SUBMITTED BYMrs. Lovera Suresh Ms. K. LAKSHMI PRASANNAHead Of The Department 1ST YEAR M. Sc. NURSINGPaediatriac Nursing COMMUNITY HEALTH NURSING

2007-2009Sarvodaya College Of Nursing, SARVODAYA COLLEGE OF NURSING, Bangalore – 560 079 BANGALORE – 560 079

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1. NAME OF THE CANDIDATE &

ADDRESSMs. K. Lakshmi Prasanna 1st Year M. Sc. NursingSarvodaya College Of Nursing,11/2, Agrahara Dasarahalli,Magadi Main Road,Bangalore – 560 079

2. NAME OF THE INSTITUTION Sarvodaya College Of Nursing,Bangalore – 560 079

3. COURSE OF STUDY AND SUBJECT 1st year M. Sc. NursingCommunity Health Nursing

4. DATE OF ADMISSION OF COURSE 01 JUNE 20075. TITLE OF THE STUDY “A Study To Assess The

Effectiveness Of Structured Teaching Programme Vs. Self Instructional Module Regarding Prevention Of Acute Respiratory Infections In Children Among Mothers In Selected Urban Area of Bangalore”

6. BRIEF RESUME OF THE INTENDED WORK6.1 Introduction6.2 Need for the study6.3 Statement of the problem6.4 Objectives of the study6.5 Operational definitions6.6 Sampling criteria6.7 Hypothesis6.8 Review of related literature

EnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosed

7. MATERIALS AND METHODS

7.1 Source of data: Mothers of underfive children in selected urban area of Bangalore.

7.2 Method of data collection – Questionnaire

7.3 Does the study require any investigation or intervention to be conducted on the patient or other human beings or animals

NO

7.4 Has ethical clearance has been obtained from your institution

Yes, ethical clearance report is here with enclosed.RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1. NAME OF THE CANDIDATE &

ADDRESSMs. K. Lakshmi Prasanna 1st Year M. Sc. NursingSarvodaya College Of Nursing,11/2, Agrahara Dasarahalli,Magadi Main Road,Bangalore – 560 079

2. NAME OF THE INSTITUTION Sarvodaya College Of Nursing,Bangalore – 560 079

3. COURSE OF STUDY AND SUBJECT 1st year M. Sc. NursingCommunity Health Nursing

4. DATE OF ADMISSION OF COURSE 01 JUNE 20075. TITLE OF THE STUDY “A Study To Assess The

Effectiveness Of Structured Teaching Programme Vs. Self Instructional Module Regarding Prevention Of Acute Respiratory Infections In Children Among Mothers In Selected Urban Area of Bangalore”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 Introduction:

“A child is precious and beautiful,

A source of joy and happiness,

A focus of love & care,

A subject of dreams for the future”

Child Care. 1996

The child is the future citizen of the nation. World’s greatest resource for a future

lies in the children of today. Today’s children are tomorrow’s citizen and leaders.

Investment in the child development is thus an investment in the country’s future and

improving the nation’s quality of life.

World Health organization, in its bulletin (2003) titled “Healthy environment for

children “stated that the largest single cause for childhood illness and death is unsafe

water and poor or non-existent sanitation. One in four of the nearly eleven million

children who die each year before reaching their fifth birthday.1

Children are our future, numbering over 2.3 billion world wide and representing

boundless potential. Children are exposed to serious health risks from environmental

hazards. Over 40% of the global burden of disease attributed to environmental factor

falls on children below five years of age, WHO account for only about 10% world

population, 60% of acute respiratory infections world wide are related to environmental

conditions ARI are a major cause of morbidity & mortality in your children world wide.

They account for nearly 4.1 million deaths every year globally. In an average a child has

5to 8 attacks of ARI annually. In India children below 14 years form 42% of the total

population.2

Acute respiratory Infections are more common in developing countries than

developed countries. ARI are caused by variety of bacteria and viruses. At a time there

can be more than one infection like tonsillitis, otitis media, and whooping cough are the

important ARI’s. The risk factors which predispose ARI infections includes climatic

conditions, poor nutrition, low birth weight, crowding, environmental pollution.3

Bulletin of the world health Organization gives a pictorial representation about

“Determinants of child health outcome”. It points out that child health outcome of the

world depends upon mainly two sectors. 1) Health system and related sectors. 2) Govt.

