SAURASHTRA UNIVERSITY

RAJKOT,
GUJARAT

PERFOMA FOR REGISTRATION OF DISSERTATION

MR. VIMAL PRAKASH DAMOR

FIRST YEAR M.Sc. NURSING
CHILD HEALTH NURSING
YEAR 2016-2018

SHRI ANAND INSTITUTE OF NURSING

BEHIND SAINIK SOCIETY
OPP. GHANTESHWAR PARK
JAMNAGAR ROAD
RAJKOT
1 NAME OF THE CANDIDATE MR. VIMAL PRAKASH DOMAR
AND ADDRESS

SHRI ANAND INSTITUTE OF NURSING

BEHIND SAINIK SOCIETY
2 NAME OF THE INSTITUTE OPP. GHANTESHWAR PARK
JAMNAGAR ROAD
RAJKOT

3 COURSE OF THE STUDY 1ST YEAR M.Sc. NURSING

AND SUBJECT CHILD HEALTH NURSING

4 DATE OF ADMISSION

A STUDY TO ASSESS THE EFFECTIVENESS

OF THE STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE
5 TITLE OF STUDY REGARDING PREVENTION OF WORM
INFESTATION AMONG MOTHERS OF
UNDERFIVE CHILDREN IN SELECTED
RURAL AREAS AT RAJKOT.
INTRODUCTION

BACKGROUND OF THE STUDY

“Children are the wealth of tomorrow. Take care of them if you wish to have strong
India. Everyday to meet various challenges”

Jawaharlal Nehru

Children as the “Nations supremely important asset” to its family and society
child is precious gift which has a lot of potentials with one which can be the best resource
for the nation if developed and utilized well.Children below five years of age group are
known as the under fives. According to the 2001 census children in the group of 0 – 5
years constitute 12% of the total population that is nearly about 150 million children in
India. By virtue of this large number they are entitled to large share of health care.1

The under five children are vulnerable or special risk group in any population
deserving special health care because of their immaturity and the various stages of
growth and development. The under five children are more prone to acquire some
infection which is not seen in adult medical care through their life span.All children are
most vulnerable group in the society, certain disease affect them, and result in increased
morbidity and mortality rates. These diseases include diarrhea, vector borne diseases,
helminthic infestation, respiratory infections and injuries.2

The term parasite relates to “any living thing that lives on or in another living
organism”. Many parasites interfere with bodily function, cause irritation; some destroy
the host’s tissues and release toxin into the blood stream.3

WHO reported that the overall prevalence of parasites was 91% followed by
Ascariasis (5.28%), Ancylostoma duodenae (37.6%). Worm infestation is one of the most
common health problems encountered in developing countries especially among
underfive children. WHO recommended that prevalence rate need to be reduced by 10%
every year to improve the health economics of the developing countries. It is the
responsilbilities of the health care professional to fulfill the goal of the WHO4.

Helminthic infestation is a serious public health problem, especially in areas of

low environmental quality and people of low nutritional status. In the growing stage,
children are more susceptible to the ill effects of parasitic attacks, as their need for
nutrients as high. In young children physical and mental development may be affected
by malabsorption, blood and protein loss and diarrhea generated often by presence worms
in the gut. There is also the risk of complications. Many parasites interfere with the
process of intestinal absorption of Nutrients. Insensitivity of the parents to children’s
hygiene and the children’s frequent exposure to ova-laden soil emerged as important
factors in parasitic infestation. Children are mainly affected as they are playing in
heavily contaminated soil. The continuous presence of worms in marginally nourished
children can cause severe anemia and affect the growth of children5.

