review of literature: - rajiv gandhi university of...
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.Name of the candidate and address
SANGEETA SARMA.M.Sc NURSING 1 YEARDr. SYAMALA REDDY COLLEGE OF NURSING#111/1 SGR MAIN ROAD,MUNNEKOLALA,MARATHAHALLI,BANGALORE-560037.
2.Name of the Institution Dr. Syamala Reddy college of nursing
3.Course of study and subject M.Sc nursing 1 year.Community Health Nursing.
4. Date of admission to course June – 2010
5. Title of the study A study to evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of asthma among mothers of under five children in a selected urban community at Bangalore
1
BRIEF RESUME OF INTENDED WORK :
6.0 INTRODUCTION:
“Children are the wealth of tomorrow; take care of them if you wish to have a strong India, ever ready to meet various challenges.” Jawaharlal Nehru.
Children constitute a large portion of the population in India. It has been a great
challenge to the nation to provide health, education and food to the growing children.
Children are the most vulnerable group in the society. Children’s are not only
our future, they are our present and we need to start taking their voices very seriously.
Children are priceless resource and any nation which reflects them would do so as its
perils.1
Children are tomorrow’s adults. The 21 st century belongs to them and to their
children and grand children. They and their descendants are deserved to enjoy all the
health facilities.
Every day, millions of parents seek health care for their sick children, taking
them to hospital, health centres, pharmacists, doctors and traditional healer. Each year
more than 10 million children die before they reach their fifth birthday.2
The morbidity associated with asthma is dramatic, under diagnosis and in appropriate
therapy are major contributions to asthma morbidity and mortality. The high
morbidity rates related to asthma may attributed to limited access to health care, an
inaccurate assessment of disease severity, a delay in seeking help, inadequate medical
2
treatment , non- adherence to prescribed therapy and increased allergens in the
environment.3
Respiratory tract infection is a frequent cause of acute illness in infants and
children. Many paediatric infections are seasonal cough and cold are very common in
children. However, there are some children who have frequent or persistent cough,
particularly children living in slums or overcrowded areas. The commonest cause of a
frequent or possible cough in a healthy baby is asthma.4
With increasing urbanization of the world’s population, it is predicted the
number of individuals with asthma will increase markedly worldwide. Chronic
diseases have a tremendous effect on the growth and development of children. Asthma
is the most common chronic lung disease of childhood and is the major cause of
hospitalization for children under the age of one to five.
The word asthma originates from an ancient Greek word meaning parting. It is
one of the most common chronic diseases, affecting 300 million people worldwide.
There has been a significant increase in prevalence over the last 30 years, particularly
in the West. Complex relationships between genetic and environmental factors, such
as viral infections, allergies and occupational agents, influence the origin and
progression of the disease.
Asthma is a chronic inflammatory disorder of the airway in which many
cells and cellular elements play a role, in particular, eosinophils, mast cells, T
lymphocytes, neutrophils and epithelial cells. Some patient develop structural changes
3
of the airway, a process known as remodelling possibly due to ongoing inflammation
and abnormal repair processes.
Asthma may have its onset at any age, 30% children are symptomatic by one
year of age and where as 80 – 90% of asthmatic children have their first symptoms
before 4 – 5 years of age. Risk factors for occurrence of asthma in children include
poverty, black- race, maternal smoking, large families, intense allergic exposure and
respiratory infection in early childhood.
Susceptible individuals experience recurrent episodes of wheezing,
breathlessness, chest tightness and cough, particularly at night and in the early
morning. These episodes are usually associated with widespread but variable airflow
obstruction, which is often reversible and bronchial hyper responsiveness to a variety
of stimuli. Acute asthma is common medical emergency and requires prompt
assessment and treatment. Advances in the understanding of the genetic and
environment factors that account for asthma and its pathogenesis should lead to
improved management strategies.5
A study conducted in Delhi shows that the prevalence of current asthma in
children is 11.9 %, while in the past it was reported by 2.1 % while that associated
with cold by 2.4 % of children. Boys had a significant higher prevalence of current
asthma as composed to girls i.e. 12.8 % and 10.8 % respectively. It is estimated that in
Delhi one out of every five children has at least one episode of wheezing.6
A study undertaken at Chennai shows that 39 % of parents accepted a diagnosis
of asthma of which three know exactly what asthma means. Perception that asthma is
contagious was observed by 26 % and 35 % believed asthma to be a hereditary
4
disease and 62 % of parents administered oral beta agonist medication at home before
proceeding to hospital, but majority used them as cough medications. Only 13 were
administering aerosol therapy at home. Nearly one third of parents opined that the
disease might remit with advancing age.7
Health education on asthma adds to the awareness of people and generates
interest in the prevention of those diseases. It also helps in motivating people to
participate in universal immunization programme. Health education is instrumental in
controlling indoor air pollution and discouraging smoking in living rooms and
congested areas.8
The overall awareness among mothers with regard to their rights, duties and
responsibility would strengthen the health care services in society. Since mothers can
make anything possible, provided they should be educated and given action plan. As a
mother is the 1st teacher of the child, she has to take a key role in the prevention of
asthma.
