RAJIV GANDHI UNIVERSITY OF

HEALTH SCIENCES

SYNOPSIS OF

THE M.SC.(N) DISSERTATION

A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE OF MOTHERS OF UNDER FIVE CHILDREN

REGARDING VIRAL HEPATITIS A AND E IN A

SELECTED COMMUNITY IN MANGALORE

Submitted By:

Mr. Dildaar R. P.

1st year M.Sc. Nursing student,

Srinivas Institute of Nursing

Sciences,

Valachil Padavu, Arkula,

Mangalore – 574 143.

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

(IN BLOCK LETTERS)

MR. DILDAAR R. P.

1st YEAR M. Sc. (NURSING)

CHILD HEALTH NURSING

SRINIVAS INSTITUTE OF NURSING

SCIENCES,

VALACHIL PADAVU, ARKULA,

MANGALORE – 574 143.

2. NAME OF THE

INSTITUTION

SRINIVAS INSTITUTE OF NURSING

SCIENCES,

VALACHIL PADAVU, ARKULA,

MANGALORE – 574 143.

3. COURSE OF STUDY

SUBJECT

M.Sc. NURSING

CHILD HEALTH NURSING

4. DATE OF ADMISSION 31-05-2010

5. TITLE OF THE TOPIC.

A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE OF MOTHERS OF UNDER FIVE

CHILDREN REGARDING VIRAL HEPATITIS A AND E

IN A SELECTED COMMUNITY IN MANGALORE

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6.

BRIEF RESUME OF INTENDED WORK

6.1. Introduction

“Mother is the name of god in the lips and heart of little child”

-William mark

Child is the mirror of his or her family and society in which he or she

grows. The first five years of life lays a crucial foundation for the healthy growth

and development of the children. It is during these years that the child develops

skill to communicate with others, move about independently and learn to solve

problems. Much of the development that occurs during this time is in context of

their close personal relationship and daily interactions with their primary care

givers, especially mother, who shapes their ability to learn and to feel confident

and secure. Thus knowledge of primary care giver/mother is important in the

preventing the occurrence of illness among children and maintenance of the

health and well being of the growing child1.

Many studies have been conducted by various researchers around the globe

to find out the relationship between the mothers knowledge and prevention of

infectious diseases among children. A study was conducted in Magna Gracias,

Italy, to assess mothers knowledge and attitude regarding prevention of infection

among children. The study result showed that mothers with good education and

better knowledge had more information regarding immunization and other

preventive aspects related to child’s health, thus it shows that knowledge of

mothers have direct relationship with prevention of infection among children .So

creating awareness among mothers will help in preventing diseases among

children2.

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Viral hepatitis is a condition which is highly prevalent among children, but

a large section of the society still has an idea that viral hepatitis is an adult disease

however; children are just as susceptible to viral hepatitis as adults are. Despite

this fact, majority of the research and information about viral hepatitis is limited

to adult population. Unfortunately this means there are many unanswered

questions how these disease affects children and how best to manage in pediatric

age group. Parents of children with viral hepatitis are often frustrated and

confused about what to do and where to turn .so it is important to educate and

create awareness among mothers regarding viral hepatitis3.

6.2. Need For The Study

Despite the health improvement in India over the last 30 years, lives

continue to be lost to early childhood diseases .more than 2 million children die

every year from preventable infections. Children in India continue to lose their

life to vaccine preventable diseases, which remains the big killer disease among

children4.

Hepatitis is the acute or chronic inflammation of the liver that can be

classified into non viral and viral hepatitis, out of these 90% of the cases are

reported as viral hepatitis5. Viral hepatitis is one of the rare diseases which are

still unconquered even in the west. In children it can cause post hepatic cirrhosis,

chronic Cholestasis, sub accute necrosis and hepatic failure. The chances for

complication are great, particularly in India due to poor hygiene and nutrition

status6.

The National Institute of Virology, India has identified hepatitis A as

predominant cause of sporadic acute viral hepatitis in children, National Institute

of Virology have stated that India is experiencing transition in the epidemiology

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of viral hepatitis A and there is more likely hood for explosive outbreaks.

During 2002-2004, total six out breaks of hepatitis where reported among

children in urban and rural India.90 % of Indian children are exposed to viral

hepatitis A virus by the age of 6 years. In Pune, Maharashtra blood samples of

499 children between the age group of 3 days to 6 years where collected and

tested for presence of antibodies against hepatitis A Exposure to HAV was 28.9

per cent soon after the waning of maternal antibodies in the 13-15 month age

group which increased to 52.5 per cent by two years of age and 90.9 per cent by 6

yr ,they concluded that preventive measures like immunization, hand washing,

food sanitation, toilet training of children, environment sanitation must be taken

to action and vaccination should be given at 9th month when the maternal

antibodies disappear7.

