A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SCABIES AND ITS PREVENTION AMONG MOTHERS OF UNDER - FIVE CHILDREN IN SELECTED URBANSLUM AREA, BANGALORE.
PROFORMA FOR REGISTRTION OF SUBJECT FOR DESSERTATION
Mrs. SHASHIKALA. K
HOSMAT COLLEGE OF NURSING, BANGALORE
2013-2014
RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES, BANGALORE,KARNATAKA
PROFORMA FOR REGISTRTION OF SUBJECT FOR DESSERTATION
01 / NAME OF THE CANDIDATE ANDADDRESS / M Mrs.SHASHIKALA.K
1ST YEAR M.Sc. NURSING
HOSMAT COLLEGE OF NURSING,
80 FEET ROAD,OPPOSITE TO
LAGGERE RING ROAD BRIDGE
BANGALORE- 560058
02 / NAME OF THE INSTITUTION / HOSMAT COLLEGE OF NURSING
BANGALORE
03 / COURSE OF THE STUDY ANDSUBJECT / MASTER OF SCIENCE IN NURSING
I YEAR PAEDIATRIC NURSING
04 / DATE OF ADDMISSION TO COURSE / 01-06-2013
05 / TITLE OF THE TOPIC / “A study to assess the effectiveness of structured
teaching programme on knowledge regarding
scabies and its prevention amongmothers of of under-five children in selected urban slum area,
Bangalore”
6. BRIEF RESUME OF INTENDED WORK
6.0. INTRODUCTION
You are successfulthe moment you startmoving toward a worthwhile good.
-CharlesCarlson.
Thestudyofscabies isreally thestudyofmanandhispersonal hygiene.Healthydevelopmentofthechildisofbasicimportancetheability to liveharmoniouslyin achangingtotalenvironmentwhichis essentialto suchdevelopment.
ChildhealthisthecornerstoneofNationalprogress.Thecommunity, whichneglectsits children,retardsitsfutureprogress.UNICEFhas given greaterattention totheconceptofthewholechildwhichmeansitis essentialtopromotetheirhealth,astheyarethevulnerablesegmentof thesociety.1
Mostofdeathsindeveloping countrieslikeIndia,resultsfrom infection andparasitic disease.Therearecloselyrelatedtosocialand economicconditions.2Parasiticdiseaseinparticulararechronicandendemicinunder developed areas.Thecommoninfectious diseaseofchildhoodisstill seriousindevelopingCountries.3
Childcarehasaprimeimportance asthemortalityandmorbidity rateishighestinthisgroupandmanyofthemarepreventable.Paediatric nursingshouldfosterthegrowthanddevelopment ofthechildand promoteanoptimum stateofhealthphysically, mentallyandsociallyso thattheymayfunctionatthepeakoftheircapacity.4
Illiteracy,ignorance,superstitions,culture,religiouspracticesand ritualshavelotsofinfluencesintheareaofhealth.5Scabiesisarelativelycommonskindiseasecausedbyitchmite knownassarcoptesscabies.6Scabiesiswidespread inchildrenandyouthparticularlystudents. Itisdeterminedbythesociodemographicandhygienecustomsofthe populationwithhighfamilialincidence.Commonly, occurincluster usuallyinchildrenandyoungadultsalthoughnoagegroupisexempt. Whenseveralmembers ofafamilyorgrouphassignsofpurities, scabies isthecommondiagnosis.7
Longincubationperiodusuallyoccursinindividualsinfestedfor thefirsttimewhichmakesitdifficulttotracethesourceofinfestation.If onememberofthehouseholdbecomeinfested,multiplemembers orthe entirefamilymayeventuallysuffer,unlessspecificintervention is performed.Poverty,poorhygiene,socialpromiscuity, misdiagnosis, demographic factors,increasedtravelandecologicalconsiderations promotestheoccurrence oftheinfections,failuretodiscoverallthe contactsleadstocontinuingspreadofthedisease.
