Proforma for Registration of Subjectsfor

PROFORMA FOR REGISTRATION OF SUBJECTSFOR

DISSERTATION

Mrs. K.INDUMATHY

I YEAR M. Sc.NURSING

COMMUNITY HEALTH NURSING

YEAR 2008-2010

PADMASHREE COLLEGE OF NURSING,

GURUKRUPA LAYOUT, NAGARBHAVI,

BANGALORE-560 072

RAJIV GANDHIUNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. K. INDUMATHY,
I YEAR M.Sc. (NURSING),
PADMASHREE COLLEGE OF NURSING,
GURUKRUPA LAYOUT,
NAGARBHAVI,
BANGALORE – 560 072.
2 / NAME OF THE INSTITUTION / Padmashree College of Nursing, Bangalore-72.
3 / COURSE OF THE STUDY
AND SUBJECT / 1st year M.Sc. (Nursing)
Community Health Nursing
4 / DATE OF ADMISSION TO COURSE / 06/06/2008
5 / TITLE OF THE STUDY / To Assess the Knowledge and Attitude of Mothers regarding Prevention of Iodine Deficiency among school children in a selected rural area, Bangalore.

6. BRIEF RESUME OF THE INTENDED WORK

“CHILDREN ARE THE FUTURE PILLERS OF THE COUNTRY”

6.1 INTRODUCTION:

Children constitute a large section of population in India. It is great challenge to the nation to Provide healthy nutrition to the children below 12 years. Good health and nutrition helps to achieve one’s full educational potential because nutrition affects intellectual development learning ability. Piaget described school children as a period of ‘concrete operations’ meaning that logical thinking develops and the child can understand cause and effect. Children are stimulated to become industrious and creative.1

Children with more adequate diets score higher on tests of factual knowledge that those with less adequate nutrition. Studies show that the academic performance and mental ability of children with good nutritional status are significantly higher than those of children with poor nutritional status. School age population comprising of 38% of the country who are dependent, unproductive but has great potential.2

The magnitude of iodine deficiency among school children constitute a major public health problem in many parts of the world. School-age children are a usual target group for iodine deficiency disorder surveillance because they are easily accessible and are particularly vulnerable to the adverse effects caused by iodine deficiency, due to inadequate consumption of iodized salt in their daily diet.3

Iodine is essential micronutrient important for essential hormone development in the human body. Inadequate intake of dietary iodine can lead to and enlarged thyroid gland (goiter) or other iodine deficiency disorders. Iodine found in food as iodide body need it to make thyroid hormones, thyroid is a gland that regulates metabolic processes. The two main thyroid hormones, thyroxin (T4) and tri-iodothyronine (T3) are synthesized from the amino acids, tyrosine and from iodide. Iodine essential for optimal physical and mental development, growth and development and well being of all humans.4

Iodine deficiency is a major nutritional problem in India. Iodine equated with goiter. In recent years, it has become increasingly clear that iodine deficiency leads to a much wider spectrum of disorders commencing with the intrauterine life and extending through childhood to adult life serious health and social implications. The social impact of iodine deficiency arises not so much from the effect on the central nerves system.5

Iodine deficiency disorders are the world’s single most significant cause of preventable brain damage and mental handicap. Iodine deficiency among school children is one of the factors which diminish his/her mental and intellectual development. Effects on children which results in goiter, hypothyroidism, retarded physical development and impaired mental function (? 13 IQ points). The intelligent Quotient score of children living in an iodine deficient environment is nearly 13 IQ points less than those living in iodine sufficient areas. Implications of loss of IQ results which results as poor scholastic performance, frequent failures or grade repetitions, absenteeism’s/dropouts, major implications of education for all, consequent economic and social effect, drain an human resource development.6

The most obvious consequence of iodine deficiency is goiter but recent studies have indicated that there is a much wider spectrum of disorders, some of them so severe as to be disabling, include hypothyroidism, retarded physical development and impaired mental function, increased rate of spontaneous abortions and still births among mothers, neurological cretinism, including deaf-mutism, myxedematous, cretinism, including dwarfism and severe mental retardation. The term “endemic goiter” is now replaced by the term Iodine Deficiency disorders .5

