RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

SYNOPSIS PROFORMA FOR THE REGISTRATION OF

SUBJECT FOR DISSERTATION

Mr. SHAIJO K J

FIRST YEAR M Sc. NURSING

PEDIATRIC NURSING

YEAR 2011-2013

NANJAPPA INSTITUTE OF NURSING SCIENCES,

COLLEGE OF NURSING, No.7, GADIKOPPA, SAGAR ROAD,

SHIMOGA, KARNATAKA-577205

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA, INDIA.

SYNOPSIS PROFORMA FOR THE REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE

CANDIDATE AND

ADDRESS

MR.SHAIJO.K.J,

1STYEAR M.Sc. NURSING,

NANJAPPA INSTITUTE OF NURSING SCIENCES,

COLLEGE OF NURSING, SAGAR ROAD, GADIKOPPA,

SHIMOGA, KARNATAKA-577205.

2 NAME OF THE

INSTITUTION

NANJAPPA INSTITUTE OF NURSING SCIENCES,

COLLEGE OF NURSING,

SHIMOGA, KARNATAKA.

3 COURSE OF STUDY

AND SUBJECT

1STYEAR M.Sc. NURSING,

PEDIATRIC NURSING.

4 DATE OF ADMISSION

TO COURSE

02-11-2011

5 TITLE OF THE TOPIC A STUDY TO EVALUATE THE EFFECTIVENESS OF

CHILD-TO-CHILD APPROACH ON KNOWLEDGE

REGARDING PEDIATRIC DERMATOSES AMONG

SELECTED INSTITUTIONALIZED CHILDREN AT

SHIMOGA.

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6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Today’s children are the citizens of tomorrow. They deserve to inherit a safer and

healthier world. As the children are the treasures of a nation, there is no task more

important than safeguarding their life.

It is said that God is closest to children because their hearts and minds are so pure.

The greatest promise that can be given to a child by a nation is that of health, because

the strength of a nation largely depends upon the health of its children. Pandit

Jawaharlal Nehru believed that children must be provided with love and care as the

future of a nation lies in their hands.1

For children as well as adults, visible disease is unpleasant. Children are emotionally

labile and a disorder of the skin on exposed areas can become a significant

psychological burden. A disfiguring skin disease in childhood may have profound

emotional effects. To achieve a prolonged remission it is essential that the children

and their parents have an understanding of the factors responsible for the increased

morbidity of Pediatric Dermatoses.2

It is estimated that the burden of disease for school-age children of 5-15 years is 11

percent of the total global burden of disease. 3 Several epidemiological studies in

pediatric age group have been undertaken across the World. Most of these studies

have shown atopic dermatitis as the most common dermatoses, followed by viral

infections, and pigmented nevi, while studies from developing countries have

infections and infestations as the most common pediatric dermatoses.4

Low socioeconomic status, malnutrition, overcrowding, and poor standards of

hygiene are important factors accounting for the distribution of skin diseases in

developing countries such as India. Skin conditions are common in children and about

one-third of them are affected at any given time. The finding that more than 85% of

the disorders can be grouped into fewer than eight categories is important in designing

training programs for medical teams involved in the delivery of primary health care

services in developing countries such as India, where about one-third of the

population is less than 15 years of age.5

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Health education and good personal hygiene will definitely help to improve the health

status of the school children. The lack of financial resources and infrastructure for

early care and education in many developing countries creates a challenge to find new

ways to improve early childhood education. A Child to Child approach to enhancing

learning in developing countries is designed to provide preschool aged children with

early learning opportunities in their homes and their communities at very low cost.

The Child to child model has already been used quiet successfully to improve

community health in developing countries. 6

Health workers and educators in India have long been receptive to the ideas inherent

in the Child to child approach. One reason why Child to child has found such fertile

ground in India is that the twin concerns of the program to promote preventive health

care for children and to encourage activity based approaches to learning support the

goal to design more effective health and educational services throughout India.

