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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MS.B.MEENAKSHI 1ST YEAR. M.SC NURSING COMMUNITY HEALTH NURSING YEAR-2009-2011

GOLD FINCH COLLEGE OF NURSING NO-150/24 KODIGEHALLI MAIN ROAD, MARUTHI NAGAR, BANGALORE 560092
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 NAME OF THE CANDIDATE AND ADDRESS MS.B.MEENAKSHI 1ST YEAR. M.SC NURSING GOLD FINCH COLLEGE OF NURSING NO-150/24 KODIGEHALLI MAIN ROAD, MARUTHI NAGAR, BANGALORE 560092 GOLD FINCH COLLEGE OF NURSING NO-150/24 KODIGEHALLI MAIN ROAD, MARUTHI NAGAR, 3 COURSE OF STUDY AND SUBJECT 4 5 DATE OF ADMISSION TO COURSE TITLE OF THE TOPIC BANGALORE 560092 1ST YEAR. M.SC NURSING COMMUNITY HEALTH NURSING 15-06-2009 A STUDY TO DETERMINE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AN PRACTICE REGARDING PREVENTION OF WORM INFESTATIONS AMONG MOTHERS WITH UNDER FIVE CHILDREN IN A SELECTED SETTING AT BANGALORE.

NAME OF THE INSTITUTION

BRIEF RESUME OF THE INTENDED WORK

6.

INTRODUCTION
Children are the wealth of tomorrow. Take care of them if you wish to have strong India. Everyday to meet various challenges
Jawaharlal Nehru

Children as the Nations supremely important asset to its family and society child is precious gift which has a lot of potentials with one which can be the best resource for the nation if developed and utilized well. Children below five years of age group are known as the under fives. According to the 2001 census children in the group of 0 5 years constitute 12% of the total population that is nearly about 150 million children in India. By virtue of this large number they are entitled to large share of health care. (Park. K; 2001) The under five children are vulnerable or special risk group in any population deserving special health care because of their immaturity and the various stages of growth and development. The under five children are more prone to acquire some infection which is not seen in adult medical care through their life span. (MarlowDorothy; 1998).

All children are most vulnerable group in the society, certain disease affect them, and result in increased morbidity and mortality rates. diseases, These diseases include diarrhea, vector borne infestation, respiratory infections and helminthic

injuries. (Health action; 2003) The term parasite relates to any living thing that lives on or in another living organism. Many parasites interfere with bodily function, cause irritation; some destroy the hosts tissues and release toxin into the blood stream. Helminthic infestation is a serious public health problem, especially in areas of low environmental quality and people of low nutritional status. nutrients as high. In the growing stage, children are more In young children physical and mental susceptible to the ill effects of parasitic attacks, as their need for development may be affected by malabsorption, blood and protein loss and diarrhea generated often by presence worms in the gut. There is also the risk of complications. Many parasites interfere with the process of intestinal absorption of Nutrients. Insensitivity of the parents to childrens hygiene and the childrens frequent exposure to ova-laden soil emerged as important factors in parasitic infestation. Children are mainly The affected as they are playing in heavily contaminated soil.

continuous presence of worms in marginally nourished children can cause severe anemia and affect the growth of children. (Ramankutty et. al., 2005)

Such infections can be prevented by practices such as safe disposal of excreta, washing hands after defection, wearing slippers and food hygiene. These can be implemented through effective education. 6.1 NEED FOR THE STUDY :Intestinal helminthics are a world wide problem especially among children of developing countries. Annual (2002 -2003) : Report estimated that, the global prevalence are 1.47 billion for ascariasis, 1.3 billion for trichurasis and 1.05 billion for hook worm infestation and more than 25% of world population infected with Helminthics. Prevalence rates of order of 50 75% have been registered in Asian countries. National institute of cholera and enteric diseases. DO. TT, Molbak et al., (2007), Estimated that prevalence of worm infestation was 71.73% the prevalence of anemia due to worm infestation was 86.66% in India. Fernandez. MC. et al., (2002), Reported that the overall prevalence of parasites was 91% followed by Ascariasis (5.28%), Ancylostoma duodenae (37.6%) Chennai. A survey on prevalence of intestinal parasites and rural area in and around

associated factors among children reported that 46.7% had one (or) more parasites and prevalence of Ascariasis was highest

(28.4.%), and Taenia saginata was (3.7%), in Kashmir.(Nadur et.al,2006). Chandra Sekar .M.R. et al (2003) Detected that 68% of children below 6 years to have infestation and the incidence of infestation in rural group of children was 79.2% in Karnataka. Bhanderi.D ,Wani et.al, stated that the factors associated with worm infestation are poor personal hygiene, poor sanitary condition low socio ecnomic data, poor nutritional status, low environmental quality, contaminated soil, open field defecation, poor food hygiene, illiteracy.

