A Study of Knowledge,Attitude and Practice Among the Parents of Respiratory Tract Infection

“A STUDY OF KNOWLEDGE,ATTITUDE AND PRACTICE AMONG THE PARENTS OF RESPIRATORY TRACT INFECTION IN PAEDIATRIC PATIENT AT A TERTIARYCAREHOSPITAL.”

M.PHARM DISSERTATION PROTOCOL

SUBMITTED TO THE

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE

BY

ABDUR RASHEED KHAN

UNDER THE GUIDANCE OF

SHRI. SHARANABASAVA.S.BIRADAR

M.Pharm

Department of PHARMACY PRACTICE

H.K.E. Society’s

MatoshreeTaradeviRampureInstitute of pharmaceutical sciences

Gulbarga-585 105

2013-14

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE –II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

TITLE OF THE TOPIC

“A STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICEAMONG THE PARENTS OF RESPIRATORY TRACT INFECTION IN PAEDIATRIC PATIENTS AT TERTIARYCAREHOSPITAL’’

Brief resume of the intended work

Introduction

Healthy children grow to become healthy adults with optimal physical strength and emotional poise to become useful members of our society and contribute effectively in the nation building process. Children are an embodiment of our dreams and hopes of the future,they are the most vulnerable group in the society1Respiratory tract infections are one of the leading causes of morbidity and mortality in young children.Respiratory problems are responsible for a large number of pediatric admissions and outpatient attendance2

In India, acute respiratory tract infection is one of the major causes of childhood death. It is also one of the major reasons for which children are brought to the hospital and health facilities. About 13% of the inpatient deaths in pediatric wards are due to acute respiratory infection(ARI). The proportion of deaths due to acute respiratory infection in the community is much higher as many children die at home. Most children have 3-5 attacks of acute respiratory infection in each year. Many of these infections have their natural course without specific treatment and without complications. Acute respiratory infection is an acute infection of any part of the respiratory tract and related structures including paranasal sinuses, middle ear and pleural cavity. It may cause inflammation of respiratory tract anywhere from nose to alveoli with a wide range of combination of symptoms and signsRespiratory diseases are very often found in children especially the respiratory infections. It is one of the leading causes of morbidity and mortality in young children.

Globally, acute respiratory infections (ARI) and acute diarrhoeal diseases (ADD) constitute 19% and 17% of mortality respectively in under-five age group.2 Morbidity is similar for ARI in developing and developed country but mortality 30 times greater in developing countries. In India mortality of under- five children is mainly due to acute respiratory infections (ARI) 23% and diarrhoeal diseases 18% as per WHO report 2002.

Need for the study

Respiratory problems are responsible for a large proportion of pediatric admissions and outpatient attendance. The respiratory problems which are commonly seen in children are pneumonia, bronchitis, bronchial asthma,PulmonaryTB,Pleural effusion and tonsillitis. The common clinical features related to respiratory diseases are cough, dyspnoea, and expectoration, chest in drawing, chest pain, cyanosis and respiratory sounds like wheezing, strider, grunting and snoring2

ARI are among the leading cause of death in under five child but prevention, treatment

and especially diagnosis and attribution are difficult and uncertain, because community

studies of children mortality depend largely on verbal autopsies, where knowledge, attitude and practice of mothers are important 3In rural areas, lack of basic health service, lack of awareness, and other associated factors like overcrowding, environmental factors, poverty, indoor air pollution are responsible factors.

The proportion of deaths due to ARI in the community is much higher as many children die at home. During 2005, there were about 24 million reported episodes of ARI with 3827 deaths.4

A study finding indicated that formal education of mothers had a positive influence on care of their children with acute respiratory tract infections. So it can be observed from other reviews that mother’s illiteracy is one of the risk factors of respiratory tract infection in children5

Another study for determining the risk factors contributing to respiratory tract infection revealed that parental illiteracy, low socio economic status, overcrowding, early weaning and environmental factors were the significant risk associated with lower respiratory tract infection in children6

A hospital-based case control study was undertaken to determine the risk factors associated with severe lower respiratory infection in under 5 children. Details of potential risk factors in cases and control were recorded in pre-designed pro-forma. Results showed that 512 children including 201 cases and 311 controls were enrolled in the study. In the logistic regression analysis it was found that lack of breast feeding (OR: 1.64 ; 95%CI: 1.23 -2.17); upper respiratory infection in mothers (OR: 6.53; 95%CI: 2.73-15.63), upper respiratory infection in siblings (OR: 24% CI: 7.8 -74.4) were the significant contributors of acute lower respiratory tract infection in children below 5 years of age. This study concluded that lack of breastfeeding, infection in mother, severe malnutrition, cooking fuel other than liquid petroleum gas, inappropriate immunization for age and history of lower respiratory tract infection in the family were the significant risk factors associated with acute lower respiratory tract infection7