6.2 NEED FOR THE STUDY

As the Chilean poet Gabriela Mistral once said, "We are guilty of many errors and

many faults, but our worst crime is abandoning the children, neglecting the fountain

of life." Good health and education are cornerstones for the development of any

civilization, and the responsibility of delivering these services lies largely with the

state. It is necessary that children be seen as an investment for the future, and

government spending in these areas must be adequate, especially in a fast-growing

economy like India.3

Skin diseases are a major health problem in the pediatric age group and are

associated with significant morbidity. Skin diseases constitute 30% of all outpatient

visit to a pediatrician and 30% of all visits to a dermatologist involve children.  The

prevalence of pediatric dermatoses in various parts of India has ranged from 8.7% to

35% in school-based surveys. Pediatric dermatoses requires a separate view from

adult dermatoses as there are important differences in clinical presentation, treatment

and prognosis. Dermatoses in children are more influenced by socio-economic status,

climatic exposure, dietary habits and external environment as compared to adults.

Cutaneous infections are common in children during school going years. Most of the

cutaneous diseases, which result from intrinsic genetic abnormalities, also have onset

in the pediatric age group. 4

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An institution based study conducted to determine the pattern of common dermatoses

in children in South India revealed the following incidence.12

Distribution of Various Dermatoses in Children.

DERMATOSES No.of CASES(%)Infections and infestations 1169 (54.5%)Dermatitis and eczema 184 (8.6%)Pigmentary disorders 123 (5.7%)Insect bite reaction 113 (5.27%)Disorders of hair and nails 112 (5.2%)Miliaria 88 (4.1%)Nutritional deficiency disorders 61 (2.8%)Urticaria 54 (2.5%)Genetic disorders 46 (2.1%)Psoriasis 31 (1.4%)Collagen vascular disorders 12 (0.5%)Hemangiomas 11 (0.5%)Drug eruptions 7 (0.3%)Pityriasis rosea 5 (0.2%)Others 125 (5.8%)Total 2144 (100%)

The frequency of dermatoses such as infections and infestations, nutritional disorders

and environment-associated disorders (insect bite reaction and miliaria) is high in

south India.12

The chronic dermatoses are associated with significant morbidity and psychological

impact. Adequate amount of health education and training for hygienic practices are

essential to reduce the prevalence of dermatoses among children.4The studies revealed

the fact that infective dermatoses is a predominant skin disorder among children and

improvement in personal hygiene & community awareness regarding dermatoses may

reduce the prevalence of pediatric dermatoses. 8

About 30-50% of rural school children suffer from much morbidity like anaemia,

worm infestation, dermatoses, under nutrition and dental caries3. Approaching every

individual in the rural area is Herculean task with poor sustainability. Child-to-child

programme offers most cost effective strategy to approach every family. Through this

method it is possible to improve the health and nutrition awareness of the people, 5

change their attitudes and help them to implement basic health principles in

practice.9Certain studies on Child to child health approach concluded that Child to

child program in their formative years improves their knowledge and helps to develop

positive attitude and healthy practices, which will eventually help to reduce the

childhood diseases.9

The observational visit made by the investigator to a particular juvenile home as a part

of the curriculum, revealed the prevalence of various skin disorders among the

children of particular institution. Hence the investigator felt the need to educate the

children regarding the prevention and care of pediatric dermatoses using Child to

child health program. This study will be interesting for the children and will be

effective in improving the health practices of them.

6.3 REVIEW OF LITERATURE

Review of literature is essential to locate similar or related studies that have already

been completed which help the investigator to develop deeper insight into the problem

and gain information on earlier studies. The review provides a basis for future

investigation, justifies the need for data collection, and relates the findings from one

study to another with the hope to establish a comprehensive body of scientific

knowledge in a professional discipline from which valid and pertinent theories may be

developed.10

For the present study, the researcher has made an extensive review of literature to

collect information related to the research topic. The researcher has made use of

various journals, texts, MEDLINE search and Internet to avail the information

pertaining to the related study. The literature for the present study is organized under

the following headings:

1. Literature related to the prevalence of Pediatric Dermatoses.

2. Literature related to the education on Pediatric Dermatoses.

3. Literature related to Child to child approach.

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1. Literature related to the prevalence of Pediatric Dermatoses.

