RAJIV GANDHI UNIVERSITY HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1 / Name of the Candidate and Address / Ms. NANDINI.R1st Year M.Sc (Nursing),
Florence College of Nursing,
Kalyannagar,
Bangalore – 43.
2 / Name of the Institution / Florence College of Nursing
3 / Course of Study and Subject / M.Sc (Nursing)
Community Health Nursing
4 / Date of admission to course / 14/06/08
5 / Title of the Topic / “ A study to evaluate the effectiveness of structured teaching programme regarding chickenpox among mothers of
Underfive children in selected rural areas, Bangalore.”
6) BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“Young children fall an easy prey to infectious disease.” A child who falls in the age group of below five years are generally called under fives. In the history of health services of many developing countries, their social and health needs were realized rather later. Today more than even before the under fives has become a focus for organized medical social welfare activities and their death rate is considered as an excellent indicator of the social situation in a country. So the importance of first 5 years of life of a child for its growth and development is very important. Any adverse influences operating on children during this period may results in severe limitations in their development. Results of research indicate how events in early life affect a child’s health when becomes an adult and how many conditions can be prevented through early actions, especially the communicable diseases.1
Communicable diseases are the deadly diseases which affect the common population today. Communicable diseases is an illness due to a specific infectious agent or its toxic products capable of being directly or indirectly transmitted from man to man, or from the environment (through air, dust, soil, water, food, etc.) to man. The current incidence of various communicable diseases is relatively low, but the potential for an increase is found in children who are not immunized. The normal growth and development of all children enlarges their social contact with other children. So the increased contact with other children can lead to increased incidence of infection. 2
Although most youngsters recover without any difficulty, certain groups of children are at risk for serious, even fatal, complications from communicable diseases, especially the viral disease of chickenpox otherwise called varicella. Varicella is an extremely infectious disease caused by the varicella zoster virus, which is also known as Human herpes virus. It is the primary infection with a viraemic stage, after which the virus persist in nerve ganglion cells, usually sensory. Herpes Zoster is the result of reactivation of this residual latent virus. This infection confers lasting immunity and secondary attacks are uncommon in healthy individual. 3
A survey was conducted in Delhi reported a major increase in chickenpox, has recorded over 2,250 cases. Children who are immuno compromised and healthy infants under 1 year of age, who also have reduced immunity are at a higher risk for reactivation of varicella Zoster virus, causing herpes Zoster, probably as a result of a deficiency in cellular immunity. Thus educating family members for home care is important especially mothers need to be informed about the disease, expected length of illness, complications and its prevention.4
6.1) NEEDFOR THE STUDY
In India, all population seems to have been infected with chickenpox once in their life time. The chickenpox disease goes unnoticed because of natural history of disease of 8 to 10 days and people attribute this to the curse of “Goddess Maramma”. Recurrence of Chickenpox is a common feature in developing countries like India. Chickenpox is benign disease in childhood. It is highly contagious with 90% secondary attack rate. But in some children, it can lead to complications like secondary bacterial infections of the
skin and soft tissue, pneumonitis and encephalitis. Studies have shown that the mortality following varicella in < 1 year child is 8 / 100,000 and in > 1 year old it is 2 / 100,000. The statistics of chickenpox in India shows 4,72,327 population per year had been suffered from it. 5
Chickenpox, caused by Varicella– Zoster virus is a common infection of childhood, where immunization coverage is low. Fifty percent (50%) of children are infected by 5 years of age. Though the disease usually runs a benign, self-limited course, yet in severe infections, life threatening complications may develop. 6
