“A STUDY TO ASSESS THE EFFECTIVENESS OF STEAM INHALATION WITH

EUCALYPTUS OIL ON ACUTE UPPER RESPIRATORY TRACT

INFECTION AMONG HIGHER PRIMARY SCHOOL
CHILDREN IN SELECTED AREA
OF RAICHUR”

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

K. SHARON EVANGELIN

NAVODAYA COLLEGE OF NURSING RAICHUR,

DECEMBER -2011
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. Name of the candidate : Ms. K. Sharon Evangelin

and address M.Sc Nursing 1st Year,
Navodaya College of Nursing
Mantralayam Road,
Raichur – 584103.

2. Name of the Institution : Navodaya College of Nursing,

Raichur

3. Course of study : M.Sc Nursing 1st Year

and subject Child Health Nursing

4. Date of admission into : 29/07/2011

the course

5. Title of the Topic:

“A study to assess the effectiveness of steam inhalation with

eucalyptus oil on acute upper respiratory tract
infection among higher primary school
children in selected area
of Raichur.”
 6. BRIEF RESUME OF THE STUDY

"There is no trust more sacred than the one the world holds with children. There is
no duty more important than ensuring that their rights are respected, that their
welfare is protected, that their lives are free from fear and want and that they can

growup in peace.”
-- Kofi Annan

6.1 NEED FOR THE STUDY

Infections of respiratory tract are among the most common of human ailments. They
are substantial cause of increased morbidity and mortality rates in young children in India.
Upper respiratory tract infection (URI) is a nonspecific term used to describe acute infections

involving the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi.1

Most often, viral respiratory tract infections spread when children’s hands come into
contact with secretions from the nose of an infected person. These secretions contain viruses.
When children touch their mouth, nose, or eyes, the viruses enter into the upper respiratory
tract and produce a new infection. Less commonly, these infections spread when children
breathe air containing droplets that are coughed or sneezed out by an infected person.
Children transmit these infections more readily because the nasal or respiratory secretions
from children with viral respiratory tract infections contain more viruses than those from
infected adults. The increased output of viruses, along with typical lesser attention to hygiene,
makes children more likely to spread their infection to others. The possibility of transmission
is further enhanced when many children are gathered together or live in overcrowded areas,
such as in child care centers, schools and overcrowded neighbourhood.6

Acute respiratory tract infections cause 4.5 million deaths among school age children
every year, the overwhelming majority occurring in developing countries. 3 Pneumonia
unassociated with measles causes 70per-cent of these deaths; post-measles pneumonia, 15per-
cent; pertussis, 10per-cent; and bronchiolitis and croup syndromes, 5per-cent. Both bacterial
and viral pathogens are responsible for these deaths. The most important bacterial agents are
Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. The data on
bacterial etiology of pneumonia during the first 3 months of life are limited, and almost no
information on the role of chlamydia and pertussis in this age period is available. The
distribution of viral pathogens in developing countries can be summarized as follows:
respiratory syncytial virus, 15-20per-cent; parainfluenza viruses, 7-10per-cent; and influenza
A and B viruses and adenovirus, 2-4per cent. Mixed viral and bacterial infections occur
frequently.4

The WHO report, indicates that specific mortality rate due to acute respiratory tract
infection is 10-15 times higher in developing countries than developed countries. Every year
acute respiratory tract infections in young children is responsible for an estimated 4.1 million
deaths worldwide. In India acute respiratory tract infections contribute a major public health
problem and is the most important contributory to mortality and morbidity in young children
especially schoolers who attend school, accounting for 15-34per-cent of all childhood
deaths.2

India accounted for 28per-cent of mortality and 30per cent of disability adjusted life
years lost due to acute respiratory tract infections as stated in WHO world health report. In all
South Indian states, the morbidity rate is 40-49per-cent due to respiratory tract infection in
school age children. In Karnataka, 74 per-cent of school age children suffer from fever,
cough, cold etc. Raichur is situated in Northern part of Karnataka. The incidence rate of acute
upper respiratory tract infections 45.95per-cent among school age children in Raichur.5

School children who attend school are large reservoirs for ARIs and they transfer
infection other children and to those who care for them. They have about 3-8 viral respiratory
illnesses per year. Common cold is the leading cause of morbidity. Risk factors that increase
the incidence and severity of upper respiratory infection in developing countries include large
family size, lateness in the birth order, crowding, low birth weight, malnutrition, vitamin A
deficiency, lack of breast feeding, pollution, and young age. Effective interventions for
prevention and medical case management are urgently needed to save the lives of many
children predisposed to severe disease.3