policy. ARI is one of the major causes for infant and child mortality in India and other

developing countries. For life to continue the person must take air (O2) into the lungs

and distributed throughout the body through blood. When there is alteration in normal

respiration it will affect other systems of the body. In most developing countries 80% of

deaths occur among children below 5years of age, even though this group generally

makes up 15% of the total population, about 20% of the babies, who are born die before

they attain five years of age in the developing countries is due to ARI’s.(WHO)4

ARI are also the main basis for drug prescriptions to children. In most cases these

drugs are unnecessary potentially dangerous and stimulate bacterial resistance. Excessive

and unnecessary use of medications significantly increases health care costs without

benefiting patients health. There is an urgent for systematic evaluation of existing

knowledge and practice which can be inturn applied to prevention and treatment.

6.2 Need for the Study:

Nearly 4.1 million deaths occurring every year globally due to ARI. In India the

Infant and child mortality rate is still high and ARI is one of the major causes of death. It

is also reported that 13% of inpatient death in pediatric ward is due to ARI. The

proportion of death due to ARI in the community is much higher, as many children died

at home. The reason for high case fatality may be that children are either not brought to

the hospital or brought too late. According to WHO, estimates that respiratory Infections

caused 9,87,000 deaths in India, of which 10,000 due to ARI and about 9000 due to otitis

media. The burden of disease in terms of DAILY (Disability Adjusted Life Years) lost

was 25.5 million of these 2.74 lakhs due to AURI and 4.75 lakhs due to otitis media.5

National Institute of Health in their "FACT SHEET" about common cold,

enumerate that common cold is a universal problem. It is most prevalent among children

and children have about 6 to 10 colds a year. In 1996 cold caused 45 million days

restricted activity and 22 million days lost from school. India is still among high

mortality rate countries 67/1000. An examination of state wise IMR shows variations

highest in Orissa 95/1000 Madhya Pradesh 97/1000 and lowest in Kerala 13/1000. IMR

in Karnataka state rural 65/1000 and urban 20/1000. Under five mortality rate in India is

93/1000 live birth,. The proposed specific and monitorable targets for the tenth five year

plan (2002-2007) is reduction to IMR to 45/1000 live birth by 2007 to 28/1000 live birth

by 2012. The view of all these, the present child health programme has come into

existence to prevent the high death rate among Infants. If the health status of children in

India has to be strengthened, adequate guidance to the mother is essential.6

All the above statistics point out the need for study of this particular topic who

has recommended an intervention strategy for ARI control as strengthening of

immunization, standard case management of ARI and health teaching regarding

prevention and management of ARI.7

Duarte D.M & Botecho. C in their descriptive and cross sectional study among

under five children with ARI in Brazil found that the most important risk factor

associated was the mothers educational status.8

Teaching is a crucial component for health team members, the nurse has more

responsibility to provide health teaching to the people to enhance their self-care ability.

Mother is an important primary care provider to children than anyone else in the world.

They can protect their children from ARI. Though science & technology improved in

advancing life situations, still a number of families are unaware of it. So community

Health Nurse plays a major role in disseminating more knowledge regarding ARI.

The American thoracic society has recommended that culturally appropriate

educational material should be prepared an evaluated for its effectiveness in areas of disease.

Structured teaching programme is a planned programme which provides clear information

and easily understandable to mothers. It helps to improve the knowledge of mothers and

contributes to general health of the nation. Self instructional module helps the mothers to gain

knowledge regarding ARI especially for educated and working women.

A comparative study to assess the effectiveness of SIM & STP will help the CHN to

impart education using appropriate method of teaching. Selection of appropriate method of

teaching is vital to make the teaching effective. Hence the investigator is intended to assess

the effectiveness of STP & SIM on ARI among mothers in a selected community.

6.3 Statement of the problem:-

“A Study To Assess The Effectiveness Of Structured Teaching Programme

Vs. Self Instructional Module Regarding Prevention Of Acute Respiratory

Infections In Children Among Mothers In Selected Urban Area of Bangalore”.

6.4 Objectives:-

1. To assess the pretest and post-test knowledge of mothers regarding prevention of

ARI.

2. To administer STP and SIM on prevention of ARI to first and second groups

respectively.

3. To determine the effectiveness of STP & SIM on knowledge regarding prevention

of ARI among the two groups.