A study conducted was on “Acute respiratory diseases in children below five years of age in Tripura”. The incidence was mainly noted in study. The annual attack rate per child was more in rural area than in urban area. Monthly incidence of acute respiratory infection was 34%in Urban area, 17.65% in rural area8

In Karnataka total population is above 52.72 million, in that above 31%are under 5 children . According to registrar generals published figures, ARIs accounts for 13-27% morbidity during infancy and childhood in India9

During community field experience the investigator has come across many children suffering from respiratory tract infection and mothers having inadequate knowledge to treat and prevent such episodes in their children. Hence the investigator was motivated to take up this study.

REVIEW OF LITERATURE

A literature review is a written summary of the state existing knowledge on a research problem, the lack of reviewing research literature involves the identification, selection critical analysis & written description of existing information on a topic.

A descriptive study conducted to correlate acute respiratory tract infection (ARI) among infants in selected area of udupi district. 110 mothers and infants above three months were selected for study. Structured interview schedule was used for data collection. Majority of children that is 60.9% had ARI 4 to 6 times in past three months. During one-month observation maximum number of children (48.6%) had at least suffered from ARI once. Chi square values computed between occurrence of ARI and selected variables revealed significant association between occurrences of ARI and physical health of the infant and environment pollution. The study showed that majority of children suffered 4-6 times with respiratory tract infection in three months of study period 10

A longitudinal a study conducted on ARI among rural under fives. This longitudinal study was formulated with the objective to determine the ARI morbidity among the rural under fives and to study some of the epidemiological factors responsible for such morbidity. All 63 children less than 5 years of age living in the village of Durgarampur (population 548) in Singur block of district Hooghly were included in the study. All children were followed up with periodic home visits at two weeks interval for 6 months. Frequency of ARI episodes was studied and association with study variables was analyzed. Overall incidence density rate of ARI episodes was 19.57 / 100 person / month at risk. Incidence was highest in infants 23.9/100 persons /month. Risk ratio analysis showed that low socio-economic class, low birth weight, under nutrition, inadequate immunization, children not exclusively breastfed and indoor smoke pollution were significantly associated with increasing number of ARI episodes. The study strongly point towards the importance of basic health promotional measures like proper infant feeding practices, proper nutrition of the child, improved general conditions of living in prevention and control of ARI11

A study conducted on knowledge and practice regarding Acute Upper Respiratory Tract Infection in selected rural area in South Bangalore. Conceptual framework adopted for the study was based on Nightingale’s Environmental model. A descriptive and evaluative approach was adopted for the study. The data was collected by Semi structured interview schedule. Sample consisted of 60 mothers using simple random sampling technique. Main findings of the study were there is significant association between knowledge and practice with selected demographic variables like education occupation medium of cooking type of. There is high positive correlation between knowledge and practice. About 48.3% on mothers had inadequate knowledge about common cold. Majority 70% of mothers practice level regarding management of AURI was unsatisfactory, so the need for improving the level of knowledge and practice was widely recognized. Mass and individual education in regional languages to enlighten the mothers can be organized at all levels of health facilities12

A study conducted on knowledge and practices of mothers in rural Haryana. In this study data was collected on knowledge and practices of mothers in two villages of block Beri of district Rohtak for devising a standard management plan. 304 mothers were interviewed. About 23% of mothers recognized pneumonia by fast breathing and 11.2% recognized severe pneumonia by chest indrawing. Only 1.3% mothers knew infective origin of ARI. Although most of them were convinced about continuation of breast-feeding, 70% of them were advising food restriction, use of herbal tea in ARI was widely prevalent and so was the practice of putting warm mustard oil in ear for curing ear pain. Primary health centre was the most frequent place for treatment of ARI13.

