RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGLORE KARNATAKA

SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / GENCY MARY GEORGE
D-4 MULAMOOTTIL ALPHONSA APARTMENT KOZHENCHERRY, PATHANAMTHITTA KERALA-689641
2 / NAME OF THE INSTITUTION / M.S RAMAIAH INSTITUTE OF NURSING EDUCATION AND RESEARCH, BANGLORE-54
3 / COURSE OF STUDY AND SUBJECT / M.SC NURSING
CHILD HEALTH NURSING
4 / DATE OF ADMISSION / 08-07-11
5 / TITLE OF THE STUDY:
KNOWLEDGE ON EFFECTS OF MOSQUITO COIL SMOKE EXPOSURE ON CHILDREN AMONG THE PARENTS OF UNDER FIVE CHILDREN.

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“There is a garden in every childhood, an enchanted place where colors are brighter, the air softer, and the morning more fragrant than ever again”.

ElizabethLawrence

Children are the future citizen of the world”. Health promotion and prevention of illness health maintenance, and health restoration are the three areas of care to be considered in assisting children and their families to achieve the highest level of wellness possible. A major role of the nurse is teaching- information are gathered that will assist in identifying the level of knowledge of parents , understanding ,their readiness to learn, their depth of knowledge or lack of it and their immediate needs.1

Continual exposure to air pollution affects the lungs of growing children and may aggravate or complicate medical conditions in the elderly. It is estimated that half a million people die prematurely every year in the United States as a result of smoking cigarettes. In fact, smoking-related disease is the number one cause of death among smokers. Although lung cancer or COPD/emphysema is all smoking-related diseases that kill many people, it is heart disease that is topmost on the list of diseases that kill smokers.2

Mosquito coils are often used overnight in sleeping quarters; where continuous exposures may occur. Chronic exposure to coil smokes occurs during rainy periods because mosquitoes are found to be more active in the environment due to collection of water and increase in green plants. This long-term exposure calls for concerns on the potential toxicological effects of the smoke on humans. Epidemiological studies have shown that long-term exposure to mosquito coils smoke can induce asthma and persistent wheeze in children. Especially in under five group children.3

For many people, a cheap alternative to preventing malaria is the use of mosquito coils despite its damaging effect to the lungs. Smoke emitted from one mosquito repellant coil, according to experts, is equivalent to smoke from 100 cigarettes, thus causing great harm to a large number of people that burn coils indoors. Mosquito coils, usually shaped into a spiral coil is typically made from a dried paste of pyrethrum powder. Pyrethrum is the major active ingredient of the mosquito coil that repels mosquitoes. The remaining components of the coil are organic fillers, binders, dyes and other additives capable of smoldering well. When a mosquito coil is burned, the insecticides evaporate with the smoke which prevents the mosquito from entering the room.2

Globally, indoor and outdoor environments are widely contaminated by complex mixtures of gases and particles that are produced by combustion of various types of fuels.2Exposure of air pollutants act to increase severity of respiratory infection and thereby increase the proportion of illness considered clinically to involve the lower respiratory tract infection that increases morbidity and mortality. the increased severity will be mediated by inflammation of the epithelial surface of the tracheobronchial tree caused by the irritants pollutants. The sustained exposure to air pollution produces chronic inflammation, and infections that become more severe as that becomes more severe as the infecting organisms further damage the inflamed and narrowed airway.4

Sources of indoor air pollution include cooking stoves, cigarettes smoking, burning of various fuels for indoor heating, burning of mosquito coils and burning of incense for religious purposes. A wild variety of semi- volatile and volatile organic compounds are found in indoor air, adversely affect health. Biological agents that are also present in indoor environment cause health problems example pollens, moulds, insects, viruses and bacteria.2

Indoor air pollution is a major environmental and public health challenge in developing countries, where according to the World Health Organisation (WHO) exposure indoor air pollution may be responsible for nearly two million excess deaths and it’s about 4 per cent of the global burden of diseases such as asthma, heart and lung ailments. Experts say effect of exposure to smoke are both long and short term. Examples of short-term effects include irritation to the eyes, nose and throat, and upper respiratory infections such as bronchitis and pneumonia. Other symptoms can include headaches, nausea, and allergic reactions. Long-term health effects can include chronic respiratory disease, lung cancer, heart disease, and even damage to the brain, nerves, liver, or kidneys.2

6.1NEED OF THE STUDY.