Acute respiratory tract infection most commonly occur during infancy till school age
of life. The delay in receiving medical care is considered to be an important reason for the
high mortality related to acute respiratory tract infections in the developing countries. Far
distance of the hospital was the main reason for not receiving treatment, followed by
ignorance, family problems, etc. These reasons may force the parents to seek treatment from
other alternate sources. The rural medical practitioners are often not institutionally qualified
and hence are frequently not able to select and use appropriate antibiotics in adequate dosage
for proper duration for the treatment of acute respiratory tract infection, making, the outcome
unfavourable in many children.6

The Eucalyptus globules is a tree indigenous to Australia. Oil is extracted from

eucalyptus leaves by aqueous distillation. It is a colourless or straw coloured liquid substance
with characteristic odour, taste and is soluble in its own weight of alcohol. Probably the most
powerful antiseptic of its class, Eucalyptus oil has decided disinfectant action.7

Eucalyptus is used in many medicines to treat coughs and the common cold. It can be
found in many lozenges, cough syrups, rubs, and vapour baths throughout the United States
and Europe. Herbalists often recommend using fresh leaves in teas and gargles to soothe sore
throats and treat bronchitis and sinusitis. Ointments containing eucalyptus are also applied to
the nose and chest to relieve congestion. Eucalyptus oil helps loosen phlegm, so many people
inhale eucalyptus steam to help treat bronchitis, coughs, and the flu.7

The most important constituent of Eucalyptus oil is eucalyptol. Two of the major
effects of eucalyptus are its role in balancing and stimulation. Its middle note aroma,
reminiscent of camphorus or woody scents make it an important ingredient as a nasal
inhalant. Eucalyptus has many medicinal properties, including analgesics, anti inflammatory,
antiseptic, antiviral and stimulant. Inhalation of vapour is safe, historical usage employed the
method of breathing vapour over bowl of hot water containing a few drops of eucalyptus oil
with a towel tent over the head. This gives a simple, low cost home delivery system of
vapour.8

The illnesses caused by an acute respiratory infection includes: tonsillitis,

pharyngitis, laryngitis, sinusitis, otitis media. As the incidence of respiratory illness is quite
appreciable among school children in Raichur, the Investigator felt the need to assess the
effectiveness of steam inhalation with eucalyptus oil as home based remedy for school
children on symptoms of acute upper respiratory infection.

REVIEW OF LITERATURE

A review of literature on the research topic makes the researcher familiar with the
existing studies and provides information which helps to focus on a particular problem, lays a
foundation upon which to base new knowledge. It creates accurate picture of the information
found on the subjects.

A randomized experimental study was conducted by Department of Paediatrics,

University of Virginia Health Sciences to examine the effect of inhalation of hot humidified
air containing 1-8 Cineole on rhinovirus infection. 1-8 Cineole is a major component of
eucalyptus oil. A sample of 40 subjects were randomly assigned into two
groups(experimental and control). The data was collected by structured questionnaire
method. The results reported that 60per cent of subjects who were given inhalation therapy of
hot humidified air containing 1-8 Cineole for 2 days had reduced symptoms of respiratory
infections to 82per-cent than the control group. The results concluded that inhalation of hot
humidified air containing 1-8 Cineole can be used as a therapeutic intervention in reducing
symptoms of respiratory infection.9

An experimental study was conducted to test the effect of inhalation therapy with
diluted eucalyptus oil as specific intervention for reducing symptoms of acute respiratory
infection by ENT Department, Israel. A sample of 20 school age children having symptoms
were selected purposively and were given inhalation therapy with diluted eucalyptus oil. Data
was collected by structured questionnaire method and the intervention was given for 3days,
thrice a day. The results has shown that about 74.62per-cent of the symptoms were reduced.
The study concluded that inhalation of hot humidified air with eucalyptus oil is effective in
reducing symptoms of respiratory tract infections.10

A comparative study was conducted to determine the effectiveness of steam inhalation

therapy with eucalyptus oil and steam inhalation with normal saline upon symptoms of
respiratory tract infection in Bhilai, Madhya Pradesh. A sample of 40 school age children
having symptoms of respiratory infection were randomly assigned into two groups(one with
eucalyptus and the other with normal saline). Data was collected by CARIF Scale. ANOVA
test was used for analysis and the results reported that the subjects who received steam
inhalation with eucalyptus oil had shown 69 per-cent reduction in the symptoms of
respiratory tract infection. The researcher concluded that steam inhalation with eucalyptus oil
decreases the symptoms of respiratory tract infections.11