4. To determine the association between knowledge on prevention of ARI and

selected variables.

6.5 Operational Definitions

1. Knowledge: Knowledge refers to the respondents verbal responses regarding meaning,

cause, signs & symptoms, prevention& management of ARI as assessed by structured

questionnaire.

2. Structured Teaching Programme: A systematically planned programme to impart

knowledge regarding ARI.

3. Self Instructional Module: It is a guide sheet given to mothers regarding ARI

4. Mother: A woman who has under five children.

6.6 Hypothesis:

There will be a significant increase in knowledge among mothers who attended STP

regarding ARI than the mothers who received SIM.

6.7 Sampling criteria

Inclusion criteria:

1. Mothers who are literate.

2. Mothers who are willing to participate.

3. Mothers who can read and understand Kannada and English.

Exclusion criteria:

1. The by-sitters of under 5 children.

6.8 Review of related literature:

Review of literature is a key step in research process. It refers to an extensive,

exhaustive and systematic examination of publications relevant to the research project.

This part deals with the review of works relevant to the present study. It is presented

under the following headings.

Literature related to:

1. Acute Respiratory Infection and its mortality and morbidity.

2. Predisposing factors, prevention & management of ARI.

3. Knowledge of mothers regarding ARI

4. Comparison of two teaching strategies.

1. Literature related to ARI & its mortality & morbidity:

Nilanjan kumar (2001) conducted a longitudinal study to determine the ARI's

morbidity among under five children in Durgampur village. Hooghly. He reported that

1957 density rate & overall risk incidence was highest in infants 23.9/100 person-

months.9

Ander Koch (1998) conducted a population based study and revealed that 41.6%

of respiratory symptoms and 4.9% of fever cases. The Incidence of ARI up to 65% of the

episodes caused activity restriction and 40% led to contact with the health center.10

Sharma A.K. (1996) conducted a study to assess the magnitude of the problem

ARI in sunderpur, Varanasi and reported that 661 episodes were observed in 5623

children i.e. 6.11 per children/year ARI accounted for 67% of all morbidities;61.4% of all

the episodes terminated with in seven days and only 26.2% continued for two weeks.11

2. Literature related to predisposing factors, prevention & management of ARI:

Patel Kamlesh and Rana Rajiv (2006) in their study found that Bovine

colostrum was highly effective in the treatment & Prevention of recurrent upper

respiratory Infections and diarrhea and 9056% of patients stated good regarding Bovine

colostrums.12

Kaushik PR (1999) in their study stated the relationship between ARI and

malnutrition in Meerut and reported that 73.4% were considered as mild ARI; 19.5%

were moderate; remaining with severe pneumonia, 57.5% of all children suffered from

PEM, 78.6% of children aged 12-14 months had PEM. ARI was more common among

malnourished children than well nourished children.13

Vinod Mishra (1997) proved from their study that the effect of cooking smoke

on ARI rate are most likely greater than children in households using cleaner fuels.14

2. Literature related to knowledge of mothers regarding ARI

Shuaib K, Nigel R, Ruth B, and Broek J (2004) in their descriptive study in

South Africa found that recognition was good among mothers and they described 12 local

types of respiratory symptoms.15

3. Literature related to comparison of teaching strategies:

Ryan GW, Martinez and Pelto GH (1996) conducted a comparative study by

using video to know the effectiveness of two different method and usage of local terms

regarding ARI. The study revealed that mostly mothers mentioned terms not related to

respiratory fullness and produced a larger list of terms associated with ARI.16

Julia A. Gars (1993) conducted a comparative study to evaluate the teaching

strategies regarding breast self Examination among nurses in Western Australian

Hospitals. The results showed that the nurses Involved greatly in the film & discussion

method in BSE proficiency.17

7. MATERIALS AND METHODS:

7.1 Sources of data

Mothers of under five children in selected urban area of Bangalore.

7.2 Methods collecting data :

I) Research design : Quasi experimental design

II) Sampling technique : Simple random sampling

III) Sampling size : 60

IV) Method of data collection : Questionnaire

V) Tool of data collection : Structured questionnaire

VI) Methods of data analysis &

Interpretation - The data will be analysed by using descriptive

statistics (frequency, percentage and standard

deviation) and inferential statistics

VII) Duration of study : 4 weeks

XII) Research variables:

Dependent variable : Knowledge of mothers regarding ARI

Independent variable : STP & SIM on ARI

I) Projected Outcome: The study will impart knowledge on ARI among mothers

having under five children.

