assessment of knowledge attitude and practice (kap) … · mother that have a bearing on worm...

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ABSTRACT

OBJECTIVE: To assess the knowledge, attitude and practice (KAP) about worm infestation and deworming among mothers of children under-5 years of age living in a slum of Islamabad.STUDY DESIGN: A descriptive cross sectional study.

st thPLACE AND DURATION: Study was conducted in urban slum of Islamabad from 1 July to 30 September 2013.METHODOLOGY: After calculation the sample size by using proportion formula, 151 mothers of children below five years of age were randomly selected for the interview through world Health Organization reliable, validated, pretested tool. Households have child under 5 years age were included in the study. However, those women's who were not medically fit were excluded from the study. RESULTS: Knowledge about worms causing illness (0.03) and deworming practice (0.01) of mother's care to their children were significantly associated with education. There is no significant association with unhygienic feeding cause's worm infection and occupation of mothers (0.7). Age of the mother and decision power for health care seeking behavior is significantly related (0.01). Child development is highly significant with worm infestation (0.001) and unhygienic feeding (0.09). Mother's education found significant association with worm infestation in their child. CONCLUSION: An inadequate knowledge about worms and deworming practices significantly associated with education of mother.KEYWORDS: de-worming, worm infestation, mother's literacy, knowledge.

ORIGINAL ARTICLE

1. Public Health Department Shaheed Zulfiqar Ali Bhutto Medical University/ Pakistan Institute of Medical Sciences Islamabad.2. Health System and Policy Department, Health Services Academy Islamabad.3. Pakistan Medical and Dental Council Islamabad.

Correspondence to:Syeda Ranna FatimaPublic Health Department, Shaheed Zulfiqar Ali Bhutto Medical University / Pakistan Institute of Medical Sciences Islamabad.Email: [email protected]

ISRA MEDICAL JOURNAL | Volume 8 - Issue 1 | Jan - Mar 2016

INTRODUCTION

Worm infestation is a major problem in children from developing countries due to poor sanitary and hygienic conditions. Hookworm infestation is one of the most common chronic infections, with an estimated 740 million cases in areas of rural poverty in the tropics and subtropics. Available evidence suggests that well over 200 million persons worldwide are carrying a burden of worms; ascaris affects 1200 million and hookworm about 800 million. Parasitic infection can be quite

1devastating especially if the worm load is heavy . Malnutrition among children is major public health threats especially in the Asia and Pakistan due to increase burden of parasitic infections. There are multiple factors responsible for malnutrition including poor living quality, low socio-economic conditions, unsafe drinking water, poor access to health system, and environmental and climatic conditions. This burden is high especially in rural areas due to the paucity of resources and

2neglected government interventions . World Health Assembly

called for the regular deworming for millions of children during 3last decades . Multiple factors pushing to achieve this are

climate changes issues in different countries systems affecting for delivering deworming drugs. A focus on using school systems may be key to achieving the worldwide goal. However, preschool and out-of-school children and pregnant women risk remaining untreated. Scientists are still investigating the possibility of a vaccine (some are in early stages of development now) and whether resistance to deworming drugs will emerge. This infection is responsible for poor mental health outcome especially in the children by invading their gut. However, preventing strategies are highly required to overcome the

4burden of worm infestation . As the worm infestation is highly associated with the anemia in children and generalized malnutrition as well as micronutrient malnutrition the mothers' knowledge about their children's vulnerability to malnutrition and anemia is important to be assessed. Hence, the evidence from this study would help stakeholders to develop and guide strategies and educate the mothers of low socio income group population about worm infestation; therefore to prevent anemia and malnutrition among these children. However, this study has provided both quantitative as well as qualitative information, such as cultural and social beliefs, habits and knowledge and practices of mother that have a bearing on worm infestation and deworming of their children.

METHODOLOGY

This descriptive cross sectional study was conducted in urban areas of Islamabad Pakistan by interviewing mothers of under 5 year old children. Four urban slums were randomly selected for

ASSESSMENT OF KNOWLEDGE ATTITUDE AND PRACTICE (KAP)ABOUT WORM INFESTATION AND DEWORMING AMONG

MOTHERS OF CHILDREN UNDER-5YEARS OF AGELIVING IN THE SLUM OF ISLAMABAD PAKISTAN

1 1 2SYEDA RANNA FATIMA , ALTAF HUSSAIN QURESHI , RAMESH KUMAR ,1 3 2IRAM NAVEED , IMDAD ALI KHUSHIK , KATRINA RONIS

ISRA MEDICAL JOURNAL | Volume 8 - Issue 1 | Jan - Mar 2016Syeda Ranna Fatima et al.