In an epidemic of Varicella investigated in rural southern India, an overall attack rate of 5.9% was observed. Attack rates were 15.9%among under fives, 11.1% among school children (5-15) and 24% among those 16 years and more. Among the 292 cases, three children (3, 3 and 5 years of age) died (1% mortality). Their deaths were unusual since they occurred during convalescence from the illness, all these occurred at night during sleep. In the absence of a history suggestive of any known complication of varicella, hypoglycaemia following Varicella as the cause of death is hypothesized. It is suggested that death following Varicella among children may be more common in India than earlier. 7
A study was conducted on parent – dependant barriers to Varicella immunization by questionnaire method from parents of children age 1 to 18 years who attended an out-
patient Pediatric Centre. A total of 1,474 parents completed the questionnaire. A history of chickenpox was reported in 850 children (57.87%), mostly (83%) between ages 1-6
years. Immunization rates were significantly lower in families with lower parental education and in patient from cities with a lower Socioeconomic ranking (P<0.05).The main reason for not being vaccinated (49%) were related to insufficient information about the vaccine and the vaccination process. Other reasons include fear of adverse effects (12%), and waning immunity (6%), Preference of natural illness over immunization (12%) and financial limitations (5%). The Author finally concluded that promoting parental knowledge about the varicella vaccine appears to be a key factor in improving the immunization rate, especially families of lower education, and from cities with low socioeconomic ranking. 8
A study was done on influence of environmental factors on under five morbidity. The sample consisted 893 children under five years of age living in the urban, urban Slum, and rural areas of Varanasi are investigated. About 273 children belonged to an urban area, 284 to urban slum area, and 336 to a rural area. Various illnesses observed included chickenpox, measles and respiratory tract infections. Total illness per child were higher in urban slum and rural children compared to the urban group (chi- square = 132.7, p0.001) children who lived in pucca and mixed houses in urban slum and rural areas had significantly higher morbidity compared to the urban group (pucca houses,
chi – square =16.98, p0.001). The findings suggest the need to educate mothers in order to maintain hygienic conditions for improving the health status of the children. 9
The secret of a Nation’s health lies in the homes of the people. Health education, properly carried out, forms one of the most effective tools in preventive medicine. It forms the basis for the prevention of diseases. Health information helps people in
becoming aware of the health problems, in developing proper perception about them and in seeking appropriate solution for the same, especially the communicable diseases like chickenpox which has devastating impact in almost whole of India. So the researcher found it relevant to evaluate the effectiveness of a planned teaching programme regarding chickenpox among mothers of under five children in a selected rural community.
6.2) REVIEW OF LITERATURE
The primary purpose of reviewing relevant literature is to gain a broad background or understanding of the information that is available related to a problem. In conducting research, the literature review facilitates selecting a problem and purpose, developing a frame work and formulating a research plan. Literature review is a key step in research process. Review of relevant literature is an analysis and synthesis of research sources to generate a picture of what is known about a particular situation and knowledge gaps that exist in the situation. In order to accomplish this goal in the present study, an attempt has been made to review and discuss the literature.10
A study was conducted on epidemiology of hospital admission for chickenpox, among 349 children with <18 years of age. Thirteen out of 349 (3.7%) of them had serious underlying diseases. Two hundred and sixty one (74.8%) children (median age: 41 months range: 6 days to 200 months) had complicated chickenpox. Among complications, neurological disorders were most common (38.3%), followed by skin and soft tissue infections (24.1%), lower respiratory infections (21.8%) and hematological disorders (9.2%). The author finally concluded that chickenpox is a disease that can provoke serious complications and long hospital stays, even in healthy children. 11
A study was done on complications of chickenpox as a reason for children’s hospitalization. Cases of chickenpox complications being the reason of children hospitalization n= 153 were retrospectively analyzed. Patient age ranged from 18 days to 18 years, with average of 4, 5 years. About 62% of children were younger than 5 and 1/3 children were younger than 1 year. The most common reason for hospitalization connected with chickenpox was symptoms of alimentary canal disorder 30%, respiratory tract inflammations with pneumonia and bronchitis 30%. Neurological complications during chickenpox occurred 15%. In that, Febrile convulsions – 6%, Cerebellar ataxia – 9%, Meningitis and brain fever – 6%, peripheral nerve – 2%, Bacterial skin infection - 16%, Hepatitis of – 3% and joint inflammation -1 % is reported.12
