INTRODUCTION:

Health is a dynamic state influenced by physical, environmental, and behavioral factors, requiring knowledge of bodily functions and healthy lifestyle habits. While physical ailments are easily recognized, many underlying causes of ill health, particularly during the monsoon season, stem from preventable communicable diseases. These diseases are especially prevalent in developing countries like India, where access to clean water and sanitation remains inadequate.¹

The monsoon season, though refreshing, significantly contributes to the spread of communicable diseases due to increased humidity, stagnant water, and poor sanitation. These conditions provide ideal breeding grounds for bacteria, viruses, and mosquitoes, leading to a spike in waterborne diseases such as diarrhea, typhoid, cholera, and hepatitis A, as well as mosquito-borne illnesses like malaria, dengue, and chikungunya.²

According to the World Health Organization (WHO), over 3.4 million people globally die each year due to waterborne diseases, with 1.2 million of them being children. In India alone, around 1 lakh people die annually due to such infections. The UN ranked India 120th among 122 countries in terms of water quality, and the World Bank estimates that 21% of communicable diseases in India are linked to unsafe water.³

Mosquito-borne diseases also pose a critical threat, with nearly 95% of India's population at risk for malaria and other vector-borne illnesses. WHO reports that Southeast Asia, particularly India, accounts for approximately 60% of global malaria cases. Despite recent progress, including a 17.6% decline in malaria cases in 2019, the burden on public health and economic stability remains considerable.⁴

Given this context, it is essential to promote preventive strategies, especially among vulnerable populations like children. School-based interventions, such as the Child-to-Child approach, can effectively enhance awareness and knowledge about monsoon diseases. Literature supports the role of peer-led education in improving health behaviors, making it a significant area of focus for community health nursing.

NEED FOR THE STUDY:

According to the National Centre for Disease Control (NCDC, 2022), it is crucial to provide timely awareness and education in preventing outbreaks of seasonal disease, especially in school setting, as disease transmission can be rapid. But also there is a significant gap existing in between awareness and preventive behavior among school-aged children regarding monsoon-related illnesses. The child to child approach has been demonstrated as an effective method for health education among children. On the basis of the study conducted by Kaur Ravirinden and Mal Hardeep, it is evident that child to child approach were helpful in improving knowledge and practice among school children. Applying this approach to monsoon disease prevention can enhance awareness, identify symptoms as early as possible, adopt preventive practices such as maintaining hygiene, avoiding mosquito breeding grounds and consuming safe drinking water.⁵

STATEMENT OF PROBLEM:

A study to assess the effectiveness of child-to-child approach on knowledge regarding selected monsoon diseases among school-age children in selected UP school, Kottayam.

OBJECTIVES:

· To assess pre-test and post-test knowledge regarding selected monsoon diseases among school-aged children.

· To determine the effect of child-to-child approach of education on knowledge regarding selected monsoon diseases among school-aged children.

· To find out the association between pre-test level of knowledge and selected demographic variables.

ASSUMPTIONS:

· The child to child approach is an effective method to enhance knowledge among school- age children.

· Children will understand the content delivered through peer education methods.

· School-age children are capable of learning and sharing health-related information with their peers.

· Peer teaching will improve the children’s knowledge about monsoon diseases and may contribute to better personal hygiene and disease preventive practice.

DELIMITATIONS:

The study is limited to:

· School-age children of age group (11–14 yrs.)

· Children who are present in the class during the time of study.

OPERATIONAL DEFINITION:

Child to child approach:

It refers to a participatory teaching method where selected school-age children are trained with health information related to monsoon disease and further they disseminate the knowledge to their peers.

Knowledge:

Knowledge refers to the awareness and the understanding of school-age children regarding selected monsoon diseases, including their cause, symptoms, mode of transmission, prevention, and management.

Monsoon Diseases:

Infections during monsoon season, which include selected mosquito-borne diseases (malaria, dengue), selected water-borne diseases (cholera, typhoid, diarrhea).

