PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MS. ARIBAM DUMBRESHWORI DEVI

FIRST YEAR M. SC. NURSING

CHILD HEALTH NURSING

YEAR 2010-2012

PADMASHREE COLLEGE OF NURSING

GURUKRUPA LAYOUT, NAGARBHAVI

BENGALURU-560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. Aribam Dumbreshwori Devi
M. Sc. Nursing 1st Year
Padmashree College Of Nursing,
Gurukrupa Lay Out Nagarbhavi,
Bengaluru – 560072
2. / NAME OF THE INSTITUTE / Padmashree College Of Nursing
Bengaluru
3. / COURSE OF THE STUDY AND SUBJECT / 1st Year M. Sc. Nursing
Child Health Nursing
4. / DATE OF ADMISSION / 02-06-2010
5. / TITTLE OF THE STUDY / “Evaluate The Effectiveness Of Structure Teaching Programme On Mother’s Knowledge And Attitude Regarding Ill Effects Of Kajal Application For Their Infants in Selected urban community, Bengaluru”.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Kajal is an ancient eye cosmetic. It was made by grinding galena (lead sulphide) and other ingredients. Kajal is known by various names in south Asian languages, like sirma or surma in Punjabi, kajal in Hindi and Urdu, kaadige in kannada, kaatuka in telegu, and kan mai in Tamil. Today the trend is to make it without poisonous ingredients. It is widely used in the Middle East, North Africa, the Horn of Africa and South Asia to darken the eyelids and as mascara for the eyelashes. It is used mostly by women, but also some men and children.1

Kajal has been worn traditionally as far back as the Bronze Age (3500 B.C. onward) by the Egyptian queens. It was originally used as protection against eye ailments. There was also a belief that darkening around the eyes would protect one from the harsh rays of the sun. India's oldest caste, the koli, used Kajal as a cosmetic. In addition, mothers would apply Kajal to their infants' eyes soon after birth. Some did this to "strengthen the child's eyes", and others believed it could prevent the child from being cursed by the evil eye.1

Application of 'Kajal' (also known as kohl or surma) is a common practice in Indian families. Kajal and surma contain high levels of lead that is harmful for the baby. Prolonged application may result in excessive lead storage in the body, affecting the baby’s brain and bone marrow formation. Some experts also relate the regular use of kajal and surma to anaemia and convulsions. Furthermore, the cornea or the central, black part of the eye is very sensitive. Dirty fingers, sharp and uneven fingernails can hurt the baby’s eyes. Apart from the immediate pain and the discomfort, the baby may even lose his vision.2

Applying kohl or kajal or surma to a newborn’s eyes has been an age-old tradition in India and in many countries of the Middle East as well. Well-meaning relatives and friends may advise to apply surma or kajal to the newborn’s eyes to ward off the evil eye and to make the eyes look bright and large. In fact, an old wives’ tale suggests that applying kajal or surma will help baby’s eye become large and attractive. This is a myth! 2

Kajal contains lead. So, there is a risk of hurting the eye while applying kajal. The blood vessels in the eyes are very rich in blood supply and prolonged use may lead to excessive lead storage in the body. Excessive lead is bad for the brain and also slows down the blood formation in the bone marrow.3

Lead-contaminated Kajal use has been linked to increased levels of lead in the bloodstream, putting its users at risk of lead poisoning and lead intoxication. Complications of lead poisoning include anaemia, growth retardation, low IQ, convulsions, and in severe cases, death. Anaemia from lead poisoning is of special concern in Middle Eastern and South Asian countries where other forms of anaemia are prevalent — including iron deficiency anaemia (from malnutrition) and hemoglobinopathy (sickle cell anaemia, thalassemia).1

The banned products are different from lead-free cosmetics that only use the term "kohl" to describe its shade/colour, rather than its actual ingredients. Some modern eye cosmetics are marketed as "kohl" but are prepared differently and in accordance with relevant health standards. Consumers should verify that any cosmetic product is lead free before usage.1

Most doctors have in the recent years been stressing on the need to do away with the traditional practices like giving of herbal root paste to the infants, heavy massaging to the babies while bathing, use of cradle, walkers and prams and kajal. The modern day doctors have been strongly discouraging applying of `kajal' or `surma' to baby eyes, which they say, could lead to eye infections. They are against buying across-the-counter medicines in the name of herbal and ayurvedic medicine. Some modern eye cosmetics are marketed as "kohl" but are prepared differently and in accordance with relevant health standards. 4

6.2 NEED FOR THE STUDY

Kajal is basically a purely cosmetic preparation .Yes, it does make the eyes look large and attractive, and it is because of highlighting the outline of the eyes so that it attracts attention.