Saldova S.R. et al. (2001) Found that 11% percent of children with worm infestation were classified as showing stunting, inadequate calorie intake observed in 78% of the population and proportion of those with inadequate protein intake was 34%. The prevalence of under weight was 43.67%, 50.3% children were found stunted with higher prevalence of worm infestation in 2nd and 5th year of life. (Bhanderi et. Al. 2006). Sadiva et al. (1999), identified that inadequate daily caloric intake was observed in 78% of the population and inadequate protein intake was 34% was especially the association between Ascariasis lumbricoides and Trichuris trichura.

Subash CH. and Parija, (1990), Explained the complications of worm infestation such as intestinal obstruction, seasonal pneumonitis, anemia, and some lesions in the skin, peritonitis, vaginitis, and pneumonia will arise due to various types of worm infestation. Ekpo et.al, 2008 conducted study on helminthiasis and hygiene conditions of school in tkenne Nigeria, concluded that burden of parasitic infestation and poor sanitary conditions are greater public health importance, including deworming, health education and improvement of conditions are recommended. During the community postings, the investigator observed the rural publics were using open field defecation, and the community was not maintaining a proper environmental sanitation. The children were walking with barefoot and also they were not practising hygienic measures like washing hands, wearing slippers, drinking safe water and latrine facility. The investigator found that many of the children were suffering with abdominal pain, vomiting, diarrhea and malnutrition etc. There were the children were not able to maintain their normal routine life. The mother play an important role in promoting the health of under five children. So researcher felt that better knowledge and habit of information regarding environmental sanitation and hygienic practices will help to gain the knowledge and there by reduce the

incidence of worm infestation. It also helps to reduce the complications which in turn improve the health and economic condition of the world.

6.2

REVIEW OF LITERATURE
This chapter includes review of literature for the study

which is organised under the following headings.

Part - I : Studies related to incidence and prevalence of worm infestation. Studies related to causes and risk factors Studies related to structure teaching programme are prevention of worm infestation among mother Helminths of worm infestations refers to worms that line as practice in the human body and are a fundamental cause of disease associated with health and nutrtion problems beyond gastro intestinal tract disturbances. Parasites eat and eliminate waste everyday. They not only eat out food, but many of them eat human diseases. The incidence is an india for of the hygenic of the population, awareness of proper sanitary facilities and awareness of safe potable drinking water.

Worm infestation is one of the commonest problems from which millions of people suffer each year. Helminthic infestation has been on an increase now, more than eves before due to poor hygienic and improper cooking of food stuffs. A number of complaints maybe attributed to worm infestation such as bloatedness, gases abdominal cramps, nausea, itching and loss of weight. Food and water are the most common sources of parasite transmission. Since most of us eat three times a day and drink water frequently throughout the day, our exposure sources is constant. (Subash 1998)

6.2.1

Studies related to incidence and prevalence of worm infestation :Dr. A padmeja et al, (2008) Helmithics or worms that line as

parasites in the human body are a fundamental cause of disease associated with health and nutrition problems beyond gastrointestinal tract disturbance. Globally, over 3.5 billion people are infected with intestinal worms of which 1.15 billion are with round worm, 1.3 billion people.The over all prevalence of worm infestation in India is about 50% in urban an 68% in rural area Dr. Sur (2006) estimated that Prevalence of worm

infestaion, globally, over 3.5 billon people are infected with worms of which 1.05 billion with wlipworm, 1.47 billion are with roundworm, 1.3 billion people with hook worm.