The symptoms of hypothyroidism are often subtle. They are not specific which means they can mimic the symptoms of many other conditions. And children with hypothyroidism become obvious as the condition worsens. Intolerance to cold decreased concentration in school studies impaired mental function, excessive sleep, retarded physical development, dry skin and loss of hair.7

The main factor responsible for iodine deficiency is a low supply of iodine. It occurs in population living in areas where the soil has low iodine content as a result of past glaciations or repeated leaching effects of water, and heavy rainfall. Crops grown in this soil, therefore, do not provide adequate amounts of iodine when consumed.

Iodine is found in food as iodide such as sea food iodized salt, cereals, fresh foods. Vegetables also contain iodine but if they are only grown in iodine-rich soils. Vegetarians may also be at risk of iodine deficiency if they do not eat sea food. Instead they can get their iodine from iodized table salt. A study published in sept-oct, 2003. Annual of Nutrition and metabolism showed that 25% of vegetarians, 80% of the vegans and 9% of those eating a mixed diet had low iodine states. Salt is the recommended the vehicle distributing iodine and best food source consumed by every body on daily basis.8

Inadequate intake of iodine in the diet is the primary cause of iodine deficiency. The World Health Organization recommendations for iodine intake by age (mg per day):

• Children 0.5 yrs. 90 mcg/day
• Children 6-12 yrs. 120 mcg/day
• Children >12 and adults 150 mcg/day
• Pregnancy 250 mcg/day
• Lactation 250 mcg/day 9

Realizing magnitude of the problem National Goiter Programme launched in the year 1962 towards end of second five year plan with objective of identification of goiter endemic regions, to supply iodized salt in place of ordinary common salt to the goiter endemic areas, to assess impact of goiter control measures. Later National goiter control programme renamed to National Iodine Deficiency Disorder Control Programme to have wider coverage.10

Goiter control mainly based on four components they are Iodized or oil, monitoring and surveillance, manpower training and mass communication. Recently the National Institute of Nutrition, Hyderabad has come with new product common salt fortified with iron and iodine. Community trails launched to examine the efficacy of “Two-in-One”.5

So, as to keep normal growth and development of children and preventing impaired physical development and to improve intellectual capacity of the children adequate intake of iodine is most important. Mothers are control figure in identifying common sources of iodine to provide their children of iodine in their daily diet. The knowledge of mothers regarding iodine deficiency will have influence on maintaining iodine status among children.

Iodine deficiency can be prevented by health promotion and specific protection is better than cure. Including early diagnosis and treatment disability limitation and rehabilitation. “Daily consumption of adequately iodized salt is a healthy habit”. Towards sustainable elimination of iodine deficiency disorders.6

6.2 NEED FOR THE STUDY

“We ourselves sometimes feel that what we do is just a drop in the ocean but the ocean would be less because of that missing drop”

-Mother Teresa

Iodine deficiency is a major public health problem through out the world, particularly among school children. They are a threat to the social and economic development of countries. The most devasting out come of iodine deficiency is the greatest cause of decreased intellectual capacity and retarded physical development of the child.

Iodine deficiency has been identified all over the world. It is significant health problem in 130 countries and effect 740 million people. One third of the world population is exposed to risk of IDD. It is estimated that in India alone, more than 6.1 crore people are suffering from endemic goiter and 88 lakh people are mental/motor handicaps. A national level survey has been carried out in 25 states and 5 union territories in the country and found that out of 282 districts surveyed, in 241 districts it is a major public health problem where the prevalence rate is more than 10%. It is estimated that more than 71 million persons are suffering from goiter and other iodine deficiency disorders like Mental Retardation, Deaf Mutism, Squint and Neuromotor defects.11

Global scenario 2 billion individuals world wide have insufficient intake of iodine including a third of all school age children. Iodine deficiency has many adverse effects on growth and development. These effects are due to inadequate production of thyroid hormone and are termed as iodine deficiency disorders. Iodine deficiency remains a public health problem in 47countries.8

Prevalence of iodine deficiency among school children (6-12 yrs.)