The practice of applying kajal / surma in the eyes is not recommended as there are chances of transmitting the trachoma infection or may even cause lead poisoning. Some children may develop persistent epiphora due to blockage of naso lacrimal duct by epithelial debris.5

Most commercially produced 'kajal' contain high levels of lead. Studies have revealed that 'Kajal' comprises of galena (PbS), minium ( Pb 3 O 4 ), amorphous carbon, magnetite (Fe 3 O 4 ), and zinc oxide (ZnO). Prolonged application may cause excessive lead storage in the body, affecting the brain and bone marrow, causing convulsions and anaemia. Dirty fingers, sharp and uneven fingernails of the caregivers are potentially harmful to the child's eyes. However, one study has questioned the authenticity of such reports and has claimed that 'Kajal' is safe for use. United State Food and Drug Administration do not permit its use in a cosmetic or in any other Food and Drug Administration-regulated product.6

The drive to eliminate lead from kajal was sparked by studies in the early 1990s of preparations of kajal that found high levels of contaminants including lead. Lead levels in commercial kajal preparations were as high as 84%. Kajal samples from Oman and Cairo, analyzed using X-ray powder diffraction and scanning electron microscopy, found galena. One decade later, a study of kajal manufactured in Egypt and India found that 1/3rd of the samples studied contained lead while the remaining 2/3rd contained amorphous carbon, zinc oxide, cuprite, goethite, elemental silicon or talc, hematite, minium, and organic compounds.1

A study of the composition of some eye cosmetics (kajal) used in the United Arab Emirates was conducted. A total of 23 kohl samples were analyzed using X-ray powder diffraction (XRPD) and scanning electron microscopy (SEM). 19 samples were obtained in Abu Dhabi and four in Dubai. None of the samples weremadein the United Arab Emirates. The main component of 11 samples was found to be galena (PbS). For the remaining 12 samples, the main component was found to be one of the following: amorphous carbon, zincite (ZnO), sassolite (H3BO3) or calcite/aragonite (CaCO3).7

Some types of kohl contain lead in amounts associated with behavioural disorders, lowered intelligence, and poor school performance. The study found a high frequency of 67% of kohl use on babies. The research, published by the Research Affairs Sector of the UAE, was aimed at preventing lead poisoning in infants.It is observed that children and pregnant women are a particularly high risk group because of their greater sensitivity to lead’s toxic effects. It has been found that chronic exposure to low levels of lead may result in mental deterioration, lowered intelligence quotients, learning disabilities, slowed growth, impaired hearing, and behavioural abnormalities. The researchers conducted a cross-sectional survey of all mothers admitted in antenatal and postnatal wards in three obstetric hospitals in united Arab emirates. A total of 15 mothers were interviewed, out of which 48 per cent nationals.Some 67 per cent confirmed the use of kohl on their babies and 46 per cent applied it during the first and the seventh days after birth. Half of the mothers were found to be aware of the contents of kohl. Although 51 per cent believed there is a risk with kohl, they still used it. 8

According to different published reports, kajal contain up to 50% lead content and may be a potential source of lead poisoning. C. Parry et al. have analysed 22 samples, purchased from USA, MK, Morrocco and Mauritania which originated from India, Pakistan, and Saudi Arabia. Nine of these samples contained lead levels less than 0.6%; six samples had 3.31 to 37.3% lead and remainder posses lead content in excess of 50%. Another report is based on the analysis of 47 kajal samples used in Oman through x-ray power diffraction and scanning electron microscopy. Out of these, 18 samples were made in Oman and in five of these the main component was galena (Pbs). Of the other 13 samples, 12 were based on amorphous carbon and one on hematite (Fe2O3). The remaining 21 samples were made in other countries and have been found to contain either PbS or Pb3O4 or Fe2O3 or ZnO or CaCO3 or H3BO3 as the main component.9

Kajal available in market contain appreciable amount of lead and thus become a source of lead poisoning. Lead exposure can result in a wide range of biological effect, depending upon the level and duration of exposure. When traces of lead salts are ingested, inhaled or absorbed, these can harm virtually every organ in the human body, especially the brain, kidney and reproductive system. The investigator felt that the issue of traditional cosmetics containing lead requires a major attention for their thorough examination. The regulations regarding the acceptable limits of lead concentration are yet to be fixed. Prioritizing identifications, monitoring of sources and implementation of regulatory norms are absolutely necessary.