6.1 NEED FOR THE STUDY:
Allergic respiratory disorders in particular asthma are increasing in the
developed and developing countries and pose a serious global health problem and
economic burden. Recognising the problem in children is very essential since the
spectrum of presentation is variable and multiple for proper management. Under
diagnosis is very common and under treatment is equally common.
5
The increased prevalence and severity of asthma in the metropolitan city
correlates any economic growth from industrialisation should focus on control of
pollution simultaneously.3
There has been an inexorable rise in the number of asthma cases and
respiratory illnesses, especially in industrialized countries over the last 30 – 40 years.
Asthma is a respiratory disease involving inflammation of the airway and reversible
symptoms of bronchospasm. Along with New Zealand, Australia, Ireland, the United
Kingdom (UK ) has one of the highest prevalence rates of asthmas in the World .
Around 8 million people in the UK are currently diagnosed asthmatic. It is the most
common chronic childhood disease, with one in eight children suffering from it.9
There is no cure for asthma, but asthma can be managed with proper
prevention and treatment. Asthma has a genetic component. If only one parent has
asthma, chances are one in three that each child will have asthma. If both parents have
asthma, it is much more likely (seven in ten) that their children will have asthma.10
WHO estimates that 300 million people currently suffers from asthma. In 2009
asthma caused 250,000 deaths globally. Asthma is the most common chronic disease
among children. It is a public health problem not just for high income countries; it
occurs in all countries regardless of the level of development. Most asthma related
deaths occurs in low- and lower middle income countries. Asthma is under diagnosed
and under treated. It created substantial burden to individuals and families and often
restricted individual’s activity for a long life time.11
The prevalence of asthma has increased continuously since 1970s, and now
affects an estimated 4 to 7% of the people worldwide. Childhood Asthma varies
6
widely from country to country. At the age of six to seven years, the prevalence
ranges from 4 to 32%. The same range holds good for ages 13 and 14. UK has the
highest prevalence of severe Asthma in the world. It has also increased the number of
preventable hospital emergency visits and admissions. It is a leading cause of
hospitalization for children. Childhood Asthma has multifactor causation.
Geographical location, environmental, racial, as well as factors related to behaviours
and life-styles are associated with the disease.12
In the United States, asthma is the most common cause of childhood
emergency department visits, hospitalizations and missed school days, accounting
annually for 867,000 emergency department visits, 166,000 hospitalizations and 10.1
million school days lost. In the United States in 2000, asthma was responsible for 223
childhood deaths, a disparity in asthma outcomes links high rates of asthma
hospitalization and death with poverty, ethnic minorities and urban living. In the past
2 decades African- American compared to white children had 2 to 4 times more
emergency department visits, hospitalizations, and deaths due to asthma. For ethnic
minority asthmatics living in US “inner- city” low income communities, a combition
of biologic environmental, economic and psychological risk factors is believed to
increase the likelihood of severe asthma exacerbation. In the US it affects over 8.6
million children and it has the highest prevalence among children between 5 and 17
years old.
Based on information collected by the National Center for Health Statistics of
the Center for Disease control and prevention in 2002, 8.9 million children (12.2 %)
had been diagnosed with asthma in their lifetime and 4.2 million children (5.8 %) had
an asthma attack in the preceding 12 months indicative of current disease. Boys (14%
7
Vs 10 % girls) and children in poor families (16 % Vs 10 % not poor) are more likely
to have asthma. Although asthma prevalence is higher in black Vs non- black US
children (17.7 % Vs 11.1 % ratio) prevalence difference cannot fully account for
disparity in asthma outcomes.