Duetotheabovementionedfactors,thechildren,parents,and healthcarprofessional shouldbeawareofthedisease.Sothatitcanbe detectedandtreatedat anearlystageandfurtherpreventionof thedisease canbedone,inturntheepidemicitycanbeprevented.Soastokeepgoodhygiene,theknowledge ofmothers’regarding scabieswillhaveinfluenceonpreventingscabiesamongchildren.So thereisaneedforupdatingtheknowledge ofmothers’ofunder-five childrenregardingscabies.
6.1 NEED FOR THE STUDY
In developing countries life of average person is seriously disrupted bydisease.Parasiticdiseasesinparticular arechronicand endemicinunderdevelopedareas.Thecommoninfectiousdiseaseof childhoodisstillseriousindevelopingcountries.
Childrenareconsideredasthemostpotentialunitofourfuture humanresources inacountrylikeours,whichreliesgreatdealonits humanresources strength.Therefore itisnecessary intheinterestofour country tolookafterthehealthandwelfareastheyformthemost vulnerablesegmentofthepopulation.Abettertomorrowdependmuch onthewellbeing,safetyanddevelopmentofchildrentoday.8Thediscovery in1678oftheitchmitemarksscabiesasthefirst diseaseofmanwithknowncause.9
Theitch mite is an extremelysmall, globular, arthropod just visibletothenakedeye.Scabiesisacontagiousdiseaseanditisspread byinfectedindividualsorthroughbedlinenorclothing.Mitesarespread by directcontactwithan infectedindividualregardlessofsocioeconomic class.10
Parasiticinfestationsoftheskinareextremelycommon inchildren allovertheworldbutmoresoamongthoselivinginovercrowdedor slumareasindevelopingcountries.Incidence ishigherinchildrenyoungerthan2yrsofage,butis fairlycommoninolderchildrenandyoungadults.11
Scabies isoneoftheeasiestandyetmostdifficulttodiagnose in dermatologyasitisacontagiousdisease.Firstepisodemaytakes4 weekstimetomanifest, in2weeks.Scabiesisusuallyspreadthrough closepersonalcontactinovercrowded areasandpoorhygienehelpsits transmission,oftensuspicionofscabiesisbasedonnocturnalitchingand familyhistoryofscabiesintheinfantsorsmallchildren. Pruritusis particularlyintenseduringthenightandatnaptime.Theyareproduced byfemalemitesharbours mainlyonthefingerwebspaces,theflexor aspects ofthewrist,thenippleofthewoman andgenitalofmen.They appearas fine,tortuous“S”shapedblackishthreadsafewmmlong.Most worryingtotheaffectedindividualsisthepopularpruriticeruptionwhich resultsfromhypersensitivityreactiontothemitesanditsproduct.This popularrashismostpronouncedaroundtheabdomen,thelowerportion ofthebuttocks,theaxillaryfolds andtheelbows.Infants morefrequently thanadultshavewidespreadinvolvementandoccasionallyareinfested on the face and scalp, sometimesrarely seen in adults, vesicles are commononthepalmsandsoles.Thisisahighlycharacteristics signof scabiesininfants.Scabiescanbediagnosed withthehelpofhistoryof nocturnalitching.1
Scabies isessentiallya disease of children, the prevalenceis higherintheagegroupbelowfiveyears.Scabies ininfantsandyoung childrenmanifestsasapruriticoftengeneralized eruptionwithfrequent involvement oftheface,scalp,palmsandsolesincontrasttothe intertriginous localizationoflesionsinolderchildrenthemostcommon presentinglesionsarepapules,vesiculopustulesandnodules.13
Scabies isuniversal butitismainlyadiseaseofunderdeveloped countries, itiswidelyprevalentinIndiaandnostateisfreefromscabies cases,scabiesoccurthroughout theyearbutmaximumcasesoccurin winterbecausethisistheoneseasonwhichfavoursovercrowdingwhich ishighlyconducivetoitsspread.14Scabiesiscausedbytheitchmiteandtransmitted byskintoskin contactisbeingseeninpandemicproportion, scabiesisoften misdiagnosedandtheclassicformsoccurlessfrequentlyinthecurrent cycle.15
Asurveyconducted inschoolthatscabiesisapruriticcontagious skindiseaseandendemicinoursociety.Itisespecially prevalentin schools and day care centers, the close physical contact where the children plays together causes close physical contact leads to transmission ofdisease.Duringthepastdecadeanewtherapeuticagent hasreplacedbystandardtherapy.Diagnosis, symptoms, possible complications and treatment options are discussed and also control programmeshouldbeimplementedbyimproving theeducation, personal hygieneandtreatment.16