6.3 STATEMENT OF PROBLEM:

“A Study To Evaluate The Effectiveness Of Structured Teaching Programme On Mother’s Knowledge And Attitude Regarding Ill Effects Of Kajal Application For Their Infants In Selected Urban Community, Bengaluru”.

6.4 OBJECTIVES:

1.  To assess the existing mother’s knowledge regarding ill effects of kajal application for their infants.

2.  To assess the attitude of mother regarding ill effects of kajal application for their infants.

3.  To evaluate the effectiveness of structure teaching programme on mother’s knowledge and attitude regarding ill effects of kajal application for their infants.

4.  To correlate knowledge and attitude of mother’s regarding ill effects of kajal.

5.  To associate the pre test knowledge of mothers with the selected demographic variables.

6.5 OPERATIONAL DEFINITION:

Knowledge – It refers to the correct responses of mothers of infant to the items or cognitive aspects of ill effects on kajal application as measured by structured questionnare and expressed in terms of knowledge scores.

Attitude – It refers to the way of perceiving, thinking and feelings expressed by the mothers regarding ill effects of kajal application for their infants as evaluated by means of 3 point likert scale.

Effectiveness –It determines the extent to which the structured teaching programme has achieved the desired effect in improving the knowledge of mothers regarding the ill effects of kajal application for their infants.

Structured teaching programme – It refers to the teaching programme planned to increase the knowledge regarding ill effects of kajal application for their infants.

Ill effects – It refers to the effects occur due to application of kajal which causes redness, discharge, watery eyes, itching and even allergies and infections in the eyes.

Mothers of infant – It refers to those mothers who are applying kajal to their children whose age is from birth to one year.

Kajal – It refers to the black colour substance made up of sesame oil or pure ghee, long thick cotton wick, which is applied to the infant’s eyes after baby bath.

6.6 ASSUMPTIONS:

1.  Mothers may have inadequate knowledge regarding ill effects of kajal application for their infants.

2.  Mother may have different belief and myths regarding ill effects of kajal application for their infants.

3.  Structured teaching programme may improve the knowledge and attitude regarding the ill effects of kajal and prevents the child from lead poisoning.

6.7 HYPOTHESIS:

H1. There will be a significant correlation between knowledge and attitude of mother regarding the ill effects of kajal application for their infants.

H2. There will be a significant association of knowledge and attitude of mothers regarding the ill effects of kajal application with selected demographic variables.

6.8 REVIEW OF LITERATURE

A literature review helps to lay the foundation for a study and also inspires new ideas. The literature review leads the reader through the development of knowledge about the chosen topic up to the present time to indicate why this current research project was necessary.10

Review of literature is given under the following headings:

i.  Literature related to lead poisoning on kajal application

ii.  Literature related to eye infection on kajal application

A study was undertaken where 100 consecutive children under 12 years of age of both genders and all religions (65% Hindus, 30% Muslims, and 5% other religions) were examined for use of 'Kajal'. 86 children had been applied 'Kajal'. Of these, 48 were girls and 38 were boys. Most of the children were under five years of age. On interview it is found that 64% mothers were educated up to class 12th and more; 90% mothers applied 'kajal' simply due to the advice of their elders; more than 50% parents did not know the advantage of applying 'kajal'; no mother who applied 'kajal' could enumerate any disadvantage of using kajal; about 80% respondents used 'kajal' made at home; of mothers not using 'kajal', most did not have any reason for not using it while some said it was harmful to eyesight.6

An experimental study was conducted where blood lead concentrations were measured in 62 Asian children, of whom 37 had definitely had surma applied to their eyes and 25 were thought not to have done. Analysis of 29 different samples of surma showed 23 of them to be composed largely of lead sulphide. It was concluded that the use of surma is associated with high blood lead concentrations. 11