A retrospective study was conducted to assess the spectrum of skin diseases among

Indian children. The setting was a tertiary care referral centre in New Delhi, during

January 1997 to December 2003. A total of 30,078 children less than 12 years of age

with dermatoses were recorded. Most of the disease was seen in the 1-5 year age

group (44.94%) The most common skin diseases were infections and infestations

(47.15%) consisting of bacterial infections (58.09%)&scabies (21.54%), followed

by eczemas (26.95%), miliaria (5.46%), nutritional deficiency dermatoses

(0.45%). A majority of patients were diagnosed to have infection followed by

dermatitis in our setting. The study concluded that the skin diseases in children are

encountered frequently and their characterization is essential for the preparation of

academic research and health plans. 11

An institution based study conducted to determine the pattern of common dermatoses

in children presenting to a tertiary care centre (JIPMER,Pondichery) in South India.

All children below 14 years were recruited between May 2001 and June 200 Out of

10,400 outpatient cases, a total of 2100 children (995 males and 1105 females) with

dermatoses were recorded (20.2%).Infection & infestation(54.5%),Dermatitis &

eczema(8.6%), pigmentary disorders(5.7%),insect bite reaction(5.27%), hair & nail

disorders(5.2%), miliaria(4.1%), nutritional deficiency disorders(2.8%)genetic

disorders(2.1%)psoriasis(1.4%) were identified. The study concluded with

highlighting the fact that many of these dermatoses can be controlled by proper

sanitation and improving nutrition and environment. 12

An institutionalized study conducted to evaluate the prevalence of dermatological

disorders among children in a hospital set up at Uttar Pradesh. The study is based on

1754 children aged 0-14 years seen at dermatology OPD of Himalayan Institute

Hospital in Dehradun, from January – December 2000. Out of 1754 children,

infectious dermatoses were found in 1250(50.9%), while non-infective & nutritional

deficiency dermatoses were seen in 775(31.6%) & 430(17.5%) respectively. This

study revealed the fact that infective dermatoses is a predominant skin disorder among

children and improvement in personal hygiene & community awareness regarding

dermatoses may reduce the prevalence of pediatric dermatoses. 8

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2. Literature related to the education on Pediatric Dermatoses.

A randomized prospective controlled trial was conducted to evaluate the efficacy of

an educational program for the self-management of Atopic Dermatitis in children.

Parents of Atopic Dermatitis children aged 0 to 7 years, parents and children aged

between 8–12 years and adolescents aged 13–18 years were included in the study. The

groups were randomized and compared with a waiting control group (0–7 years:

n=518; 8–12 years: n=208; 13–18 years: n=148) and followed up for 1 year. The

dropout rate after 12 months follow-up was relatively low in all three age groups (0–7

years: 17.9%; 8–12 years: 11.1%; 13–18 years: 18.9%). Significant better effects were

observed in the intervention group compared to the control group. The study results

demonstrate that this educational group intervention program is effective in the long

term disease management of atopic dermatitis in children aged between 0 and 18

years. 13

3. Literature related to Child to child approach.

A controlled trial was conducted in two Govt. Primary schools in Belgaum, Karnataka

to assess the impact of Child to child program in increasing the knowledge, change in

practices and attitude with respect to diarrhea among rural school children. The VI

standard students of one school included as control group and VI standard students of

other school as study group. The study period was from June 2000 to October 2001.

Results of this study showed that Child to child program had made significant

improvement in the knowledge, practices and attitude of study group students after

the intervention when compared to the controlled group students. The study

concluded that Child to child program in their formative years improves their

knowledge and helps to develop positive attitude and healthy practices, which will

eventually help to reduce the childhood diseases. 9

A triangulated research design of quantitative (survey) was conducted in September

2007 at a feasibly selected village Dhotra (Kasar) in Wardha district of central India

to find out the prevalence of intestinal parasites and its epidemiological correlates

among rural Indian school going (6-14 years) children and to study the effect of

focused, need based Child to child hygiene education on personal hygiene of school

children. Out of enlisted 172 children, data of 118 children with complete information

was used for final analysis. School based participatory life skills based Child to child

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hygiene education was undertaken for message dissemination and behavior change.