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this study 1st July to 30th September 2013. Total 151 participants have been enrolled for the interview after proper sample size calculation by using the proportion formula by taking 14% prevalence found in previous studies, 95% relative confidence interval and 5% level of significance and were interviewed. By using formula N/n sampling was done e.g. total number of children who got sick are 50 then 50/10=5. First household was selected randomly then every 5th household was selected and interviewed. All households in identified slums with children under the age of five are included. If there are 300 households in the identified slum area then the average number of people living in each household is six according to PDHS [5]. Average number of people in all households of slum, 300×6 = 1800. According to PDHS 2006-07, 14% of the whole population of Pakistan is under five children. So the 14% of 1800 is 252. Assuming 50% go to seek health care, we have 126 children whose parents were interviewed. Taking as non-response, we have total of 151 respondents were interviewed. Thirty women from each randomly selected rural slum area were interviewed to maximize the regional representation. Questionnaire was developed; piloted, pretested in another area on 30 mothers. Ethical consideration was taken from institutional review board of Health Services Academy. Data was analyzed and entered through Statistical Program/package for Social Sciences (SPSS) version 20 and descriptive statistics such as frequencies, proportions, mean and percentages were then calculated. Qualitative data was analyzed manually by generating themes and quantitative data were measured in percentage, mean, mode, median and SD, proportion and Chi square test was applied for any association.

RESULTS

Total of 151 responded mothers participated in this study, 64%

were illiterate, 26% had 5 year education, 8% had 10 and 12 years of education. Regarding the age of the mother, mean age had been reported 28.6, mode 24, SD± 7.6 in our study area (figure-1 & table 1). The average number of child was 3, however few mothers had 6 child and minimum one child. Majority 70.2% of mothers <5 in our study area were house wives and 24.4% participants were working with private and other areas. 9.3% participants of fathers of <5 children in our study area were unemployed, 55% laborer and 19.9% were private employees. Majority 78% of the participants were belonging to poor class as their income was below 6000 Pakistani rupees per month. 75% of the mothers said that their babies had worn illness in their life. The findings indicated that 53.6% of the interviewed mothers knew the source of worm infestation, 13.9% about the medicine for worm infestation, 67.5% knew the signs and symptoms of worm infestation. Nearly two thirds of the study participants ( 58.3%) believed that worm infestation is a health problem for their children under 5 years of age , 62.9% thought that unhygienic feeding to their children causes worm infection , 59.6% participants took action when their child was infected with worms. About one fourth 28.5% child had found worm infestation during the data collection period. Nearly 32.5 of the child were reported with asymptomatic, while 20.5% had itching around anal areas. It was reported by 62.5% mothers that their child developed worm infestation due to unhygienic feeding practices. Usually their child has been checked by doctors 48%, however, in 40% no any action was taken by the families for the health of their child. Nearly half 46.4% of the mothers does n't know the exact cause of worm infestation, while some of the respondents said that infection occurred due to drinking of contamination water, food and eating mud by their child (Table-I).

FIGURE 1: AGE OF THE MOTHERS OF CHILDREN UNDER 5 YEARS OF AGE


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(0.09). Knowledge about worms causing illness (0.03) and deworming practice (0.01) of mother's care to their children were significantly associated with education. There is no significant association with unhygienic feeding cause's worm infection and occupation of mothers (0.7). Age of the mother and decision power for health care seeking behavior is significantly related (0.01).

When we crosstab the variables to check their significant association in this study, it was found that child development is highly significant with worm infestation (0.001) and unhygienic feeding (0.09). Mother's education found significant association with worm infestation in their child. However, unhygienic feeding was found statistically non-significant association with worm infestation (0.07) and child development was found statistically non-significant association with un hygienic feeding

TABLE - I: CHARACTERISTICS AND KNOWLEDGE ABOUT WORM INFESTATION AMONG MOTHERS OF CHILDRENUNDER 5 YEARS OF AGE (n=151).