NEED FOR THE STUDY

Intestinal helminthic are a world wide problem especially among children of

developing countries. It is a common health problem in children. It is commonly in
tropical and sub-tropical areas. It occurs through the fecal-oral route. Children who are
affected with worm infestation may shows the sign and symptoms of weight lost, itching
at anal area, abdominal pain, diarrhea, anemia, sleeplessness, irritability and fever. It can
be prevented through proper health education regarding personal hygiene and
environmental sanitation.7

In 2010 annual report at the global prevalence regarding types of worm infestation
shows that 1.47 billion for ascariasis, 1.3 billion for trichurasis and 1.05 billion for hook
worm infestation and more than 25% of world population infected with Helminthics.
Prevalence rates of order of 50 – 75% have been registered in Asian countries. National
institute of cholera and enteric diseases.8
 An epidemiological study was conducted to identify the prevalence of intestinal
parasites and associated factors among 50 underfive children in Kashmir, India. The
study reported that 23(46.7%) had one (or) more parasites and prevalence of Ascariasis
was highest 17(28.4.%), and Taenia saginata was 10 (3.7%). The study recommended
that the prevalence rate can be reduced through proper impartment of knowledge
regarding preventive measures by the health care personnel to the mothers or care takers
of under-five children.9

A survey report stated Helminthic or worms that line as parasites in the human
body are a fundamental cause of disease associated with health and nutrition problems
beyond gastrointestinal tract disturbance. Globally, over 3.5 billion people are infected
with intestinal worms of which 1.15 billion are with round worm, 1.3 billion people.The
over all prevalence of worm infestation in India is about 50% in urban an 68% in rural
area.10

A community survey conducted to detect the incidence of worm infestation

among 100 preschooler children in Tumkur district, Karnataka. The survey report shows
that 68(68%) of children have infestation. The study revealed that it was mainly due to
the lack of knowledge of the mother and poor practices regarding health care.11

An analytical study was conducted to identify the sign and symptoms of worm
infestation related to protein and calorie intake among 80 children in Tnzania. The study
found that 11% percent of children with worm infestation were classified as showing
stunting, inadequate calorie intake observed in 78% of the population and proportion of
those with inadequate protein intake was 34%.12

A correlational study was conducted to identify the relationship between the

prevalence of under weight and worm infestation among 50 children in between the age
group of 2nd and 5th year of life in Poonamalle, Chennai. The study revealed that 50.3%
children were found stunted with higher prevalence of worm infestation in 2nd and 5th
year of life.12

A hypothetical study was conducted to identify the relationship between calorie

and protein intake with worm infestation in Maharashtra among 200 underfive children.
The study identified that inadequate daily caloric intake was observed in 78% of the
population and inadequate protein intake was 34% was especially the association
between Ascariasis lumbricoides and Trichuris trichura.13

A cross-sectional study was conducted to explained the complications of worm

infestation among 80 children affected with worm infestation in Beijing, Japan. The study
shows that complication such as intestinal obstruction, seasonal pneumonitis, anemia, and
some lesions in the skin, peritonitis, vaginitis, and pneumonia will arise due to various
types of worm infestation among affected children.14

A correlational study was conducted to identify the relationship between

helminthiasis and hygiene conditions of 20 school in Tkenne Nigeria. The study
concluded that burden of parasitic infestation and poor sanitary conditions are greater
public health importance, including deworming, health education and improvement of
conditions are recommended14

During the clinical posting the investigator found that many of the children were
affected with worm infestation and shows suffering with abdominal pain, vomiting,
diarrhea and malnutrition etc. There were the children were not able to maintain their
normal routine life. The mother play an important role in promoting the health of under
five children 14

STATEMENT

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF WORM
INFESTATIONS AMONG MOTHERS OF UNDER FIVE CHILDREN IN
SELECTED RURAL AREAS AT RAJKOT.
OPERATIONAL DEFINITIONS

Effectiveness:

In this study, effectivenss refers to the extent to which the structured teaching
programme on worm infestation among mother has achieved the desired effects in
terms of gain in post test knowledge scores.

Knowledge:

In this study, knowledge refers to the right response given by the mother to the
questions on worm infestation underfive children.

