20

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME AND ADDRESS

OF THE CANDIDATE

MR. PRAVEEN. R. SANNAPPAGOL

1ST YEAR MSC NURSING,

RAJEEV COLLEGE OF NURSING,

K R PURAM HASSAN.

2 NAME OF THE

INSTITUTION

RAJEEV COLLEGE OF NURSING

3 COURSE OF THE

STUDY AND SUBJECT

FIRST YEAR M.SC NURSING

CHILD HEALTH NURSING

4 DATE OF ADMISSION

TO THE COURSE

05/10/2011

5 TITLE OF THE

TOPIC

“EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON

KNOWLEDGE REGARDING PICA

HABITS IN CHILDREN AMONG

MOTHERS OF PRESCHOOL

CHILDREN.”

6 STATEMENT OF

THE PROBLEM

“A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON

KNOWLEDGE REGARDING PICA

HABITS IN CHILDREN AMONG

MOTHERS OF PRESCHOOL

CHILDREN IN URBAN SLUM AREAS

OF HASSAN.”

20

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

“What is done to children, they will do to society.”

Karl A. Menninger

The child is the most precious possession of mankind, most loved and perfect

in its innocent and a child is beautiful, a source of joy and happiness, a focus of love

and care and a subject of dream for the future.

Under five children tend to establish eating habits during the first 2 to 3 years

of life. During childhood, the eating preferences and attitudes related to food habits

are established by family influences and culture. Unhealthy diets are common among

lower income families, often because of the lack of nutritious fresh fruits and

vegetables and adequate milk and protein intake. In addition, the lifestyles of

homeless and migrant children place these populations at risk for inadequate food,

causing nutrient deficiencies, developmental and growth delay, depression, hunger

and behaviour problem.1

The world is full of strange diseases and disorders, but the one known as pica is

one of the strangest eating disorders of all. Pica is an eating disorder, of the childhood

which is characterized by the persistent urge to eat inedible things such as clay, hair,

wood, coal, and plaster. It is associated with the passage of these substances

unchanged in the stool, and with radiological evidence of their presence in the gut

when they are radio-opaque.2

The term pica comes from the Latin word meaning magpie, presumably

named after this bird's peculiar eating behaviors. The magpie shows an indiscriminate

preference for foods and nonfoods. Pica of dirt and clay was known to the Greeks and

the Romans and was recorded in a 13th century Latin work. Pica was first addressed

in a medical book in 1563, where geophagia was described in pregnant women and in

children.3

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Pica behavior still occurs almost ritualistically in some modern cultures.

Geophagia has been described as a common act during the 1800s in the southern

United States, primarily among slaves, and is still an accepted behavior in many

cultures. It has been practiced as part of religious ceremonies, magical beliefs, and

attempts at healing. Clay ingestion has been used for medicinal purposes by many

cultures, possibly to affect the microorganisms in the gut or to help relieve intestinal

spasms. During the 1950s and 1960s, geophagia was so common in the south that one

could purchase small brown bags of clay outside bus stops. As members of the

southern population moved north, it was not uncommon to have special local clays

mailed from family members back home.4

Pica is known to occur throughout the world. It is common enough that up to

one quarter of children seen in mental health facilities have some symptoms of this

disease. Worldwide, 25% to 33% of all pica cases involve small children, 20% are

pregnant women, and 10% to 15% are individuals with learning disabilities. The true

incidence of pica is not known but it is estimated to be 75% in infants, 15% in two-

three year old toddlers and 10-33% among the institutionalized mentally retarded

children.5

6. 1 NEED FOR THE STUDYPica is observed most frequently in children, it is the most common eating

disorder in individuals with developmental disabilities. In some societies, pica is a

culturally sanctioned practice and is not considered to be pathologic. Pica may be

benign, or it may have life-threatening consequences.6

The rate of eating disorders seems to be declining as time goes on. According

to the Agency for Healthcare Research and Quality, disorders such as bulimia and

anorexia have decreased 23% as the primary cause of hospitalization regarding eating

