RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES, KARNATAKA.

BANGALORE
PROFORMA FOR REGISTRTION OF SUBJECT FOR DESSERTATION
01 NAME OF THE CANDIDATE AND ADDRESS MS. LAKSHMIDEVI. B. 1st YEAR M.Sc NURSING RAJEEV COLLEGE OF NURSING HASSAN.

02 NAME OF THE INSTITUTION

RAJEEV COLLEGE OF NURSING. KR PURAM, HASSAN M.Sc NURSING 1st YEAR CHILD HEALTH NURSING

COURSE OF THE STUDY AND SUBJECT

0! DATE OF COURSE

ADDMISSION

TO MAY 1"t# 200$

0" TITLE OF THE STUDY

EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON PREVENTION OF GASTROENTERITIS

0% STATEMENT OF THE PROBLEM A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME TO MOTHERS OF UNDERFIVE CHILDRENS ON KNO&LEDGE AND PRACTICE REGARDING PREVENTION OF GASTROENTIRITIS IN SELECTED SLUM AREA AT HASSAN

%. BREIF RESUME OF INTEDED &ORK %. INTTRODUCTION' (THIS THE MIND THAT MAKES THE BODY RICH)1
Children are vulnerable group of society. Mothers are here on earth to take care of the children . over the past decades, peadiatric acute gastroentiritis has been the study of considerable world wide attention and effort. Gastroenteritis means inflammation of the lining of the stomach and intestainal mucosa. Rotavirus is the most common cause of severe gastroenteritis in young children world wide. Rotavirus has been long been recognized as a leading cause of acute diarrheal disease in young children throughout both the developed and developing world. The debilitating nature of rotavirus is reflected in that an estimated one third of all diarrheal pediatric hospital admissions globally can be attributed to this viral agent. The actual number of rotavirus infection with associated diarrhea is probably much greater because severity appears diminished resulting from immunologic tolerance evolving from repeat e!posures.2 Rotavirus infection is generally characterized by vomiting, fever and watery diarrhea with incubation ranging from "#to $"hrs. severe debilitating diarrheal disease and associated fatalities are fre%uently attributed to this enteric viral pathogens. &articularly in developing countries. 'here young children are often already immunologically compromised, e!ample poor nutritional status, person to person transmission is principally via fecal oral contamination and e!posure while seasonality implicating colder month has been recognized in more temperature climates occurrence in tropical regions is year round. This investigation promoted by anecdotal diarrheal outbreak reports (upang, 'est timor, )ndonasia was designed to provide recognition of evidence of epidemic occurrence via trend analysis, associated etiology, affected population and community impact and determinants contribution to transmission. *acterial gastroenteritis is a leading cause of morbidity and mortality world wide.

+pidemiologic investigations indicate that in less than ,-. of cases where diarrhea appears to be an infectious etiology ,no agent can be recovered . This suggest that there is still a number of new bacterial and viral enter pathogens yet to be discovered or proven to be

causes of gastroenteritis . This review shows that the present information in medical literature for a number gram negative bacterial belonging to five separate families implicated as causes of infectious gastroenteritis .! / study conducted on costs of community 0ac%uired pediatric rotavirus gastroenteritis in seven +uropean countries , a prospective epidemiologic study of acute gastroenteritis in children less than 1 years of age in selected areas of *elgium, 2rance, German, )taly, 3pain, 3weden and the united kingdom we calculated the average cost per episode of confirmed rotavirus gastroenteritis in primary care, emergency department and hospital settings. The result shows that total society cost 4including direct medical, direct non medical and indirect cost 5 &er episode of gastroenteritis ranged from 6-- euros to #$, euros in primary care setting, from ,,# euros to $$7 euros in emergency setting, from 61"1 euros to "676 euros hospital setting. The study conclude that rotavirus gastroenteritis in cure considerable resource utilization all healthcare setting and substantial cost for national health care payers families of patients and employers. Routine rotavirus prevention in children could be significantly reduce the health and economic burden of pediatric rotavirus gastroenteritis." / study was conducted on incidence impact on the family and cost of Gastroentritis among , 1 years old children in 3outh /ustrlia4"77-5. This study shows that the incidence of community Gastroenteritis among , 1 year children was 1.1, episodes per child year .This conclude that the incidence of community Gastroenteritis among , 1 year children in 3outh population high and need to beprevention of Gastrenteritis through improve the mothers knowledge and practice.% / study conducted /cute gastroenteritis8 does mother9s knowledge of the disease reduce admission of children under two years of age4"77#5. shows that There was statistical association between patient admission with acute diarrhea and poor social economic conditions 4p : 7.765;a study conclude that study disclosed association between admission of children under two years of age with gastroenteritis and poor social economic conditions.$