Worldwide, asthma appears to be increased in prevalence, despite considerable
improvement in management and pharmacopoeia to treat asthma. Numerous studies
conducted in different countries, including the US, have reported an increase in
asthma prevalence of about 50 % per decade. Globally, childhood asthma prevalence
varies widely in different locales. A large International survey study of asthma
prevalence in 56 countries (International Study of Asthma and allergies in childhood)
found a wide range in asthma prevalence from 1.6 to 36.8 %. Furthermore, asthma
prevalence correlated well with reported allergies rhinoconjunctivites and atopic
eczema prevalence. Asthma seems particularly common in modern metropolitan
locales and is strongly linked with other allergic conditions. In contrast, children
living in rural areas of developing countries and farming countries are less likely to
develop asthma and allergy.
Approximately 80 % of all asthmatics report disease onset prior to 5 years of
age. Of all young children who experience recurrent recurrent wheezing, however,
only a minority will go on to have persistent asthma in later childhood.13
According to American Academy of Allergy asthma and Immunology,
approximately 34.1 million Americans have been diagnosed with asthma by a health
professional during their life time. The prevalence of asthma increased 75 % from
1980- 1994. Asthma rates in children under the age of 5 have increased more than 60
8
% from 1980 – 1994. It is estimated that number of people with asthma will asthma
will grow by more than 100 million by 2025. Asthma accounts for approximately
500,000 hospitalization each year. In 2006, asthma prevalence was 20.1 % higher in
African American than in whites. In 2005, 8.9 % children in the US currently had
asthma. Nearly 4 million children have an asthma attack in the previously year.
Asthma accounts for 217,000 emergency room visits and 10.5 % million physician
office visits every year.14
A study was conducted on the global epidemiology of asthma in children at
Wellington. Recently most studies reported that asthma prevalence has increased in
recent decades. The best indication of what is now happening globally will be
provided by phase III of the ISAAC. Some individuals ISAAC centers in Western
countries have already reported no increase or even a decrease in asthma prevalence
over the last 10 years. The package of changes in the intrauterine and infant
environment occurring with westernisation is causing increased susceptibility to the
development of asthma. The findings show that global comparison of asthma
prevalence and assessment of time will continue to play a major role in this process.15
In India, the estimated burden of asthma is believed to be more than 15 million.
There was a constant and variable increase in asthma prevalence worldwide in the last
two decades and the same is being observed in India.12
A survey reports that, there was a low prevalence of asthma (1- 3.3 % ) in the
children of Lucknow, Ludhiana and Punjab, while in Delhi the prevalence of asthma
was 11..6.16
9
The study about prevalence of asthma revels that, childhood asthma at 13- 14
years of age was lower than in younger children. Researcher in the field opined that
higher prevalence of asthma in the younger age group was consistent with the
believed concept of “Children growing out of allergic diseases.”17
Different Indian studies, reveals that urban and male predominance with wide
inter- regional variation in prevalence, with a wide variation (4 – 20 %) and increase
in mortality in younger age groups. Environmental factors, including increase
exposure to pollution, tobacco smoke, and sedentary life style were identified for
asthma.12
In a recent landmark Indian study, the researchers found a consistent
association between being exposed to, and having experienced domestic violence, and
childhood asthma prevalence in India. In an age- stratified analysis, a strong
association was observed in age groups 5, 5- 14, 15- 24 and 25- 44 years. Stress
induced mechanisms, partially captured through violence and social circumstances
may be a missing link in furthering our understanding of social disparities in asthma.18
Other studies have also reported higher incidence of psychological adaptation
problem in children with asthma, particularly severe asthma, than children in the
general population. This has been ascribed to adverse developmental impact of having
a chronic health problem, increased demands on the family and dysfunctional familial
interactional patterns.19
A study was conducted on prevalence of asthma in urban and rural children in
Tamil Nadu. A total of 584 children from Chennai and 271 children from 25 villages
around Chennai participated in the study. Total 855 children were studied, the overall
prevalence of diagnosed asthma was 22 % of urban and 9 % of rural children reported
10
breathing difficulty at any time in the past, urban children reported recent wheeze
more often than rural. The findings suggest that further studies are needed to confirm
the difference in the prevalence between urban and rural children and also to identify
possible cause that could account for the higher prevalence of asthma in Tamil
Nadu.20
A hospital based study was conducted on 20000 children in Bangalore, India.