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female employment ratio is very low as compared to male. However, in the rural areas they women remain engaged in field work besides their house hold work. Therefore, the health care problems in their children remain low as compared to those who do not consult to any physician in this way their knowledge also improved due to interaction with health care providers and receives health education. Half of the respondents were not aware regarding the source of worm infection. Worm infection can bring about the decrease of nutritional status. As a consequence, this makes easy to get other infective diseases. Many studies showed that there was a strong relationship

8between helminthic infection and sanitation . Worm infestation was more prevalent in poor socio economic population in children where as it was not present in the children of rich class in our study area. A study has shown that several predictors of worm infection including lack of toilets, insanitation, unemployment of parents, lower socio-economic status, younger age, house hold overcrowding, lower level of

9education, and lack of access to clean water . Above half of the participants who thought that Unhygienic feeding to their children causes worm infection to them and facing the problems of sanitation as well. Similar findings were observed in populations of developing countries, often lack the knowledge

10and resources to follow the hygienic practices . In a recent study by Turner et al, it was found that both a household hygienic behavior and mother's reliance on medical knowledge

11were directly correlated to child's parasitic infection . There is dearth of research or the way in which behavior, knowledge,

12poverty, and cultural factors interact among one another . The cost of worm medicine reaches 50% of the total medicinal cost, and some harmful side effects have been found in the application of pharmaceutical worm medicines. However,

13home remedies for worm infestation are very useful . The study brought out several characteristics that have been found to be

14associated with ownership of sanitary latrines .

CONCLUSION

Study concluded that child development and mother's education is highly significant with worm infestation. However,

DISCUSSION

The present study findings revealed that the majority of participants were illiterate and have poor knowledge regarding worm infestation and deworming for their children. It is well known phenomenon that the literacy is main factors which is very important to improve the behavior and health status of the any society. Above half 57 percent of ever married women in

5Pakistan are illiterate according to recent survey . Low women education in Pakistan is due to multiple factors like; poverty, population growth, cultural issues and social structure of society. However, the education level attained by the mothers in our study area is more or less the same as described in Pakistan

6Demographic and Health Survey . When education level and knowledge on worm infestation was compared it showed that few of Illiterate mother has knowledge that worms cause illness where as high majority said no illness caused by worms. Education also effects on practice of mother's care to their children. The same pattern was observed where practice of de worming the children by mothers improving as the level of education increased. Practices on deworming their children were observed poor among illiterate mothers and primary and good among mothers who received education intermediate and above. Mother education had a positive effect for the

7decreasing of parasitosis among children , a study conducted in Ghaza Palestine showing decrease parasitic infection in those children whose mother's education level is high. Regarding the

3number of children by the mothers, mean children . Today, a woman in Pakistan will have 4.1 children, on average. Fertility varies by residence and by region. Urban women have 3.3 children, on average, compared to 4.5 children per rural woman5. Despite the decline in fertility, Pakistani women have more children than women in neighboring countries. The total fertility rate in Pakistan (4.1) is still higher than the TFR in India (2.7 children), Bangladesh (3.0), and Nepal (3.1). In my study area the average numbers of children were better as compared to national figure and approximately equal to Bangladesh and Nepal.Majority participants in my study area were house wives. They were not engaged to any professional work. In Pakistan the

TABLE-II: ASSOCIATION BETWEEN WORM INFESTATION AND CHILD DEVELOPMENT,UNHYGIENIC CONDITIONS AND MOTHER EDUCATION.


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7. Nokes C, Bundy D. Does Helminth Infection Affect Mental Processing and Educational Achievement? Parasitology Today 2009; 10:4-8.

8. Almekhafi MH, Surin J, Atiya AS, Arrifin WA, Mahdy AKM, Abdullah HC. The patterns and the predictors of soil transmitted helminthes. Acta Tropica 2008; 107: 200-204.

9. Turab RJ. The prevalence and the risk factors associated with geo helminth infection. Trop Med and Int health 2009; 9(6): 688-701.

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11. Turner S. The effect of local medicinal knowledge and Hygiene on helminthic infection in an Amazonian Society, Social Sciences & Medicine 2011; 72(5):701-9.

12. Grahm JP, Polizzotto ML. Pit Latrines and Their Impacts on Groundwater Quality: A Systematic Review. Environ Health Perspect 2013; 121(5): 521–30.

13. Amein NM, Eldin SAB, Bayomi SS, Hossein YS. Knowledge and practice of Caregivers about Intestinal Parasitic Infestations at EL- Minia City. Journal of Education and Practice 2014;5(3):105-21.

14. Toyad LM. Study of Worm Infestations among the Melanaus and the lbans of the Sixth Division of Sarawak, J Parasitology research 2010; 106(5):1021-26.

unhygienic feeding and child development was found statistically non-significant association with worm infestation and un hygienic feeding.

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2. Hussain Z. epidemiological Factors Affecting Prevalence of intestinal Parasites in Children of Muzaffarabad Dstrict Pakistan. J. Zool 2004; 36(4): 267-71.

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