7.3 Does the study require any investigation or intervention to be conducted on the

patient or other human beings or animals?

NO

7.4 Has ethical clearance has been obtained from your institution?

YES, ethical committees report is here with enclosed.

8. BIBLIOGRAPHY:

1. Carol Bellarny. Healthy environment for children. Bulletin of the world health

organization. 2003; 81(3): P.157-234

2. World health organization. Childrens environmental health. [serial online] 2007 Jan

[cited 2007 Aug 14]; Available from: URL:http://www.who.int

3. Pan American health organization - Respiratory infections in children. [serial online]

2007 Feb [cited 2007 Aug 14]; Available from: URL:http://www.paho.org/English/

ad/dpc/cd/aiepil.htm

4. Flavia, Bustero, April H, Henrik A. Can developing countries achieve adequate

improvements in child health outcomes without engaging the private sector. Bulletin

of the world health organization – policy and practice 2003; 81(12): P.886-93

5. Park. K. Textbook of preventive and social medicine. 17th ed. Jabalpur: Banarsidas

Bhanot Publishers; 2002. P.132-8

6. The common cold. [serial online] 2007 Jan [cited 2007 Aug 14]; Available from:

URL:http://www.niaid.nih.gov/fact sheets/cold.htm

7. Kasturi Sundar Rao. An introduction to community health nursing. 4 th ed. Chennai:

B.I publishers; 2004. P.502-7

8. Duarte D.M, Botelho C. Clinical profile in children under five years old with ARI.

Indian Journal of pediatrics [serial online] 2000 May-Jun [cited 2007 Aug 14];

[P.207-12] Available from: URL:http//www.journal of pediatrics

9. Nilanjan K. Acute respiratory infections among rural underfives. Indian Journal of

Community medicine [serial online] 2001.03 [cited 2007 Aug 14]; 26(1): [P.25-7].

Available from: URL:http//www.IndianJr.com

10. Ander Koch. Emerging infectious disease [serial online] 1998 [cited 2007 Aug 14];

[P.22-5]. Available from: URL:http://www.medscape.com/view article /434412

11. Sharma A.K. Magnitude of the problem of ARI. Indian Journal of Communicable

Disease [serial online] 1998 [cited 2007 Aug 14]; [P.22-5]. Available from: URL:

http://www.journalcommundis.org

12. Patel Kamlesh, Rana Rajiv. Pedimmune in recurrent respiratory infection and

diarrhoea. Indian Journal of Pediatrics [serial online] 1998 [cited 2007 Aug 14];

73(7): [P.585-91]. Available from: URL:http://www.ijppediatricsindia.org

13. Kaushik P.V. Nutritional correlates of ARI. Indian Journal of Mother and Child

Health [serial online] 1999 Jul-Sep [cited 2007 Aug 14]; 6(8): [P.71-2]. Available

from: URL:http://www.ind journal

14. Mishra. V, Rutherford R.D. Cooking smoke increases the risk of ARI in children,

family health survey bulletin 1997 Sep; 8: P.1-4

15. Shuaib Kauchali, Nigel Rollins, Ruth Bland, J.V. Broek. Maternal perceptions of

acute respiratory injections in children. A European Journal of Tropical Medicine &

International Health 2004 May; 9(5): [P.585-91]. Available from: URL:http://www.

blackwell-synergy.com

16. Ryan GW, Martinez H, Pelto G.H. Methodological issues associated with ARI.

Archieve Medical Research [serial online] 1998 [cited 2007 Aug 22]; 27(3): [P.359-

65]. Available from: URL:http://www.pubmed.com

17. Julia A. A comparative study to evaluate the teaching strategies regarding BSE

among nurses. Journal of Advisory Nursing [serial online] 1998 [cited 2007 Aug 14];

18(10): [P.1593-603]. Available from: URL:http://www.journaladvanced nursing.org

9. Signature of the Candidate :

10. Remarks of the Guide :

11. Name & designation of (in block letters) :

11.1 Guide :

11.2 Signature :

11.3 Head of the Department :

11.4 Signature :

12. 12.1 Remarks of the Chairman & Principal :

12.2 Signature :