http://doi.org/10.33698/NRF0196 – Lata Sethi
Effectiveness of planned health teaching on knowledge and practices regarding prevention and management of diarrhoea among the mothers of under-five age group children in selected slum of Indore city.
Lata Sethi
Abstract : Children are the future citizens of the nation. Children all over the world suffer from diarrheal diseases, but in developing countries like India, it may have potential life threatening health hazards and leading cause of death among under- five children and the problems of this group need special care and attention. To reduce mortality and morbidity it is necessary to impart knowledge to mothers regarding prevention of diarrhoea. This study was undertaken to assess the effectiveness of planned health teaching on knowledge and practices of mothers of under-five age children regarding prevention from diarrhoea residing in slums of Indore city. Total 60 subjects were selected with convenient sampling technique. The data was collected by using structured interview schedule and planned health teaching were given after taking pre-test and the final data was analysed by using both descriptive and inferential statistics. The study was concluded that planned health teaching is one of the effective methods to impart the knowledge and to improve knowledge of practices.
Keywords
Knowledge and practices regarding prevention from diarrhoea, effectiveness of planned health teaching.
Correspondence at
Mrs. Lata Sethi
Associate Professor
R.D Gardi College of Nursing, Agar Road, Surasa, Ujjain (M.P) 456006
Introduction
“Children are the investment of country and healthy children are the pride of mothers”
The National Policy for children (1974)1,2 stated that, “A Nation’s children are its assets, their nature and solicitude are our responsibility.”
In global scenario, 10.5 million population of under 5 children die every year and 99% of death are there in low and middle
income group countries. Six countries account for 50% of all child deaths these are India, Nigeria, China, Pakistan, Ethiopia, D R Congo (WHO 2002)3,4
In Indian scenario, India contributes
2.4 million child deaths to the global burden i.e.; highest for any nation in the world. Nearly 26 million children are born every year of which 1.2 million are neonatal deaths and 1.7 million are infant deaths. ICMR study in five rural sites showed that 25% of the under-five mortality occurs by day three and Infants contribute 75% to all the under- five death.
Diarrheal disease claiming over three million young lives in the world every year is the second biggest killer of children in developing countries. Using data for over 13,000 children in rural India, under the age of 3 years, this paper examines the relative effects of the different factors, quality of the water supply, mother’s literacy, housing conditions, and the level of development of the villages in which the children lived—contributing to diarrhoea. More than 55% of mothers acknowledge that poor hygiene is the most important cause of childhood diarrhoea. Even so, sanitation is generally poor and inadequate.6-7 Education of mother can help in improving the knowledge and practices in prevention of diarrhoea, which in turn can help in reducing incidence of diarrhoea among children. Hence present study was conducted
Objectives
To assess the effectiveness of planned health teaching on knowledge and practices of mothers regarding prevention from diarrhoea among mothers of under five children.
Methodology
An evaluatory approach was used to assess the effectiveness of planned health teaching and quasi experimental/ pre-test- post-test design was adopted for the present study.
The protocol of teaching as well as tools was developed by review of literature and discussion with experts in nursing and community health field. Lesson plan was prepared for imparting planned health teaching to samples and it was arranged in Anganwadi’s for duration of 20-25 minutes. Content included in session were on diarrhoea, its preventive aspects, importance of breast feeding and hand washing, method of ORS preparation, diet in diarrhoea and complications. Content was explained with the help of different A.V aids as posters, Flash card, PowerPoint presentations and using different techniques of teaching as group discussion, demonstration etc.
The tool comprised of three sections:
(1) Performa for demographic status which is having 7 items, (2) 25 Multiple choice questions for assessing the knowledge level and (3) Rating scale was also developed for assessing the practices based on mothers’ report. The total score of multiple choice question was 25 and it was classified in three categories for assessing the knowledge score of sample as: Poor(1-9), Good(10-17), and excellent (18-25). For assessing practices, total items was 14 and scored as 2, 1, 0 as reported by mother always, sometimes and never i.e., total of 28 marks. Practice scores was classified as; poor (1-10), good (11-20) and excellent (21-28)
Pilot study was done in 6 samples to assess the reliability of the tool. Test re-test method was used by administering the tool twice to the same sample of 6 mothers. The language of tool was found to be clear and easily understandable and reliability of the structured interview schedule was 0.97. For data collection, total sample of 60 mothers of under-five age children were taken from Bhagirathpura slum of Indore city and non- probability, convenient sampling method was used to select the sample. Data was collected during the month of February and March of 2010. An aganwadi of the area was arranged for data collection. Consent of all the samples was taken before data collection. An interview was taken with the help of structured interview schedule to collect the data for assessing the knowledge and rating scale was used for assessing the practices of mothers. Firstly interview was taken from each sample with the help of structured interview interview schedule with in a time limit of 20-25 minutes. After pretest health teaching was given to the same sample in aganwadi’s of that area with the help of posters, flash card, and PowerPoint presentation as well as with the help of demonstration method. After 7 days, Again interview from the same sample were taken at the same aganwadi and with the help of same tool i.e, structured interview interview schedule and rating scale. Similarly data was collected of 60 mothers of that area. Then the data was analysed by using both descriptive and inferential statistics.