Place / %
America / 40.8%
East Mediterranean / 48.8%
Europe / 52.4%
Southeast Asia / 30.3%
Western pacific / 22.7%
Total (World wide) / 31.5%

The magnitude of the problem in India is far greater than estimated in 1960s when it was estimated that about 9 million persons were affected by goiter, currently, no less than 170 million people are estimated to be suffering from endemic goiter. In one particular district (Gonda) of Utter Pradesh is highly endemic. In recent years renewed surveys iodine deficiency and associated iodine deficiency disorders are endemic in parts of Madhya Pradesh, Gujarath, Andhrapradesh, Kerala, Karnataka and Tamilnadu. In short, no state in India can be said to be entirely free from goiter.5

Cross sectional study was conducted in the rural field practice area of department of Community Medicine, Manipal, Karnataka, India to find out prevalence of goiter among school children in the age group of 8-10 years. 722 children selected from study population by probability proportion, children examined for goiter and graded according to Who guidelines. Urine & salt sample conducted from sub sample for urinary iodine excretion & iodine content in salt Results of the study prevalence of goiter was 312% in females & 28.8% in males.12

At present 17 districts have been declared endemic and supply of iodized salts is made compulsory in these districts. Four survey teams have been sanctioned for conducting sample surveys in various districts. Initial survey shown more than 20% prevalence in districts and more than 10% prevalence in 19 districts. 13

“Global Iodine Deficiency day is on 21st October 2008” Ensuring the required daily intake of iodine to maintain normal brain function is as important as the provision of iodized salt. There should be expertise to ensure the sustained elimination of IDD from the entire the world. An important statistics that should be borne in mind is that out of 26 million children borne in India every year, nearly 13 million are unprotected in terms of iodine deficiency.14

Knowledge and attitude can help mother to move from a passive role in iodine deficiency prevention. Information, Education and communication (2001-02) activities helps mothers to promote awareness about the importance of iodated salt and its consumption through appropriate health teaching. Future planes are states to complete survey in the remaining districts to assess the exact magnitude of IDD, further strengthen IEC (Information Education Communication) activities focus on rural, urban slums to promote iodated salt, supply of good quality of iodated salt at reasonable rate, control problem of IDD and its prevalence.9

By the prevalence of inadequate knowledge regarding iodine deficiency among mothers by the researcher’s personal witnesses during field experience. The investigator felt strong need to educate mother among rural community regarding importance of iodine intake in their daily diet.

6.3 STATEMENT OF PROBLEM

A Study to Assess the Knowledge and Attitude of Mothers regarding Prevention of Iodine Deficiency among school children in a selected rural area, Bangalore.

6.4 OBJECTIVES

1. To assess the knowledge of mothers regarding prevention of iodine deficiency among school children.

1. To assess the attitude of mothers regarding prevention of iodine deficiency among school children.

1. To find out association of knowledge and attitude of mothers regarding prevention of iodine deficiency with the selected demographic variables.

1. To develop the health education pamphlet on prevention of iodine deficiency based on findings and distribute to the mothers.

6.5 OPERATIONAL DEFINITIONS:

1. Knowledge: Refers to the level of understanding and awareness of mothers regarding iodine deficiency and its prevention.

1. Attitude:In this study it refers to the ideas, views and opinions of mothers on prevention of iodine deficiency.

1. Mothers: Rural mothers having school age children between 6-12 yrs.

1. Iodine Deficiency:Is referredto a group of signs and symptoms commonly observed among school children such as intolerance to cold decreased concentration in school studies impaired mental function, excessive sleep, retarded physical development, dry skin and loss of hair.

1. Prevention: It refers to the measures or practices followed by mothers to avoid the occurrence of the above clinical manifestations by consuming adequate intake of iodine content food in their daily diet pattern.
2. School children: Children between 6-12 years of age.