%.2 NEED FOR THE STUDY '

'orldwide appro!imately 177 million children are suffers which gastroenteritis each year and "7. of all deaths of children are due to gastroentiritis in rural area.* / study conducted on *urden of disease and molecular epidemiology of group rotavirus infections 4"77$5 in )ndia. Rotavirus is the ma<or cause of severe dehydrating diarrhea in young children worldwide.Considerable research has been carried out on rotavirus disease in )ndia. This review collated data from #- epidemiological studies to determine rotavirus positivity rates and genotypes of infecting rotavirus strains from various settings in )ndia.3tudies on diarrhea presenting to hospitals, neonatal rotavirus infections, symptomatic and symptomatic infections in the community and nosocomial enteric infections were included. Rotavirus positivity rates varied greatly between different settings diarrhoea hospitalizations 4"7.5, neonatal infections 4,1.5, symptomatic and asymptomatic infections in the community 461.6. and -.,. respectively5 and nosocomial enteric infections 4"".1.5.+ / study conducted on gastroenteritis hospitalization in =ewzeland children under , years of age 4"77-5. . The aim of the study is to describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalization rates of this illness in this =ewzeland children under , years of age. Methods are children under , years of age with acute diarrhea admitted to 6of > study hospital between one may 6??> and ,7 /pril "777 were surveyed. This study shows that estimated national hospitalization rate for Rotavirus in children under , years of age -,#per 677777 in =ewzeland rotavirus result in 6 in 1" children being hospitalized by , years of age. This study conclude that rotavirus gastroenteritis is an important preventable cause of hospitalization in =ewzeland children.10 / study was conducted on peadric burden of Gastroenteritis diseases in +urope 4"77-5.This sudy shows that burden of Gastroenteritis diseases in @ 1 years old childen +urope ./n estimated $"77 $$77 hospitalizatin for community ac%uried Rotavirus disease occurred in annually ", million under five living in +urope .The study concluded that concludes that to evaluate the impact and effectiveness of rotavirus gastroenteritis prevention programme in +urope, additional epidemiological studies will be critical desirable.11 / study was conducted on incidence ofGastroenteritis of among young )ndian

children4"77#5.Gastroenteritis climing over ,million young lives in the world every year , is

the second biggest killer of children in developing countries using data 6,77 children in rural )ndia under the age of , years.12

Rotavirus is the most important cause of severe life threatiatening Gastroenterits 4"77,5 in )ndia. children accounting for "7. $7. of hospitalization of children world wide in )ndia incidence of Rotavirus Gastroenteritis from 1. $7. . +arly diagnosis is essential for effective treatment and is aprere%usite for the prevention and control of potential out break .the aim of study was to determine the incidence of rotovirus infection in children below five years.1 / study was conducted on prospective evaluation of community ac%uired gastroenteritis in pediatric impact and disease burden of rotavirus infection4"7765. shows that the incidence of community ac%uired gastroenteritis was#.-$ per 677 children per year and of rotavirus positive gastroenteritis 6.,, per 677 children per year . 3tudy conclude that rotavirus is a relevant cause community ac%uired gastroenteritis in children aged # years and younger treated by pediatrician. The data can be used as basis for developing strategies to prevent infection.1! / study conducted on prevelance of rotavirus dirrhoea among hospitalised children 46???5 in pune )ndia. 3hows that in developing countries, gastroenteritis leads to an estimaed -77,777 to >$7,77deaths each year , acccounting for "7 "1.of all deaths due to diarrhoea and -. of alldeaths among children under1 year of age ".)in )ndia "7 ,7. hospitalised cases of dirrhoea are due to rotovirus . This study reports the prevelance of Rotovirus gastroentiritis among hospitalised childrens and its association with risk factors such as age ,se! and seasonlity on the rotavirus diarrhoea have been reported.1" / study conducted on rotovirus gastroentiritis impact on young children,their families and the health care system46??$5in 3ydney. The study design is cross sectional descriptive survey setting is new childrenAs hospital 4 Royal /le!ander hospital for children 5 3ydney, new south wales, 61th Buly to #th Cctober 6??-. &articipants children age under , year attending the emergency department with acute diarrhea as the presenting symptom 46??$5. This study results that 6>> children with confirmed rotovirus infection $>. were aged $ "#