Effectiveness:

It refers to the degree of improvement in knowledge level about monsoon diseases among school-age children after implementation of child to child approach of education among as evidenced by a statistically significant increase in post-test knowledge score compared to pre-test score.

HYPOTHESIS:

All hypothesis will be tested at 0.05 level of significance.

H₁: There is a significant difference between pre-test and post-test knowledge scores among school-age children after the implementation of child to child approach of education on monsoon disease.

H₀₁: There is no significant difference between pre-test and post-test knowledge scores among school-age children after the implementation of child to child approach of education on monsoon disease .

H₂: There is a significant association between pre-test level of knowledge and selected demographic variables.

H₀₂: There is no significant association between pre-test level of knowledge and selected demographic variables.

METHODOLOGY:

Research design:

The research design is an overall plan and investigation used to obtain valid answer to a research question.

The research design of study is pre-experimental one group pre-test post -test design

Setting of study:

The setting of the study is St Mary's UP School, Kidangoor

Population:

In this study Population was children who are less than 13 years studying in class VII.

Sample:

Sample is the subset of the population that is selected to represent population in the study. In this study Sample is 35 high school students in a selected school of Kottayam District.

Sample size:

Sample size articulated for study include 35 students' in a class below 13 years of age in a selected school of Kottayam District and who met the inclusion and exclusion criteria.

Sampling technique:

In this study change agents are selected using purposive sampling and the Samples are selected by using purposive sampling technique.

Criteria for Sample selection:

Inclusion criteria: Students:

· who are willing to participate in the research study.

· both male and female students aged below 13 years.

Exclusion criteria: Students who:

· have any physical/mental disability.

· are not studying in the school.

· are absent or sick.

Method of Data Collection:

Instrument:

The instrument used for this study was structured knowledge questionnaire on selected monsoon diseases after thoroughly reviewing the literatures and articles pertaining to monsoon disease and its prevention.

Description of the tool:

Tool 1: It is divided into section A and B.

Section A: Socio demographic data

The questionnaire was prepared by the investigators and includes the baseline data such as age, class, type of Residence, occupation of the father and mother, type of the family, previous knowledge and source of information.

Section B: Structured knowledge questionnaire

The section B consists of 27 questions of multiple choice as per the blueprint to assess the knowledge of children's of selected UP School regarding selected monsoon diseases. The knowledge level of students will be assessed based on following scores.

Score Key: 0-9 poor knowledge, 10-18 average knowledge, 19-27 good knowledge.

ANALYSIS AND INTERPRETATION OF DATA:

Section A: Distribution of samples according to Demographic data:

This section deals with the distribution of samples according to the demographic variables such as age, family type, occupation of father and mother, residence, previous knowledge and source of information.

Table 1: Frequency and percentage distribution of sample according to demographic data. N=35

SI.

No.

Variables

Frequency

Percentage

Age (in years)

22.85%

65%

8.57%

2.85%

Family

Nuclear

Joint

extended

68.57%

31.42%

Occupation of father

Daily wages

Private job

Government job

Unemployed

20%

57.14%

11.42%

Occupation of mother

Daily wager

Private job

Government job

unemployed

8.57%

40%

8.57%

42.85%

Residence

Urban

Rural

Semi-urban

37.14%

31.42%

Previous Knowledge

Yes

65.7%

345.28%

Source of information

Television

Parents

School

Internet

20%

25.71%

5.71%

11.42%

Section B: Distribution of pretest and posttest level of knowledge

Test

Mean

Standard Deviation

t Value

Significance

Pre-test

Post-test

11.77

21.38

2.31

1.38

19.926

Significant

P <0.05

Hypothesis H1 is tested here. The above table reveals that a substantial increase in the mean knowledge (mean=11.77, SD =2.13) to the post test (mean= 21.38) following the implementation of child to child approach. The calculated T value of 19.926 is statistically significant at p<0.05. This indicates that there is significant difference between the pre test knowledge score regarding the selected monsoon diseases among school aged children. Hence the null hypothesis (H₀₁) rejected and research hypothesis accepted that is child to child approach is an effective teaching methodology to increase the knowledge of children.

