RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCESBANGALORE, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.

Name of the candidate and address (in block letter)

MRS.SHARMATHA BANUIKON NURSING COLLEGE

NO:32/33 ,BHEEMANAHALLY,B.M.MAIN ROAD BIDADI,

BANGALORE .

2. Name of the Institution IKON NURSING COLLEGENO: 32/33, BHEEMANAHALLY,

B.M.MAIN ROAD BIDADI,BANGALORE .

3. Course of study and subject MSC.NURSINGCHILD HEALTH (PEDIATRIC)

NURSING

4. Date of the admission to the course 28.09.2009

5.Title of the topic:

A Study To Evaluate The Effectiveness Of Structured Teaching Programme On Knowledge Regarding Selected Waterborne Diseases And Its Prevention Among Mothers Of Under five Children In Selected Rural Community Of Ramanagar District At Bangalore.

6.BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION: “Water an elemental, fundamental” “Water is building block of the life” “Water is we and you need” -Anand Dixit Water is the most indispensable nature resource in the world for every living being. The

entire life-support systems are dependent upon this vital resource. It is most important to all as it

is directly consumed by all living entities. From that point of view, water is particularly related with

health. Ninety percent of cases are reportedly attributed to the supply of unsafe drinking water

coupled with improper sanitation and poor hygiene.1

In developing countries four-fifths of all the illnesses are caused by waterborne diseases,

with diarrhea being the leading cause of childhood death.1

The global picture of water and health has a strong local dimension with some 1.1 billion

people lack basic access to drinking water resource, 2.4 billion People have inadequate sanitation

facilities, which clearly accounts for many related acute and chronic diseases. Some 3.4 million

people, many of them are young children die each from waterborne diseases such as intestinal

diarrhea, cholera, typhoid and dysentery. Today we have strong evidence that water-sanitation and

hygiene-related diseases account for some 2,213,000 deaths annually. Diarrhea occurs worldwide

and causes 4% of the health loss to disability.2

Most waterborne diseases occur worldwide. In developing countries, contagion is prevented by drinking water purification and by hygienic measurements. But even in developed countries, people

can fall ill from waterborne diseases. This is caused by using insufficiently disinfected water, by

implementing non- hygienic food preparation and by insufficient personal hygiene.3

.

In developing countries, waterborne diseases are a major problem which contributes to the

vicious circle that people are in. In many developing countries,there is a lack of medicine to treat ill

people. Many people weaken because of waterborne diseases and as a result, are more susceptive to

other infections. During wars and natural disasters (floods)many people are infected with waterborne

diseases.Diseases are easily spread because water treatment and sewage no longer function or are

lacking completely.3

Waterborne diseases spread by contamination of drinking water systems with the urine and faeces of infected animal or people. The germs in the faeces can cause the diseases by even slight

contact and transfer. This contamination may occur due to floodwater, water runoff from landfills,

septic fields and sewer pipes.4

The only way to break the continued transmission is to improve the people’s hygienic

behavior and to provide them with certain basic needs; drinking water, washing and bathing facilities and sanitation.4

Clean water is a pre-requisite for reducing the spread of waterborne diseases. It is well

Recognized that the prevalence of waterborne disease can be greatly reduced by provision of clean drinking water and safe disposal of faeces. Water should be disinfected while people are

consuming. Without disinfection, the risk from waterborne disease is increased.4

After the Tsunami attack in Asia on Sunday the 26th of December 2004, people faced the

threat of waterborne diseases linked to flooding like shigellosis, cholera, hepatitis A, leptospirosis,

typhoid fever, malaria and dengue fever.5

As noted by Toepfer (2004), disease statistics are stark and tragic. 80% of the illness and

death in the developing world is water related, half of the world hospital beds are occupied by

people with water related diseases. Diarrhoea and malaria are by far the largest cause of mortality

in children less than five years of age(34%)in Africa and the number of deaths from water related diseases approaches five million annually.6

To improve the economical progress of developing countries, water contamination and spread of infectious diseases must be handled. This is achieved through(drinking) water treatment, sewage, waste and sewage water treatment and education on personal and food hygiene.3

