be used for assessing the staff nurses

level of knowledge regarding common bacterial infection in children.

Inferential statistics: Chi–square test will be used to find out the association between knowledge

score and selected demographic variable and paired‘t’-test for assessing the effectiveness of

structured teaching programme. Product moment correlation coefficient ‘r’ will be used to find

out comparison of pre and post test knowledge scores.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE

CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Since the study design is quasi-experimental in nature, investigation or interventions are not required.

7.4. ETHICAL CLEARANCE

The main study will be conducted after the approval of research committee of the college.

Permission will be obtained from the head of the institution. The purpose and details of the study will be

explained to the study subjects and assurance will be given regarding the confidentiality of the data

given.

20

8.LIST OF REFERENCES: [VANCOUVER STYLE FOLLOWED]

1. T.M.Wassenaar. Bacterial Diseases in History. Washington State Uni.2008 December. Available

from URL: http://www.bacteriamuseum.org.

2. Wikipedia the free encyclopedia. Article related to bacteria. Available from URL:

http://www.en.wikipedia.org

3. Howard B.J. Bacterial infection 1994. Article available from URL: http://www.lef.org

21

4. Life extension foundation. Bacterial infections protecting yourself from

commonpathogens:2006:January.Availablefrom URL: http://www.garynull.com

5. Best practice impetigo Basic Epidemiology. Available from URL: http://bestpractice.bmj.com.

6. P.K Patra, M.Jayashree. Nosocomial Pneumonia in a pediatric intensive care

unit.Indianpediatrics:2007July:44(7):511518.AvailablefromURL:http://www.ncbi.nlm.gov/

pubmed.com

7. Kumar D, Aggarwal AK. The effect of interrupted 5-day training on integrated management of

neonatal and childhood illness on the knowledge and skills of primary health care workers.

Health policy and planning : 2007 march;24(2):94-100. Available from

URL:http://www.ncbi.nlm.nih.gov/sites/entrez.

8. Dabas.P.AgarwalC.M. knowledge of general public and health professional about Tetanus

immunization, Indian journal of pediatrics: 2005 December: 72(2):1035-1037: Available

from URL: http://www.ncbi.nlm.nih.gov/pubmed. com

9. Singh J,Harit AK. Diphtheria is declining but continues to kill many children: analysis of data

from a sentinel centre in Delhi,1997.Epidemology andinfection.1999October:123(2):209-

15.Available from URL:http://www.ncbi.nlm.nih.gov/pubmed.com

10. C.Baker nosocomial septicemia and meningitis in neonates. The

AmericanJournalofMedicine2009:70(3):698-701Availablefrom

URL:http://www.elesvier.com

22

11. Larson EL, Foglia A. Hand washing practices and resistance and density of bacterial hand flora

on two pediatric units in Lima,Peru.1992April:20(2):65-72.Available from

http://www.ncbi.nlm.nih.gov/pubmed.com

12. Rasmussen Z,Pio A. Case management of childhood pneumonia in developing countries : recent

relevant research and current initiatives. International journal of tuberculosis and lung disease .

2000 September ; 4 (9):807-26. Available from http://www.ncbi.nlm.nih.gov/pubmed .com

13. Walsh, Anne. Pediatric nurse’s knowledge, attitudes and factors influencing fever management.

Journal of advanced nursing. 2005 march; 49(5): 453-464. Available

fromhttp://www.ncbi.nlm.nih.gov/pubmed .com

14. Baribwira C, Kalambay K, Knowledge and practice of physicians and nursing personnel about

respiratory infections in children. French article of pediatrics.1996;56(1):95-8.Available from

http://www.ncbi.nlm.nih.gov/pubmed .com

15. Elliott C, Farmer K. Immunization status of children under 7 years in the Vikas Nagar area,

North India. Child care health development. 2006 July ;32(4):415-21. Available from

http://www.ncbi.nlm.nih.gov/pubmed .com

16. King N. Nursing care of the child with neutropenic enterocolitis.journal of pediatric oncology

nursing 2002 november; 19 (6):198-204.available from

http://www.ncbi.nlm.nih.gov/pubmed .com

17. Nicole Haung. Laurq Morlock. Antibiotic prescribing for children with nasopharingitis (common

cold) upper respiratory infections and bronchitis who have health professional pare.nts. Journal

23

of pediatrics : 2006 September: 118(3):1323: Available from

URL:http://www.ncbi.nlmonih.gov/pubmed.com

18. Sarasa M.A, Alonso Greyoriom. Child Vaccination the coverage knowledge and attitude of the

population. A study in a health area. Article i9n Spanish : 1996 may:44(5):464-

468:AvailablefromURL: http://www.ncbi.nlm.nib.gov/sises/entrez

19. Labeau SO, Witdouck SS, Nurses knowledge of evidence based nursing : 2009

november16(epob ahead of print). Available from URL: http://www.pubmed.com

20. Sarell.M, Cohen H.A, Physician nurses and parents attitudes to the knowledge about fever in

early childhood. Patient education and counseling: patient education and counseling : 2002

January: 46(1): 61-65. Available from : URL:http://www. Pubmed.com

9. Signature of the Candidate.

10. Remarks of the Guide.

11. Name and Designation.

24

11.1 Guide

11.2 Signature

11.3 Co-Guide

11.4 Signature

11.5 Head of the Department

11.6 Signature

12. 12.1 Remarks of the Chairman & Principal

12.2 Signature.

25