Effectiveness of Structured Teaching Programme on Knowledge regarding Helminthic Infestations among Mothers of Under- Five children
Juby Rose Kuriakose1, Annu Lilly James2, Blessy Thomas2, Jemy George2, Merlin P Raphael2, Neena Joy2,
Neslin Antony2, Reshma Thomas2, Shirley John2
1Professor, Department of Child Health Nursing, St. Philomena’s College of Nursing, Bangalore.
24th Year B.Sc. Nursing Students, St. Philomena’s College of Nursing, Bangalore.
*Corresponding Author E-mail: jubykuriakose129@gmail.com
ABSTRACT:
Background: Worm infestation is a major public health problem. It has been estimated that more than 25% of the world’s population are infected with worms, with the major incidence occurring in developing countries. Worm infestation can be prevented by practices such as safe disposal of excreta, washing hands after defection, wearing slippers and food hygiene, washing vegetables and fruits properly before using. These can be implemented through effective education of mothers because the mother is only the person who provides the proper education to their children. Objectives: 1. To assesses the existing knowledge regarding helminthic infestations among the mothers of under- five children. 2. To evaluate the effectiveness of structured teaching programme on knowledge regarding helminthic infestation among the mothers of under- five children. 3. To determine the association between pre-test knowledge scores regarding helminthic infestations among the mothers of under five children with selected sample characteristics. Methodology: The research design used for this study was pre experimental, one group pre-test post-test design. The study was conducted at St. Philomena’s hospital in Bengaluru, Karnataka. The sample size selected for this study consists of 30 mothers of under- five children. Non- probability purposive sampling technique was used to select the samples. The tool used in this study was socio-demographic profile and structured knowledge questionnaire. Result: In the pre-test, none had adequate knowledge, whereas 11 (36.6%) samples had moderate knowledge and 19(63.4%) of them had inadequate knowledge. In the post-test, 9(30%) samples had adequate knowledge, whereas 21 (70%) samples had moderate knowledge and none of them had inadequate knowledge. The mean post- test knowledge (24) score was higher than the mean pre-test (12.5). The scores predicted the significant difference (11.5) at p<0.05 level. The calculated “t” value was (14.66) at p <0.05 level of significance, which indicated the significant difference in the level of knowledge before and after the implementation of structured teaching program. Among socio-demographic variables; occupation of mother, type of family and source of information had association with the pre-test knowledge scores of mothers of under- five children. Conclusion: From the findings of the study, it was concluded that the structured teaching programme regarding helminthic infestations was effective in improving the knowledge among the mothers of under- five children.
KEYWORDS: Structured Teaching Programme (STP), Helminthic Infestations, Mothers of Under- five.
INTRODUCTION:
Malnutrition is a leading cause of child morbidity and mortality in low-income countries.1
Malnutrition continues to be a growing problem in most developing countries. Malnutrition increases the economic burden of a society because it leads to increased risk of death from infectious diseases, more severe infections and higher case fatalities creating an additional psychological burden.2
Worm infestation is a major public health problem. It has been estimated that more than 25% of the world’s population are infected with worms, with the major incidence occurring in developing countries. It is one of the main health concerns especially among children.3
Approximately two billion people are infected with soil-transmitted helminths worldwide. Over 270 million preschool-age children and over 600 million school-age children live in areas where these parasites are intensively transmitted, and are in need of treatment and preventive interventions.4
Even today 50% of total children of our country suffer from malnutrition with diarrhoea, intestinal worm infection from poor sanitation or lack of hygienic practices.5
The problem of helminthic infestation in children is wide spread in all tropical and subtropical area due to prevalent method of defecation and disposal of excreta. The World Bank claims that worm infestation impair learning and thus helminthic control is one of the most effective strategies to improve health in developing countries.6
Malnutrition in young children is attributed to inadequate feeding; faulty feeding practices, repeated infections like diarrheal diseases, acute respiratory infections and worm infestations.7
Nutritional anaemia remains common in many countries of the world and its eradication through effective interventions must be a priority for attention and action. The strategies to prevent nutritional anaemia aim at improving diet, increasing biodiversity of dietary iron, prevention and treatment of infections like hookworm and malaria and iron folic acid supplementation.8