disorders between the years of 2007 and 2009,but in-patient hospital stays for a

different eating disorder known as pica has drastically increased since 1999 by an

astounding 93%. It is considered normal for children less than two years old to put

anything in their mouth. After this age, eating non-food items is thought to be

abnormal. According to the United States National Library of Medicine, 10% to 32%

of all children between the ages of one and six exhibited pica behaviors.7

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Most writers reported pica to be associated with severe iron deficiency

anaemia in up to half of patients. In a survey of urban slums, 31% of children with

anaemia had pica. A study conducted to assess the association of pica with iron

deficiency stated that iron deficiency anaemia is three times more common in clay

eaters; clay and starch absorb iron and prevent its absorption by the body. A study

assessing impacts of iron deficiency stated that abnormal eating behaviour may either

be the cause or the effect of iron deficiency. It has been observed that iron therapy can

accelerate the cessation of these generally self-limited aberrations of behavior.8

The mortality of plumbism (lead poisoning) is high and many survivors are

subject to brain damage of varying severity. The substandard housing with its ready

availability of loose plaster and flaking lead content paint, coupled with the increased

pica tendencies of disadvantaged youngsters, provides the ill-fated combination which

ultimately can result in lead intoxication. The prodromal symptoms of plumbism are

vague and simulate a variety of other diseases in children with persisting pica. It

means that repeated screening of large population groups and constant supervision of

children at risk is necessary. The present-day treatment of clinical lead

encephalopathy does not prevent serious sequelae like mental retardation and other

neurological damage in many instances and expensive rehabilitation may be

subsequently required. In order to prevent such serious consequences, it has to be

broken at an early juncture.9

In children aged 18 months to 2 years, the ingestion and mouthing of non-

nutritive substances is common and is not considered to be pathologic. Pica is

observed more commonly during the 2nd and 3rd years of life and is considered

developmentally inappropriate in children older than 18-24 months. Research

suggests that pica occurs in 25%-33% of young children and 20% of children seen in

mental health clinics. Pica typically occurs in equal numbers of boys and girls;

however, it is rare in adolescent and adult males of average intelligence who live in

developed countries.10

The number of people hospitalized with pica, the disorder in which people eat

non-edible substances including dirt and chalk, has nearly doubled within a decade, a

new study finds between 1999 and 2009, yearly hospitalizations in the United States

20

for this disorder increased 93%, from 964 to 1,862, said the report from the

Government's Agency for Healthcare Research and Quality.11

Eating earth substances such as clay or dirt is a form of pica known as

geophagia, which can cause iron deficiency. One theory to explain pica is that in some

cultures, eating clay or dirt may help relieve nausea control diarrhoea, increase

salivation, remove toxins, and alter odour or taste perception, nutritional deficiencies,

such as iron or zinc, that may trigger specific cravings (however, the non-food items

craved usually don't supply the minerals lacking in the person's body) dieting people

who diet may attempt to ease hunger by eating non-food substances to get a feeling of

fullness malnutrition, especially in underdeveloped countries, where people with pica

most commonly eat soil or clay cultural factors in families, religions, or groups in

which eating non-food substances is a learned practice parental neglect, lack of

supervision, or food deprivation often seen in children living in poverty.12

6.2 REVIEW OF LITERATURE

A review of literature involves a systematic identification, location,

scrutinization and summary of written materials that containing information on

research problems.

Studies related to the knowledge of mothers regarding pica habits has been

presented under the following categories

Literature related to the incidence of pica habits

Literature related to the effects of pica habits among preschool children.

Literature related to the knowledge of mothers regarding pica habits.

STUDIES RELATED TO THE INCIDENCE OF PICA HABITS.

A study was conducted on “Clinical profile of pica in childhood”. The various

aspects of clinical profile in 200 children (18 months to 10 years) with pica have been

highlighted. There was a definite male predominance i.e. M: F=1.5:1 and majority of

children belonged to 2– 4 year age group. Direct history of pica was given by 32%

mothers. The presenting complaints were cough (30 %), pain abdomen (34%), poor

appetite (26%), increasing pallor (19%), diarrhoea on and off (17%), vomiting (12%),

abdominal fullness (11%), generalized weakness (8%), passage of worms in stool

(7%) etc. The pica was observed more in children of working mothers as compared to

20

house wives. Pica was seen more in bottle-fed children as compared to breast-fed.

