A Study to Assess the Effectiveness of Structure Teaching Programme on Knowledge Attitudes

"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE ATTITUDES

AND PRACTICES OF MOTHERS REGARDING

GROWTH MONITORING OF UNDER FIVES

AT SELECTED PHC, BIDAR,

KARNATAKA.”

BY

JYOTHI SUPRIYA K

Synopsis submitted to the RajivGandhiUniversity of

Health Sciences, Karnataka, Bangalore.

In Partial fulfillment of the requirements for the degree of

MSc Nursing In Community Health Nursing

under the Guidance of

Mrs. VANITHA KULKARNI

Community Health Nursing,

AkkamahadeviCollege of Nursing, Chidri, Bidar, Karnataka.

2010

"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE ATTITUDES

AND PRACTICES OF MOTHERS REGARDING

GROWTH MONITORING OF UNDER FIVES AT

SELECTED PHC, BIDAR, KARNATAKA.”

BY

JYOTHI SUPRIYA K

GUIDE

MRS. VANITHA KULKARNI

DEPARTMENT OF COMMUNITY HEALTH NURSING

AKKAMAHADEVI COLLEGE OF NURSING,

CHIDRI, BIDAR, KARNATAKA.

A SYNOPSIS SUBMITTED AS A PART OF PRACTICAL EXPERIENCE IN AKKAMAHADEVICOLLEGE OF

NURSING, CHIDRI, BIDAR, KARNATAKA.

2010

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

JAYANAGAR, BANGLORE, KARNATAKA.

PROFOMA FOR REGISTRATION OF SUBJECT FOR SYNOPSIS

6 BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study:

The word ‘growth refers to increase in the physical size of the body. It is a measure of physical maturities, signifies an increase in size of the body and its various organs. Thus, it can be measured in terms of centimeter (height) and kilograms (weight). The word ‘development’ refers to increase in skills and function i.e., it is a measure of functional or physiological maturation. It signifies accomplishment of mental acquisition of skill, etc., emotional) (development of attitudes, etc.) and social (adaption to family and society, etc.)abilities.1

“Monitoring” implies the routine continuous collection and evaluation of the measurement which reflect the “nutritional situation.” Anthropometric measurements, which include weight, length, height, MUAC, triceps skinfold (TSH), and date of birth for calculation gives clues for nutritional status of the children.1

The factors influencing growth and development are Genetic inheritance, Nutrition, Socioeconomy, Environment, Chronic diseases, Infections and Parasitoeses, Emotional trauma, Others.1

One of the basic activities of the under-fives clinic is growth monitoring, i.e., to weigh the child periodically at monthly intervals during the first year, every 2 months during the second year, and every 3 months thereafter up to the age of 5 to 6 years. When the child’s weight is plotted on the growth chart against his/her age, it gives what is known as the growth curve. This will help the health worker to detect early onset of growth failure.2

Most trainers of health workers agree that activities with mothers and children are the most important part of health work in a community.This is because ,Women and children make up more than half the people (up to 75%). The health needs of mothers and children are especiallygreat. Mothers and older children are the main providers of care for babies and younger children, whose needs are greatest of all.3

Mother’s Status in the Family and Nutritional Status of Their Under- Five Children.Paper presents part of findings from a longitudinal collaborative project of UNICEF, Kolkata and ICMR, undertaken in four demarcated villages of West Bengal during 1998-99. Present analysis aims to relate status of 450 mothers in the family with the nutritional status of their 530 under five children. For assessing mother’s status their education and employment levels and role in decision making were ascertained. Role in decision-making included control over daily household expenses, decision regarding use of family planning and seeking permission for visit to parental house or watching a movie. The information was collected by a social scientist by undertaking in depth interview of mothers. For assessing nutritional status of children height and weight measurement were taken using standard techniques and method. Proportions of under weight and stunting were calculated using NCHS standard,showed that proportion of both underweight and stunting was more among children of illiterate mothers (55.2% and 55.8 %) while comparing with children of mothers having above primary education (41.0% and 42.9 %), employed mothers (77.4% and 80.6 %) while comparing with children of housewives (46.8% and 47.8 %) and mother who don’t have any control over daily family expenditure (54.7% and 50.3%) while comparing with children of mothers who had such control (25.6% and 30.0 %). More than 80 % of families belonged to labour class and thedifferences persisted irrespective of economic status of families. Thus the study shows that educated mothers and those having control over family expenses take care of children more effectively reflected in better nutritional status of their children, while children of poor employed mothers suffer nutritionally. Hence there is need for some place like crèche to take care of children of poor working mothers during their working hours. 4

India is a third world war country. Since independence, one of the gravest problems India is confronting with is malnutrition among under-5 children. As in other developing nations, malnourishment is a burden on considerable percentage of population, the most vulnerable being the youngest group of the society. About two-third of the under-five children of our country is malnourished. Among them, 5-8% are severely malnourished while rest fall in the group of mild or moderate malnutrition. So it can be said that malnutrition is one of the most widespread conditions affecting child health. The 'germ' of malnutrition 'infects' a foetus in the intra-uterine life due to lack of sufficient antenatal care on part of the mother. The condition deteriorates further when after birth the infant is deprived of exclusive breast feeding or initiation of weaning is delayed.5