Infectious gastrointestinal illnesses are transmitted through a variety of routes including contaminated food or water borne, the faecal oral route, and person-to-person. A significant proportion, about 36%, of gastrointestinal illnesses is attributable to food borne transmission.9
Most helminths infections, if left untreated, result in multi-year, chronic inflammatory disorders that cause both concurrent and delayed-onset pathology to the afflicted human host, it is now appreciated that chronic helminths infections are also linked to more insidious persistent health conditions such as anaemia, growth stunting, and protein-calorie under nutrition, fatigue, and poor cognitive development.10
Worm infestation can be prevented by practices such as safe disposal of excreta, washing hands after defection, wearing slippers and food hygiene, washing vegetables and fruits properly before using. These can be implemented through effective education of mothers because the mother is only the person who provides the proper education to their children. World health organization (WHO), estimated that about 1400 million people worldwide are infected with at least one type of intestinal worm.11
NEED OF THE STUDY:
India is a larger country with various forms of diversities. Current Indian population is 1.25 billion; of this 25% are children. Lack of knowledge on hygiene and malnutrition in general public has contributed largely to the failure of achievement of “health for all by 2000 A.D”. Even though under- five mortality has come down to 93, morbidity is on the rise mainly due to malnutrition which is the major cause for under 5 mortality.12
Worm infestation is common from 1-5 years of age when the child begins to lead a more independent life. The magnitude of parasitic infestation among children constitutes a major health problem in many parts of the world. It is estimated that 85% of the total incidence is due 5 to ineffective disposal of human excreta.
Intestinal parasitic infection (IPI) constitutes a global health problem. These parasites are estimated to affect approximately 3.5 billion persons worldwide and cause morbidity in 450 million, many of these 1 being children in developing countries.13
In world’s population 24% or more than 1.5 billion people are infected with soil-transmitted helminthic infections worldwide. Preschool-age children over 267 million and school-age children over 568 million live in areas where these parasites are intensively transmitted and are in need of interventions. In 2018, over 676 million school-aged children were treated with anti-helminthic medicines in endemic countries, corresponding to 53% of all children at risk.
In India, 225million preschool (3-6years) and school age (6-12 years) children are estimated to be at risk of worm infestations. India accounts for 65% of soil-transmitted helminthic (parasitic worms) cases at South East Asia and 27% of cases world-wide. In recent years, India has implemented national deworming programme, through which almost 250 million children are dewormed in February and August (twice a year).14
In Dakshina Kannada district ascariasis superseded all other helminthes with an incidence of 48.33% worm infestation is the most common problem in children due to its close association with health practices and sanitary conditions.15
Mothers are in the unique position of influencing their children growth and development. The practices that cultivate the childhood will follow up to tomb. So the mothers have to learn and practice and make the child too to follow hygienic habits. So, education to mother of under- five children plays a crucial role for the betterment of tomorrow. Keeping this in mind the research team has decided to conduct this study to create awareness among the mothers of under- five children regarding helminthic infestations.
STATEMENT OF THE PROBLEM:
“A study to assess the effectiveness of structured teaching programme on knowledge regarding helminthic infestations among the mothers of under- five children in a selected hospital, Bengaluru”.
OBJECTIVES:
1. To assess the existing knowledge regarding helminthic infestations among the mothers of under five children.
2. To evaluate the effectiveness of structured teaching programme on knowledge regarding helminthic infestation among the mothers of under- five children.
3. To determine the association between pre-test knowledge scores regarding helminthic infestations among the mothers of under five children with selected sample characteristics.
HYPOTHESIS:
· H1 -There will be a statistically significant increase in the level of knowledge following structured teaching programme regarding helminthic infestations among the mothers of under five children as measured by structured questionnaire at p<0.05 level.
· H2 - There will a statistically significant association between pre-test knowledge scores of mothers of under five children regarding helminthic infestations with selected sample characteristics at p<0.05 level.
MATERIALS AND METHODS:
Research approach: Quantitative evaluative approach was adopted for this study.
Research design: Pre experimental, one group pre-test post-test design was adopted.
Setting: For this study St. Philomena’s Hospital was selected. The samples were selected from selective wards as per the availability.