Family history for pica was positive in 44% children. 46% children had poor

nutritional status. Intestinal parasites were identified in 63 % of pica children as

compared to 18% in controls. Initial hemoglobin levels were less than 8 gm/dl in 34.5

% and 11 gm/dl or greater in 20 % of pica children compared with 12 % and 56 %

respectively in control for children.13

A study was conducted on “Pets, pica, pathogens and preschool children”, aim

of the study was to explore the relevance of pica in particular eating the pet's food, as

a possible cause of infestation. The study was done over the 6 month period, 192

children attending the hospital and 69 attending the surgery, 47% of the hospital

group and 51% of the general practice group were pet owners. The mean age of those

children with pets was 3.0 years (range 0.6 years 5.6 years) and the mean age of those

with no pets was 2.7 years (range 0.6 years-5.7 years). The summary of the presenting

complaints is shown that, more of the pet-owning group presented with gastro-

intestinal complaints, the incidence of pica was found to be higher in those children

who owned pets in both hospital and surgery children. This finding was statistically

significant; about half of the pet-owning children with pica were or had been in the

habit of eating their pet's food.14

The study was conducted on “Characterization of Pica Prevalence among

Patients with Sickle Cell Disease”. The result shown that of 395 patients, 134 (33.9%)

reported pica. Ingested items included paper, foam and powders. There was a

significantly higher prevalence of pica among patients homozygous for Hb S (Hb SS,

sickle cell anemia) compared with the combined group of double heterozygous

patients with Hb SC, Hb SD and Hb Sβ thallasemia (Sβ+ or Sβ0) (35.6% vs 25.5%;

P=.03). Overall, the mean age of patients with pica was significantly lower; however,

the prevalence was 23.3% (27/116) among those aged 10 to 14.9 years and 14.8%

(8/54) among those aged 15 to 19 years. The association between pica and low body

weight suggests a nutritional effect on its prevalence.15

A study was conducted to observe the various aspects of clinical profile of

pica in Jammu, India. The study was conducted at a paediatric clinic 200 children

between the age group of 18 months to 5 years with direct or indirect history of pica.

These children were compared to that of 100 non-pica children aged 2 to 4 years. The

20

results showed that 64% of cases with a direct or indirect history of pica belonged to 2

to 4 years of age group and there was a definite male predominance (M: F- 1.5: 1).

Poor nutritional status (46%) and intestinal parasites (63 %) were identified in

children with direct history of pica. Initial haemoglobin levels were less than 8

grams/dl in 34.5 % and 11 grams/dl or greater in 20 % of pica children compared with

12 % and 56 % respectively in control children. The researcher concluded that pica is

more common in childhood and the major contributing factors resulting in pica are the

short family size, the working mothers and bottle-feeding. The children who practice

pica are prone to malnutrition, anaemia, diarrhoea, constipation and worm

infestation.16

A study was conducted on the prevalence of parasitic infections in young

Jamaicans, West Indies. Samples from 2,947 young Jamaicans drawn from all

ecological zones and from all parochial divisions of the island were analyzed. The

result showed that pica was practiced by 9% of the population. A. lumbricoides and

T. trichiura reached peak prevalence of 15% and 20 % respectively in 5 to 9 year-olds,

while hookworm peaked later at 15-19 years of age. The study concluded that there is

a need for a national and even regional antihelminthic programme for the mass

treatment of pre- and primary school age children.17

A study was conducted to assess the association of pica with anemia among 63

children in the age group of 10-59 months with pica habits in a polyclinic in Tunis,

France. The study used survey method compared 63 pica children with 43 non pica

children presenting with a similar degree of anemia. The study revealed that most

children ingested earth, but 50% of the patients ingested multiple substances.