The study reveals a prevalence of asthma from 1979, 1984, 1989, 1994 and 1999 is 9
%, 10.5%, 18.5%, 24.5% and 29.5%. The increased prevalence, co-relate well with
demographic changes of the city (Genetic predisposition is one of the factors in the
children for the increased prevalence urbanisation, air pollution and environmental
tobacco smoke contributes more frequently) like increase in numbers of industries,
increased density of population from migration of rural population in search of jobs
and increased number of automobiles to commute resulting in pollution.
A study reports that asthma may have its onset at any age: 26.3 % of patients
are symptomatic by one tear of age, 1 to 5 years 51.4 %, over 5 years 22.3 %. It was
observed that in 77.7 % the asthma begins in children less than five years and the
male to female ratio is 64 % to 36 % on par with various other studies.
According to International Conference on Health Care Delivery for Asthma,
shows that the obstacles to asthma care in India are the costs of care and medications,
the socio economic disparity within the country, use of multiple language, cultural
issues and the common use of alternative remedies.3
11
The birth of an infant is a highly significant event that alters the behaviour of
both mother and father. Some of the predominant factors affecting parenting are the
age of the parents, chronic illness of the child and quality of the parental relationship,
the amount of previous experience with child rearing parental support system and the
effects of stress on parent behaviour.
The Investigator felt that the study on the effectiveness of structured teaching
programme on knowledge regarding prevention of asthma would improve the health
practices of mothers of under five children. This study will benefit the mothers of
under five children to take measures in order to prevent asthma among children. Thus
the community health nurse can protect the community from asthma and reduce the
burden of health problems of under five children.
6.2. REVIEW OF LITERATURE:
Asthma is the most common chronic childhood illness about half of all cases of
asthma develop before the age of 10 and about 80 % develop symptoms below age 5.
Asthma in children is highly associated with allergens, family history of asthma,
dietary habits which commonly include more fast foods and less fruits, vegetables,
fibres, minerals, children spreading more time indoor watching television, playing
video games or using computers are therefore overexposed to indoor allergens.21.
The literature of review has been arranged in the following order:-
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1. Studies related to Causes / Triggers of asthma.
2. Studies related to Clinical features of asthma.
3. Studies related to Management of asthma.
4. Studies related to Prevention of asthma.
5. Studies related to knowledge regarding asthma.
1. Studies related to Causes / Triggers of asthma
A study was conducted on socio- economical conditions as risk factors for
asthma in children aged 4- 5 years in Norway. A questionnaire was given to
parents in connection with the ordinary child control of 4- 5 years old children, in
Vestfold Country, Norway. In addition to the question “Has the child at present or
ever had asthma?” a number of medical and socioeconomic background sectors
were registered. Out of 2,430 parents, 1,913 (79 %) responded. Of the 163
(cumulative prevalence 8.7 %) children with confirmed asthma, 19 did not use any
medication and were regard as having outgrown their asthma. Several background
factors were significantly associated with asthma in a logistic regression analysis:
few rooms at home, psychosocial problems, fever more than three times during the
previous year, reaction to food and mother or father with chronic disease. The
findings indicate that socio- economic background factors are associated with
asthma in children in addition to other known risk factors.22
A study was conducted on childhood asthma and exposure to traffic and
nitrogen dioxide in USA. The study examined the association between traffic
related pollution and childhood asthma in 2008 children. Study subjects were
randomly selected. Life time history of doctor diagnosed asthma was associated
13
with outdoor nitrogen dioxide , the ratio was 183 per increased of 1 in IQR is
exposure, also observed increased asthma associated with closer residential
distance to free way is 189 per IQR and outdoor pollution from free way is 2.22
per IQR . The results indicate that respiratory health in children is adversely
affected by local exposure to outdoor nitrogen dioxide, or other free way related
pollutants.23
A study was undertaken on environmental chemical hazards and child health
at Port Alegre. Around 85,000 synthetic chemicals are produced to day and 2,800
of them are mass produced. There has been a growing chemical. Children have a
greater exposure to environmental pollutant than adults, because their metabolic
needs and behaviours put them at special risk. The findings suggested that
screening of risk situation using tools such as environmental history has been
stimulated along side the greatest commitment of paediatrics towards measures
that can reduce the exposure of children to environmental chemicals.24
2. Studies related to clinical features of asthma.
A cross- sectional survey was conducted to compare physical activity
and physical self- concepts between children with and without asthma in Taiwan.