Population: Mothers of under- five children admitted in St. Philomena’s Hospital, Bangalore
Sampling Technique: Non-probability purposive sampling technique.
Sample Size: 30 mothers
Description of the tool:
Section I: Socio-demographic profile for mothers of under- five children consisted of age of mother ,religion ,educational status of mother ,occupation of mother ,dietary pattern of child ,place of residence, type of family ,monthly income of the family, do you deworm the child ; if yes, frequency of deworming the child and any previous source of information ; and if yes, source of information.
Section II: Structured knowledge questionnaire. It consists of 30 multiple choice questions. Out of which 5 questions assessed the general knowledge on helminthic infestations and the remaining 25 questions assessed the knowledge on each worm infestations. The maximum score was 30. The score interpretation was done as; good knowledge >75% (23-30 marks), average knowledge 50-75% (15-22 marks) and poor knowledge <50% (<14 marks).
Method of data collection:
A formal written permission was obtained from the Principal of St. Philomena’s College of Nursing and from the administrator of St. Philomena’s Hospital, Bengaluru. Samples were selected based on the inclusion and exclusion criteria. The researchers explained about purpose of the study, confidentiality was assured and written consent was obtained. Structured knowledge questionnaire was administered to assess the pre-test knowledge of mothers of under-five children regarding helminthic infestations. Structured teaching programme was administered to the mothers for about 1 hour on the same day. Post-test was conducted on the 2nd day after the teaching programme using the same structured knowledge questionnaire as samples would get discharged from hospital and it would be difficult to contact them for post-test. This decision was even taken to prevent sample attrition and finish the study within the allocated time frame. Collected data was coded, tabulated and analysed by descriptive (frequency, percentage, mean, mean difference and standard deviation) and inferential statistics (paired t- test and chi-square test).
RESULTS:
Section I: Related to socio- demographic variables of samples.
Table No.1: Distribution of samples according to socio-demographic variables of the mothers of under fivechildren (n = 30)
|
Sample Characteristics |
Frequency (f) |
Percentage (%) |
|
AGE IN YEARS <20 YRS |
0 |
0 |
|
20-30 YRS |
23 |
76.7 |
|
> 30 YRS |
7 |
23.3 |
|
RELIGION |
|
|
|
Hindu |
13 |
43.4 |
|
Christian |
12 |
40 |
|
Muslim |
5 |
16.6 |
|
EDUCATIONAL QUALIFICATION OF MOTHER |
|
|
|
Non formal education |
1 |
3.3 |
|
Primary school |
0 |
0 |
|
Middle school |
0 |
0 |
|
High school |
4 |
13.3 |
|
PUC/ +2 |
8 |
26.7 |
|
Diploma |
8 |
26.7 |
|
Graduate and above |
9 |
30 |
|
OCCUPATION OF MOTHER |
|
|
|
Government employee |
1 |
3.4 |
|
Private employee |
14 |
46.6 |
|
Self employed |
5 |
16.6 |
|
Unemployed |
10 |
33.4 |
|
DIETARY PATTERN |
|
|
|
Vegetarian |
5 |
16.6 |
|
Non- vegetarian |
25 |
83.4 |
|
PLACE OF RESIDENCE |
|
|
|
Urban |
19 |
63.3 |
|
Rural |
11 |
36.7 |
|
TYPE OF FAMILY |
|
|
|
Nuclear |
13 |
43.3 |
|
Joint |
16 |
53.4 |
|
Extended |
1 |
3.3 |
|
MONTHLY INCOME |
|
|
|
<10000 |
1 |
3.3 |
|
10000-15000 |
16 |
53.4 |
|
>15000 |
13 |
43.3 |
|
DO YOU DEWORM THE CHILD |
|
|
|
Yes |
9 |
30 |
|
No |
21 |
70 |
|
ANY PREVIOUS SOURCE INFORMATION |
|
|
|
Yes |
9 |
30 |
|
No |
21 |
70 |
The data represented in the table-1 shows that out of 30, mothers of under -five; majority 23(76.7%) were in the age group of 20-30 years. With regard to religion, majority 13(43.4%) samples were Hindus. 9 (30%) samples had educational qualification of graduation and above. 14(46.6%) samples were privately employed. Mostly 25(83.4%) of samples were non-vegetarians.19 (63.3%) samples resided in urban areas. Majority 16(53.4%) samples belonged to joint family. With regard to monthly income, 16(53.4%) samples had monthly income between Rs.10000-Rs.15000. 21(70%) samples did not deworm their children and 9(30%) samples dewormed their children. Out of 9 samples, 7(77.8%) dewormed their children once in every 6 months, 1(11.1%) sample each dewormed her child once a year and on doctor’s advice. With regard to any previous source of information, majority 21(70%) samples had had not obtained any previous information regarding helminthic infestations and 9(30%) had obtained information previously. Out of the 9 samples, 3(33.3%) each had attained information from relatives and friends and through health professionals, 1(11.2%) sample obtained information from electronic media and 2(22.2%) samples obtained information from educational programmes.