The effect of this hygiene education on identified key behaviors was assessed after

one month. One month after hygiene education, the proportion of children having

practice of hand washing with soap after defecation significantly improved from

63.6 % to 78%. The proportion of clean and cut nails also improved from 67.8% to 80

% (p<0.05). The study concluded that the need based, focused, life skills based Child

to child hygiene education was effective for behavior change.15

A randomized trial was conducted to determine the effectiveness of Child to child

school health program on the oral health behaviors of the pupil in Northern Ireland. A

total of 353 pupils of grade 1 took part in the study (178 in test group & 175 in control

group). An assessment of the oral health behavior of pupil in terms of tooth brushing

and sodium fluoride mouth rinsing was conducted before starting the study. The

schools were randomly distributed to either the test group or control group. The Child

to child health program & dental health education was provided to the test group,

while only dental health education was provided to the control group. An assessment

of oral health behavior and an analysis of the significant differences between oral

health behaviors of the test and control groups were conducted after 5 months of the

interventions. After statistical analysis, it is found that oral health behaviors of test

group improved than the control group. There was significant difference between test

and control group. The study reveals that Child to child health program was effective

in improving the health behaviors of pupils. 14

6.4 STATEMENT OF PROBLEM

A STUDY TO EVALUATE THE EFFECTIVENESS OF CHILD- TO-CHILD

APPROACH ON KNOWLEDGE REGARDING PEDIATRIC DERMATOSES

AMONG SELECTED INSTITUTIONALIZED CHILDREN AT SHIMOGA.

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6.5 OBJECTIVES OF THE STUDY

1. To assess the existing knowledge of institutionalized children regarding

pediatric dermatoses, through structured interview schedule.

2.To evaluate the effectiveness of Child to child approach on knowledge

regarding pediatric dermatoses.

3.To find out significant association between pre test knowledge score and

selected demographic variables.

6.6 OPERATIONAL DEFINITIONS EFFECTIVENESS: In this study effectiveness refers to the extent to which

the intervention regarding pediatric dermatoses, produce the desired beneficial

effect to the knowledge of institutionalized children as evident from the gain

in post test knowledge score.

CHILD-TO-CHILD APPROACH: In this study Child to child approach

means one group of children passing the preventive and curative health

message regarding pediatric dermatoses to another group of children (samples)

through a role play.

PEDIATRIC DERMATOSES: Any abnormal skin conditions in children,

which includes infections, infestations & dermatitis.

INSTITUTIONALIZED CHILDREN: In this study institutionalized

children refers to the children (6 to12 years of age) staying in a selected

institution at Shimoga.

6.7 ASSUMPTIONS

The study assumes that:

1. The childrens’ knowledge regarding pediatric dermatoses will be poor.

2. The Child to child concept of health education can improve the

knowledge of children.

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3. The children will be interested to participate in the Child to child

programme.

6.8 DELIMITATIONS

1. This study is limited to the children in a selected institution only.

2. Children in the age group 6 to 12 years only.

3. Measurement of knowledge gained by Child to child approach once after Child

to child approach only.

6.9 PROJECTED OUTCOMEThe study would provide evidence based on which information in the form of

Child to child concept can be used as a method to improve knowledge and

adopt healthy practices which will eventually help to reduce the prevalence of

pediatric dermatoses .

6.10 HYPOTHESIS

H1:-The mean post test knowledge score of institutionalized children, those who are

undergoing Child to child approach, will be greater than their mean pre test

knowledge score.

7. MATERIALS AND METHODS7.1 SOURCE OF DATA: The data will be collected from the children in a selected

institution at Shimoga through structured interview schedule.