6.2 NEED FOR STUDY:

“Teach a Mother about health and She will teach rest of the mankind”

The awareness of mothers about waterborne disease and preventive services is a barometer by which we can measure the progress of family, community and country. Lack of awareness can

lead to health hazards in country. Waterborne diseases are one of the leading causes for under five children morbidity and mortality. One of the objectives of child survival and safe motherhood (CSSM) was to reduce 30% of diarrhoeal related deaths in children under the age of five years by 1995 and 70% by 2000A.D(IAP, 1999).7

Early in this century in USA, 1,687 deaths associated with waterborne outbreaks between

1920 and 1991,943 were attributed to typhoid fever while 102 were caused by amebiasis.From 1986

through 1990, 20 waterborne outbreaks due to intestinal protozoa were reported in US. These

outbreaks occurred in ten states and affected more than 15,000 people. The total number of reported

cases of cholera is 7, 46,968 with 9,448 deaths.8

A Nepalese government report for 1999/2000 blamed poor sanitation for wrecking the

people’s health. It’s stated some 28,000 children die due to diarrhoea related diseases.8

Worldwide estimates report that shigellosis is responsible for approximately over 600,000

deaths and above per year. The majority of these happened in the developing countries and two-third of the victims are children under age of five years.9

World Health Organization report in 2002, estimates 21% of communicable diseases

in India are water related. Of these diseases, diarrhoea alone killed over 7, 00, 000 Indian, over 1,600

deaths each day. The highest mortality from diarrhoea is in children under age of five, highlighting and urgent need for focused interventions to prevent diarrhoea. Improved hygiene and sanitation plays and important role in reducing diarrhoea and related waterborne diseases.10

Today 85% of India’s population is covered by water infrastructure, said the report from India’s planning commission, New Delhi(2000). Between 400 000 and 500 000 children aged

underfive years die each year from diarrhoea, the report said, citing a failure to improve personal and

home hygiene as a factor. Reported data indicate that the incidence of viral hepatitis is 12 cases per

100 000 people.11

In Niamey, 20 April 2007, around 40 percent of Nigeriens don’t have access to clean

running water in their homes. Almost 13.4 million people have been diagnosed as suffering from

waterborne diseases.12

In Zimbawe, 2007, Twelve people have so far died due to a cholera outbreak as hundreds

are hospitalized.Serious waterborne diseases are spreading across the Zimbawe’s urban areas due to

severe crisis within the country’s water and sanitation services. 13

On June 2008, over 20% of Alamarsikere village in Harpanahalli taluk, Karnataka. have

been admitted to the general hospital after they complained of vomiting, diarrhoea and several people

of Hadadi village in Davangere taluk have been admitted to the general hospital with the same

complaint. The diseases were developed because people were consuming contaminated water.Mr.Bankar,

Medical officer of the general hospital advised the people to drink water only after boiling. He said that

tanks in the villages had been chlorinate and claimed that steps had been taken to ensure that more

people would not fall prey to waterborne disease.14

On 26th May 2009, a cyclone alia hit the Bay of Bengal in kolkatta at midnight; more than

80% of the fragile homes in the area were totally destroyed. The storm broke through the century-old

embankments flooding rice paddies,devastating crops and forcing families to seek shelter at higherground.

1, 00,000 diarrhoeal cases resulting in 31 deaths, have been reported by the government. UNICEF is

partnering with the National Rural Health Mission, National Institute of cholera and Enteric Diseases

(NICED) and the Integrated Disease Surveillance Program to strengthen antibiotic protocols,

epidemiological surveillance and diarrhoea control.15

On October 9th 2009, Bangalore, after battling rains and flood furry, over a million people of

North Karnataka is now facing the scare of outbreak of waterborne diseases. Over 7, 00, 000 cases of

people suffering from diarrhoea, typhoid and chickungunya.16

On October 15th 2009, in New Delhi, Diarrhoea kills nearly 1,000 children below the age of

five everyday in India, due to poor sanitation and unhygienic practices.16

. In the wake of recent viral infection, nearly 200 patients have reportedly been affected with

the outbreak of diarrhoea in different parts of the district. This was stated by Dr.Vinod Pathak, Joint

Director of Health Services, Chamba District, New Delhi on November 24, 2009.17

In Combodia, 2009, most of the people were affected with typhoid fever. The disease were

spread through contact with food and water contaminated by faecal matter or sewage. Victims exhibit

sustained high fever, left untreated, mortality rates can reach twenty percent.16

Based on above mention literature, the researcher felt that the mother in the family play a

vital role to prevent common waterborne diseases among their underfive children.The investigator will

assess the mothers knowledge and develop a structured teaching programe to enhance the target population.