months and >". visited atleast one other health care worker ,usually a general practioner. 3evenity 4,$.of 6>>5were admitted to hospital ,, of these 4#$.5 were aged 6, "# months. This study reveals that rotovirus gastroentiritis has significant impact on young children,their families and the health care system. &revention of severe disease through improve the level of knowledge and practice of mothers.1% /rea there is a lack of health education and knowledge awareness among mothers of under five children.)nvestigator during the posting found that may mothers are admitted their children to hospital with gastroenteritis . 3o investigator felt that if the mothers understood about gastroenteritis and its prevention it may reduce incidence rate, reducing complication and mortality rate among under five children and also it may increase the knowledge and practice toward the prevention among mothers. Dence the investigator felt the need to prepare planned teaching programme to educative the knowledge of mothers regarding gastroenteritis and its prevention.

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6.4 OBJECTIVE :
6. To assess the level of knowledge and practice of mother on prevention of gastroenteritis before giving planned teaching programme. ". To evaluate the level of knowledge and practice of mother on prevention of gastroenteritis after giving planned teaching programme

,. To compare the pre and post test knowledge score of mothers of under five children

#. To associate the post test level of knowledge and practice of mothers of under five children on prevention of Gastroenteritis with selected demographic variables.

%." HYPOTHESIS'
There will be a significant difference between pre test and post test knowledge score and practice score of mothers of under five children on prevention of gastroenteritis.

%.% ASSUMPTIONS'
6. Mothers of under five children knowledge will influence the prevention of gastroenteritis ". 3tructured teaching programme will improve the knowledge and practice of mothers of under five children on prevention of gastroenteritis.

%.$ OPERATIONAL DEFINITION 1. ASSESS'

)t is a statically measure on knowledge and practice on prevention of gastroenteritis among mothers of under five children

2. EFFECTIVENESS'
)t is defined as significant increase in level of knowledge and practice of mothers of under five children which is measured from the responses of pretest and post test after the planned teaching programme.

,. PLANNED TEACHING PROGRAMME'

)t is systematically prepared teaching programme for mothers about the definition, causes, and prevention of gastroenteritis

#. KNO&LEDGE

/bility to recall the instruction given in the planned teaching programmes and respond towards %uestionnaires.

1. PRACTICE'
)t is activity towards the mothers of under five children of prevention of gastroenteritis.

-. GASTROENTERITIS'
Gastroenteritis means inflammation of the lining of stomach and intestine

$. UNDERFIVE CHILDRENS'
The children age group between 7 1 years

>. SLUM AREA MOTHERS8

/ Group of mothers living in slum area

%.* CRITERIA FOR SELECTION OF SAMPLES 8 1. INCLUSIVE CRITERIA8

6.Mothers of under five children age between 6 1 years ".'ho are willing to participate ,..Mothers of under five children living in penshanmola area.

". E,CLUSIVE CRITERIA8

6. Mothers who are not having under five children. ". Mothers who are not willing to participate ,. Mothers who are not residing in penshanmola village at Dassan. #. Mothers who are not available during the collection of data

%.+ DELIMITATIONS OF STUDY8

6. 3tudy limited only to penshanmola mothers of under five childrenAs living in slum area. " 3tudy limited to # - weeks of duration ,. 3ample size limited to -7 #3tudy design limited to pre e!perimental study

%.10 SIGNIFICANCE OF THE STUDY'

This e!plores the knowledge through planned teaching programme on gastroenteritis in future according to their living condition