Differences were observed between the pica children and the anemic children without

pica habits in term of anamnestic, clinical and biological data. Treatment with iron

supplements led to cessation of pica in most patients. The researcher concluded that

pica appears to remain very frequent among Tunisian children. The prevention

requires information of parents and dietary prevention of early iron deficiency.18

A cross sectional study was conducted among school children between the age

group of 5-18 years to determine the prevalence of geophagy and the types and

amounts of soil eaten in Western Kenya. The study was conducted to determine the

prevalence, age and sex distribution of geophagy and the types and amounts of soil

20

eaten and the method used was qualitative assessment based on structured interviews

among 285 school children. The silica content of stools of 53 subsamples samples was

assessed to quantify the prevalence of geophagy in a population. The results indicated

that the prevalence of geophagy was found to be 73% and as age increases boys seem

to abandon this habit but girls continued to eat soil. The median daily soil ingestion of

28g was found to be higher compared to previous studies. Geophageous children had

higher faecal silica compared to non-geophageous children, shows the increased

prevalence of geophagy in this region of Western Kenya.19

In a double-blind experiment 16 children with pica received suitable doses of

iron given intramuscularly and 16 received similar injections of saline solution. Iron

was not significantly more effective than saline solution in curing or improving the

habit of pica. There was no correlation between changes in pica and changes in

haemoglobin concentration. At 2 to 3 months after the treatment period, 10 treated

children and 8 controls were without pica. The improvement in haemoglobin

concentration was significantly greater in the treated group, but improvement in pica

was approximately the same and highly significant in both groups. At 13 to 27 months

after the treatment period, 11 of 14 children remaining in the treated group and 9 of 13

remaining controls were reported to be without pica. There were five severe relapses,

two in the treated group and three in the controls, all of which took place in children

with initial levels of haemoglobin above 10.5 gm/100 ml. These five children also

came from the most seriously disturbed family situations in the whole series. If iron

medication is a factor in curing certain cases of pica, the number of such cases in the

present series is not sufficient to affect the statistical reults.20

STUDIES RELATED TO THE EFFECTS OF PICA HABITS AMONG

CHILDREN.

A study was conducted on “Low Plasma Zinc and Iron in pica”. The main

objective of this study was to determine role of trace elements in causation of pica

with specific reference to zinc and iron. Researcher studied plasma levels of iron (Fe),

Zinc (Zn), calcium (Ca) levels by atomic absorption spectrophotometer in 31 children

with pica (Pica Group) and 60 controls matched for age, sex and nutrition (Control

Group) in an observational case control study in the settings of outpatient clinic of a

tertiary care, teaching hospital. The method used was, data from each group were

20

further stratified by haemoglobin level <9 and >9 g/dl into two subgroups pica-1 and

pica-2, and control-1 and control-2 respectively, to control for confounding effect of

iron deficiency anaemia. The results of the study was, the plasma Fe level (mean ±

SD) in children with pica (42.7 ± 9.2) mg/dl) was about 20% lower than that in

controls (51.5 ± 10.0 mg/dl, p<0.001). Plasma Zn levels in the pica group (60 ± 4.4

mg/dl) was about 45% lower than those in controls (110.2±8.5 mg/dl, p<0.001).

Correlation of Zn and Fe levels with pica-related variables such as age at onset,

duration and frequency and number of inedible objects ingested was not significant.

These findings suggest that hypozincemia with low iron levels may be the possible

cause of pica and contradict the contention that low levels of plasma Zn and Fe could

be an effect of pica.21

A clinical trial of mentat in children with behavioural problems was conducted

at the S.N. Children’s Hospital, Allahabad on 105 children whose age ranged from 2

to 5 years, suffering from various behavioural problems comprising of nocturnal

enuresis, speech defects, pica, learning disability, school phobia, breath-holding spells

and thumb-sucking. The result showed that marked improvement was seen in children

with nocturnal enuresis, pica and breath-holding spells with mild improvement in

school phobia, learning disability and speech defect. In cases of pica, apart from

mentat administration the parents were given counselling and the cases received

haematinics and nutritional additives. Improvement was seen in 8 cases 90% of which

fourteen 70% showed marked improvement and 4 cases mild improvement. The

maximum incidence was in the 2 to 5 year’s age group (40%). Simultaneous

improvement in IQ was seen in 10 cases 50% with marked improvement in 10% and

mild in 40% of cases. The study concluded that mentat holds out promise in the

treatment of certain behavioural problems and further extensive trials are desired.22