Wani SA et al, (2007) couducted study on Helminthic infestation in children of kupwara district, srinagar investigated that the prevalence of Ascariasis lumbricoides (69.23%). richuris trichiura (30.76%), enterobius (7.69%) and taenia saginata (7.69%) were found in rural areas. Data et al, (2005) conducted study on prevalence of multiple intestinal helminths among children in a rural community Nigeria estimated that the prevalence of hook worm infestation was 52.6% and enterbious vermicularis had 2.6% . Farook Mu. et al (2002) conducted study on intestinal helminthic infestations among rural populations of kottor and Achankovil areas in kerala surveyed that the prevalence of hookworm infestation was found to be predominant was(58.82) and round worm was 41.1%. Arene Fo, et al (2000) couducted study on intestinal parasitic infections in pre-school children in the nigeria delta, detected that the prevalence of Ascaris lumbricoides was 51.9%. 6.2.2 Studies related to casuses and risk factors :-

Do. TT et al (2007) conducted study on Helminth infections among people using waste water and human excreta in semi urban in vietnam concluded that waste water exposure, lack of sanitation facilities and inadequately composted human excreta were important risk factors of Helminth infestation.

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Ostan et. al, 2007, explained the Conditions and higher incidence of intestinal parasites found that the increase incidence of intestinal parasites were uneducated and unemployment mother, lower social status of mother, living in crowded houses with insufficient indoor spaces. Bandak et al (2007) conducted study on water handling, sanitation and defecation practices in rural southern India knowledge, attitudes and practice study observed that 30.9% people had toilets but only 2.5% used.

Sharma BBL & sherin Raj T.P reported in Health action that lack of quality water puts peoples health at risk and forces them to extract water from alternative unsafe source. It is estimated that about 95% of the rural population defecate in the open. Such unhygienic practice leads to helminthiasis to the community. Open defecation and system lead to higher incidence of worm infestation. Bansal et. al 2006,explained the Intestinal parasites and intra familial incidence in a low socio economic area of chandigarh indicated that there is a high prevalence of parasitic infection in the community where personal hygiene and sanitary conditions are poor and may be one of the contributing factors for transmission with in the families.

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Subramoniam .Gopal Dr, et. al, (2005) reported on clinical profile of worm infestation in children, Ooty reported that children between 1-2 years have increased incidence. Though most of the children used open air defecation and are playing in heavily contaminated soil. Ramankutty et. al, (2005), conducted study on pattern of helminthes infestation in primary school children of Thiruvananthapuram of reported that congested living conditions are a major factor behind infections with pin worm and whip worm poor sanitation and walking bare foot on the soil are major reasons for spreading round worm and hook worm respectively.

6.2.3

Studies related to types :-

Gandhi et al (2001) couducted study on epidemiology of Necator americanus hook worm infestation was the predominant intestinal helminthes in xlulongkan, where it was determined that 60% of these tested were infected. Females were worm likely to have moderate or heavy infections, whereas male were more likely to have light infections. Albonico et al (2000) conducted study on hook worm infestation and disease: advances for control and estimated that hook worms infect approximately 1.3 billion people world wide,

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and 96 billion suffer from associated morbidity including also insidious effects on nutritional status and on physical development. Karrar ZA et al (1999) conducted a community based study on prevalence and risk factors of parasitic among underfive, sudanese children, detected that the prevalence of taeniasis (10.4%) and enterobiasis (7.4%), Taenia saginata in 2.7% children aged between 3 years and above were the most affected group. 6.2.4 Studies related to complications :-

Brooker S et al, (2007) conducted study on Age related changes in hook worm infestation, anemia and iron deficiency in an area of high hook worm transmission in south eastern Brazil, found that 68% of the individual were infected with the human hookworm necator americanus. The prevalence of iron deficiency (11.8%) and anemia was 12.7%.

Gangopadhyay et al (2007) reported regarding conservative treatment for round worm intestinal obstruction reported that Intestinal obstruction has been estimated to occurs in 2 per 1000 ascaris infected children per year in kupwara district. Zelefsky JR. et al (2006) conducted study on Hook worm infestation as a risk factor for moorens ulcers in south India, concluded that intestinal hook worm infestation appears to be associated with the development
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of