Figure 1: Percentage distribution of mean percentage of pre-test post-test

DISCUSSION:

The present study was undertaken to assess the knowledge of students on monsoon diseases and its preventive measures. The discussion of the study is organized based on the objectives formulated.

1. Findings related to pre-test and post-test level of knowledge regarding selected monsoon diseases and its prevention:

Present study was conducted among students less than 14 years of age. In pre-test, 6(17.14%) students were having poor knowledge level, 29 (82.85%) were having average knowledge level and none of them having good level of knowledge. In post-test, 83 (94.28%) students were having good knowledge level, 2 (5.71%) were having average knowledge level and none of them belongs to the category of poor knowledge level . The meanpercentage of post-test knowledge was 83.25% which is higher than the mean percentage of pre-test knowledge which was 45.81%.

Similar finding is obtained in the study conducted in a selected school, in Coimbatore, by V. Roseline and L. Pramiladevi, among 90 samples to assess the effectiveness of child-to-child approach. The findings of the study shows that 24 (27%) students were having inadequate knowledge, 66 (73%) students were having moderately adequate knowledge and none of them were having adequate knowledge in pre-test. In post-test, 1 (1%) student was having Inadequate knowledge, 14 (15%) were having moderately adequate knowledge, and 75 (84%) students were having adequate knowledge. The mean percentage of posttest level of knowledge was 82.3%, which was greater than the mean percentage of pretest level knowledge, 43%. The above findings of the study supported present study findings.⁶ Also a supportive similar study was conducted at a selected school in Faridkot, Punjab by Paraminder K, among 100 samples to assess the level of knowledge regarding hand washing the study reported that there is a significant improvement in mean knowledge score from pretest (15.57) to posttest (28.205). The above findings of the studies supported present study findings.⁷

2. Findings related to association between demographic variables and pretest level of knowledge regarding selected monsoon diseases among school children:

The present study revealed that there is no significant association between pretest level of knowledge of students on selected monsoon diseases with demographic variables like, family type, occupational status of father and mother, residential area, previous knowledge and source of information. But, there is a significant association found between pretest level of knowledge of students on selected monsoon diseases with age distribution.

In contrast, a study conducted at St. Joseph’s UPS, Koonammavu, and St. Francis school, Pizhala, Kochi by D. Antony regarding the relationship between pretest level of knowledge and demographic variable showed a significant association between knowledge score and sex of the children.⁸

The present study was contraindicated by another study conducted by at higher secondary school, Dharapuram at Tamilnadu by B. Muneeshwari, in which there was no significant association between knowledge score when compared to age, sex, religion, family type, residential area and order of child in their family. However, significant association was found between knowledge score with their academic performance. The above findings of the study contrast present study findings.⁹

RESULT:

· Present study was conducted among students less than 14 years of age. In pre-test, 6 (17.14%) students were having poor knowledge, 29 (82.85%) were having average knowledge and none of them having good knowledge. In post-test, 83 (94.28%) students were having good knowledge, 2 (5.71%) were having average knowledge and none of them having poor knowledge. The mean percentage of post-test level of knowledge was 83.25% which is higher than the mean percentage of pre-test level of knowledge which was 45.81%. This indicates that child to child approach was effective as the paired t value (t= 19.926; p < 0.05) was significant at 0.05 level of significance and helps to increase the knowledge of selected monsoon diseases among school age children.

· There is no significant association between pre-test level of knowledge of students on selected monsoon diseases with demographic variables, family type, occupational status of father and mother, residential area, previous knowledge and source of information. But, there is a significant association found between pre-test level of knowledge of students on selected monsoon diseases with age distribution.

NURSING IMPLICATION:

Nursing education:

The studies support the inclusion of child to child approach as an effective teaching method of nursing curriculum. Encourages nursing students to engage in evidence-based research projects involving innovative community approaches. Enhances critical thinking, problem-solving, and data analysis skills through small-scale school-based studies.