7.1.1 Research Design : Pre experimental design. One group pre test and

post test design.

7.1.2 Research Setting : Study will be conducted in an orphanage and juvenile homes where approximately 50-60 inmates are residing.

7.1.3 Population : The population comprises of all school age children

between 6-12 years admitted to the juvenile home after 1day of

admission.

7.2 METHODS OF DATA COLLECTION

7.2.1 Sampling Procedure : Purposive sampling.

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7.2.2 Sample Size : 40 children.

7.2.3 Inclusion criteria:

Children in a selected institution at shimoga between 6-12

years of age.

Children who are available at the time of data collection.

7.2.4 Exclusion criteria:

Children above 12 years of age.

Children who are not co operative.

7.2.5 Instruments intended to be used:

Structured interview schedule will be used as a tool for data collection. It

consists of three sections.

Section 1: Information regarding demographic variables.

Section 2: Questions related to Pediatric Dermatoses.

Section 3: Child to child approach regarding Pediatric Dermatoses.

7.2.6 Data collection method:

Researcher introduces himself.

Administers structured interview schedule on knowledge regarding

pediatric dermatoses. (Pre-test)

Conducts Child to child approach regarding dermatoses. (Intervention)

Administers same structured interview schedule on knowledge regarding

pediatric dermatoses. (Post-test)

7.2.7 Data analysis plan:

The data will be analyzed by using:

Statistical techniques such as mean, median, mode & Standard Deviation.

Inferential statistics like Chi-square test & other relevant statistical

techniques.

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The analyzed data will be presented in forms of figures and tables.

7.3 Does your study require any investigation or intervention to conduct on

patients or other humans or animals? If so, please describe briefly.

Yes, data will be collected from the children in a selected institution at

Shimoga and Child to child approach will be administered, which will not

harm the subjects.

7.4 Has ethical clearance been obtained from your institution?

Yes, administrative and ethical clearance with regard to the study will be

obtained from the research committee of NINS CON and concerned

authorities prior to the study.

8. LIST OF REFERENCES.

1. Importance-of-children’s-day http://www.indiaparenting.com/.html

2. Pediatric dermatology, volume 17, number 3, May/June 2000, page 174.S

3. Meeting the Needs of Children's Health in India Anusha Bharadwaj April 10,

2011 http://worldpress.org/Asia/3726.cfm

4. Indian Journal of Dermatology,Venereology, Leprology 2010 ,  Volume : 76 ,

Issue : 5,  Page : 451-454

5. Pediatric Dermatology. 2003 Nov-Dec; Vol.20 No.(6): p.470-473

6. Indian Journal of Dermatology, Venereology, Leprology 1999 May-

Jun;Vol.65(No.3):p.126-127

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7. "Children Caring for Children. A Review of Programs, "/

http://www.ecdgroup.com/

8. Indian pediatrics, Journal of IAP, Volume 38, January 2001, page 79-82.

9. Indian Journal of Community Medicine, Vol.31, No.2, April- June 2006.

10.Nursing Research, B T Basavanthappa,Jaypee Medical Publishers,p.

11. Indian pediatrics, Journal of IAP, Volume 43, June 2005, page 321-325.

12. Indian pediatrics, Journal of IAP, Volume 41, April 2004, page 373-376.

13.Journal of Investigative Dermatology (2005) Vol.125, p.853–853;

14.Journal of National Institute of Public Health,2011,Vol.60, No.1, p.44-49.

Online Journal of Health and Allied Science, 25 Feb 2008

http://cogprints.org/5932/ ( Dongre, AR and Deshmukh, PR (2008) An

approach to hygiene education among rural Indian school going children.)

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9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

Educating children in their formative years improves health behaviour regarding pediatric dermotosis

11.NAME AND DESIGNATION OF (IN BLOCK LETTERS)

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE (IF ANY)

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

1212.1 REMARKS OF PRINCIPAL Study is feasible therefore forwarded for kind and

needful attention.

12.2 SIGNATURE

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