They recruited 120 children with mild and moderate asthma from three paediatric
asthma clinic in Taiwan and 309 non- asthmatic children from four elementary
schools in Taiwan’s three largest cities. The study results showed that asthma was
the primary factor determining vigorous physical self – concept, especially in
terms of endurance, obesity and strength. No statistically significant relationships
were noted between asthma and gender in terms of effects on physical activity and
physical self concept. The study concluded that asthma interferes with children’s
14
ability to participate in vigorous physical activity but not in moderate to vigorous
physical activity. Gender determines primary differences in physical self concept.
Appropriate exercise recommendations are necessary to encourage children with
asthma to engage in vigorous physical activity for normal growth.25
A study was conducted on wheeze and urban variation in South Asia.
Urban South Asia is characterized by narrow streets, heavy traffic, visible haze,
unplanned city architecture and the use of kerosene or wood burning stoves at
home. The study aim to compare the prevalence of asthma between 2 South Asian
cities i.e. Galle and Chandigarh. The validated ISAAC questionnaire was used for
the study. Out of 1814 distributed questionnaire 95 % were completed correctly
and returned. The prevalence rate for Wheezing in Galle is 28.7 %, higher than
Chandigarh 12.5 %. The findings suggested that there is a higher prevalence of
wheeze in children who are living in an old fashioned and congested city than in a
clear and modern city in South Asia.26
4. Studies related to Management of asthma:
A study was conducted on medical management of asthma and folk
medicine in a Hispanic community. The objective of the study is to describe beliefs
about asthma and asthma treatment in a Hispanic (Dominican – American)
community to determine how alternative belief systems affect compliance with
medical regimens. So 25 mothers of children with asthma were interviewed in
homes, in their primary language, Spanish. Mother were questioned about their
beliefs regarding their asthma aetiology, treatment, prevention of acute episodes
and use of prescribed medicines for the prevention of asthma, instead they
15
substitute folk remedies called “ Zumos ” . The home remedies were derived from
their folk beliefs about health and illness, 60 % thought that their child did not
have asthma in the absence of an acute episode, 88 % said that medications are
over used in their country and that physician hale infection from them.27
5. Studies related to Prevention of asthma:
A study was conducted on women who eat apple and fish while pregnancy may
provide significant protection to their baby against developing asthma, respiratory –
related allergy symptoms and eczema. Nearly 2,000 pregnant women in the
Netherland and Scotland was participated in this study. The study result showed that
children whose mothers ate more than 4 apple per week while pregnancy were 37 %
less likely to experience wheezing and 53 % less likely to have doctor confirmed
asthma, compared to mothers who ate 1 or no apple per week while pregnant.28
A study was conducted on childhood asthma prevention in Australia. The
objective of the study was to test house dust mite avoidance and dietary fatty acid
modification, implemented throughout the first 5 years of life, as interventions to
prevent asthma and allergic diseases. They have taken new borns with a family
history of asthma alternatively and randomized them, separately to HDM avoidance
or control and to dietary modification or control. At the age 5 years, they were
assessed for asthma and eczema and had skin prick tests for atopy. 616 children are
selected randomly and 516 (84 %) were evaluated at the age 5 years. The HDM
avoidance intervention resulted in a 61 % reduction in HDM allergens concentration
(mg/ g dust) in the child’s bed but no difference in the prevalence of asthma, wheeze
or atopy. The prevalence of eczema was higher in the active HDM avoidance groups
(26 % Vs 19 %). The ratio of V- 6 to V-3 fatty acids in plasma was lower in the active
16
diet group (5.8 Vs 7.4). However, the prevalence of asthma, wheezing or atopy did
not differ between the diet groups.29
6. Studies related to knowledge regarding asthma :
A study was conducted on asthma knowledge and behaviour among mothers
of asthmatic children in Aseer, South- east Saudi Arabia. During the study period
171 mothers of asthmatic children were interviewed and enrolled in the study. The
mother’s ages ranged from 22 to 45 years with a mean of 33.9 years. Illiterate
mothers were 17.5 % and the rest were educated. Only 28.7 % were working. The
study revealed that the least known information among mothers was the
complications of asthma. Breathing exercise during asthma attacks were the least
practised behaviour. In a multivariate analysis, significant risk factors for poor
knowledge and behaviour among mothers were female sex of the child, illiterate
mothers are young age of mother. More education is needed to help the mothers of
asthmatic children and acquire the necessary knowledge and practices to care for
their children.30
A study was conducted on parent education and guided self management of
asthma and wheezing in the pre- school child in Leicester. 101 child were
randomized into control group and received pre- school asthma booklet, written
guided self management plan and two 20 minute structured educational sessions
between a specialist respiratory nurse and the parent and child subjects were
assessed at 3,6 and 12 months. The results shows that the introduction of an
educational package and a written guided self management plan to the parents
reduces morbidity, over the subsequent 12 month.31
17
STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of structured teaching programme on
knowledge regarding prevention of asthma among mothers of under five children in
a selected urban community at Bangalore.