A cross sectional study was conducted to test the efficacy of a specific intervention for
reducing symptoms of bronchitis in Melbourne, Australia. A sample of 10 school age children
having symptoms were selected purposively and were given inhalation therapy of hot
humidified air containing blue gum oil (eucalyptus oil). Data was collected by structured
questionnaire method and the intervention was given for 3days, thrice a day. The results has
shown that about 75per-cent of the symptoms were reduced. The researcher concluded that
inhalation of hot humidified air with blue gum (eucalyptus) oil is effective in reducing
symptoms of respiratory tract infections.12

An experimental study was conducted on effectiveness of home based steam

inhalation with Eucalyptus oil on common cold and cough in Pune, Western India. A total of
30 school aged children with the symptoms were selected randomly and the intervention was
given thrice a day for four days. The data was collected through structured interview schedule
and analysed by Chi-square test. The study shown that the subjects reported about 60per-cent
of reduction in the degree of cold. This study support the use of steam inhalation with
eucalyptus oil as a therapeutic intervention.13

A quasi experimental study was conducted to study the effectiveness of steam

inhalation with Eucalyptus oil on common cold and cough by Institute of Internal Medicine at
Madras Medical College, Chennai. A sample of 30 children were divided into experimental
and control group. Data was collected through structured interview schedule. Intervention
was given to the experimental group for 3days twice a day and the assessment of the scores
of cold and cough symptoms was done by using CARIF scale. Data analysis was done and
the results showed that the symptoms were reduced to 65.9 per-cent. Hence the researcher
concluded that steam inhalation with eucalyptus oil reduces symptoms of upper respiratory
tract infection.14
6.3 STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of steam inhalation with eucalyptus oil on acute
upper respiratory tract infection among higher primary school children in selected area
of Raichur.”

6.4 OBJECTIVES OF THE STUDY

1. To determine the degree of acute upper respiratory tract infection among higher primary
school children.

2. To assess the effectiveness of steam inhalation with eucalyptus oil on acute upper
respiratory infection among higher primary school children.

3. To identify the association between post intervention degree of acute upper respiratory
tract infection with socio-demographic variables.

6.5 OPERATIONAL DEFINITIONS

Effectiveness : It determines the extent to which the steam inhalation with Eucalyptus oil has
achieved the desired effect in reducing the symptoms of acute upper respiratory tract
infection.

Steam inhalation : It refers to the inhalation of warm, moist air into the mucous membranes
of nose and respiratory tract. In the present study steam inhalation will be given with
eucalyptus oil.

Eucalyptus oil : It refers to an essential oil derived from leaves of Eucalyptus tree. For the
present study 2 drops of eucalyptus oil will be added in750ml of hot water for steam
inhalation therapy.

Acute upper respiratory tract infection : It refers to the infection in the upper respiratory
tract characterized by cough, sore throat, runny nose, nasal congestion, headache, low grade
fever, facial pressure and sneezing.
 Acute upper respiratory tract infection will be categorized into mild, moderate and
severe degree of infection based on scores of CARIF Scale. For the present study higher
primary school children with moderate degree of infection will selected as sample.

Higher primary school children : It refers to the children who fall under the age group of 9
to 12 years living in selected area of Raichur.

6.6 HYPOTHESIS

On the basis of the objectives, the following hypothesis have been formulated.

H1: There will be a significant difference between the degree of acute upper respiratory tract
infection before and after implementation of steam inhalation with eucalyptus oil.

H2 : There will be a significant association between the post intervention degree of acute
upper respiratory tract infection with selected socio-demographic variables.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA :

Design

One group pre test and post test pre experimental design is adopted for the present
study.

O1 X O2

Setting of the study

Research setting refers to the physical location and condition in which the data
collection takes place.

The study will be conducted in selected area of Raichur. It is one of the backward
district situated in northern Karnataka having an area of 14,013sq.km. It consists of 5towns
and 300villages. The total population in Raichur is 2,32,456 according to the censes of 2011.
By using convenient sampling technique, Manik Nagar area is selected for the study.

Population

The Population included in this study are:

Higher primary school children of age 9 to 12 years having acute upper respiratory tract
infection residing in the selected area of Raichur.

Sample Size

Sample for the present study consists of 40 higher primary school children with acute
upper respiratory tract infection in the selected area of Raichur.

Sampling technique

Sample refers to the study process of selecting a portion of the population to represent
the entire population

Convenient sampling technique will be used to select the area and purposive sampling
technique will be used to select the sample.