Considering mainfactorswhichcausescabiesfromtheabove studies,totakeanactivesetuptowardsanintensivepublicawareness programmeoneshouldhave theinsightofexactlyknownandwhatisthe attitudesofpeopleandespeciallymothers,theprimarycaregiverwith regard to scabies. So the investigator felt the need to assess the knowledge ofmothers’ofunder-fivechildrenregardingscabies,soasto provideadatabaseforfurthersystematic planofactionforeducating mothersofunder-fivechildrenaboutprevention, causes,signsand symptomsandpreventionofscabiesalongwithmanagement.
6.2 REVIEW OF LITERATURE
Oneofthemajorfunctionofaliteraturereviewistoascertain whatisalreadyknowninrelationtoaproblem ofinterest.Reviewof literature isawrittensummaryofthestateofexistingknowledgeona research problem. A review of literature involves systematic identification,location,scrutinization,andsummaryofwrittenmaterial thatcontaininformationonaresearchproblem.17
Thereviewofliteraturehas been organised under following:
•Literature related toscabiesinfestation.
•Literature related to the effectiveness of structured teaching programmeonscabies infestation.
Literature relatedtoScabies infestation
Aepidemiologicalstudyonriskfactorsforscabieswasconducted inMali.Thestudyresultswere,theprevalence rateofscabiesamongall childrenexaminedwasfourpercentage,butonly1.8percentinhighsocio economicgroup,overallprevalence rateofscabieswas0.7percent. The highestrate(1.1percent) wasfoundamongchildrenof0-9yearsofage. Thedataindicatethat,poorsocioeconomicconditions, inparticular crowding
andpublicwatersuppliesareriskfactorsofscabies.18
A case study conducted on paediatric scabies, reported that scabies is an intensely pruritic dermatosis that is caused by mite, sarcoptesscabieivarhominis.Scabiesisahighlycontagiousandmay havethepathognomonic signofburrowsinadditiontoerythematous papules. Theselesionsareoftenexcoriated.Inaddition toclassicscabies, specialformswithdistinctiveclinicalfeaturesexists.19
Anepidemiological studyconductedonscabiesinarural communityinIndia.Intheirstudyreportanepidemiological surveyfor scabieswasconducted inaruralcommunity of2771personsamong404 households livingin238houses.Prevalence rateswere13percentby populationand30.9percent byhousehold.Eachindexcasewas responsible, onaverageforthespreadofinfectionto1.9personsin affectedhouseholds.Significantly lowerratesofsecondaryattackand transmissibilityagedupto19years,bothsexesbeing affectedequally.Averagemorbiditydurationforscabieswas64.5days.wereobservedamongthemoreprosperousvillagers.The proportion of infectedhousehold increasedlinearlywithhousehold size. Theprevalence washighestinthose16.3 percentofthepatientsshowedsecondarypyogenicinfectionofthe skin.20
Astudyconducted onscabiesinfestation inchildreninTokelau Island.InthisstudyTokelau children haveexamined forscabies infestation intwogroups,thoselivingintheirhomeatollsofTokelau thoselivinginNewZealandtherewaslessinfestation intokelauthanin homesofNewZealand.Themanifestationofthemiteinchildrenin New Zealandvariedfromclassicaldescriptions inthatthemitesitself,andits burrowswereseldomfound andtheskinlesionsweremoreoftenseenon thebodythanonthewristsandhands.Atreatmentregimewhichwas oundsatisfactory. Itwasfoundessentialtotreattheentirefamilyatthe sametime.2