6.6 ASSUMPTIONS

1. The mothers may have inadequate knowledge regarding iodine deficiency and its prevention.

1. Adequate knowledge and positive attitude of mothers regarding iodine deficiency and its prevention leads to healthy life of school children.

6.7. HYPOTHESIS

H1- There is a significant difference between knowledge and attitude of mothers regarding iodine deficiency and its prevention.

H2- There is a significant association between knowledge and attitude of mothers in relation to selected demographic variables.

6.8 REVIEW OF LITERATURE

The review of literature is an extensive, systematic selection of potential sources of previous work, acquainted fact findings after securitizations and location of reference to the problem under study. It is helpful in understanding and developing in sight in to the selected problem under study and also to develop a conceptual frame work for the study.

A Community-based cross sectional study was conducted among 2,392 school children, aged 8-10 years in Malda district of West Bengal, India, in January 2001 to assess their iodine status. The children were selected through a multistage 30 cluster sampling techniques to determine status of iodine deficiency disorder (IDD). The prevalence of goiter assessed clinically using the standard palpation method and a total goiter rate of 11.3% was found.15

A comparative study conducted, on effects of the iodine deficiency on intellectual variables among children comparing iodine – deficient zones with non deficient zones at jean (southern spain). 760 school children were selected to examine relationship between moderate & mild iodine deficiency and intellectual capacity. The study results showed that with low levels of iodine intake & with urinary iodine concentration lower then 100 microg / liter had a lower IQ and disruptive behavior that with high levels of criteria.16

A knowledge, Attitude, practice study was conducted along with prevalence study of iodine deficiency disorders on elimination of iodine deficiency disorders by 2000 and its bearing on people in a district of orissa, India. A total of 635 people were interviewed by a pre tested structured questionnaire, adopting probability proportional to size cluster sampling method. Result shown that only 37% of males & 29.3% females perceived goiter as a disease only 16.4 used iodized salt regularly. The awareness and perception of IDD implies poor knowledge about IDD.17

A study conducted to assess the status of iodine deficiency in school going children of Pondicherry to find out the urinary excretion of iodine and the prevalence of goiter among school children. 315 children between the age group of 9-13 years from 30 schools, examined for the presence of goiter and urine samples for urinary iodine levels. The study results showed that the percentage of children who had inadequate iodine intake showed urinary iodine levels less than 100 mcg / l was 44.4%.18

A study conducted to evaluate of efficiency of iodine prophylaxis based on obligatory model of salt iodization. 1444 children from the rural and urban area, age of 8-12 years. The prevalence of goiter detected in children population was 40%.19

A study conducted on iodine nutrition status among school children after salt iodization at Jayatissa, Fernando. 6574 school children randomly selected in the age group of 8-10 years urinary iodine levels measured in 2630 of children and 6181 samples of salt used in house hold study shown that 16.3% to 26.2% of prevalence rate.20

A study was conducted on iodine nutritional status of school children in a rural area of Howrah district in the Gangetic, West Bengal. 969 school children in the age group of 6-12 years clinically examined for goiter. On the spot 242 urine samples collected from children and 108 edible salt samples collected from home of children to measure iodine level, results have showed that 37.6% goiter prevalence.21

A cross sectional population survey conducted to determine the level of knowledge regarding iodine nutrition and its relationship in South Africa population, stratified cluster study sampling by home visits in the language of the respondents from 2164 house holds, participants are 98%. Results shown that 15.4% respondents iodized salt as the primary dietary source of iodine, 16.2% knew thyroid gland needs iodine for its functioning, 3.9% considered brain damage, 0.8% considered cretinism. Compared with respondent from high socio-economic house holds, respondents from low socio-economic house holds were considerably less informed about aspects of iodine nutrition covered in this study.22

A comparative study conducted on evaluation of the impact of an iodine supplementation programme on severely iodine-deficient school children with hypothyroidism at Northern rural areas of Tehran. 571 students aged 6-14 years studied. Goiter graded according to the serum concentration of thyroid hormones. Results showed that goiter rate reduced by 42 % in 1999 compared that in 1989.23