Section II: Distribution of mothers of under five children according to level of knowledge The data represented in the table-2 shows that out of 30 mothers of under- five children; in the pre-test, none had adequate knowledge, whereas 11 (36.6%) samples had moderate knowledge and 19(63.4%) of them had inadequate knowledge. In the post-test, 9(30%) samples had adequate knowledge, whereas 21 (70%) samples had moderate knowledge and none of them had inadequate knowledge.
Section III: Effectiveness of structured teaching programme on level of knowledge regarding helminthic infestations among mothers of under- five children
The data represented in the table-3 shows that the mean post- test knowledge (24) score was higher than the mean pre-test (12.5). The scores predicted the significant difference (11.5) at p<0.05 level. The calculated “t” value was (14.66) at p <0.05 level of significance, which indicated the significant difference in the level of knowledge before and after the implementation of structured teaching program. Hence it was concluded that there was a significant increase in knowledge of mothers of under- five children regarding helminthic infestation after the administration of structured teaching programme.
Section IV: Association between the pre-test knowledge scores of mothers of under- five children regarding helminthic infestations with socio-demographic variables:
Chi square value was calculated to find out the association between the pre-test knowledge scores of the mothers of under- five children (n=30) with socio - demographic variables. The findings revealed that there was no significant association between the pre-test knowledge scores of mothers of under- five children regarding helminthic infestation with socio-demographic variables i.e. age - χ2 value of 0.28 (df- 1, chi square value - 3.84 , p>0.05) , religion - χ2 value of 4.46 (df- 2, chi square value - 5.99 , p>0.05), educational status of mother - χ2 value of 2.07 (df- 1, chi square value - 3.84 , p>0.05), dietary pattern - χ2 value of 0.72 (df- 1, chi square value - 3.84 , p>0.05) ,place of residence - χ2 value of 2.79 (df- 1, chi square value - 3.84 , p>0.05) , monthly income- χ2 value of 0.08 (df- 1, chi square value - 3.84 , p>0.05) , and deworming the child - χ2 value of 1.35 (df- 1, chi square value - 3.84 , p>0.05) . There was significant association between the pre-test knowledge scores of mothers of under- five children regarding helminthic infestation with occupation of mother - χ2 value of 10.33 (df- 3, chi square value - 7.82, p<0.05), type of family - χ2 value of 6.18 (df- 1, chi square value - 3.84, p<0.05) and source of information - χ2 value of 3.93 (df- 1, chi square value - 3.84, p<0.05). Hence, it was concluded that among socio-demographic variables; occupation of mother, type of family and source of information had association with the pre-test knowledge scores of mothers of under- five children.
DISCUSSION:
In the pre-test, none had adequate knowledge, whereas 11 (36.6%) samples had moderate knowledge and 19(63.4%) of them had inadequate knowledge. In the post-test, 9(30%) samples had adequate knowledge, whereas 21 (70%) samples had moderate knowledge and none of them had inadequate knowledge. The mean post- test knowledge (24) score was higher than the mean pre-test (12.5).The scores predicted the significant difference (11.5) at p<0.05 level. The calculated “t” value was (14.66) at p <0.05 level of significance, which indicated the significant difference in the level of knowledge before and after the implementation of structured teaching program. , it was concluded that among socio-demographic variables; occupation of mother, type of family and source of information had association with the pre-test knowledge scores of mothers of under- five children. Hence it was concluded that structured teaching programme was effective in improving the knowledge of mothers of under- five children regarding helminthic infestations.