Aepidemiological studyconductedonskindiseasein10,000 patientsofpaediatric agegroup.Tenthousandnewpatientswereseenin theDepartmentofpaediatricdermatology, “HospitaldelNinoIman”in Mexico City. The patients were 18 years old. They represented 10.4 percent oftheentirepaediatricpopulationattendingthegeneralout patientclinicofthehospital. Theresultsofstudyshowednosignificant differenceamongthesexes ofpatients.Thehighestproportionofpatients inthesamplewereunderoneyearofage.Themostfrequently observed groupsofdermatoses wereparasitic,cutaneousreactions,viraland bacterial.Thetendiseasesmostfrequently observedwere,papular urticaria (16.3percent), atopic dermatitis (12.9percent), scabies (10.4percent), viralwarts(8.4percent),impetigo(6.8percent),pitiriasis alba(6.6percent),vitiligo(2.6percent),acne(2.5percent), dermatophytosis (2.4percent)andnumulareczema(2.3percent). The20skindiseasemost frequentlyrecordedaccountedfor85.8percentofthesample.Theten mostfrequentlyskindiseaseineachgroupofagewerealsorecorded. The present study provides epidemiological information for a rational development of programs on care, education and investigation in pediatricdermatologyinmexico.22
Astudyonacommunity outbreakofscabiesconductedin Browardcountry,florida,reportedanoutbreakof scabiesin the monthof January and February. Investigator identified 23 cases of scabies in schoolchildrenwithat leasttwocasesof in eachgrade.Thefirstcasehad appeared asearlyasinthemonthofJuly,butmostoccurred after December.Therewaslittlecontactbetweenstudentsindifferentgrades, mosttransmission wasfoundtohavetakenplacewithinfamiliesandin thecommunity. Anadditional28caseswerefoundinfamiliesand contacts.Altogether,51cases in24familieswereidentifiedonclinicalor historicalgrounds.Infestation wasmorefrequentinchildrenwho exchanged clotheswithfriendsorrelativesandinthosewhoonoccasion spentthenightwithotherchildren.23
Aarticleonscabiesandpediculosis. Inthisarticlescabiesand pediculosis areubiquitouscontagiousanddebilitating parasitic dermatoses. Theyhavebeenknownsinceantiquityandaredistributed world wide. Scabies affecting immunocompromised individuals or patientsandstaffinhospitals andnursinghomesfortheelderly,and pediculosis affectingschoolchildrenorhomelesspeople.Associations with other disorders are common, infections with human T-cell leukaemia/lymphomavirus-IandHIV areassociatedwithscabies,trench fever and exanthematous typhus with pediculosis specific forms of scabiesincluding bullousscabiesorlocalisedcrustedscabiesmaybe misdiagnosed.Moreover,definitiveparasiticdiagnosiscanbedifficultto obtain.Thevalueofnewtechniquesremainstobeconfirmed.Difficulties inmanagementhavereturnedscabiesand pediculosis tothelimelight.24
Aretrospectivestudyconductedonscabiescomplicatedbyacute glomerulonephritisinchildreninDakar.Thatdeterminestheclinicaland epidemiologic characteristics of144casesofscabiosiswithacute glomerulonephritis,represented56.2percentofthewhole205casesof scabiosis,observedinthesameperiod.Themostimportantpartofthe caseswasobserved betweenNovemberandJanuary. Usuallychildren camefrompoorandnumerous families.Thescabieslesionsweremostly generalizedandtheinfectionwasrecent.Themainfeaturesofkidneydiseasewere,Oedama(93.2percent),highbloodpressure(89.1percent) and haematuria (54.70percent),cardiac and neurological involvement werethemaincomplication. Theglobalmortalitywasverylow(1case). Theevaluationwasgoodin97percentofthecasewithcompletecure.25
Literaturerelatedto theeffectivenessof structuredteachingprogramme onscabiesinfestation
Anexperimentalstudyconductedoncommunityhealthworkers examined5780schoolsandpreschools childrenfrom13primaryschools inthreelocations. Onthespottrainingandweekendseminarsabout importantandcommondermatoses werealsogiven.Nextyeara dermatology programmewasstartedwithprimaryhealthcaresystem. Twelve-trainedcommunity health workers carried out regular school visitsonceaweekanddiagnosedandtreatedpupilswithdermatoses.All schoolswerevisitedagaintoevaluatethelong-term effectofthe programme.Resultsofthestudy were: Theprevalencerateofdermatoses was32.4percent.Mostoftheskindiseasesfoundwereinfectivein origin.Dermatitisaccountedfor3.5percentaftertreatmenttheprevalence rateofdermatosesdeclinedto29.6 percentandthisreductionwasmost.