Results
Table no.1 describes the demographic characteristic of 60 mothers. Less than half (45%)of mothers was only 5th passed and very negligible percentage i.e., 5% of mothers is up to graduate or post graduate. Their occupation data showed only 2% mothers were employed and 9% were their business and rest of them were housewives.
63.3% of mothers were in the range of monthly income of Rs. 2001-5000. More than half (53.4%) of mothers were from joint families. Almost half of mother (51.7%) had only one under five child and only 15% has 3 & above under five children. Most of mother (93.3%) were following Hindu religion.
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Table 1 : Socio-Demographic characteristics of the subjects
The table no.2 showed that 27(45.0%) mothers scored poor i.e, having poor knowledge about Diarrhoea and very negligible i.e, 2 mothers (3.3%) scored excellent but in post test 47 (78.3%) mothers scored excellent, which clears that there is remarkable increase in the
knowledge of mothers regarding diarrhoea. Regarding practices in pre test only 6 (10%) mothers had excellent practices but after planned health teaching 58 (96.7%) mothers had scored excellent and improved practices regarding prevention and management of diarrhoea and no mothers reported poor practices.
Table no. 2: Knowledge and practice scores of mothers of under-five age children regarding prevention and management of diarrhoea
| Score Range | Knowledge Score | Score Range | Practice Score | ||
| Pre-test n(%) | Post test n(%) | Pre-test n(%) | Post test n(%) | ||
| Poor (1-8) | 27(45.0 %) | 0(0.00) | Poor (1-10) | 3(5.0) | 0(0.00) |
| Good (9-16) | 31(51.7%) | 13(21.6) | Good (11-20) | 51(85.0) | 2(3.3) |
| Excellent (17-25) | 2(3.3%) | 47(78.3) | Excellent (21-28) | 6(10.0) | 58(96.7) |
Table no 3 and 4 clearly showed that the correct answer scores of respondent of each question in post test is higher than the scores in pre test, which clearly depicted that planned health teaching is an very effective tool in increasing the knowledge as well as practices regarding prevention and management of diarrhoea.
Mothers had prior knowledge in some of aspects such as Diarrhoea involved Gastro Intestinal system where 90% mothers could give correct response. On other aspects where more than 50% mother responded correct during pretest were diarrhoea is very common among below five years children, breast feeding is linked with diarrhoea and foods which are not home based should be avoided during diarrhoea.
Some of the items where very few mothers (8.3%) could response correct such as poor weaning practice bottle feeding & malnutrition are the risk factor of diarrhoea.
During post test percentage of correct responses of all the statements increased
and more than (80%) of mothers could answer correct most of the statements. Few statements were there which only 50-60% mothers could answer correct even during post test such as Bacteria, Viruses & parasitic infections causes diarrhoea ; poor wearing practices, malnutrition & bottle feeding are risk factors of diarrhoea.
Similarly the practice score improved during post test. Most of mothers reported the improvement in practices such as only (8.3%) mothers were giving breast feeding to children during diarrhoea episodes and during post test 96.6% mothers acknowledged that they will give breast feeding to children during diarrhoea episode.
During post test more than 90% mother reported that in most of statements always, only few practices were there less than 50% of mothers reported always i.e. giving banana to child during diarrhoea (43.3%), boil drinking water if clean drinking water is not available (15%).