6.3. OBJECTIVE:
1. To assess the level of knowledge among mothers of under five children
regarding prevention of asthma before structured teaching programme.
2. To evaluate the effectiveness of structured teaching programme on prevention of
asthma among mothers of under five children.
3. To determine the relationship between selected socio- demographic variables and
the level of knowledge among mothers of under five children regarding
prevention of asthma.
HYPOTHESIS:
H1 : There is a significant difference between the pre-test & post test knowledge level
of the mothers he of under five children regarding prevention of asthma.
18
H2 : There is a significant relationship between the selected socio- demographic
variables and the level of knowledge of the mothers of under five children regarding
prevention of asthma.
OPERATIONAL DEFINITION:
EVALUATE: It refers to the statistical measurement regarding the knowledge on
prevention of asthma as observed from scores obtained on self administered
questionnaire.
EFFECTIVENESS: It refers to the improvement seen in terms of knowledge of
mothers of under five children regarding prevention of asthma after structured
teaching programme measured using structured self administered questionnaire.
KNOWLEDGE: It refers to the awareness of the mothers of under five children
regarding prevention of asthma.
STRUCTURED TEACHING PROGRAMME: It refers to a systematically planned
teaching activity to provide information about prevention of asthma through lecture
and flash card.
MOTHERS OF UNDERFIVE CHILDREN: It refers to the mothers, who are
having children between the age of 0 – 5 years.
ASTHMA: Asthma is a common chronic inflammatory disease of the airway.
19
ASSUMPTION:
Mothers of under five children have some knowledge regarding prevention of
asthma.
Knowledge levels of mothers of under five children vary from individual to
individual.
Socio demographic variables influence the knowledge level of mothers of
under five children regarding prevention of asthma.
Mass media influences the knowledge level of mothers of under five children
regarding prevention of asthma.
7.0. MATERIAL AND METHODS:
7.1. SOURCES OF DATA: Mothers of under five children residing at a
selected urban community at Bangalore.
7.2. METHOD OF COLLECTION OF DATA:
RESEARCH APPROACH: Quasi experimental approach.
RESEARCH DESIGN: One group pre-test & post test design only.
20
SETTING: A selected urban community at Bangalore.
VARIABLE UNDER STUDY:
In this study there are two variables such as dependent variable
and independent variable.
DEPENDENT VARIABLE:
In present study dependent variable is the knowledge of mothers
regarding prevention of asthma among under five children.
INDEPENDENT VARIABLE:
In this independent variable is considered as structured teaching
programme.
POPULATION: Target population for the study is the mothers of under five
children in a selected urban community at Bangalore.
SAMPLE: Mothers of under five children.
SAMPLE SIZE: 80 mothers of under five children in a selected urban
community at Bangalore.
SAMPLE TECHNIQUE : Convenience sampling terchnique.
CRITERIA FOR SELECTION OF SAMPLE:
21
INCLUSION CRITERIA:
a) Mothers of under five children who are willing to participate in the study.
b) Mothers of under five children who can be able to speak and communicate in
Hindi and English.