An epidemiologicalstudy conducted on skin disease in 5780 pupilsfrom13schoolsinruralWesternKenya.Adermatologyproject withintheprimaryhealthcaresystemwasestablished in1994bythe Germannon-governmentorganization(NGO). Doctorsinaidofchildren with skin diseasesin Africa.Withinthis projecttrainedcommunity healthworkerscarriedoutregularvisitstoschool,nurseries andtreated childrenwithhydrocortisone acetate1percentcreamfordermatitis, gentianviolet1percentsolutionforbacterialskininfections andbenzyl benzoateemulsion25per centforscabies.In1999,aftera5yearsperiod,4861 pupils from the same 13 schools were reexamined and the prevalencerateswerecompared.Afterthatnoninfectivedermatitishada prevalence of1.7percentin1993aswellasin1999;amongthe communicablediseasesbacterialinfectionsdeclinedform12.7percentto 11.3 percent and arthropod infections (mainly scabies) remained at similarlevelsof8.3%in1993and8.0% in 1999.26
A survey conducted in schools about scabies, a pruritic, contagious skindiseaseandisendemicinoursociety.Itisespecially prevalentinschoolsanddaycarecenters. Closephysicalcontact,suchas thatofchildrenplaying,isrequiredfortransmission. Duringthepast decadeanewtherapeuticagenthasreplacedstandardtherapy. Diagnosis, symptoms,possiblecomplicationsandtreatmentoptionsarediscussed andalsocontrolprogrammeshouldbeimplemented byimprovingthe education,personalhygieneandtreatment.27
Anarticleemphasizes thatifnursingstaffsarewelltrainedin universalprecautions,especiallyhandwashing,muchtransmission of scabiescouldbeprevented.Moreoverifscabiesisrecognized early, accuratelydocumented andquicklytreated,scabiesoutbreakcanbe prevented.28
6.3 STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SCABIES AND ITS PREVENTION AMONG MOTHERS OF UNDER – FIVE CHILDREN IN SELECTED URBAN SLUM AREAS, BANGALORE.
6.4 OBJECTIVES OF THE STUDY:
•To assess the knowledge of mothers’ of under-five children regarding scabies
•Toassess the effectiveness of structured teaching programme in terms of pre test and post test knowledge scores.
•Todetermine the association between the knowledgeof mothers of under five children regarding scabies with selected socio demographic variables.
6.5 OPERATIONAL DEFINITIONS:-
- Effectiveness :-
Referstodetermining theextenttowhichstructuredteaching programme regarding scabie hasachievedthedesiredeffectandmeasuredintermsof significantgainintheposttestknowledgescoresofmothersasmeasured bystructuredknowledge questionnaire.