%.11 CONCEPTUAL FRAME &ORK ' &-.-/0-12 T#-314 %.12 REVIE& OF LITERATURE'
Eiterature review is a standard re%uisition of scientific research. )t means reading and writing the pertinent information of the attempt in research topic to understand better about the proposed topic. )t also supports and e!plains why the proposed topics taken for research and avoid unnecessary duplication, e!plore the 2easibility and illuminate way to new research.6$ / study conducted on +conomic and health burden of rotavirus gastroenteritis for "77, birth cohort in Eatin /merican J carbben countries 4"77$5./n economic model was constructed using epidemiological data from published articles, national health administration studies and country specific cost estimates. The model estimated the rotavirus outcomes for the "77, birth cohort during first 1 years of life. This study shows that estimated that gastroenteritis would result in an average of "#- output visits "# hospitalization ,7.- deaths .this study conclude that rotavirus gastroenteritis is likely to the result in substantial diseases .1* / study conducted on epidemiology and characterization of rotavirus gastroenteritis in Malaysia 4"77-5. . the aim of study was tom determine the proportion of hospitalization for diarrhea attributable to rotavirus among children under five years of age and to estimate the disease burden of rotavirus diarrhea Malaysia. a cross sectional study conducted on children 7 1? months of age admitted for acute gastroenteritis (uala Eumpur hospital or Dospital

Fmum 3arwak were surveyed. The study shows the highest rate of rotavirus associated diarrhea was among children age - 6$ months accounting for 11. of rotavirus. This study conclude that rotavirus was responsible for ,>. of hospitalization for gastroenteritis it was most common in - 6$ months.1+ Consumption of untreated tank rain water and gastroenteritis among young children 4"77-5in 3outh /ustralia. / cohort study of 676-# to - years old children who drank rain water or treated mains water in rural 3outh /ustralia was under taken in 6???. This study result that the incidence of gastroenteritis among children ,.> 0 1., episodes per child year. *ut most episodes 4-7.5 lasted <ust one day. =o increase in odds of gastroenteritis was observed among children who drank rain water compared with treated mains water. The ad<usted odd ratio for gastroenteritis associated with rain water consumption compared with the mains consumption was 7.># 4?1. confidence interval 7.-, 0 6.6,5. This study concludes that gastroenteritis was found to be significant cause of morbidity among young children. Houng children who work regular consumers of tank rain water, were at no greater odds of gastroenteritis than those who drank treated public mains water. 20 / study conducted on Gastroenterits prevention through food safety education in Gu<arath )ndia 4"77#5.This study shows that )mprovement in the practice of hand washing and avoidance of feeding leftovers to children was seen. There was reduction in the microbial load in the hand rinse samples of both mothers and children. This study conclude that effective change agents and food safety education was successful in bringing about a positive behavior modification in mothers.21 / study conducted on Maternal knowledge, attitude and practices towasds Giarrhea in rural Maharastra ,)ndia 4"7765. The method is $1 mothers of under 1 children participated in this study. They were interviewed by an interviewer using pre designed and pre tested %uestionnaire. This study shows that nearly half of the mothers were not practicing ade%uate hand washing.this study conclude that the maternal knowledge towards the dirrhea was inade%uate in the population studied and there was actual and desired practices."". / study conducted knowledge and practice of mother about infantAs gastroenteritis episodes in 3oudhi /rbia 4"7775. . This study sub<ect included ,77 million 4617 from sulaimanira pediatric hospital and 617 from maternal child hospital5 with diarrheal episodes during the study period selected by systematic random sampling. Gata was collected via a structured

open ended poilet tested modified %uestionnaire filled in trained /rabic speaking research assistants who interviewed mothers about diarrheal aspects of their infants, assessed their knowledge and practice concerning diarrheal disease in children as well as collecting the necessary sociodemographicaE character tics of the mothers and infants themselves. This study shows that motherAs knowledge about many aspects of gastroenteritis was grossly deficient but tends to increase with increasing age, education level, and birth order. MotherAs practices were better but still deficient and sources of information about gastroenteritis were mostly from non health professionals. This study concludes that intervention strategies to control under five gastroenteritis episodes needs to be through an integrated approach aiming at boosting mothers knowledge and improving their concerning gastroenteritis.2 . . / study conducted on maternal knowledge on risk behavioral practices and it9s association with diarrhea in a rural community of 'est *engal, )ndia 46??>5. This study shows that Risk of gastroenteritis amongst children of mothers having risk practice without knowledge as compared to those who utilized their knowledge to avoid risk practice was found significantly higher 4p @ or : 7.7715 e!cept for bottle feeding 4p : 7.,,75. The results of this study indicate that children can be protected significantly from gastroenteritis if mothers9 gastroenteritis behaviors can be altered through educational intervention.2!