6.3 REVIEW OF LITERATURE:

A Review of Literature on a research topic makes the researcher familiar with the existing

studies and provides information which helps to focus on a particular problem and lay a foundation upon

which to base new knowledge. It creates accurate picture of the information found on the subject. (Polit and

Hungler, 2000).

The Investigator carried out an extensive review of literature on the research topic in order

to gain deeper insight into the problem as well as to collect maximum relevant information for building up

the study. A Cross sectional study was conducted to assess sanitary practices of residents of a Kenyan

urban slum and faecal contamination of their domestic water sources. Forty water samples were collected

from the water sources used by the respondents for laboratory analysis of coliforms.The study found that

most people (91%) in the langas slum used wells as the main source of domestic water, whereas the rest

used tap water. Total coliforms were found in 100% of water samples from shallow wells, while 97% of

these samples from shallow wells were positive for thermo tolerant coliforms. Because the presence of

thermotolerant coliforms in water indicates fecal contamination, there is a high possibility of the presence of

disease pathogen in the water. To address this problem, treatment of the water at community or household

level and intensive behavioral change in sanitary practices are recommended.18

A research study was conducted to find a high incident of water borne disease in kerala’s

kuttanad region. The medical college records for the past five years reveals that of the total patients admitted

with waterborne diseases, more than 70% all in same region. The total number of patients admitted wit this

disease was 279 in 2006 which dropped to 113 in 2007 and then moved up to 210 the next year. Hepatitis A,

a major waterborne disease caused by drinking water contaminated with human excreta is common among

the people in the region. Typhoid has also become endemic in the region with 28 patients admitted to the

medical college in the month of January and February. Total number of patients admitted in 2008 with the

diseases as 154, this incidence is normally noticed only during the monsoon season in the state. The main

reason for such serious waterborne diseases is contamination of water in the rivers and in the vembanad

lake. Contamination of water in kuttanad has acquired serious dimension in recent years.19

A project study was conducted on Combating diarrhoeal in India through safe drinking

water the world bank estimated 21% of communicable diseases in India are water related. Of these

diseases, diarrhoea alone killed over 7, 00, 000 Indians (estimated) over1,600 deaths each day.The highest

mortality from diarrhoea is in child age of five, highlighting an urgent need for focused interventions to

prevent diarrhoea. Despite investments in water and sanitation infrastructure may low income communities,

other developing countries to lack access to safe drinking water. Regardless of quality, widespread

unhygienic practices during water collection and storage, poor handling limited access to sanitation facilities

perpetuate the transmission of diarrhea.10

A quantitative study was conducted on “Prevlence of water borne diseases with in the

health facilities in Nakuru District, Kenya from 2000 to June 2001”, the study population was the residents

of Nakuru, seeking health care services in nakuru health facilities. The estimated sample size (number of

records) was calculated using the formula, n = Z2 * P (1 – P). Total number of records viewed from health

facilities on Nakuru are 28,128. Among these, 16,124 from nakuru provincial general hospital and 11,974

from Nioro health centre. Out of 28,128 records were reviewed, 1,568 cases were identified as suffering

from waterborne disease. Typhoid contributed up to 49.0% (n = 768) of the four waterborne diseases.

Typhoid was followed by gastro enteritis with 29.0% (n = 448) and amoebiasis with 18.0% (n = 288).