Institute of Pediatric Gastroenterology conducted a survey to identify the

incidence of hepatitis E in Indian subcontinent, the statistics show that 101,500

cases of proven Hepatitis E in Pediatric population in India. More than 70% acute

hepatitis occurring in under five populations in this subcontinent is caused by

Hepatitis E virus and 80% of these are sporadic. 90% cases were enterically

transmitted; spread primarily by fecally contaminated drinking water (70%) and

by food (20%), in 9.5% case spread probably was because of person to person

and household contact. Researcher could demonstrate Hepatitis E virus in urine,

respiratory secretions. Interestingly they also found Hepatitis E virus in insects

like flies, cockroaches, and also in engorged bedbugs and in mosquitoes, apart

from briefly boiled mussels, and partially cooked cockles8.

A prospective hospital based study was conducted in a large leading

paediatric hospital in Karnataka, 224 consecutive patients with acute viral

hepatitis were studied for their presentation, aetiology and clinical features.

Result showed that Hepatitis-E was detected in 102 (45.4%), hepatitis A in 74

(33%) and hepatitis B in 28 (12.5%) patients. Acute hepatitis C was detected in

two patients. 15 patients had a mixed infection. Hepatitis A constituted

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41.2% and 31.3% of all cases in the age groups 3-16 years respectively.

Cholestasis was present in 68 (30.4%) patients with hepatitis E accounting for

most (61.8%) cases. There were four (1.8%) cases of acute liver failure. Two

cases were due to hepatitis E and one case each was due to hepatitis A and

hepatitis B. A relapsing course was seen in four cases due to hepatitis-A9.

Viral hepatitis A and hepatitis E are primarily feco orally transmitted and is

common in India, due poor food hygiene, lack of proper environmental

sanitation, contamination of drinking water with infected fecal material and poor

knowledge of the public regarding the prevention of the infection is causing the

infection to transmit from one child to the other child. Therefore it is important to

assess the knowledge of public and provide adequate health teaching and

information to the general population. the researcher when working in the ward

had seen many children getting admitted to the hospital diagnosed with viral

hepatitis and mothers are finding to difficult to manage the child with the disease

as they do not have much knowledge regarding the prevention of the hepatitis

infection, thus the investigator would like to undertake the present study to

evaluate the knowledge and practice of mothers of under five children regarding

viral hepatitis A and E in a selected community in Mangalore, to improve their

knowledge and practice on viral hepatitis A and E by administering a structured

teaching programme.

6.3. Review of LiteratureReview on knowledge:

A cluster sampling survey was carried out to investigate community

perceptions of pilia (the local word for hepatitis) in east Delhi (India). Of 416

samples (mothers of children aged < 2 years) interviewed, 339 (81%) were aware

of pilia as an illness. Only 322 (77%), 164 (39%), 73 (18%) and 71 (17%) people

knew about correct symptoms, dangers, causes and prevention of pilia. Most of

the correct responses were related to the feco-orally transmitted viral hepatitis.

Literate respondents were significantly more aware of pilia (chi2 52.81, P <

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0.0001), its symptoms (chi2 48.88, P < 0.0001), causes (chi2 39.34, P < 0.0001),

dangers (chi2 19.3, P = 0.0007), and prevention (chi2 60.8, P < 0.0001). However,

age of the respondents had no significant bearing (P > or = 0.05) on the

correctness of responses. About 293 (70%) subjects considered pilia as a treatable

illness; of them, 193 (66%) and 77 (26%) respectively expressed their preference

for the 'modern' and indigenous systems of medicine for its treatment. In contrast,

110 (38%) respondents said that they would prefer faith healers for the treatment

of pilia. Although only 31 (7%) persons were aware of a vaccine against pilia

(hepatitis A&B vaccine), virtually all agreed to have their children immunized if

such a vaccine were made available. The study underscores the usefulness of pilia

in lay-reporting of viral hepatitis and epidemiological studies on hepatitis-

associated illnesses and the need for educating the community about its causes

and prevention to increase people's participation in controlling viral hepatitis10.

A descriptive study was conducted to investigate knowledge, attitudes and

related behavior on food borne hepatitis and food-handling practices among

mothers in Italy. A self-administered questionnaire was offered to a random

sample of mothers of children attending public schools. Of the 394 responding

mothers, 11.1% correctly indicated six related different food vehicles; education

level was a predictor of this knowledge. A positive attitude towards forborne

hepatitis control, significantly higher in older and more educated women, was

reported by the great majority, who agreed that improper storage of food

represents a health hazard (95.7%), that washing hands before handling

unwrapped raw or cooked food reduces the risk of food contamination (93.2%),

and that the awareness of the temperature of the refrigerator is crucial in reducing

risk of food contamination (90.1%). Only 53.9% reported washing hands before

and after touching raw or unwrapped food and 50.4% reported using soap to wash

hands. A total of 75.6% clean kitchen benches after every use and 81.1% use hot

water and soap for this purpose. Washing hands before and after touching

unwrapped food was significantly higher in women living in larger families and

who had been informed by physicians about foodborne hepatitis. Educational

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programs and the counseling efforts of health workers, particularly focused to

less educated subjects, are greatly needed11.