A retrospective study was conducted on hospitalization rates for complicated and uncomplicated chickenpox in a poorly vaccinated pediatric population. The study, result shows that out of 650 cases, 306 were uncomplicated and 344 were complicated chickenpox. Total hospitalization rate was 22.66 per 100,000 children and 11.52 per 1,000 notified chickenpox cases. Hospitalization rates for complicated chickenpox were 12 per 100,000 children and 6.09 per 1,000 notified cases. Notably, significantly increased hospitalization rates for complicated chickenpox were evidenced (p<0.001). The author concluded that chickenpox complications, requiring hospitalization, occurred at a substantial rate in pediatric population. 13
A Study was conducted on varicella zoster in children attending day care centers. Descriptive study was carried out through inquiries with parents of 664 children who acquired varicella after admission to day care centers. The median age was 36 months
(range 6 to 80 months); 8.4 of the children had varicella before 1 year of age. About 517 children (77.9%) had at least 1 medical visit, and 80.6% received at least 1 medication, 73 (11.0%) received non steroidal anti-inflammatory drugs, and 52 (7.8%) received antibiotics, complications occurred in 38 children (5.7; 95%: confidence interval: 3-8 %); 8 (1.2%) were hospitalized, and 5 (0.7%) had sequelae complications. Hospitalizations rates were 3 times more frequent in children with < 1 year of age than in older children. The author finally concluded that the vaccination of the children, older than a year could avoid by herd immunity the transmission to babies. 14
A study was conducted on controversies in chickenpox immunization. Due to its extremely contagious nature, varicella is experienced by almost every child, in the world. Although varicella is not commonly perceived as an important public health problem, the socio economic consequences in industrialized countries of a disease that affects practically every child and causes the carrier absence from work should not be underestimated. The public health impact of varicella and zoster may be increasing in region of high endemic rates of HIV infection. Thus the study suggest that varicella vaccine may be used either an individual level to protect susceptible adolescents and adults, or at a population level, to cover all children as a part of national immunization program. 15
A study was done on varicella outbreak in a residential home, reported incidence, complication and hospitalization rate of varicella despite anti-viral therapy. Statistics pertaining to the general population for comparison was used. Among 29 children with severe physical and learning disability (4 to 16 years) 15 were non-immune children
contracted Varicella with in 30 days of the index case. The complication rate was 9 in 15, three times higher than in the general population. The hospitalization rate was 5 in 15. Which is remarkably high. The incidence of hospitalization in the general population is 1 to 5 per 1,000. The author finally suggest that the guidelines for varicella vaccination should include all non-immune children and adults with severe to profound physical and learning disability and also these findings are important in countries where Varicella vaccination is not a part of the routine vaccination programme. 16
A study was done on preventing Varicella zoster disease. Varicella zoster virus (VZV), the cause of chickenpox and shingles, is a pathogen in retreat following the introduction of mass vaccination. The live attenuated OKA vaccine, which is safe and immunogenic, gives good protection against both Varicella and zoster in the short to medium term. It has undoubtedly been highly effective to date in reducing all forms of Varicella, especially severe disease. However, the huge pool of latent wild type virus in the population represents a continuing threat. Both the biology and the epidemiology of VZV disease suggest that new vaccination strategies will be required overtime. 17
A study was done on Varicella outbreak reporting, response, management and national surveillance in USA. Two national surveys were conducted to evaluate the status of Varicella, case-based surveillance and outbreak response. Although progress toward national surveillance has been significant, a large number of jurisdictions are still without case-based surveillance. The national outbreak survey showed that a significant number of varicella outbreaks continue to occur. Depending on the outbreak response approach, costs per outbreak ranged from $3000 for a typical or passive response to