Dysentery contributed only 4.0% ( n = 64) of the total number of waterborne diseases.20

A cross sectional survey was conducted among mothers of children aged less than five

years in Ibadan. The questionnaire used for this survey sought. Information about the occurrence of

diarrhoea among children less than five years their knowledge about management of diarrhoea and their

practices. The study showed that among 520 mothers only one – third of respondents resorted to home

treatment of diarrhoea with ORS. More than 80% of them know the composition of ORS solution.21

A research study was conducted to find the association between extreme precipitation and

waterborne diseases in the united states (Curriero, Patz, Rose and Lele, 2001). 51% of waterborne disease

outbreaks were preceded by precipitation events above the 90th percentile(p = 0.02) and 68 %of waterborne

disease outbreaks were preceded by precipitation above the 80th percentile ( p = 0.01). A recent study of

precipitation and waterborne illness in the united states found that more than half the waterborne disease

outbreaks in the United States during the last half century followed a period of extreme rainfall.22

A descriptive study was conducted in Douala, Cameroon (1995 – 2006) to assess the

monthly occurrence and mean age distribution of waterborne disease. Disease of interest includes

gastroenteritis, amoebic dysentery, typhoid fever and cholera. Waterborne disease occurrence was

observed to follow a seasonal pattern with peaks occurring between the months of January and May

followed by drops between June and October. Children below five years were found to be more

vulnerable mostly, 80% of people are affected with gastroenteritis.23

A Research study was conducted in Peru (2000), to find the cholera epidemic , brought

to light the miserable state of local water and sanitation condition . The study was conducted in

Peruvian Peri-urban areas,and the study population was people who are residing in Peri-urban areas.

The researcher discusses the relationship between waterborne diseases and water and sewage conditions.

In 1989, only 5 2% of the population had access to piped water and only 39% to sewerage.2 million people daily eat meals from street vendors who lack access to fresh water or facilities and 90% of a

sample of their food was faecally contaminated. Around 70% of people are suffering from water and

food borne illnesses.These diseases are associated with poor living conditions.24

A Research study was conducted in USA (2006), to find the incidence of acute gastro

intestinal (AGI) attributable to public drinking water systems in the united states.The randomized trial is

one study design used to evaluate the risks attributable to drinking water.In this study, researcher review

all published randomized trials of drinking water intervention in industrialized countries conducted

among immunocompetent populations.Using this approach they estimate there to be 4.26 – 11.69

million cases of AGI annually attributable to public drinking water systems in the united states.25

World Health Organisation (2008) conduct a project study on the global Challenge

of water quality and health . Unsafe water ,together with inadequate sanitation and hygiene, is the

overwhelming contributor to the 4 billion illnesses and 1.8 million deaths caused by diarrhoea every

year. 90% of this toll is borne by children under five. Every diarrhoeal episode reduces calorie and

nutrient uptake and sets back a child’s growth and development . WHO estimates that 94% of

diarrhoeal cases are preventable through modification to the environment, including through intervention

to increase the availability of clean water.26

STATEMENT OF THE PROBLEM :

A Study to Evaluate The Effectiveness Of Structured Teaching Programme on Knowledge

Regarding Waterborne Diseases and its Prevention among Mothers of under five children in selected

rural community of Ramanagar district, Bangalore. 6.4 OBJECTIVE OF THE STUDY;

1. To determine the pretest knowledge of the mothers of underfive children regarding waterborne

disease and its prevention.

2. To find the effect of structured teaching programme on waterborne diseases and its prevention in terms of gain in knowledge among subject.

3. To know the association between posttest knowledge with their selected demographic variables.

6.5 OPERATIONAL DEFINITIONS:

Effectiveness:

It refers to the output of structured teaching programme in terms of improvement in the knowledge

regarding waterborne disease and its prevention among mothers of underfive children as assessed by a

structured knowledge questionnaire.

Structured Teaching Program :

Structured teaching program refers to giving teaching and impart the knowledge regarding

waterborne diseases such as diarrhoea, cholera,typhoid and its prevention among mothers of under five

Children. Knowledge:

It refers to the information regarding selected waterborne diseases such as diarrhoea, cholera

and typhoid. This is assessed by response to the questionnaire and measure the in terms of knowledge score.

Waterborne Disease :

In this study waterborne diseases refers to typhoid,diarrhoea,cholera that is caused by pathogenic

micro organisms like bacteria, virus and protozoa which are directly transmitted when contaminated water

is consumed.