A qualitative study was done on parents difficulties and information needs

in coping with acute hepatitis in preschool children in Newcastle UK, sample

consists of 95 parents of preschool children and the study was done using semi

structured one to one and group interviews with parents of preschool children .the

researcher found that parents felt disempowered when dealing with acute

hepatitis in their children because of difficulties making sense of the illness.

Central to parents difficulties were their experience of inadequate information

sharing by their general practitioners and variations in their doctors decision and

behavior. Disparity between parent’s belief s and expectations for a range of

accessible and specific information to support them through their negotiation of

children’s illness. Thus researcher concluded that communication with parents

requires greater recognition of parent’s difficulties. Professionals have

considerable potential to empower parents by sharing more information and

skills. Such information should be consistent and address parents concern, beliefs

and expressed needs if this potential to be realized12.

A survey study was conducted in California to assess parent’s

knowledge, attitude and practice associated with not receiving hepatitis

A vaccine among children. A random cluster sample survey was

conducted of parents of children who attended kindergarten in Butte

County. Because of a history of recurrent epidemics, an aggressive

hepatitis A vaccination program was ongoing during the time this study

was conducted, of 896 surveys sent, 648 (72%) were completed. The vaccination

coverage for at least 1 dose of hepatitis A vaccine was 398 (62%)

and for 2 doses were 272 (42%). Factors associated with not receiving

the vaccine included lack of provider recommendation

(vs. having recommendation; odds ratio [OR]: 7.8; 95% confidence interval [CI]:

4.9-12.2), not having heard of the vaccine (OR: 2.4; 95% CI: 1.2-4.9),

and parent's not perceiving child is likely to get hepatitis A (vs. perceiving child

might get disease; OR: 2.1; CI: 1.6-2.9). Thus the study concluded that

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Vaccination coverage among kindergartners did not reach high

levels (i.e., >90%), despite aggressive vaccination efforts in this community.

Lack of provider recommendation and lack of parental awareness of hepatitis A

vaccine were the 2 most significant factors associated with failure to receive

vaccine. These findings will facilitate the development of vaccination strategies

for communities in which hepatitis A vaccination is recommended13.

A cross-sectional study was conducted in Brazil to assess the school

teacher’s knowledge on prevention of viral hepatitis among students.

The sample consisted of 360 subjects, 334 women and 26 men. A questionnaire

was used to assess the knowledge on transmission and preventive practices. The

result was categorized into transmission category (TC) and prevention category

(PC) .under transmission category food and water born transmission had the

frequent mentioning (40%) followed by blood borne (16%) and inadequate

knowledge(9%).for prevention items food and water safety had the maximum

responses followed by general prevention (13%) and immunization(9%).

The study concluded that more investment should be made to disseminate

appropriate knowledge on viral hepatitis among school teachers and public14.

6.4 Statement of the Problem

A study to assess the effectiveness of structured teaching programme on

knowledge of mothers of under five children regarding viral hepatitis A and E in

a selected community in Mangalore.

6.5. Objectives of the StudyThe objectives of the study are to

assess the existing knowledge among experimental and control group of

mothers of under five children regarding viral hepatitis A and E.

develop and deliver a Structured Teaching Programme on viral hepatitis A

and E to the experimental group of mothers of under five children.

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assess the knowledge of both experimental and control groups of mothers of

under five children after administering the structured teaching programme.

evaluate the effectiveness of structured teaching programme by comparing

the post test knowledge scores of the experimental and control group.

find out the association between selected demographic variables like age,

occupation, socio economic status, education, source of information on viral

hepatitis and previous exposure to hepatitis with knowledge of mothers of

under five children regarding viral hepatitis A and E.

6.6. Operational Definitions Effectiveness:

Effectiveness refers to the extent to which the Structured Teaching

Programme has achieved the desired improvement as assessed by post test

knowledge and practice scores among mothers of under five children regarding

viral hepatitis A and E.

Structured Teaching Programme:

Structured Teaching Programme refers to the teaching programme

designed to provide information to the mothers of under five children regarding

viral hepatitis A and E and it includes meaning, incidence, etiology and

pathophysiology, clinical features, diagnostic evaluations, management and

preventive measures.

Knowledge:

Knowledge refers to the correct responses to the items to the questionnaire

on viral hepatitis which is measured by structured knowledge questionnaire.