A pre-experimental study was carried out in the field practice area of M.S. Ramaiah Medical College Bangalore, Karnataka to assess the impact of educational intervention on the knowledge of mothers of under five children on home management of diarrhoeal diseases. Sample of 225 mothers were included in the study. The study was conducted in 3 stages. Stage I-initial knowledge, attitude and practice of mothers were assessed. Stage II-one to one educational intervention was conducted and supported by audiovisual aids and live demonstration. Stage III-included post intervention knowledge, attitude and practice after 2 months and 2 years. After the educational intervention, there was significant improvement on knowledge of mothers regarding definition of diarrhooea, signs of dehydration, awareness of ORS solution, correct preparation of ORS solution, shelf life of ORS solution, seeking health care and rational drug therapy during diarrhoea. McNemar test was used to find out the change in knowledge before and after the educational intervention. The overall knowledge scores improved significantly after 2 months as well as 2 years of the educational intervention. Though the proportion of mothers retaining the knowledge at the end of 2 years dropped, yet there was significant improvement when compared to the baseline study.14

A study was designed to determine the effect of the health education program in terms of changes in mothers' knowledge, practices and beliefs using Health Belief Model, and to determine the haemoglobin and haematocrite levels of the children of the target group before and after the program. The sample size was 200 anaemic children aged 6-24 months and their mothers, 100 of them were randomly assigned to face-to-face intervention program (experimental group) (I), the other 100 were the control group (II). Only 16% of mothers of group I and 18% of mothers of group II got satisfactory level of knowledge. After the conduction of health education program, the mothers' knowledge was significantly increased among group I, while almost there was no change of the knowledge's level among group II. Only 28% of mothers of group I and 21% of those of group II had good dietary practice. After the program, 74% of mothers in-group I showed good dietary practice. There were highly significant increases in the levels of haemoglobin and haematocrite of children of group I after the program, while the increases were not significant in-group II.15

1. Parents who are having children of age group of 0- 5 and 6 to 12 years
2. Mothers who are willing to participate in the study.

1. Parents who are willing to participate in the study

References

1. Edwin S. Planned teaching programme on practice of acute respiratory tract infectionsamong mother of under five children. Nightingale Nursing Times 2007 Aug.
2. Parul D. Paediatric nursing. New Delhi: Jaypee Brothers Medical Publishers; 2007.
3. World health organization report 2002 Geneva Available:
4. Park K. Preventive and Social Medicine. 19th ed. Jabalpur: Banarsidas Bhanot Publishers; 2007
5. Muhe L, Byass P, Freij L, Sandstrom A. A one year community study of under-fives in rural Ethiophia: Patterns of morbidity and public health risk factors. Public Health 1999; 109(2): 99-109.
6. Savitha M R, Nadeshawara S B, Pradeep M G, Raju C K. Modifiable risk factors for acute lower respiratory tract infections. Indian journal of pediatrics 2007 May; 74: 139-141.
7. Broor S, Pande RM, Gosh M, Maitreyi RS, Lodha R, Singhal T, et al. Risk factors for severe acute lower respiratory tract infection in under five children. Indian Paediatrics 2001 Dec;38(12):1361
8. National institute of health and family welfare. Reproductive and child health module for medical officer [primary HealthCenter]. Munirka, new Delhi; May 2000
9. Trainers guide, Infection control measures with care of patients with acute respiratory disease in community settings ,WHO document production services, Geneva, Switzerland
10. Pai Mamatha Shivanada. A study of correlate of acute respiratory tract infection (ARI) among infants in selected area of Udupi district. The nursing journal of India 2004 Jan; XCV(1):5-6.
11. Mitra Nilanjan Kumar. A longitudinal study on ARI among rural under fives. Indian journal of community medicine 2001 Jan-Mar;26(1):8-11
12. Flower Little. Assessment of knowledge and practice of mothers of under five children regarding acute upper respiratory tract infection in selected rural area in south Bangalore. The nursing journal of India 2007 April; XCVIII(4):75-76
13. Saini NK, Gaur DR, Saini V, Lals. Acute respiratory infection in children a study of knowledge and practice in rural Haryana. Journal of community diseases 1999 Jan; 24(1):75-77
14. Mangal S, Gopinath D, Narasimhamurthy NS, Shivaram C. Impact of educational intervention on knowledge of mothers regarding home management of diarrhoea. Indian journal of pediatrics 2001 Sept;68(9):901-02
15. Hassan AE, Kamal MM, Fetohy EM, Turky GM. Health education program for mothers of children suffering from iron deficiency anaemia in United Arab Emirates.J Egypt Public Health Assoc. 2005;80(5-6):525-45.

12.2 Principal

12.3 Signature