A longitudinal study was conducted on “Geophagia as a risk factor for

diarrhoea” The aim of this study was to investigate whether earth eating within the

home environment by children is a risk factor for diarrhoeal disease. In 350

households having children aged below five years were included in study, between

April and October 2005. Questionnaire and observation were used to collect data on

participant demographics, earth eating practices in children, incidence of diarrhoea,

structure of the home, sanitary facilities available and presence of faecal matter in the

20

yard. Results revealed that 37% of index children ingest earth occasionally (less than

a handful) and 12% ingest a lot (a handful or more). Diarrhoea is positively correlated

with earth eating (r = 0.306), presence of human faeces in the yard (r = 0.587),

presence of animal faeces in the yard (r = 0.225) and the index child not wearing

loincloth (r = 0.471). Chi-square test of independence also indicates that earth eating

is significantly related to diarrhoea (p < 0.005). The study concluded that earth eating

is a risk factor for diarrhoea in the home environment in this region of Kenya.23

The study was conducted on the cause and treatment of pica among 12 patients

from the department of child health, university of Cape Town and Red Cross war

memorial children's hospital, Cape Town, South Africa. The purpose of this study was

to find out the causative factor for pica and treatment modalities, 12 samples, which

were selected from the Red Cross war memorial children's hospital, presented either

with pica, or where pica was part of the history, were investigated. Haemoglobin,

packed cell volume estimations were done and peripheral smears were examined to

determine whether an iron-deficiency existed. The results showed that there is a

marked iron deficiency state in these 12 children. 11 of these children showed

parasitic infestation, 5 of them eosinophilia, and all passed roundworms. As a result of

treatment with intramuscular iron therapy, mean haemoglobin level increased from 7

gram% to 11 gram% in these 12 samples. The researcher concluded that iron

deficiency is the major cause of pica and that iron therapy is curative.24

A case study was reported on pica and its association with iron deficiency in 3

patients. The results showed that 70% of them developed uterine bleeding from

geophagia and chewing of rubber bands and 20% developed bleeding from colonic

polyps because of drinking frozen bottled water. All 3 patients presented with

haematological parameters diagnostic for iron deficiency anaemia. The study

concluded that pica is an important sign of iron deficiency that should never be

ignored and the craving for any unusual substance should compel clinicians to search

for occult blood loss with secondary iron deficiency.25

A study was conducted to ascertain the attitude of hospital physicians in the

Paris area concerning pica and its relation to iron deficiency and to compare findings

with data in the literature. An anonymous questionnaire was sent to 174 department

heads of specialty units caring for iron deficiency patients: internal medicine (n = 56),

20

hepatogastroenterology (n = 39), hematology (n = 13), gynecology and obstetrics (n =

34), pediatrics (n = 32).The overall response rate was 40.2%. 97% of all the

physicians found pica in less than 10% of patients with iron deficiency, and 95.6%

considered geophagia as the most frequent pica. For 58.5% of the adult medicine

practitioners, pica was regarded only as a cause of iron deficiency, but for 64.7% of

the pediatricians. In the majority of the cases, the attitude of hospital physicians

concerning pica is in disagreement with published data, suggesting either

epidemiological characteristics specific to the Paris area, or unawareness of the

phenomenon 26

The study was conducted to determine the association between specific forms

of pica and toxocariasis and elevated blood lead in children. The sample include 100

children aged 1-6 years in Allegheny country, Pennsylvania, US. The study results

shows that significant associations were found between 1.Feces, soil, or grass pica and

toxocara infection; 2.Paint or plaster pica and elevated blood lead, 3.Dog ownership

and toxocara infection. The study concluded that significant associations were found

between specific forms of pica and toxocariasis and elevated blood lead in children.27