Inclusion criteria

The study includes the higher primary school children who are

 available at the time of study

 having moderate degree of acute upper respiratory tract infection(score between 14-
28) according to CARIF Scale

 willing to participate in the study

 in the age group of 9 to 12 living in selected area of Raichur

Exclusion Criteria

The study excludes the higher primary school children who are

 not available at the time of study

 having mild or severe acute upper respiratory tract infection

 not willing to participate in the study

  not in the age group of 9 to 12 and not living in selected area of Raichur

Selected variables

Variables included in the present study are

Dependent variable: The variable hypothesized to depend on or be caused by another

variable (independent variable); the outcome variable of interest

In the present study, acute upper respiratory tract infection among higher primary school
children is the dependent variable.

Independent variable: The variable that is believed to cause or influence the dependent
variable.

In the present study, steam inhalation with eucalyptus oil is independent variable.

Extraneous variables

a) Age: It refers to the chronological age of the higher primary school children. For the
present study age is categorized as

i. 9 – 10 years

ii. 10 – 11 years

iii. 11 – 12years

b) Religion : It refers to the system of faith of worship, the higher primary school children
follows. For the present study the religion is categorized as

i. Hindu

ii. Muslim

iii. Christian

iv. Others
 c) Education of parents : It refers to educational status of the parents. It is
categorized as

Serial no Educational status Father Mother

i. Illiterate

ii. Primary education

iii. Secondary education

iv. Graduation and

higher

d) Type of family : It is categorized as

i. Nuclear family

ii. Joint family

e) Ventilation of the house : It is categorized as

i. Well ventilated

ii. Inadequate ventilation

f) Family income : It refers to the monthly income of the family

i. Rs 2000-3000/-

ii. Rs 3001-4000/-

iii. Rs 4001-5000/-

iv. Rs 5000 and above

g) Any previous history of respiratory illness

 Yes

 No

If yes, specify-

h) Any family history of respiratory illness

  Yes

 No

If yes, specify-

i) Immunization:

S.No Name of the vaccine Given Not given

1 BCG

2 OPV

3 DPT

4 Measles

5 Tetanus toxoid

j) Source of information

i. Parents

ii. Friends

iii. Relatives

iv. Mass media

v. Neighbours

vi. Health care professional

7.2 METHOD OF DATA COLLECTION

Data collection instrument

 Data collection is the gathering of information from the sample. Data collection will
be done through structured interview schedule. It consists of 2 parts

Part-1 – deals with socio demographic information

Part-2 – deals with assessment of degree of acute upper respiratory tract infection with
modified CARIF scale

CARIF Scale consists of 14 items denoting the symptoms of acute upper respiratory tract
infection, each answered on a 4 point ordinal scale (0 indicates no problem, 1 indicates
minor problem, 2 indicates moderate problem and 3 indicates major problem). The score will
be calculated as the sum of the 14 items. The scores will be divided into:

Mild degree of infection – 1-14

Moderate degree of infection – 15-28

Severe degree of infection – 29-42

Data collection method

After obtaining prior permission from the concerned authorities and consent from the
parents and participants, the sample will be assessed.

Data collection will be carried in 3 phases;

1st phase:- pre-interventional assessment will be done to assess the degree of acute upper
respiratory tract infection by using modified CARIF Scale.

2nd phase:- After that, the Investigator implements the intervention i.e, steam inhalation
therapy with 2 drops of eucalyptus oil added in 750ml of hot water of 70`c given for 5 mins
for 4days, twice a day.

3rd phase:- Post-interventional assessment will be done on the 5 th day, to reassess the degree
of respiratory infection using same modified CARIF Scale to evaluate the effectiveness of the
intervention.

7.3 PLAN FOR DATA ANALYSIS

 Data analysis is the systematic organization and synthesis of research data, the testing
of the research data and the testing of research hypothesis by using the obtained data. It is
planned to analyse and interpret data with the help of descriptive and inferential statistics.
The following methods are planned to analyse the data

 Descriptive statistics like frequencies and percentages will be used to describe sample
characteristics.

 Mean, standard deviation and paired ‘t’ test will be used to evaluate the effectiveness
of steam inhalation therapy with eucalyptus oil

 Chi square test values will be used to find the relationship between the post
intervention degree of acute upper respiratory tract infection among higher primary
school children with the selected demographic variables.