moorens

ulcer.The

prevalence of under weight to 43.67% and 50.3% children were found stunted with higher prevalence in 2nd and 5th year of life respectively due to worm infestation. These nutritional parameters showed a significant association with parental education, socio economic status, family size, environmental conditions and episodes of common disease. Al Mekhlafi HM et.al (2005) conducted study on protein energy malnutrition and soil transmitted helminithasis among orangasli children in selangor, malasia vividly showed that the prevalence of mild stunting was 25.6% while another 61.3% had significant stunting. Over all prevalence of Ascariasis, and hook worm infestation were 61.9% and 37.0% respectively. Kaur R et al (2002) conducted study on Intestinal parasites in children with diarrhea in Delhi, identified that intestinal parasite may increase susceptibility to infection with other intestinal pathogens. Saldiva SR et al 2001 conducted study on Ascaris Trichuris association and malnutrition in Brazilion children evaluated that a high prevalence of intestinal parasites, was detected, in estimators of low economic income, inadequate protein intake especially the association between Ascarsis lumbricoides (41%). Inadequate daily caloric intake was observed in 78% of the population and the proportion of those with inadequate protein intake was 34%. Stunting was significantly associated with low income and inadequate protein intake.

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Studies related to prevention :Albonico et al 2008 conducted study on controlling soiltransmitted helminthias in pre school age children through preventive chemotherapy in Italy, detected that pre-school age children account for 10% -20% of the 2 billion people infected world wide. WHO recommended that pre school children should be included in regular deworming programme. Hoter PJ et al (2006) explained about New technologies for the control of hook worm infestation. This requires parallel efforts to develop new and complementary hook worm control tools such as new anathematic drugs (tribendimidine) and recombinant hookworm vaccine. Ouihai et al (2006) conducted study on Role of the employment status and education of mothers in the prevalence of intestinal parasitic infection in Mexican, rural children. Lower income, defecation in open areas, employment status and lower education level of mothers were the significant factors related to these infestations. It concluded that mothers should be involved in health intiatives to control intestinal parasitism. Farook MU et al 2002 conducted study on environmental factors in relation to helminthic infestation among tribal population of kottoor concluded that the practice of hand wash alone was found statistically significant. Showing that habit of

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proper hand wash considerably reduces the risk of helminthes infestation Donsi. U JK, and ogan VN (1999) ludhiana, conducted study on Assessment of the effectiveness of primary care interventions in the control of three intestinal nematode infections in rural communities evaluated that health education, environmental sanitation and mass expulsion chemotherapy were effective in controlling endemic parasitic infections. The communities worked together to build ventilation improved pit latrines. These findings concluded that improvement in environmental sanitation result in considerable reduction of nematode infections. Chidambaram (1999) about herbal treatment for helminthes infestation that pumpkin seed is taken to eliminate many varieties of worm, peppermint helps to cleanse and strengthen the entire body. Hyssop contains an essential hormone oil to help build resistance to infections disease. Curtale et. al, (1998) conducted study on knowledge perceptions and behaviour of mothers toward intestinal helminthes in upper Egypt, concluded that good hygienic practice includes the prevalence of infestation in the house hold. Health education should seek to improve hygienic behaviors later rather than knowledge of the disease and use of television should be considered to reach illiterate mothers. STATEMENT OF THE PROBLEM :-

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A study to determine the effectiveness of structured teaching programme on knowledge an practice regarding prevention of worm infestations among mothers with under five children in selected rural areas, under Bangalore district.

6.3

OBJECTIVES OF THE STUDY: To assess the pretest knowledge and practice regarding prevention of worm infestation among mothers with under five children in experimental group and control group. To formulate and to conduct a structured teaching programme To assess the post test knowledge and practice scores regarding prevention of worm infestation among mothers with under five children in experimental and control group. To compare the pre and post test knowledge and practice scores regarding prevention of worm infestation among mothers with under five children in experimental group and control group. To associate the post test knowledge and practice score regarding mother prevention with under of five worm infestation and among selected children

demographic variable,

6.4

OPERATIONAL DEFINITIONS :-

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Effectiveness:It refers to the gained level of knowledge and practice as determined by significant difference between pre and post test scores of knowledge and practice among mothers with under five children regarding prevention of worm infestation. Structured Teaching Programme :It refers to a planned series of information to the group of people so as to help them to learn something.In this study, it refers to a structured set of activities implemented in sequence by researcher to spread the knowledge to the mothers regarding prevention of worm infestation. It includes definition, types, causes, mode of transmission, signs and symptoms, complication and prevention of worm infestation .It was given by using flash cards for the period of 45 minutes. Knowledge :Information and skills gained through experience or education. In this study knowledge refers to information and education of mothers about prevention of worm infestation which is measured by structured interview schedule. Practice :The usual way of doing something. to the verbal response In this study, it refers of mothers with under five children

regarding prevention of worm infestation which is measured by structured interview practice questionnaire. Mothers with under five children :-