Structured Teaching Programme

It refers to a planned series of information to the group of people so as to help

them to learn something. In this study, it refers to a structured set of activities
implemented in sequence by researcher to spread the knowledge to the mothers regarding
prevention of worm infestation. It includes definition, types, causes, mode of
transmission, signs and symptoms, complication and prevention of worm infestation .It is
planning to teach the mother by using flash cards and charts for the period of 45 minutes.

Mothers with under five children

Mothers who are having children below 5 years of age who are living in selected
rural areas ,Rajkot.

Worm Infestation

The penetration and multiplication of the parasites into the alimentary tract.

Prevention

It is stopping something from happening.In this study,it refers to the action taken
to remove the possibility of worm infestation occurring in underfive children by creating
awareness to the mothers with underfive children regarding prevention of worm
infestation.
OBJECTIVES FOR THE STUDY

1. To assess the knowledge regarding prevention of worm infestation among

mothers of under five children .

2. To assess the effectiveness of structured teaching programme on

Knowledge regarding prevention of worm infestation among mothers of under
five children. .

3. To determine the association between pre-test knowledge score and selected

demographic variables.

HYPOTHESIS

1. There is a significant difference between pre test and post test mean knowledge
score on knowledge regarding prevention of worm infestation among mothers of
under five children.
2. Significant defense between post test with demographic variable.

ASSUMPTIONS

 Mothers with under five children may not be aware about preventive measures of
worm infestation.
 The structured teaching programme will enhance the knowledge of mothers with
under five children regarding prevention of worm infestation.

LIMITATIONS

 The study is to mothers who are willing to participate in the study.

 The study is limited to mothers of under five children
 The study is limited to mothers who know Gujarati
 The study is limited to mothers who are available during the study
 The study is limited to mothers who are residing in rural area.
REVIEW OF LITERATURE

Literature review refers to an extensive, exhaustive and systematic examination of

publication relevant to the research study.

Veerannan (2014) conducted a study to estimate rate of parasitic infestation in

relation to age, sex, diet, environmental hygiene and economic status around Madras city.

Baseline information was collected. Faeces samples of 348 persons were tested. The

study revealed 37 (10.62%) had Ascaris lumbricoids, 24(6.89%) had Aanchylostoma

duodenalle, 9(2.58%) has Enterobius vermicularis. Ascaris had the highest incidence

11(23.87%) in zero to ten years and Enterobius vermicularis 2(4.34%) in zero to ten

years. Ascaris lumbricoided was comparatively higher in females & in non-vegetarians.

The study revealed that provision of latrine would significantly lower the incidence of

intestinal parasites. Surprisingly the prevalence rate was higher among the members

using tap water than those who are using well water. The findings indicated that

economic status was also an important factor governing the prevalence of parasitic

infestation.

A study conducted in China 2014 to understand the infection status and risk

factors of soil transmitted nematodes by Kato-Katz technique and influencing factors

were surveyed by using a standardized questionnaire. A total of 1707 children were

examined with a soil transmitted nematode infection rate of 22.2%, the crowd infection

rates of Ascaris lumbricoides, hookworm and Trichuris trichiura were 16%, 3.8% and

6.6% respectively and 495 children were examined on Enterobius vermicularis eggs, with

the infection rate of 5.1%. The educational level of mother could reduce the probability

of infection (ME=-0.074), while the number of drinking unboiled water and raising
livestock and poultry could increase the probability of the infections (with ME of 0.028,-

0.112 and 0.080 respectively. Implementing the health education about parasitic diseases

in mothers would be of great significance for the prevention and control of soil

transmitted nematodiasis.