Weaning should be started after the age of 6 months and should contain energy rich semi-solid food. Malnutrition makes a child susceptible to infections and delays recovery, thus increasing mortality and morbidity. Every time an innocent child suffers the curse of malnutrition; the responsibility goes to the mother, the family and to the community due to their faulty or no knowledge regarding the harmful effects of prelacteal feeding, benefits of exclusive breast feeding and initiation of proper weaning at the correct time. It is to be realized that a million children die worldwide each year because they are not breast fed. Several millions who survive suffer from acute or chronic illness related to harmful effects of artificial feeding. These sufferings are unnecessary and are the preventable ones by discouraging bottle feeding and initiating efforts to bring back the breast feeding culture. On this background, a project has been carried out under the above mentioned title, which is discussed in detail in the pages to follow. A study like this is very much essential to estimate graveness of the situation so that effective and adequate measures can be taken at the individual, family, community and government levels to combat the curse of malnourishment.5

6.2 Review of literature:

The related literature are presented in the following subheadings.

1. Knowledge and attitudes of mothers on growth monitoring.

1. Practices of mothers on under five growth monitoring.

1. Problems related to under fives.

1. Knowledge and attitudes of mothers on growth monitoring:

The reliability and validity of the schedule was evaluated through a 10-month monitoring programme of 95 children, aged 2–10 months. The acceptability of the process was evaluated by studying retention rates and by organizing focus group discussions with participating mothers. Results are, The structured interview ‘Developmental Milestones Checklist’ consisted of 66 items covering three broad domains of child functioning: motor, language and personal–social development. The interview yielded scores of developmental achievements that showed high internal consistency and excellent test–retest reliability. The results were sensitive to maturational changes and nutritional deficiencies. In addition, acceptable retention rates of approximately 80% were found. Participating mothers reported that they found the procedures both acceptable and beneficial.Conclusion is Developmental monitoring using caregiver report is a viable method to identify and monitor at-risk children in Sub-Saharan Africa.6

It was therefore necessary to evaluate mothers’ knowledge and attitudes of these activities. A descriptive cross-sectional study of nursing mothers and their children attending well-baby clinics in Ibadan was designed. Two hundred and forty nursing mothers and their children were recruited from three types of well baby clinics (university teaching hospital, state maternity hospital and primary care health centers) in the Ibadan North local government area of Oyo state, Nigeria. Interviewer-administered questionnaire were used to obtain information from mothers about Anthropometric measurements of the children were taken to determine ‘wasting’, ‘stunting’ and ‘underweight’. Result of the analyses showed that majority of the mothers (74%) were married and 17% were single, 31.3% had completed primary and/or secondary education, 16.7% had no formal education while 51.8% had tertiary education. Timely and complete immunization was practiced by 93.8% for BCG, 80.4% for one dose, 60.4% for two doses and 49.2% for three doses of DPT and oral polio vaccines, 53.8% for measles and 12.1% for hepatitis B. About 55% of the mothers were currently using family planning methods. Sixty-three percent of the children were underweight, 68% were stunted and 23% were wasted. There was no significant relationship between mothers’ practice of CSS and nutrition of the children. Mothers’ education was negatively correlated to ‘wasting’ in the children. This study reaffirms the importance of female education in the practice of CSS and good nutritional outcomes in children. Basic knowledge of child health, nutrition and related issues should continue to be made available to women and be included in the school curricula7.

1. Practices of the mother in under fives growth monitoring

A study was conducted on practice of mothers regarding infant feeding and nutritional status of under-five children attending the Immunisation Clinic at the Department of Community Medicine , N .R.S. Medical College and Hospital, Kolkata .It was a clinic-based cross-sectional study .Data collection was done by interview of mothers with predesigned and pretested schedules, and by examination of children. Total number of children in the study = 55,4. Male children = 29 (52.70%) Female children = 26 (47.30 %) 5. 29 .27 % children were born with low -birth weight and 87.27% children were delivered at institutions. ( 98.18% ) 90.9% .In case of 14.54% children, Age of initiation of weaning was more than 6 months in 70.59% children. In 3.64% children,while 29.09% children had grade-I malnutrition. 68.96% of male children and 57.69% of female children had normal nutritional status. 71.43% . illiterate mothers had initiated breast feeding within 24 hours of birth of their children. 57.14% children receiving exclusive breast feeding and 57.19% children not receiving exclusive breast feeding had a normal nutritional status.5