Acute respiratory infection is the most common illness in children and a major cause of illness in children and a major cause of death in the world.Indian population for children is 31.1%. Among children of under five years of age, 3 to 5 million death annually have been attributed to acute respiratory tract infection. India ranks 48th in under five mortality rate.2

In most urban and rural areas of the country, mosquito populations are menacing throughout the year, except for some attenuation during summer and winter. Mosquitoes transmit diseases such as malaria, filariasis and many viral diseases such as the Japanese encephalitis, dengue haemorrhagic fever, yellow fever (in Africa), etc. Mosquito coils containing DDT and other organ phosphorus compounds were not effective in repelling mosquitoes. Currently a variety of coils are marketed in India. These coils use allethrin group of compounds, herbs, oils or diethy toluimide (DEET). Theprotection provided by these coils generally lasts for 2 to 4 h.5

The current Indian market for mosquito coil is in the range of Rs 500–600 crores withannual growth of 7 to 10%. This increase in growth rate is the result of constant environmental degradation, leading to the creation of mosquito-breeding grounds and also the fact that people’s capacity to buy coils is increasing steadily. Marketing of mosquito coil in India is well organized, so that many brands can be found throughout the country.6According to a research done on “Exposure to mosquito coil smoke cause risk factor for lung cancer in Taiwan”. The main aim of this study was to determine whether exposure to mosquito coil smoke is a risk for lung cancer..The result showed that Mosquito coil smoke exposure was more frequent in lung cancer patients. It is about 38.1% than controls 17.8%. Risk of lung cancer was significantly 3 times higher in frequent burners of mosquito coil than non burners.7

The World Health Organization (WHO) has determined that about 1 billion people, mostly women and children, are regularly exposed to levels of indoor air pollution that are up to 100 times those considered acceptable. Young children, who spend more time indoors, are more exposed to the noxious by products of cooking and heating.In India, nearly 500,000 women and children under age of 5 die every year from indoor pollution, largely from acute respiratory infections (ARIs).7

According to article in Deccan Heralds by it states that smoke emitted from one mosquito coil repellant coil is equivalent to those of 100 cigarettes, thus causing harm to a number of people in India. This was based on the study conducted in Malaysia. According to the estimates India loses one million children under five because of respiratory problems per year. Indoor air pollution is a major environmental and public health challenge in developing countries,where according to the WHO exposure indoor air pollution is responsible for nearly two million excess deaths and about 4 per cent of global burden of diseases such as asthma, heart and lung ailments.8

Based on the different study and taking in consideration the harmful effect of indoor air pollution the researcher felt the need to assess the knowledge of parents and educate regarding the harmful effect of mosquito coil smoke exposure on children.

6.2 REVIEW OF LITERATURE

A study was conducted in Pune to assess theeffects of short-term inhalation of Mosquito Coil smoke on lung functions, symptom scores and airway hyper responsiveness in healthy and asthmatic subjects. The purpose of the study was to see whether comprising single 1 hour exposures to Mosquito Coil and room air on two separate occasions, at least 5 days apart. Spirometrywas performed to measure before and one hour after exposure to Mosquito Coil and room air. Symptoms (cough, chest pain, irritation in the nose, irritation in the eyes, irritation in the throat, headache and wheezing) were scored using a 10cm visual analogue scale. The room temperature and humidity were kept constant during all the study visits. Differences in the Pulmonary circulation values between the visits were analyzed using Mann Whitney test, Spirometry were analyzed using analysis of variance with 95% confidence intervals and symptoms scores were analyzed using the Wilcoxon’s sign test. A p-value <0.05 was considered significant.. Both healthy and asthmatics subjects showed increased symptoms (cough p=0.046: irritation in the nose p=0.016: irritation in the throat p=0.017: headache p=0.002) when exposed to mosquito. The result stated that increasedexposure to mosquito coil produces asthmatic problems.9