In the 27 Member States of European Union 2014, zoonotic parasites

transmitted by food are circulating with different prevalence according to the country, the

environmental conditions, the human behavior, and the socio-economic level. These food

borne parasites reach the human beings through the consumption of raw infected food

such as muscle tissues of different animal species and contaminated food and water

resources. As a general role , the control strategies should be based on the education of

the consumers, farmers and shepherds, the improvement of farming conditions, the

development of more sensitive methods to detect these parasites in slaughtered animals

and in food stuff and control of sewage sludge of drinking water resources.15

Study in d'Ivoire, Ivory Coast (2012) to assess the impact of improvement

measures for hygiene and water supply, installation of latrines and health education on

the incidence of ascaridiasis and ankylostomiasis with toddlers. The method used is the

comparison of children carrying parasites before and after intervention. The results show

a reduction of the rate of incidence for ascaridiasis by 75% and ankylostomiasis by 82%.

They demonstrate the importance of an appropriate evacuation of excreta, of an education

of mothers and of domestic hygiene in the process of prevention of children parasitosis.

A survey was conducted in rural zone of Cajamarca's Andean region, Peru to

determine knowledge, attitudes and practices about fascioliasis was administered to 62

mothers. Only 37% recognized the alicuya (local name for Fasciola hepatica) as the

parasite responsible for the disease; 56.5% knows that the disease affects the liver in the

humans and 85.5% knows affects also animals; 98.4% have a positive predisposition to

attend informative talks about the disease and 75.8% to support their authorities actively

to solve the problem.38.7% referred drinking emollients in the street, 75.6% have

domestic animals considered host for the parasite. In conclusion, attitudes of mothers are

mostly favourable for prevention and control activities, despite their mistaken knowledge

risky practices for fasciolasis among members of their families.

A survey was conducted in Kingston, Jamaica on 145 toddlers, 6-36 months of

age to measure the prevalence of parasitism. 34% had one or more parasites, particularly

Trichuris trichuria (21%) or Ascaris lumbricoides (63%). Peak prevalence of parasitism

was among the 30-36 month old children (63%).Among this group of toddlers 42% were

malnourished, most commonly (76%) in the 12-17 month age group. This is mainly

because of poor sanitation among Jamaican toddlers and lack of education among

mothers about worm infestation.16

Sharma, Gautam and Gupta (2010) conducted a study to assess the health and

welfare status and rights of toddlers of age 1-3 years in slums of Agra city. Baseline

information revealed that the health and living standards of children, socio-economic and

educational profiles were very low and mortality and morbidity was very high. Personal

hygiene was poor in 73%of children, nails were not trimmed in, 75% took bath

irregularly, in 85% teeth was dirty and showed poor personal hygiene was predisposing

to gastrointestinal and parasitic disorders.16

 A study conducted in Western Rajasthan, Jodhpur, India(2008) stated that

prompt and appropriate health seeking is critical in the management of childhood

illnesses. It explores in detail actions taken by 28 mothers when their children become

sick. Sixty-two in-depth interviews with mothers were conducted from four study

communities. The mothers were identified from a demographic surveillance system. The

interviews were tape-recorded, transcribed and thematically analyzed. The study shows

that mothers classify childhood illnesses into four main categories: a) not serious—

coughs, colds, diarrhea; b)serious but not life-threatening—malaria; c)sudden and

serious—pneumonia; and d)chronic and therefore not requiring immediate action—

malnutrition, tuberculosis, chronic coughs. This classification is reflected in the actions

taken and time it takes to act. Shops are used as the first source of healthcare, and when

the care moves out of the home, private health facilities are used more compared to

public health facilities, while even fewer mothers consult traditional healers. It was

concluded that there is a need to train mothers to recognize potentially life-threatening

conditions and to seek appropriate treatment promptly. Drug vendors should be involved

in intervention programs because they reach many mothers at the critical time of Seeking.