Mothers of underfive children :

It refers to the mothers who have children between the age of six months to five years in selected

rural area.

6.6 ASSUMPTION:

1.Mothers in the family play a pivotal role and may have inadequate knowledge.

2.A structured teaching programme will help to enhance the knowledge regarding

waterborne diseases and its prevention among mothers of under five children,

which in turn to prevent complication associated with it.

6.7 HYPOTHESIS: H1: There will be significant difference among mother’s regarding waterborne diseases and its prevention after posttest.

H2: There will be significant association between posttest knowledge with their selected demographic variables.

7. MATERIALS AND METHODS:

The study is designed to evaluate the effectiveness of structured teaching programme on

waterborne diseases and its prevention among mothers of under five children in selected rural community

in Bangalore.

7.1 SOURCE OF DATA :

The data will be collected from mothers of under five children in a selected rural

community of Ramanagar District at Bangalore.

7.2 METHOD OF DATA COLLECTION :

The data will collected from the mothers of under five children by using structured

interview schedule regarding waterborne diseases and its prevention.

i) RESEARCH DESIGN: Quasi experimental design will be used in this study.

ii) RESEARCH VARIABLES :

1) Dependent variables: Knowledge of mothers of underfive children on waterborne diseases

and its prevention.

2) Independent variables: structured teaching programme on knowledge regarding waterborne

diseases and its prevention in a selected community of Ramanagar district at Bangalore.

iii) SETTING: The study will be conducted in kailancha village, Ramanagar district, Bangalore.

iv)POPULATION :

Mothers of under five children who are residing in kailancha village, Ramanagar district

Bangalore. v)SAMPLE SIZE :

Based on the subject who fulfill the inclusion criteria, 100 samples will be selected for the study.

vi)SAMPLING CRITERIA :

Inclusion criteria :

1) Mothers who have children between the age of six months to five years and are available in kailancha village, Ramanagar district, Bangalore.

2) Mothers of underfive children who are willing to participate in the study.

Exclusion criteria :

1) Mothers who are working in health agencies.

2) Mothers who are having children more than five years of age group.

vii) SAMPLING TECHNIQUE :

Sample will be selected by the method of purposive sampling technique.

viii)TOOL FOR DATA COLLECTION :

Tool for data collection consists of three section

Section A: Demographic variables which gives base line information obtained from the mothers of underfive children.

Section B:Structured knowledge questionnaire to assess the knowledge of mothers of under five children regarding waterborne diseases and its prevention.

Section C: structured teaching programme on knowledge of mothers of underfive children regarding waterborne diseases and its prevention in a selected rural community of

Ramanagar district, Bangalore.

ix) METHOD OF DATA COLLECTION:

Permission will be obtained from the concerned authority and the informed consent will be

taken from the subject. Phase-1 : Assess the existing knowledge of mothers of underfive children with the help of structured questionnaire.

Phase-2 : Structured teaching programme will be given to the mothers for 45 minutes using flash cards.

Phase-3 : After a period of one week, level of knowledge will be assessed with the same

group using same questionnaire. Duration of the data collection will be four to six weeks.

x) METHOD OF DATA ANALYSIS:

The investigator will administer questionnaire to collect data from the subjects. Descriptive statistics: 1.Organises the data in master sheet/computer. 2.Frequencies and percentage distribution to describe the demographic data.

3.Mean, standard deviation and paired ‘t’test to determine the level of knowledge.

Inferential statistics:

Chi –square to measure the associate knowledge of mothers of underfive children

on waterborne diseases and its prevention with selected demographic variables.

xi)PROJECTED OUTCOME:

The structured teaching programme will improve knowledge of mothers of underfive children regarding waterborne which in turn to prevent the complication.

7.3:DOES THE STUDY REQUIRE ANY INVESTIGATIONS INTERVENTION TO

BE CONDUCTED ON PATIENTS OR OTHER HUMAN BEING OR ANIMALS?

IF SO PLEASE DESCRIBE BRIEFLY?

Yes, structured teaching programme will be administered to the mothers of underfive children on waterborne diseases and its prevention in selected rural community of Ramanagar

district at Bangalore.

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN

CASE OF 7.3?