The present study was performed to assess, beyond socio-economic factors, independent associations between the health and nutritional status of children under 5 years old and (1) family behavioural factors related to women with regard to child care and (2) war-related experience by the household of hardships in Afghanistan. methods are The subjects were all children born during the previous 5 years from 1400 households in Kabul Province, Afghanistan and were selected by multistage sampling in March 2006. A total of 2474 children from 1327 households completed the examinations and interviews; among them, 101 children were deceased by the time of the interview visits. Diarrhoea (32.5%) and acute respiratory infection (41.0%) were common child health problems and both emaciation (12.4%) and linear growth retardation (39.9%) were prevalent.(odds-ratio = 1.72; 95% confidence interval = 1.23, 2.40), and linear growth retardation of children (odds-ratio = 1.38; 95% confidence interval = 1.01, 1.90); a lack of education of the mother (71.7%) and child marriage of the mothers (18.3%) were associated with diarrhoea (odds-ratio = 1.84; 95% confidence interval = 1.40, 2.41; odds-ratio = 1.46; 95% confidence interval = 1.08, 1.96, respectively).8

1. Problems related to under fives:

To identify under-five-year-old children with vision or ocular defect in two provinces (Wilayats) of central Oman in 2006. Public health intervention study.Ocular examination in Manah Wilayat was conducted by nursing staff of the primary health center (PHC) and in Mudhaiby Wilayat was conducted by a trainee Omani optometrist. Abnormal sized eyeball, strabismus,nystagmus and white pupil were recorded. Visual acuity was tested by LOGMAR chart with Lea's symbols in children >2 years of age and preferential viewing was assessed by Lea's grating paddle or 'Hiding Heidi' picture in children </=2 years age. Data was analyzed using Statistical Package for Social Studies (SPSS 12). Among 1,520 examined children, three children had absent eyeball bilaterally and three had unilaterally absent eyeball. Strabismus and nystagmus were detected in 44 (2.9%) and 18 (1.2%) children respectively. 'Hiding Heidi' test was normal in 530/537 (87%) of children.9

This study was to assess the magnitude of under-nutrition and its correlation. This cross-sectional study was undertaken during March–February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemiaResults Significant proportion (40.4%) of under-five children were stunted (height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. [OR = 1.5, (95% CI: 1.1–2.0)]. Conclusion In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic.10

6.3 Statement of the problem:

“A Study to assess the effectiveness of Structure Teaching Programme on Knowledge, Attitudes and Practices of Mothers regarding Growth Monitoring of Under fives in selected PHC, Bidar,karnataka.”

6.4Objectives of the study

1. To asses Knowledge, Attitudes and Practices of mothers on under-fives growth monitoring.

1. To Evaluate the effectiveness of structure teaching Program on under-five growth monitoring

1. To determine the association between the pre-testscore of and selected demographic variables.

6.2 Hypothesis

H1 :- There will be a significant difference between knowledge, attitudes and practices score of mothers after structure teaching program at 0.05 level of significance.

H2 :- There will significance association between knowledge attitudes practices score of the mothers with demographic variables.

6.5Operational definitions:

1. Assessment :- Refers to the statistical measurement of knowledge of the mothers regarding the under-fives on growth monitoring.

1. Knowledge :-Refers that it is the correct response of the mothers to the knowledge in terms regarding growth monitoring as per the structured interview schedule.
2. Attitude :-Refers that it is expressed opinion of the mothers towards under-fives growth monitoring.
3. Practice :-Refers to verbal responses of the mothers to the practice items

related to growth monitoring of under-five children

1. Mother :-Refers to a women who is biological mother and is responsible for the care of the under fives
2. Under-five :-Refers to the children below five years of age.

1. Growth monitoring :- Refers to weigh the child periodically at monthly interval during the first year, every two months during the second year and every three months thereafter up to the age of five years as per ICDS standards.
2. Structure Teaching Programme:- Structure teaching plan prepared by the investigator to improve the knowledge attitudesand practices of mothers regarding under five growth monitoring.

6.6 Assumptions

1. The mother of the under five children will have some knowledge regardinggrowth monitoring.

2. They mothers may have either positive or negative attitude towards growthmonitoring of the under fives.

3. Structure teaching program will improve the knowledge, attitudes and

practices of mothers regarding growth monitoring of under fives.

6.8 Delimitations

The study is limited to the mothers,

• Who have one or more than one child below 5 years of age.

• Who are willing to participate.

• Who will be available during data collection

6.9 Projected outcome:

The finding of the study will reveal the knowledge attitudes and practices of the mothers which help in growth monitoring of under fives in selected PHC, Bidar, karnataka.

7. MATERIALS AND METHODS:

7.1 Source of data:

7.1.1 Research design:

The research design will be for this study is one group pre-test post-test design.

7.1.2 Setting of the study

The study will be undertaken at PHC, area Manahalli, which is about 20 kilometers from Bidar city. The populations of the PHC is 2057 (2010). The PHC has 7 subcenters. It provides promotive, preventive and curative services to the people.One of the clinical activities of the PHC is well baby clinic which is considered every week on Friday.

7.1.3 Population:

All mothers of under-fives in the PHC, in Bidar will be the Population of the study.

7.2 METHODS OF DATA COLLECTION:

7.2.1 Sampling procedure:

Random sampling will be the strategy that proceeds through a set of stages.