The global strategy for the control of soil-transmitted helminthiasis, based on

regular antihelminthic treatment, health education and improved sanitation standards, is

reviewed. The reasons for the development of a control strategy based on population

intervention rather than on individual treatment are explained. The evidence and

experience from control programme that created the basis for (i) the definition of the

intervention package, (ii) the identification of the groups at risk, (iii) the standardization

of the community diagnosis and (iv) the selection of the appropriate intervention for each
category in the community are discussed. The factors influencing the cost-benefits of

helminthes control are also considered. The recent progress on the control of soil-

transmitted helminthes infection is illustrated. Research needs are analyzed in relation to

the most recent perceptions from private-public partnerships involved in helminthes

control. The way forward for the control of soil-transmitted helminthes infection is

described as a multi-disease approach that goes beyond deworming and fosters a pro-poor

strategy that supports the aims of the Millennium Development Goals

Pre-school age children account for 10-20% of the 2 billion people worldwide

who are infected with soil-transmitted helminths (STHs): Ascaris lumbricoides

(roundworm), Trichuris trichiura (whipworm), and Ancylostoma duodenale/Necator

americanus (hookworms). Through a systematic review of the published literature and

using information collated at World Health Organization headquarters, this study

summarizes the available evidence to support the recommendation that pre-school

children should be included in regular deworming programme. The first section describes

the burden of STH disease in this age group, followed by a summary of how infection

impacts iron status, growth, vitamin A status, and cognitive development and how STHs

may exacerbate other high mortality infections. The second section explores the safety of

the drugs themselves, given alone or co-administered, drug efficacy, and the importance

of safe administration. The third section provides country-based evidence to demonstrate

improved health outcomes after STH treatment. The final section provides country

experiences in scaling up coverage of pre-school children by using other large scale

public health interventions, including vitamin A programme, immunization campaigns,

and Child Health days.

 A study of the prevalence and intensity of soil-transmitted helminthiasis

among pre-school children aged 0 to 7 years from an Orang Asli village resettlement

scheme in Gua Musang, Kelantan was undertaken. The overall prevalence of soil

transmitted helminthic (STH) infections was 56.0%. The predominant helminth found

was Ascaris lumbricoides while the commonest type of infection was a mixed infection

with Ascaris lumbricoides and Trichuris trichiura. The prevalence rates of Ascaris,

Trichuris and hookworm infections were 47.5%, 33.9% and 6.2% respectively. The

prevalence of helminthiasis (STH) shows an-age dependent relationship, with the lowest

prevalence in 0-< 1 year age group and highest in the 6-< 7 year age group. This study

shows children between age group of 1-5 years are also effected and needs special care.17

METHODOLOGY

Research Approach – An quantitative research approach.

Research design – One group pre-test and post-test design.

VARIABLE

Dependent Variable: Level of knowledge on prevention of worm infestation.

Independent Variable – STP on knowledge regarding prevention of worm infestation

Extraneous Variable – Age, Education, income, number of children, society

Setting - The study will be conduct in selected rural area at Rajkot.

Populations – All mothers of under five children

Sample size – N=50

INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria:

A. Study Children between five year of age

B. Study who are able to read and write Gujarati.

C. Study participants who are willing to participate in the study

Exclusion criteria:

A. Study participants who don’t know Guajarati.

B. Mother with critically ill under five children

Sample Technique – Non- probability convenient sampling technique.

TOOL FOR DATA COLLECTION

The following tools will be used by the researcher exclusively for this study

 Tool 1: Socio demographic Performa will be prepared by the investigator

 Tool 2: Structured knowledge Questionnaire on prevention of worm infestation
among underfive children will be prepared by the investigator.

METHOD OF COLLECTION OF DATA

Prior to data collection, permission will be obtained from the concerned

authority. After accepting the permission the following steps will be taken
up by the investigator:

Step1 – Researcher introduces herself and explain the purpose of the study
to the subjects.

Step2 – Administration of pretest knowledge questionnaire regarding

prevention of worm infestation.
 Step3 – Introduces structured teaching programme.

Step4- Administration of posttest knowledge questionnaire regarding

prevention of worm infestation.

PILOT STUDY

After getting validation of tools from experts, a pilot study will be conducted on
10 subjects meeting sampling criteria rural area at Rajkot . Data will be collected with
the help of structured questionnaire. Subjects selected for pilot study will be excluded in
main study

PLAN FOR DATA COLLECTION PROCEDURE

For data collection, I will first obtain the permission to conduct study. After
obtaining permission, I will meet the subject and establish rapport with them after
ensuring the physical comfort.