A study conducted in Taiwan in Institute of Medicine, chung shan Medical university About 50% of lung cancer deaths in Taiwan are not related to cigarette smoking. Environmental exposure may play a role in lung cancer risk. Taiwanese households frequently burn mosquito coil at home to repel mosquitoes. The sample size consist of 147 patients and the method used was Questionnaires which was given to 147 primary lung cancer patients and 400 potential controls to ascertain demographic data, occupation, lifestyle data, indoor environmental exposures (including habits of cigarette smoking, cooking methods, incense burning at home, and exposure to mosquito coil smoke ), as well as family history of cancer and detailed medical history. The result obtained was, Mosquito coil smoke exposure was more frequent in lung cancer patients than controls. Risk of lung cancer was significantly higher in frequent burners of mosquito coils (more than 3 times [days] per week) than no burners (adjusted odds ratio = 3.78; 95% confidence interval: 1.55-6.90). Those who seldom burned mosquito coils (less than 3 times per week) also had a significantly higher risk of lung cancer. 7

A study was conducted about the content and mosquito coil effects on health. The study were questionnaires based survey. Children and their parents in residences are often protected from nuisance and disease-bearing mosquitoes by insecticides. The most common active ingredients an coils are pyrethroids. It also contains octachlorodipropyl ether(S2) which emites emits content that causes lung carcinogenic. The result was noticed that 11.8% users comprising all age groups complained of a variety of acute toxicity either soon after or within a few hours of using repellant coil, like breathing problems (42%) accompanied with headache & eye irritation. Pain in ear and throat, cough, cold, running nose irritation.9

According to a study conducted mosquito coil emission and health implication it states that burning mosquito coils indoors generates smoke can control mosquito effectively, its current practice is higher in Asia, Africa, and South America .mass balance equation was used to determine the emission rates of fine particles. It has been identified that a large suite of volatile organic compounds including carcinogens and suspected carcinogens are present in the coil smoke. The result suggested that exposure to the smoke of mosquito coils cause significant acute and chronic health risk.10

STATEMENT OF THE PROBLEM

“A study to assess the knowledge on effects of mosquito coil smoke exposure on children among the parents of under five children in a selected urban area of Bangalore with a view to develop an information booklet”.

6.3 OBJECTIVES

  1. To assess the level of knowledge on effects of mosquito coil on children among the parents of under five children.
  2. To find the association with the knowledge of parents of underfive children with selected socio demographic variables.
  3. To develop and distribute an information booklet to parents of under five children on effects of mosquito coil smoke exposure on children.
  4. HYPOTHESIS

HO1: There is no significant association between the level of knowledge with socio-demographic variables.

6.5 OPERATIONAL DEFINITIONS

Knowledge of parent on Mosquito coil smoke exposure- In this study knowledge refers to the level of understanding of parents regarding the effect of mosquito coil smoke exposure, measured in terms in response given to structured knowledge questionnaire.

Mosquito coil- Mosquito coil is when heat produced from smoke leads to air pollution, mosquito-coil is usually shaped into spiral, and typically made from a dried paste of pyrethrum powder.

Parents of under five children- parents of under five children are first teacher who understand them better than anyone else. By talking to them, playing with them and introducing simple skills you can help them in their future development.

Information Booklet: It refers to the written self learning material on effect of mosquito coil on children which is prepared in simple language to understand.The contents of the booklet will be about the use of mosquito coil its ill effects on children, content that produces harmful effects on children.

6.6 ASSUMPTION

  • Parents of under five children may have some knowledge on effects of mosquito coil on children.

6.7 DELIMITATION

  • The Study is delimited to selected urban area.
  • One month period of data collection

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA:

Parents of under five children living in selected urban area of Bangalore.

7.2 METHOD OF DATA COLLECTION:

7.2.1 TYPE OF STUDY/RESEARCH APPROCH

Exploratory study

7.2.2 RESEARCH DESIGN

Exploratory research design

7.2.3 VARIABLES

Study variable- knowledge on effects of mosquito coil smoke exposure.

Attribute variables- socio demographic variables such as Age, gender, education of parents, occupation of parents, annual income of family, mother tongue, language spoken, residence, Number of children present in the family.