$6000 for a more active response. As varicella surveillance and outbreak control improves, jurisdictions may benefit from more standardized out break-control practices. Thus the recent recommendation by the advisory committee on immunization practices for a routine second dose of Varicella vaccine should lead to better Varicella disease control, making case-based surveillance and appropriate outbreak response even more feasible. 18
A study was conducted on the prevalence of Varicella zoster virus infection in normal healthy individuals aged above 6 months. The prevalence of Varicella zoster virus (VZV) infection was studied by determining the presence of IgG antibody to VZV (anti-VZV IgG) using ELISA method. Three hundred and fifty sera collected from healthy individuals aged above 6 months (mean age +/- standard deviation =
14.9 +/- 11.4) were tested, the prevalence of VZV infection was 64.6% (225/350). The mean amount of anti-VZV IgG was highest in 6 months to3 years age group. There was a co-relation between history of varicella and the presence of anti-VZV IgG in the serum. The important associated factors that might involve VZV infection were age, number of members in family and place of exposure to VZV infection. 19
A study was conducted on parental knowledge, attitude and demand regarding a vaccine to prevent Varicella. A cross-sectional study was conducted by mailed survey among a sample of parents of 23 to 35 months old children. Effective response rate was 65%, resulted three quarters of parents had heard about the vaccine to prevent varicella. The lay media was the most frequently mentioned source of information. Thirteen percent of parents had already obtained the vaccine for their child, another quarter
planned to get it, and one half were undecided. The study concluded that publicizing a new vaccine through the media may be effective in raising public awareness.20
6.3) STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of structured teaching programme regarding chickenpox among mothers of under five children in selected rural areas, Bangalore”.
6.4) OBJECTIVES OF THE STUDY
The objectives of the study are to:
1) Assess the knowledge of mothers of under-five children regarding chickenpox.
2)Prepare a structured teaching programme on chickenpox.
3)Evaluate the effectiveness of a planned teaching programme on knowledge of mothers of under-five children regarding chickenpox.
4)Determine an association between the mean pre-test knowledge score of mothers
of under five children regarding chickenpox with selected demographic variables.
6.5)HYPOTHESIS
H1-The mean post test knowledge scores of mothers of under five children regarding
Chickenpox is significantly higher than their mean pre-test knowledge scores.
H2- There is a significant association between the mean pretest knowledge scores of mothers of under five children and the selected demographic variables.
6.6) OPERATIONAL DEFINITION OF TERMS
Evaluate
It refers to the finding of the value of a structured teaching programme on knowledge of the rural mothers of under-five children regarding various aspects of Chickenpox.
Effectiveness
It refers to the desired change brought about by the structured teaching programme and measured in terms of knowledge score gained in the post test and graded as adequate, average and inadequate knowledge.
Structured teaching programme
It is a systematically developed information and teaching aids developed by the investigator for a selected group of mothers of under-five children to provide information about various aspects of chickenpox.
Knowledge
Refers to the respondent’s response to the item in the tools regarding various aspects of chickenpox
Chickenpox
It is a highly infectious viral exanthematous disease caused by Varicella zoster virus (VZV).
Mothers of Under five children
Woman having children in the age group of 0 – 5 years.
6.7)ASSUMPTIONS
The study is based on the following assumption
1)Rural mothers of under five children may have inadequate knowledge regarding chickenpox.
2)Structured teaching programme is an accepted teaching strategy that can enhance the knowledge of mothers of under five children regarding chickenpox.
6.8)DELIMITATIONS
The study is delimited to:
1)Mothers of under five children residing at selected rural community.
2)Knowledge of mothers will be only assessed as correct responses given to the item in the tools.
7) MATERIALS AND METHODS
7.1) SOURCES OF DATA
Mothers of under five children.
7.2 ) METHOD OF DATA COLLECTION
Research Method : -Pre experimental method.
Research Design: -One group pretest-post test design.