STUDIES RELATED TO THE KNOWLEDGE OF MOTHERS REGARDING

PREVENTION OF PICA HABITS

A study was conducted to establish various methods to prevent pica, through

ingestion of plaster or paint among 331 children from the patient sample of the child

development study at the medical college of Virginia. Interview technique was used to

the mothers of children below the age group of 7 years regarding pica habits of their

children. The status of lead exposure was evaluated in groups of children, those with

pica and those without. The result showed that children from urban areas (92%)

ingested plaster and paints more in amount compared to rural areas. In mothers of

both groups of children, 64.7% believed that pica leads to lead poisoning, 26% were

unaware, six (6%) were uncertain & three (3%) were unknown. As response to the

health teaching provided to the mothers of ninety children who had a heavy plaster

intake, pica was stopped in forty six children (51.1%) of different age groups(under 4

years ) within a month, thirty five of them(39%) stopped within two months and nine

(10%) of them continued the habit for more than six months. The researcher

concludes that through removal of dilapidated houses and health education to people

20

through leaflets, Medias, interviews, health clinics will help to reduce pica. In

addition, an aroused public as a motivating force as a means of dealing with

substandard housing and other environmental sources of lead exposure can also be a

help in reducing a preventable man made disease.28

A study was conducted regarding prevention of pica. The main objective of

this study is to control pica by components of an over correction procedure among

children. The study results that one of the components, oral hygiene, could eliminate

pica by 2 retarded subjects when used alone. Although oral hygiene was the most

effective component, each of other components, tidying and personal hygiene, did

decrease pica. The study concluded that effective implementation of oral hygiene

procedure will decrease pica among children.29

A descriptive and longitudinal study is presented detailing the development of

an effective integrated approach to the treatment of pica. The subject was a mentally

retarded male whose history of life-threatening pica resulted in 37 surgeries for the

removal of foreign objects. Etiological explanations for the behavior are considered

and their roles in generating elements of treatment are described. Results indicated

that pica was eliminated by: (a) directing the subject to engage in other behaviors, (b)

encouraging developmental progress through environmental exploration and trusting

relationships, and (c) analysis of and responsiveness to the subject's cues concerning

the maladaptive behavior.30

6.3 STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PICA HABITS IN CHILDREN AMONG MOTHERS OF PRESCHOOL CHILDREN IN URBAN SLUM AREAS OF HASSAN.”

6.4 OBJECTIVES OF THE STUDY:1) To assess the knowledge regarding pica habits in children among mothers of

preschool children before and after the intervention.

2) To compare the pre and post-test scores regarding knowledge of pica habits in

children among mothers of pre-school children.

20

3) To find the association between knowledge scores among mothers of pre-school

children regarding pica habits in children with their selected socio demographic

variables.

6.5 OPERATIONAL DEFINITIONS:

1. ASSESS: It refers to measure the level of knowledge regarding pica habits in

children among mothers of pre-school children.

2. EFFECTIVENESS: It refers to gain or increase in knowledge after administration

of structured teaching programme, obtained on a structured knowledge

questionnaire regarding pica habits in children among mothers of preschool

children.

3. STRUCTURED TEACHING PROGRAMME: It refers to a systematically

organized teaching programme containing information about pica habits in

children prepared by the investigator and validated by experts.

4. KNOWLEDGE: It refers to the responses given by mothers of pre-school

children to the knowledge questionnaire regarding pica habits in children.

5. PICA HABITS: It refers to an eating disorder that involves satisfaction of a

craving by oral ingestion of substances that are unusual in kind (nonfood or food

items) or amount.

6. MOTHERS OF PRE-SCHOOL CHILDREN: It refers to mothers who have

children age between 3-6 years.

6.6 ASSUMPTIONS:

The study assumes that:

1. Mothers of pre-school children may have some knowledge regarding pica habits

in children.

2. Structured teaching programme will improve the knowledge of mothers with pre-

school children regarding pica habits in children.