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Mothers who are having children below 5 years of age. Worm Infestation :The penetration and multiplication of the parasites into the alimentary tract. Prevention: It is stopping something from happening.In this study,it refers to the action taken to remove the possibility of worm infestation occurring in underfive children by creating awareness to the mothers with underfive children regarding prevention of worm infestation. ASSUMPTIONS : Mothers with under five children may not be aware about preventive measures of worm infestation. The structured teaching programme will enhance the knowledge and practice of mothers with under five children regarding prevention of worm infestation. Sample Criteria :Inclusion Criteria : Mothers who have under five children Mothers who knows Kannada Exclusion Criteria : Mothers who are not willing to participate in the study. Mothers who have got sick children.

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HYPOTHESES :H1 : The mean post test knowledge scores of experimental group is significantly higher than mean post test knowledge scores of the control group. H2 : The mean post test practice scores of the experimental group is significantly higher than mean post test practice scores of the control group. H3 : There will be a significant association between the post test knowledge scores of mothers with under five children with their selected demographic variables in experimental group. 7.0 7.1 MATERIALS AND METHODS SOURCE OF DATA

Mothers who have under five children 7.2 7.2.1 METHODS OF DATA COLLECTION: RESEARCH DESIGN :True experimental design 7.2.2 SETTING OF THE STUDY :Study will be conduced in rural area in Bangalore district 7.2.3 SAMPLING TECHNIQUE:-

Simple Random sampling technique

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7.2.4 group 7.2.5

SAMPLE SIZE :Sampling size will be 30 experimental and 30 control

METHOD OF DATA COLLECTION:Structured interview practice questionnaire

7.2.6

TOOL FOR DATA COLLECTION:Structured interview practice questionnaire was to assess

the practice regarding prevention of worm infestation among mothers with underfive children. 7.2.7 METHODS OF DATA ANALYSIS AND

INTERPRETATION :The researcher will use appropriate statistical technique for data analysis by using mean m standard deviation. 7.2.8. 7.2.9 DURATION OF THE STUDY :VARIABLES :mothers teaching will gain adequate The knowledge structured through teaching

7.2.10 PROJECTED OUTCOME :The structured programme.

programme will be effective in improving the knowledge and practice regarding prevention of worm infestation and there by reduce the prevalence of worm infestation among under five children.

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7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CONDUCTED ANIMALS? 7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FORM THE INSTITUTION ? Permission will be obtained from The research committee of the Gold finch College of Nursing, Bangalore. 8.0 LIST OF REFERENCES :1. Park. K (2007). Parks Text book preventive and

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62. Udonsi J.K, Ogan.V. (2003), Assesment of the effectiveness

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and risk factors, journal parasitological, Dec 93(6) : Pp 1541-1543


65. Zelefsky et al. (2008), Hookworm infestation as a risk

factor for moorhens ulcer in South India, Journal of ophthalmology Jan; 115(1) Pp450-453

SIGNATURE OF THE CANDIDATE

10

REMARKS OF THE GUIDE

IT HELPS THE MOTHERS TO IMPROVE KNOWLEDGE REGARDING PREVENTION OF WORM INFESTATIONS.

11

NAME AND DESIGNATION OF THE GUIDE

MRS.SOFIA JULIET ASSOCIATE PROFESSOR GOLDFINCH COLLEGE OF NURSING BANGALORE 92.

11.2

SIGNATURE

29

11.3 11.4 11.5 11.6

CO-GUIDE SIGNATURE HEAD OF DEPARTMENT SIGNATURE

NIL NIL MRS.SOFIA JULIET ASSOCIATE PROFESSOR GOLDFINCH COLLEGE OF NURSING BANGALORE 92.

12 12.1 REMARKS PRINCIPAL OF THE THIS HELPS THE MOTHERS OF UNDER FIVE CHILDREN TO PLAN FOR PREVENTION OF WORM INFESTATIONS. 12.2 SIGNATURE

30