Table No.2: Comparison of pre-test and post-test knowledge scores of mothers of under- five children regarding helminthic infestation (n=30)
|
Knowledge level
|
Category |
Respondents |
|||
|
Pre-test knowledge scores |
Post-test knowledge scores |
||||
|
Frequency (f) |
Percentage (%) |
Frequency (f) |
Percentage (%) |
||
|
ADEQUATE |
>75% |
0 |
0 |
9 |
30 |
|
MODERATE |
50-75% |
11 |
36.6 |
21 |
70 |
|
INADEQUATE |
<50% |
19 |
63.4 |
0 |
0 |
|
TOTAL |
|
30 |
100 |
30 |
100 |
Table No.3: Mean, Standard Deviation, Mean Difference and Paired‘t’ - Test Scores (n=30)
|
Knowledge |
Maximum Scores |
Mean |
Standard Deviation |
Mean Difference |
Paired t-test |
Significance |
|
Pre- test |
30 |
12.5 |
3.88 |
11.5 |
14.66 |
Significant |
|
Post-test |
30 |
24 |
3.14 |
‘t ‘(df 29) =2.05, *Significant at 0.05 level of significance.
NURSING IMPLICATIONS:
The nursing implications are discussed under nursing practice, nursing education, nursing administration and nursing research.
Nursing practice:
This study provides awareness among mothers regarding helminthic infestations and motivates mothers of under - five children to practice all the measures to prevent helminthic infestations and to provide appropriate care at home.
Nursing education:
Even though helminthic infestations are already included in the present curriculum, nursing faculty can emphasize more on preventive aspects and home care management in detail.
Nursing administration:
· The nurse administrator should take active steps in organizing various educational programmes periodically in rural areas to train the mothers of under five children regarding preventive measures of helminthic infestations.
· The nurse administrator has a significant role in updating the knowledge of the staff nurses regarding helminthic infestations through in-service education programmes and there by staff nurses can impart the information to the mothers.
Nursing research:
· Extensive research studies can be undertaken in different population to quantify the magnitude of deficiency of knowledge regarding helminthic infestations.
· This study will be a motivation for budding researchers to conduct similar studies on a larger scale.
CONCLUSION:
From the findings of the study, it was concluded that the structured teaching programme regarding helminthic infestations was effective in improving the knowledge among the mothers of under- five children. Nursing students must be actively involved in conducting teaching programmes on larger scale to spread awareness.
ACKNOWLEDGEMENT:
Our special thanks go to the management of St. Philomena’s college and hospital for permitting us to conduct this study. We are thankful to all the participants of the study.
CONFLICT OF INTEREST:
The authors declare no conflict of interest.
REFERENCES:
1. Patel N. A Study to assess the effectiveness of planned teaching programme on the knowledge regarding prevention of Malnutrition among the mothers of under five children in selected urban area at Visnagar. Asian J. Nursing Education and Research. 2020; 10(4):529-531. Available from: https://ajner.com/HTMLPaper.aspx?Journal=Asian%20Journal%20of%20Nursing%20Education%20and%20Research;PID=2020-10-4-32
2. Kaur P, Cheema PK. To assess prevalence of malnutrition and its contributory factors among children aged 1-5 years in selected rural area of district Sangrur, Punjab. Int. J. of Advances in Nur. Management. 2018; 6(3): 175-178. Available from: https://ijanm.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Advances%20in%20Nursing%20Management;PID=2018-6-3-2
3. Nebhinani MR. Effectiveness of structured teaching programme on prevention of worm infestation among school children. RRJNHS. 2015; 1(3):29-33. Available from: http://www.rroij.com › open-access › effectiveness-of-stru...