6.7 HYPOTHESES:

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H1: There will be a significant difference between the pre and post test knowledge

scores regarding pica habits in children among mothers of pre-school children.

H2: There will be a significant association between the knowledge scores with their

selected socio demographic variables.

CONCEPTUAL FRAMEWORK

The study is based on “Ludwing Von Bertanlanffy General System Model”.

6.8 DELIMITATIONS:

This study is limited to:

1) Mothers of pre-school children.

2) Mothers whose age is between 20-45 years.

3) Data will be collected in 4-6 weeks of period.

4) Sample size is limited to 60.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

Data will be collected from mothers of preschool children who are available at

the time of data collection in urban slum areas of Hassan.

7.2 METHODS OF DATA COLLECTION:

7.2.1 Research approach

Evaluative and educative approach.

7.2.2 Research design

A Pre-experimental design with one group pre test post test design.

GROUP PRETEST INTERVENTION POSTTEST

Mothers of O1 X O2

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preschool children

KEY01 = Pre test assessment on knowledge regarding pica habits in children.

X = Structured teaching programme on knowledge regarding pica habits in

children.

02 = Post test assessment on knowledge regarding pica habits in children.

7.2.3. Research Setting

The study will be conducted in urban slum areas of Hassan.

7.2.4 Population

Mothers of preschool children in urban slum areas of Hassan.

7.2.5 Sample

Mothers of preschool children who fulfil the inclusion criteria.

7.2.6 Sample size

The sample consists of 60 mothers of preschool children.

7.2.7 Sampling technique

Nonprobability convenient sampling technique will be used in this study.

7.2.8 Selection of tool

Structured questionnaire consists of two sections.

Section A - Socio Demographic variables.

Section B –Structured knowledge questionnaire regarding pica habits in

children among mothers of preschool children.

7.2.9 CRITERIA FOR SELECTION OF SAMPLE:

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INCLUSION CRITERIA:

This study will include mothers:

1) Who have children aged between 3 to 6 years.

2) Who are available at the time of data collection.

3) Who are willing to participate in the study.

4) Who can read and write Kannada and English.

EXCLUSIONCRITERIA:

This study will exclude mothers:

1) Whose age is below 25 and above 40 years

2) Who are unable to read and write English or Kannada.

3) Who are sick during data collection.

7.2.10 SIGNIFICANCE OF THE STUDY

The study signifies the importance of structured teaching programme

regarding knowledge of pica habits in children among mothers of preschool

children and it will enhance their knowledge regarding prevention and

management of pica habits.

7.2.11 PILOT STUDY

The pilot study is planned with 10% of the total sample size which will be

conducted in urban slum areas of Hassan and that will be excluded in the main

study.

7.2.12 VARIABLES

Independent variable: Structured teaching programme on knowledge regarding

pica habits in children among mothers of preschool children.

Dependent variables: Knowledge regarding pica habits in children among

mothers of preschool children.

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Extraneous variables: Socio demographic variables such as age, sex,

religion, education, occupation, number of children, type house, type of

family, area of residence, dietary pattern.

7.2.14 DATA ANALYSIS METHOD:

It includes descriptive and inferential statistics.

Descriptive statistics: The statistical analysis includes frequency,

percentage, mean, median and standard deviation.

Inferential statistics: Chi square test will be used to analyse the association

between knowledge scores and selected socio-demographic variables.

Paired ‘t’test wil be used to find out the significant difference between

pretest and posttest knowledge scores.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMAN’S OR ANIMALS? IF SO DESCRIBE.

YES: Only a structured knowledge questionnaire will be used. No other

intervention which causes any physical harm will be used in this study.

Permission from the ethical committee will be obtained.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED? YES:

1) A written permission from the concerned authority will be obtained prior to

the study.

2) Consent will be taken from the mothers before conducting the study.

3) Confidentiality and anonymity of the subjects will be maintained.

7.5 HAS THE CONSCENT BEING TAKEN FROM THE LOCAL

AUTHORITIES?

YES, consent has been taken from the local.

8 LIST OF REFERENCE:

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