EXCLUSION CRITERIA:
a) Mothers of asthmatic children.
b) Mothers of under five children who have mental illness.
SELECTION AND DEVELOPMENT OF TOOL:
SELECTION OF TOOL: A structured interview schedule is selected for the study.
DEVELOPMENT OF THE TOOL: The questionnaire is prepared in English in the
following two sections:
Section 1: It consists of socio- demographic data like age, education, occupation,
monthly income etc.
Section 2: Closed ended questionnaire on knowledge of the mothers of under five
children regarding prevention of asthma.
22
The entire question has 4 options where as one will be the correct answer
and other 3 will be the wrong answers.
Validity of tool will be ascertained in consultation with guide and other
experts from various fields like nursing, paediatricians.
DATA COLLECTION PROCEDURE:
The study will be conducted in a selected urban community at Bangalore. An
extensive survey will be done to identify the mothers of under five children who
are meeting the inclusion criteria. Then oral consent is obtained from the subjects
for the study, 80 mothers of under five children will be selected through
convenience sampling technique. A structured interview schedule is prepared to
collect the relevant information before and after teaching regarding prevention of
asthma. The duration of the data collection will be 4 weeks. Per day, the data will
be collected from 4 to 5 mothers of under five children.
PLAN FOR DATA ANALYSIS:
The collected data will be analyzed using descriptive & inferential statistics. The
plan for data analysis is as follows:
Organizing the data on a master sheet of computer.
23
Analysis of the demographic characteristics of the sample by using
descriptive inferential statistics like frequency distribution, percentage,
mean and standard deviation.
Analysis of the data by using inferential statistics like t- test & Chi-
square test.
Representation of data in tables & graphs.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMAN OR ANIMALS?
No .Only structured interview will be used for data collection. No other
invasive or laboratory procedure will be conducted on the samples.
7.4. HAS ETHICAL CLARANCE BEEN OBTAINED?
Yes
Ethical consent is obtained from Kadugudi PHC
Bangalore.
Confidentiality & anonymity of subjects will be
maintained. Consent will be taken from adults before conducting the study.
8. LIST OF REFERENCES:
1 Http /en. Wikipedia. org./ wiki / Jawaharlal –Nehru
2 IMCI, Integrated Management of childhood illness.
www.childinfo.org/eddb/imci/index.htm.
24
3 H Paramesh. Epidemiology of Asthma in India. Indian Journal of Paediatric.
Vol 69 .2002 April. 309- 312 pp.
4 The Lippincott. Manual of nursing practice. 7th edition, Jaypee Brothers
Medical publishers, (2001), 48 pp.
5 N C Thomson, G Vallance. Asthma/ Intrinsic/ Encyclopaedia of Respiratory
Medicine, 2006. 206-215 pp.
6 Chhabra SK, Gupta CK, Chhabra P, Rajpal S. Risk factors for development of
Bronchial Asthma in children Delhi. Journal of Ann Allergy Asthma
Immunol, 1999, Nov, 83 (5) .385 – 390 pp.
7 Shivbalan S, Balasubramanian S, Anandnathan K. What do parents of
Asthmatic Children Know about asthma? Indian Journal of Chest disease
allied Science, 2005 April, 47 ( 2 ) .81-87 pp.
8 Shay D. K, Study on asthma among mothers of under five children. Indian
Journal of Paediatrics, 2004, 22 (1), 48-50 pp.
9 Richardson G, Eick S and Jones R. How is the indoor environment related to
asthma? Literature Review. Journal of Advanced Nursing, 2005 Jan, 52
(3) .328- 339 pp.
10 Asthma Allergies AAFA, Education Advocacy Research .2001 04 16, 46pp.
11 WHO fact Sheet, No 307, 2008 May.
12 Ranabir Pal, Sanjay Dahal, Shrayan Pal, Prevalence of bronchial asthma in
Indian children. Indian Journal of Community Medicine .2009, Vol 34, Issue
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9. Signature of Candidate
10. Remarks of the Guide
11. Name and Designation
11.1 Guide
11.2 Signature
11.3 Co-guide
11.4 Signature
11.5 Head of the Department
28
11.6 Signature
12 12.1 Remarks of the Chairman and Principal
12.2 Signature
29