7.4 PROJECTED OUTCOME

The results of the study throws a light on effectiveness of steam inhalation therapy with
eucalyptus oil on acute upper respiratory tract infection among school children. It helps
the future researchers to adopt other innovative strategies to reduce morbidity rate due
to acute respiratory tract infection among school aged children.

7.5 DOES THE STUDY REQUIRE ANY INVESTIGATOR OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMAN OR ANIMALS ? IF SO PLEASE DESCRIBE BRIEFLY

Yes, the study requires the intervention in the form of steam inhalation with
Eucalyptus oil on acute upper respiratory tract infection.

7.6 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.5?

Permission will be obtained from the Institutional Ethical Committee, Navodaya

Education Trust, Raichur.

Permission will be obtained from the Research Committee of Navodaya College of

Nursing, Raichur
Permission will be obtained from the authorities of the selected area of Raichur.

Consent will be obtained from the participants and their parents.

8. LIST OF REFERENCES

1. Cotton M, Innes S, Jaspan H, Madide A, Rabie H. Paediatric Infectious Diseases Unit,

Department of Paediatrics and Child Health, Stellenbosch University.

2. WHO/UNICEF estimates of repiratory disease incidence and mortality rates in Indian

Children, Geneva, World Health Organization,
2011(www.who.int/immunization_monitoring/data/en/).

3. Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. Survey: 2006 Summary. Hyattsville,
MD: National Center for Health Statistics; 2008. National health statistics reports.

4. CDC. Influenza: The Disease. Centers for Disease Control and Prevention.
Available at http://www.cdc.gov/flu/about/disease/index.htm. Accessed April 30, 2009.

5. Statistics of respiratory infections. National Family health Survey for Karnataka-2010-

2011.(indiastat.com)

6. Gupta N and Jain SK. An Evaluation of Acute Respiratory infection control programmes in
a Delhi Slum. Indian Journal of Paediatrics, 2007:74 (5):471-6.

7. Dr. Kenneth R. The Best Alternative Medicine, Part I: Naturopathic Medicine. New York:
Simon and Schuster, 2002.

8. Sadlon AE, Lamson DW. Immune-modifying and antimicrobial effects of Eucalyptus oil
and simple inhalation devices.Altern Med Rev. 2010 Apr;15(1):33-47. Review.

9. Hendley JO, Abbott RD, Beasley PP, Gwaltney JM Jr. Department of Pediatrics,
University of Virginia Health Sciences Center, Charlottesville 22908, 1994 Apr
13;271(14):1112-3.

10. Rakover Y, Ben-Arye E, Goldstein LH. ENT Department, Ha'Emek Medical Center,
Afula, The Bruce Rappaport Faculty of Medicine, The Technion, Israel Institute of
Technology, Haifa, Israel. rakover@clalit.org.il, 2008 Oct;147(10):783-8, 838.

11. Maitreyi RS, Broor S, Kabra SK, Ghosh M, Seth P, Dar L, Prasad AK. Comparative study
on steam inhalation with normal saline and eucalyptus oil, Bhilai, Madhya Pradesh. Indian
journal of Pediatrics. 2002 Apr; 47.
12. Marty Sampson. Kevin NE. Department of Internal Medicine, Survey on Blue Gum Tree.
Melbourne, Australia: 2000 Oct; 52.

13. Yoelekar LR, Damle RG. Kamat AN, Khude MR, Simha V, Pandit AN. Home based
remedy for acute respiratory infection in Pune, Western India. Indian Journal of Paediatrics.
2008 Apr; 75(4).

14. Puvanalingam A, Rajendiran C, Subramanian K et al. inhalation of steam with medicated

oils. Institute of Internal Medicine, Madras Medical College, Channai-2005 Jan;59:14-6,18.

15. B Jacobs et.al, Canadian Acute Respiratory infection and Flu scale, Journal of Clinical
Epidemiology 53(2000) 793-799.

16. Polit DF and Hungler BP. Nursing Research Principles and Methods, Philadelphia, J.B.
Lippincott Company 1999; 320.
9. Signature of the Candidate :

10. Remarks of the Guide :

11. Name and Designation of the : Mrs. Shameem Gulnaz Unissa

Guide Associate Professor & HOD

Dept. Child Health Nursing

Navodaya College of Nursing

Raichur.

11.1 Signature :

11.2 Co-guide(if any) :

11.3 Signature :

11.4 Head of the department : Mrs. Shameem Gulnaz Unissa

Associate Professor & HOD

Dept. Child Health Nursing

Navodaya College of Nursing

Raichur.

11.5 Signature :

12. Remarks of the Chairman

and Principal :

12.1 Signature :