$. MATERIALS AND METHODS OF STUDY' $.6 3CFRC+ C2 G/T/8

The data will be collected from the mothers of under five children aged between 7 1 Hears.

$."RESEARCH DESIGN'
/ &re e!perimental research design with pre test and post test with

'hich includes manipulation

GRCF& Mothers of under five children at selected area in Dassan

&retest C6

)nterventions K

&ost test C"

K-4531.s
C6 &retest on knowledge and practice of prevention of gastroenteritis among Mothers. &lanned )ntervention L3tructured teaching programmeM on knowledge and practice of prevention of gastroenteritis among mothers. C" &osttest on knowledge and practice of prevention of gastroenteritis among Mothers.

$."METHOD OF DATA COLLECTION'

Gata will be collected with 3tructured )nterview 3chedule. The 3tructured )nterview 3chedule consists of three parts. S-ct63/ A8 3emi 3tructured Nuestionnaire seeks information about Gemographic Gata. S-ct63/ B' 3tructured Nuestionnaire seeks information about mothers (nowledge of prevention of gastroenteritis in children S-ct63/ C' 3tructured Nuestionnaire seeks information about mothers of gastroenteritis in children. SAMPLING PROCEDURE8 P3789:t63/' /ll mothers of penshanmola. S:;79-' Mothers of under five children in. penshanmola. S:;79- s6<-' 3ample comprises to -7 mothers of under five children.

S:;79- t-c#/6=8-8 =on &robability convenient sampling is felt to be suitable for the study S-tt6/2' The study will be conducted in slum area penshanmola at Dassan. P693t st8.4' &ilot study is planned with the 67. of population

*. VARIABLES' *.1 I/.-7-/.-/t >:16:09-'

&lanned teaching programme on &revention of gastroenteritis.

*.2 D-7-/.-/t >:16:09-'

knowledge and practice of prevention of gastroenteritis among mothers of under five children .

+. ETHICAL CONSIDERATION'
6. Goes the study re%uire any intervention to be conducted on mothers of Fnder five ChildrenO Hes ". Das ethical clearance being obtained from your institutionO Hes ,. Das consent taken from primary health center authoritiesO Hes