PLAN FOR DATA ANALYSIS

After obtaining data, It will be analyzed by using descriptive and inferential

statistics.

ETHICAL CLERANACE

Permission will be obtained from the research committee of the Shri Anand
institute of nursing.
REFERENCES

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Bhanot; 2005.

2. Montresor A, Crompton DWT, Hall A, Bundy DA, Savioli L. Guidelines for the
evaluation of soil-transmitted helminthiasis and schistosomiasis at a community level.
World Health Organization, Geneva: 1998. WHO/CTD/SIP/ 98.1.
3. Panwannda G. Effect of Health education programme on worm infestation in
schoolchildren, India:The nursing journal of india;2011.nov vol.cll no.11
4. www.healthnet.com/ worm infestation.
5. Awasthi S, Verma T, Kotecha PV, Venkatesh V, Joshi V, Roy S. Prevalence and risk
factors associated with worm infestation in pre-school children (6-23 months) in
selected blocks of Uttar Pradesh and Jharkhand, India. Indian Journal of Medical
Science 2008; 62:484-91.
6. Okyay p, Ertug S, Gultekin B, Onen O, Beser E. Intestinal parasites prevalence
and related factors in school children, a western city sample-Turkey, British medical
journal of Public Health 2004, 4:64.
7. Adefemi S. A, Mussa O.I, Intestinal Helminthes infestation among pupils in rural and
urban communities of Kwara States, Nigeria, African Journal of clinical and
experimental microbiology 2006 September; vol 11:3:208-211
8. Denise.F. Polit, PHD, Nursing Research,8th edition.pg 106-107
9. Vasumathi K ,Comparative Study on Assessment of Knowledge on Prevention of
Worm Infestation among Urban and Rural People in Selected Community Areas,
Coimbatore. Asian Journal of Nursing Education and Research. January-March 2011
Volume 01, Issue 01, pg-9
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Garha, Jabalpur. Journal of the Indian Medical Association :2000, 98(9):567, 570-1
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13. Nallam NR, Paul I, Gnanamani G. Anemia and hypoalbunemia as an adjunct to soil
transmitted helminthiasis among the slum school children in Visakhapatnam, south
India. South pacific Journal of Clinical Nutrition;1998:7(2);164-169
14. Asfaw S T, Goitom L, Malnutrition and enteric parasitosis among under five children
in Aynalem Village,Tigray, Ethopia Journal of health Development.2000;14(1):67-75
15. Veerannan,K.M.1997.”Intestinal Parasites of man around madras”.Indian Journal of
PublicHealth. 21(3) :157-164.
16. Sharma,D.S,Gautham,K.D. and Gupta,S.C.2014.”Assessment of the health and
welfare status and rights of children below 15 years in slums of Agra city”. Swasth
hind, 30(10):151-15218
17. Western rajasthan Social decision making and life skills development-a critical
thinking approach to health promotion in the middle school”,Journal Of School
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through Nursing
1 SIGNATURE OF CANDIDATE

MR. FRANCICE
GUIDE
ASSISTANT LECTURER,
NAME
2 CHILD HEALTH NURSING
DESIGNATION
SHRI ANAND INSTITUTE OF NURSING

SIGNATURE

REMARK OF GUIDE

MISS. RUPAL PATEL

ASSISTANT LECTURER,
3 CO-GUIDE
CHILD HEALTH NURSING
SHRI ANAND INSTITUTE OF NURSING

SIGNATURE

REMARK OF GUIDE

MR. SAM PRASAD

ASSOCIATE PROFESSOR,
4 HEAD OF DEPARTMENT
CHILD HEALTH NURSING
SHRI ANAND INSTITUTE OF NURSING

SIGNATURE

REMARKS OF THE
5
PRINCIPAL

SIGNATURE