Mothers of under five children:

Mothers of under five children refers to those mothers who have one or

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more children under the age group of five years residing in a selected community

in Mangalore.

Viral hepatitis A & E:

Hepatitis A & E is an acute inflammatory disease of the liver caused by

hepatitis A & E virus, which spreads through the feco-oral route.

6.7. Assumptions

1. Mothers of under five children may have some knowledge regarding

viral hepatitis A and E.

2. The mothers of under five children can be educated regarding viral

hepatitis A and E.

6.8. Delimitations

The study will be limited only to the mothers of under five children in

selected community in Mangalore.

6.9. Hypotheses

H1: there will be significant difference in the mean post test knowledge

scores between the experimental and control group of mothers of under five

children.

H2: there will be significant association between prê-test knowledge scores

of mothers of under five children on viral hepatitis A and E and selected

demographical variables such as age, occupation, socio economic status,

education, source of information on viral hepatitis and previous exposure to

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7.

hepatitis.

MATERIALS AND METHODS

7.1 Source of DataThe data will be collected from the mothers of under 5 children residing in

a selected community in Mangalore.

7.2 Research Design

Non equivalent control group design

PRE TEST INTERVENTIONS POST TEST

O1 X O2

O1 O2

Day 1 Day1 Day 7

O1-asessment of knowledge before administering the structured teaching

programme among control and experimental group.

X-is the structured teaching programme given.

O2-asessment of knowledge after administering the structured teaching

programme.

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7.2.1 SCHEMATIC OUTLINE OF RESEARCH DESIGN

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DESIGNNon equivalent control group design

POPULATIONMothers of under five children

SAMPLE TECHNIQUENon random purposive

sampling

FINDING, DISCUSSION AND CONCLUSION

STUDY SAMPLE30 control group and 30

experimental group

STUDY SETTINGSelected community in

Mangalore

TOOLKnowledge questionnaire

Descriptive and inferential

statistics for baseline Performa

Un paired “t” test to compare the

knowledge scores of experimental &

control group

Paired t test for significance of difference between pretest

and post test scores. chi square test for association between pre test and socio

demographic variables

VARIABLES

DEPENDENT Knowledge on viral

hepatitis A & E

INDEPENDENT Structured Teaching

Programme

ATTRIBUTES Age, occupation, socio

economic status, educational status, source of information on viral hepatitis, previous

exposure to hepatitis

ANALYSIS

7.3 Setting

Study will be conducted in a selected community in Mangalore.

7.4 Population

The population selected for the study will be mothers of under five

children in a selected community in Mangalore.

7.5. Method of Data Collection

A written permission will be obtained from the concerned authority of

selected community by explaining the purpose of study. The samples will be

divided into experimental and control group using non random purposive

sampling .the investigator will introduce him to the participant’s. The objectives

of the study will be explained to the participants and an informed consent will be

taken from the subjects. Pretest will be conducted by administering the

questionnaire to both the experimental and control group after which a structured

teaching programme will be given to the experimental group. On the 8th day a

post test will be conducted for both experimental and control group using the

same questionnaire.

7.5.1. Sampling Procedure

Sampling procedure will be non random purposive sampling.

7.5.2. Sample Size

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The data will be collected from 60 mothers who meet the inclusion criteria.

7.5.3. Inclusion Criteria for Sampling

Mothers,

who are willing to participate

present on the day of data collection

of under five children

who can read and write Kannada or English

7.5.4. Exclusion Criteria for Sampling

Mothers with psychological illness

Mothers who are in health profession

7.5.5. Instrument Used

A self administered structured questionnaire to assess the knowledge of

mothers of under 5 children regarding viral hepatitis A and E, the instrument

consist of two sections.

Section A: demographic variables consist of base line information of mothers

regarding age, sex, education, socio economic condition, previous exposure to

knowledge on viral hepatitis, exposure to patient with viral hepatitis.

Section B: structured questionnaire consisting items regarding knowledge on

viral hepatitis A and E consisting of meaning, incidence, etiology and

pathophysiology, clinical features, diagnostic evaluations, management- nursing

14

and medical, prevention.

7.6 Data Analysis Plan

The data will be analyzed using descriptive and inferential statistics. By

using frequency, percentage, ratio, standard deviation, mean, paired” t “test,

correlation and chi square. The knowledge scores will be calculated and

represented on table, diagram and graphs.

7.7. Does the study require any investigation or intervention to be conducted

on patient or other human or animals? If it so please describe briefly.

No ‘this study does not require any investigation or interventions to be

conducted on patients or animals.

7.8. Has ethical clearance been obtained from your institution in case of 7.3?

The proposal has been accepted and recommended by the institutional ethical

committees.

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8.

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