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6. '''.Google.co.in ". /lbert MB, 3onearto I,*ishop R2,+pideomilogy of rotavirus diarrhea in Hogyakarta, )ndonasia, as revealed by electrophoresis of genome R=/. B Clin Microbiol 6-8$,6 $,,. *arnes GE, Fren +, et.al.etiology acute gastroenteritis in hospitalized children in Melbourne ,/ustralia .B Clin Microbiol.6??> ,-86,, 6,>. ,.&arashar FG, *resee B3, Gentsch BR, et.al. Rotavirus emergency infect Gis. 6??> #81-6 1$7 #. Ref, Banda B Michael ,/bbolt, 3haron E.Reviews in Medical Microbiology. Ban "77- ; 6$4658"$ ,$. 1.Gia%uinto C, Ian Gamme & et.al. cost of community ac%uired pediatric rotavirus gastroenteritis in $ european countries. B )nfect Gis."77$ May;6?1 3uppl 6;1,- 1## -. Deyworth B3, Bardine /, Glonek G, Maynard +B. )ncidence, impact on the family and cost of gastroenteritis among , 1 years old children in 3outh /ustralia. B Gasterol hepatol. "77- /ug; "64>586,"7 1. $. Iander lei EC, 3ilva G/. /cute diarrhea8 does mother9s knowledge of the disease reduce admission of children under two years of age. . Rev /ssoc Med *ras. "77# Bul 3ep;174,58"$- >6. >. .Gonna E, 'ong Marily Dockenberry 0+aton, 'ilson, 'inkelstein, 3chwartz.'ongs +ssential of &ediatric =ursing .si!th +dition &ublished at "77".page number >>,. ?. 3asirekha Ramani J Gagandeep (ang .*urden of disease J molecular epidemiology of group / rotavirus infections in )ndia. )nd ian B Med Res 6"1, May "77$, pp -6? -,". 67. . Grimwork R+ , Duang N3, Cohet C, Gosling )/, Dook 3M, Teele Gw, &innock Re, =icholson 'R,Graham G/, 2arrek /& Eeadbitter &,Eennon GR. Rotavirus hospitalization in =ewzealand children under three years of age. B &eadiair child health . "77- /pril ;#"4#58 6?- ",. 66. . The &eadiatric Rotavirus +uropean committee 4protect5.+pidemol. infect ."77-oct; 6,#4158 ?7> 66". Grimwork R+ , Duang N3, Cohet C, Gosling )/, Dook 3M, Teele Gw, &innock Re, =icholson 'R,Graham G/, 2arrek /& Eeadbitter &,Eennon GR. Rotavirus hospitalization in =ewzealand children under three years of age. B &eadiair child health . "77- /pril ;#"4#58 6?- ",. 6,. /nil.C, &hukan, Gilip ( patgiri, Bagadish mahanta.Rotavirus associated with acute diarrhea in hospitalized children in Gibrugarh,=orth east )ndia. B pathol microbiology "77,; #-4"58"$# "$>. 6#.2ruhwirth M,(armaus ', Moli 3chler ), *rosis,Mutz ) ./prospective +valuation o f communityac%uired gastroenteritis in peadiatric practices ; impact and diseases burde of rotavirus infection . /rch Gis child."776 may; >#4.58,?, $ . 61.(elkar, 3hobhana G, &urohit, 3udha G, 3imna, ( Ii<aya.prevelance of ritavirus diarrhea among hospitasalized children in &une , )ndia.)ndian Bournal of Medical Research ,6??? /pril. 6-. Eiddle,*urgess M/, Gilbert Gl, Danson RM, MC )ntyre &*, *ishop Rf,2erson MB.Rotavirus gastroenteritis impact on young children ,their families and health care system .Med.Baugt.6??$ sep 61;6-$4-58,7$ $. 6$. Genise.2.&ilot. Cherryl Tataro *eck. =ursing Research &rinciples J Methods. "77; $ th edition 8 >> ?6.

6>.Rheinagans RG,Constenla G,/ntil E, )nnis *E,*reuer T. +conomic and health burden of rotavirus gastroenteritis for "77, birth cohort in Eatin /merican J carbben countries.Rev &anam 3alud &ublica."77$ /pr ;4#586?" "7#. 6?. . Dung EC, 'ong 3E, Chan EG, Rosli, =g /=,*resee B3 .epidemology and strain characterization of rotavirus diarrhea in Malaysia .)nt B )nfect Gis."77- =ov; 674-58#$7 # "7. , Gia%uinto C, Ian Gamme & et.al. cost of community ac%uired pediatric rotavirus gastroenteritis in $ european countries. B )nfect Gis."77$ May;6?1 3uppl 6;1,- 1##. "6. 3heth M Cbrah M. Giarrhea prevention through food safety education. . )ndia B &ediatr. "77# Cct;$646758>$? >" ."".Galta I,Bohn R,3ing I&, Chaturvedi &.(nowledge .attitude and practices towards diarrhea in rural Maharastra.)nian B &eadiatric "776 Gec;->46"58661,. ",. Moawedc3a, 3aeed //.(nowledge and practice of mothers about infants diarrhel episodes in 3audi /rbia.3audi Med B."777 Gec; "646"5866#$ 16. "#. Ghosh 3, 3engupta &G, Gupta G=, Mondal 3(, Goswami M, *hattacharya 3(, 3ircar *( Maternal knowledge on risk behavioral practices and it9s association with diarrhea in a rural community of 'est *engal, )ndia. B Commun Gis. 6??> Gec;,74#58"16 1.

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