Yes, the permission will be obtained from the concerned authority of Ramanagar

district, Bangalore.The investigator will take the informed consent from the sample.

8.LIST OF REFERENCES

1) Narongsak Noosorn and prasit .Journal of American Water Works Association,may

2000, vol 9 pp 24-43.

2) Kamala et al. Journal of water for people, water for life, The united nations world

water .Development Report, 2001 vol 4 pp 102-105.

3) Khamgaonkar et al. Journal of medical science, Awareness of mothers regarding

waterborne diseases,vol 6(44), pp 55-61.

4) Mittal s.k.Indian Journal of Paediatrics,Diarrhoea In Tropics,1999,vol 65(4) pp 4-5.

5) Aidea – global (n.d) Waterborne Diseases (Electronic Version). Retrieved 21st 2009,

From http://www.aldeaglobal.com ar/agua/wbd.htm.

6) Shruff.Journal Of Public Health And Epidemiology, Public Participation to minimize

Waterborne diseases in Yom riverside communities,2005,vol 1(1) pp 09-23.

7) Dua .t.et.al Indian Journal of paediatrics,prevalence of Diarrhoea,vol 9 pp 55-59.

8) Patrick Burke.Preventing Waterborne diseases,EPA publication,2000,EPA/625/5-

90/025.

9) CDC(1990) Waterborne diseases outbreak (Electronic Version) Retrieved MAY 16th

2009,from http://www.edc.gov/nephi/diss/nndss/print /waterbornecurrent.htm.

10) Normandie De Justin and Sunitha Janette.WHO Project Report,Combating Diarrhoeal

disease through safe drinking water, November 2002.

11) Dr.Ongore.Journal of Public Health and Epidemiology,October 2001,vol(2) pp 081-99.

12) Gupta et al.Indian Journal of Medical Science,vol 12 pp 326-329.

13) Editorial in THE HINDU waterborne diseases break out in Davanagere,June 18,2008.

14) Dr.Joerge G. Caravota,UNICEF Report,Battling waterborne diseases in cyclone

affected west Bengal,2009.

15) Trivedi,Journal of public health and epidemiology,Better management can keep

Waterborne disease at bay,2009,vol 18 pp 78-80.

16) Editorial in THE HINDU Tribune,New Delhi,November 24,2009.

17) CIA World Factbook,Cambodia Major Infectious Diseases,vol 9,pp 221-230.

18) Elizabeth Wambui Kimani-Murage and Augustine M.Ngindu: Quality of water the

slum Dwellers Use: the Case of a Kenyan Slum. Journal of urban health.2007; 84 (6):

829 – 838

19) Editorial in the THE HINDU BUISNESS LINE Kuttanad Region in the grip of

waterborne diseases,March,21,2009

20) Swinburne et al .Local Agenda 21 incentive project,Nakuru,Kenya,2000.

21) Omachodian et al.1997,Indian Journal Of Paediatrics,vol 55(9) pp 17-20.

22) Curriero,Patz.Rose and Lele,2001,Journal Of Public Health and Epidemiology,vol 2(7)

pp 11-15.

23) Cameroon. Journal Of Water Science and Technology,WST, vol 59, no 12, pp 2321-

2329, IWA publishing 2009, 10.2166/wst,2009,268.

24) Alm .E. W. Burke . J. and spain. Disease surveillance and waterborne outbreaks,vol

37(16), pp 3978-3982.

25) John M ,Calford et al . Journal of water and health, vol 04 no suppl 2 pp 71- 88,

IWA publishing 2006,10.2166/wh.2006.018.

26) J. Barton and Gordon. Journal of water practice and technology, World

Health Organisation, 2008, 10.2166/wpt, 2008.090.

9. SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE

11. 11.1 NAME & DESIGNATION OF GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THEPRINCIPAL

12.2 SIGNATURE

.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

MRS. SHARMATHA BANU S.

FIRST YEAR M.SC (NURSING) CHILD HEALTH (PAEDIATRIC) NURSING YEAR 2009 – 2010

IKON NURSING COLLEGE N0.32/33,BHEEMANAHALLY, B.M.MAIN ROAD, BIDADI, BANGALORE