Nursing Research:

The study provides research-based evidence supporting the effectiveness of the child-to-child approach as a health education. The study highlights the role of innovative, child-centered teaching methods in improving health knowledge. Nursing researchers can use these findings to develop new models for community health education. Promotes active involvement of children in the research process, aligning with participatory research principles.

Nursing Practice:

Encourages practicing nurses to adopt community-friendly, peer-led methods to reach wider audiences through school children. Promotes early disease prevention and health promotion at the grassroots level. By training children, nurses indirectly extend their reach to families and communities through child-to-child and child-to-family knowledge sharing. Nurses can implement the child-to-child approach to effectively promote awareness about monsoon-related diseases.

CONCLUSION:

The aim of the study was to assess the effectiveness of child-to-child approach on knowledge regarding selected monsoon diseases among school children. Pre-test result shows that among 35 samples, 6 (17.14%) students were having poor knowledge, 29 (82.85%) were having average knowledge and none of them having good knowledge. In post-test, 33 (94.28%) were having good knowledge, 2 (5.71%) were having average knowledge and none of them having poor knowledge. The mean percentage of posttest level of knowledge was (BB-25%) which is higher than the mean percentage of pretest level of knowledge was 45.81%. (T value = 19.926, table value = 1.691, P< 0.05). Also there is no association between pretest level of knowledge on selected monsoon diseases with demographic variables except for age distribution.

The findings of the study clearly indicate that the child to child approach is a highly effective educational method in enhancing the knowledge and awareness among school children regarding monsoon diseases and its prevention. it also builds in children a sense of responsibility, teamwork and instill leadership qualities too. The method paves path for the healthy environment and healthy generations.

LIMITATIONS:

The study is limited to:

● school age children of age group 11-14 years.

● children who are present in the class during the time of the study.

● students in the selected school only.

● Small number of 35 samples.

RECOMMENDATIONS:

● A similar study can be conducted by including a control group of children who do not receive the child to child intervention to compare outcome and assess true effectiveness

● A similar study can be conducted with a larger sample so that findings can be generalized.

● A similar study can be conducted by assessing behavioural changes through the checklist along with knowledge.

REFERENCE:

1. Muthumari, et al. Effectiveness of planned teaching programme on knowledge regarding prevention of selected water borne diseases among the mothers of under five children. TNNMC J Community Health Nursing. 2025; 13(1): 18–22.

2. Arya A, et al. Knowledge regarding water borne diseases and its prevention. Asian Journal of Nursing Education and Research. 2019; 9(4): 501–3.

3. Devi, LD. Knowledge regarding selected mosquito borne disease and its prevention. Asian Journal of Nursing Education and Research. 2022; 12(4): 409–12.

4. Sharma AK, Bhasin S, Chatuvedi S. Predictors of knowledge about malaria in India. J Vector Borne Dis. 2007; 44:188–91.

5. National Centre for Disease Control. Guidelines on prevention and control of vector-borne diseases. Ministry of Health and Family Welfare, Government of India; 2022.

6. Roseline V, Parmeeladevi L. A study to evaluate the effectiveness of child-to-child approach on prevention of dengue fever in terms of knowledge and practice among school children. J Med Res Dev. 2017; 9(3): 51–7.

7. Parminder K, et al. A study to assess the effectiveness of child-to-child approach on knowledge and practices regarding handwashing among primary school children. Int J Nurs Educ. 2019; 11(4): 61–6.

8. Antony D, et al. Effectiveness of structured teaching programme on knowledge regarding food and waterborne diseases among school children. Int J NursEduc Res – Indian J Public Health Res Dev. 2018; 9(4): 166–70.

9. Munneswari B. A study to assess the effectiveness of planned health teaching programme using child-to-child approach on knowledge regarding selected first aid measures. Glob J Med Public Health. 2014; 3(1): 18–24.

Received on 27.08.2025 Revised on 01.10.2025

Accepted on 03.11.2025 Published on 23.02.2026

Available online from February 25, 2026

Int. J. Nursing Education and Research. 2026;14(1):57-62.

DOI: 10.52711/2454-2660.2026.00012

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