4. S.N Praveen Kumar, K Ambika, Williams S. A study to assess the effectiveness of child-to-child teaching programme on prevention of hookworm infestation among school children in a selected rural government school in Mysuru District Karnataka. Asian J. Nursing Education and Research. 2018; 8(1): 69-72. Available from:https://ajner.com/HTMLPaper.aspx?Journal=Asian%20Journal%20of%20Nursing%20Education%20and%20Research;PID=2018-8-1-16
5. George AD, R Ram Anupama , Joy S, Simon S, Thomas S. Effectiveness of child to child approach and knowledge on personal hygiene among peer group students of selected upper primary school, Kollam. Int. J. Nur. Edu. and Research. 2018; 6(2): 207-209. Available from: https://ijneronline.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Nursing%20Education%20and%20Research;PID=2018-6-2-17
6. K Vasumathi. Comparative study on assessment of knowledge on prevention of worm infestation among urban and rural people in selected community areas, Coimbatore. Asian J. Nur. Edu. & Research.2011; 1(1): 09-11. Available from: https://ajner.com/AbstractView.aspx?PID=2011-1-1-4
7. S Lokesha, K Ambika, Williams S .a study to assess the nutritional status of preschool children (3-5 years) in selected rural anganawadis at Mysuru with a view to develop information booklet. Int. J. Adv. Nur. Management. 2017; 5(2):159-163. Available from: https://ijanm.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Advances%20in%20Nursing%20Management;PID=2017-5-2-13
8. V. Indra. A study to assess the knowledge of antenatal mothers on prevention of nutritional anaemia in selected hospital, Thrissur with a view to develop a self-instructional module. Int. J. Nur. Edu. and Research .2015; 3(2): 209-217. Available from: https://ijneronline.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Nursing%20Education%20and%20Research;PID=2015-3-2-21
9. Kavita, Rashmi. Prevalence of gastro-intestinal diseases among primary school children in a selected school of Jhajjar, Haryana. Int. J. of Advances in Nur. Management. 2020; 8(2):145-148. Available from:https://ijanm.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Advances%20in%20Nursing%20Management;PID=2020-8-2-9
10. Mulik MS, H Avinash. Salunkhe. Evaluate the effectiveness of planned teaching programe on knowledge regarding prevention of worm infestation. Int. J. Adv. Nur. Management.2014; 2(2): Page 82-85. Available from:https://ijanm.com/AbstractView.aspx?Journal=International%20Journal%20of%20Advances%20in%20Nursing%20Management&PID=2014-2-2-7
11. Yadav S, Kumar R, Singh SK. Effectiveness of planned teaching programme regarding worm infestation on knowledge among mothers of under-five children in rural area of Lucknow district. International Journal of Community Medicine and Public Health. 2021; 8(1): 267-272. Available from: https://www.ijcmph.com/index.php/ijcmph/article/viewFile/7249/4568
12. Patidar R. A study to evaluate the effectiveness of structured teaching programme on prevention of worm infestation among mothers of under-five children in selected rural area of Mehsana District, Gujarat. Int. J. Adv. Nur. Management. 2016; 4(4): 407-409. Available from:https://ijanm.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Advances%20in%20Nursing%20Management;PID=2016-4-4-19
13. Bashir N. A study to assess the effectiveness of planned teaching programme on knowledge regarding prevention of worm infestation among mothers of under-five children in selected hospital of Srinagar, Kashmir. Indian journal of applied research. 2019; 9(2):32-35. Available from: https://www.worldwidejournals.com/indian-journal-of-applied-research-(IJAR)/recent_issues_pdf/2019/February/February_2019_1548853494__73.pdf
14. Kalaivani E, G Ambujam. Comparative study to assess the knowledge on worm infestation among urban and rural mothers of school going children (3-12 yrs) at Karaikal district. Medico-legal Update.2020; 20(4): 273-277. Available from: http://ijop.net › index.php › mlu › article › view
15. Y Swarajyam. A study to assess the knowledge and practices of mothers regarding worm infestation among school age children (6-12 years) in order to develop health education pamphlet in a selected rural community, Bangalore. Asian J. Nur. Edu. & Research .2011; 1(1): Page 28-30. Availablefrom:https://ajner.com/HTMLPaper.aspx?Journal=Asian%20Journal%20of%20Nursing%20Education%20and%20Research;PID=2011-1-1-10
Received on 05.07.2021 Modified on 29.10.2021
Accepted on 05.01.2022 © A&V Publications all right reserved
Int. J. Nur. Edu. and Research. 2022; 10(1):30-36.
DOI: 10.52711/2454-2660.2022.00008