7.2.4 SAMPLING TECHNIQUE

convenient sampling technique

7.2.5 SAMPLE AND SAMPLE SIZE

50 parents of under five children

7.2.6 SELECTION CRITERIA

Inclusion criteria- Parents of under five children who

  • Are willing to participate in the study.
  • Parents who can understand and respond in English and kannada.

Exclusion criteria- Parents of under five children

  • Who are not using mosquito coils.

7.2.7 FOLLOW UP

yes follow up will be done by giving information booklet.

7.28 COMPARISION PARAMETER- Nil

7.2.9 DURATION OF THE STUDY

Four weeks of data collection

7.2.10 TOOL OR INSTRUMENTS

Section A:Socio demographic variables such as Age, gender, education of parents, occupation of parents, , annual income of family, type of family, mother tongue, language spoken, residence, Number of children present in the family.

Section B:Knowledge level of parents of under five children is elicited through the structured questionnaire.

7.2.11 DATA COLLECTION PROCEDURE

Formal permission will be obtained from the concerned authorities. Samples will be selected by Non-probability convenient sampling. After explaining about self and the study due consent will be taken from the participants. Knowledge on effects of mosquito coil smoke exposure on children among the parents of under five children will be obtained through structured questionnaire.

7.2.12 PLAN FOR STATISTICAL ANALYSIS

The data will be entered into the master sheet. Keeping the objectives of the main study in view, the descriptive and inferential statistics will be done.

Descriptive statistics

The mean, mean percentage, standard deviation, frequency and percentage will be calculated.

Inferential statistics

  • Chi square test will be used to assess the knowledge on effect of mosquito coil smoke exposure on children among parents of under five children.

7.3 Does the study require any investigation or intervention to be conducted on patients or other human or animals?If so, please describe briefly.

Yes, the structured questionnaire is administered in parents of under five children to assess the level of knowledge of mosquito coli smoke exposure on children.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Ethical clearance will be obtained from the ethical committee and written consent will be obtained from the participants. Confidentiality and anonymity will be maintained.

8. LIST OF REFERENCES

  1. Marlow DR, Redding BA, Textbook of pediatric Nursing: Concept relating to care of child. 6th ed. Philadelphia: Elsevier; 2010. P.21
  2. Firewood, mosquito coils cause asthma, lung cancer[online].2011 Sept 07; Available from:

URL:

  1. Krieger I Robert, Dinoff M Travier, Zhang Xiaofer. Octachlorodipropyl ether(S-2) mosquito coil are inadequately studied for residential use in Asia and illegal in the united states [online].2003.

Available from URL:

  1. Smith K, Samet J, Indoor air pollution in developing countries and acute lower respiratory infection in children.[online] 2000.

Available from URL:

  1. Rd Mehta, Rural buyer’s perception about mosquito repellents. [online] 2010.

Available from URL:

  1. Sarma VP. Health hazards of mosquito repellents and safe alternatives. [online]. 2000 Feb 10.

Available from:

URL:

  1. Chen SC, Wong RH, Shinu LJ. Exposure to mosquito coil smoke may be risk factor for lung cancer in Taiwan.[online].2008.

Available from URL:

  1. Salvi. One mosquito coil equal to 100 cigarattee. The Deccan Hearld. 2011 Aug31; (IANS).
  2. Brashier B, Jantikara A. Effect of mosquito coil smoke inhalation in healthy and mild to moderate asthmatic subjects. [online] 2009

Available from URL:

  1. Zhang Junfeng, Liu Weli. Mosquito coil emission and health implication. [online].

Available from URL:

9. / SIGNATURE OF THE CANDIDATE:
10. / REMARKS OF THE GUIDE:
11.
11.1
11.2
11.3
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11.6 / NAME AND DESIGNATION
GUIDE:
SIGNATURE:
Co-GUIDE(if any):
SIGNATURE:
HEAD OF THE DEPARTMENT:
SIGNATURE: / Mr R.K. MUNISWAMY
ASSOCIATE PROFESSOR & HOD
CHILD HEALTH NURSING
Mr R.K.MUNISWAMY
ASSOCIATE PROFESSOR AND HOD,CHILD HEALTH NURSING
12.1
12.2 / REMARKS OF THE PRINCIPAL:
SIGNATURE:

1