- StructureTeaching Porgramme:-
Referstothesystematicallyorganizedanddevelopedinstruction andteaching aids,designed forthegroupofmothers, toprovidebasic knowledgeregardingscabiesand its prevention.
- Knowledge :-
It refers to the extent to which the knowledge of the mothers of under five children improved on to the knowing and understanding about the scabies and its prevention.
- Scabies :-
Scabies is a common skin infection caused by itchmite sarcopts scabi that causes small itching bumbs and blisters due to tiny mass that burrow into top layer of human skin to lay their eggs.
- Mothers’ofunder-fivechildren:-
Mothers who are having childrens of under five years of age.,
- Urban slum area :-
It refers to heavily populated urban area characterised by substandard
housing and squalor in selected area,Bangalore..
6.6 RESEARCH HYPOTHESIS:-
H1: There will be significant association between knowledge of mothers of undefive children regarding scabies wit selected socio demographic variables.
H2: The mean pre test knowledge scores will be significantly higher than the mean post test knowledge scores.
6.7 ASSUMPTIONS:
The study assumes that
- The mothers of under-five childrens will have some knowledge regarding scabies.
- Therewillbeeffectofthestructuredteaching programme in improving the mothers’ knowledge regardingscabies .
6.8 DELIMITATIONS
•The study is limited to mothers of under five children.
•Thestudy will be done in selected urban slum area of Bangalore.
6.9.VARIABLES OF THE STUDY:
- Independent variable : Structured teaching programme.
- Dependent variable : Knowledge of mothers of under-five children regarding scabies.
- Demographic variable: Age, religio, familytype, education,occupation,monthlyfamilyincome and numberofunder-five childreninthefamily.
7.0 MATERIALS AND METHODS OF STUDY:
7.1 Source of data: The data will be collected from the mothers of under five children in selected urban slum areas of Bangalore.
7.1.1Research design: Research design adopted for the present study is pre-experimental, one group pre test- post test design.
7.1.2 Research approach:The research approach used in this study is evaluative approach.
7.1.3 Setting of the study: Setting of the study will be selected urban slum areas of Bangalore.
7.1.4 Population: The mothers of under-five children in selected urban slum areas of Bangalore.
7.1.5 Sample size: The sample size is 50 mothers of under-five children.
7.1.6 Sampling technique: Convenience Sampling technique.
7.1.7 CRITERIA FOR SELECTION OF SAMPLES :
InclusionCriteria
•Mothers who are having children under five years of age.
•Mothers residing in urban slum area.
•Mothers who are available at the time of data collection.
ExclusionCriteria
•The mothers who are not having under five children.
• Mothers who are not able to speak and understand kannada.
• Mothers who are not willing to participate.
7.2METHOD OF DATA COLLECTION:
7.2.i. Tools for data collection:- It consist of two sections.
Section A:-It consists of demographic variables like Age, religio, familytype, education,occupation,monthlyfamilyincome and numberofunder-five childreninthefamily.
Section B:-Structured knowledge Questionaire regarding scabies and its prevention.
7.2.ii. Procedure for data collection
The Researcher will obtain Permission from the Concerned Authorities of selected urbanslumarea. Before data collection oral consent will be obtained from participants and pretest will be administered. Following pretest structured teaching programme will be administered and post test will be conducted after a week.
7.2 iii. Data analysis method: -
The data analysis through descriptive and inferential statistics.
Descriptive statistics:-
Frequency, mean, median and standard deviation of described Demographic variable.
Inferential statistics:-
t- Test will be used to Evaluate the Effectiveness.
Chi- square test will be used to find out association with selected demographic variables.
7.3: DOES YOUR STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO CONDUCT ON PATIENTS OR OTHER HUMANS OR ANIMALS ? IF SO, PLEASE DESCRIBE BRIEFLY.
Yes, structured teaching programme will be administered to mothers of under-five children regarding scabies.
7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION ?
Yes, ethical clearance obtained from the concerned authorities of the institution.
8. REFERENCES
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