Table No 3: Response of mothers in Pretest and Post-Test showing Knowledge regarding prevention and management of diarrhoea
N=60
| S.No. | Statements | No. of samples answered correct | |
| Pre Test n(%) | Post Test n(%) | ||
| 1. | Diarrhoea is passage of more number of loose watery stool | 22(36.6) | 60(100.0) |
| 2. | Diarrhoea is more common in below 5 yr children | 36(60.0) | 57(95.0) |
| 3. | Diarrhoea involved GI System | 54(90.0) | 57(95.0) |
| 4. | Bacteria, Virus and parasite infection causes diarrhea | 07(11.6) | 38(63.3) |
| 5. | Contaminated water, unhygienic environment and open defecation Causes diarrhoea diseases | 13(21.6) | 51(85.0) |
| 6. | Poor weaning practices, bottle feeding, malnutrition are the risk factors of diarrhoea | 05(8.3) | 38(63.3) |
| 7. | Bore well water which is properly maintained is Safe to drink | 25(41.6) | 51(85.0) |
| 8. | Faeco -oral route is the mode of transmission of diarrhoeal disease | 28(46.6) | 52(86.6) |
| 9. | Headache and vomiting are the symptoms associated with diarrhoea | 21(35.0) | 43(71.6) |
| 10. | Major signs of dehydration are sunken eyes, dryness of mouth and tongue, skin pinch goes back slowly | 06(10.0) | 55(91.6) |
| 11. | Passing less amount of urine is the sign of dehydration | 12(20.0) | 33(55.0) |
| 12. | Primary treatment given to the child during diarrhoea is only water and salt | 22(36.6) | 54(90.0) |
| 13. | One standard ORS packet requires four big glass of pre-boiled cooled water | 16(26.6) | 55(91.6) |
| 14. | Availability of ORS packets are available in all hospitals, PHC and aganwadi. | 26(43.3) | 54(90.0) |
| 15. | A fistful sugar, 3 finger pinch salt and 1 litre boiled cooled water are required for the preparation of ORS solution at home | 24(40.0) | 55(91.6) |
| 16. | Prepared ORS packet is kept for only 24 hrs. | 15(25.0) | 53(88.3) |
| 17. | ORS provide to the child after each episode of diarrhea | 23(38.3) | 57(95.0) |
| 18. | Breastfeeding is linked with prevention of diarrhoea. | 33(55.0) | 58(96.6) |
| 19. | Breastfeeding promotion, appropriate complimentary and supplementary nutrition is required for 0-1yr infant during diarrhoea | 12(20.0) | 48(80.0) |
| 20. | Fluids such as rice water, coconut water and dal water can be given to the child during diarrhoea | 27(45.0) | 56(93.3) |
| 21. | Foods which are not home based should be avoided during diarrhoea | 42(70.0) | 57(95.0) |
| 22. | Use of safe drinking water, covered stored food and hand washing Practices are helpful to prevent diarrhoea | 28(46.6) | 57(95.0) |
| 23. | Proper hand washing, use of boiled cooled water and hand washing practices prevent the child with further intestinal infection | 27(45.0) | 57(95.0) |
| 24. | Flies control can be done with proper cleanliness, use of sanitary latrines and use of pesticides | 25(41.6) | 53(88.3) |
| 25. | Complications of diarrhoea are fever and dehydration | 21(35.0) | 51(85.0) |
Table no. 4 : Response of mothers showing knowledge of practices in pretest and post test regarding diarrhea
N=60
| Items | Always n%
Pre Test Post Test |
Sometime n%
Pre Test Post Test |
Never n%
Pre Test Post Test |
|||
| Using cup & spoon for feeding | 28 (46.6) | 60 (100) | 30 (50.0) | – | 2 (3.3) | – |
| Giving breast milk to child during diarrhoea | 5 (8.3) | 58 (96.6) | 45 (75.0) | 2 (3.3) | 10 (16.6) | – |
| Preparing ORS solution during diarrhoea. | 9 (15.0) | 60 (100) | 30 (50.0) | – | 21 (35.0) | – |
| Using clean utensil for preparing ORS solution. | 10 (16.6) | 60 (100) | 29 (48.3) | – | 21 (35.0) | – |
| Giving ORS solution till diarrhoea stop | – | 60(100) | 3 (5.0) | – | 57 (95.0) | – |
| Preparing khichdi during diarrhoea | – | 46 (76.6) | 22 (36.6) | 14 (23.3) | 38 (63.3) | – |
| Giving banana to child during diarrhoea | – | 26 (43.3) | 11 (18.3) | 34 (56.6) | 49 (81.6) | – |
| Washing hand before feeding | 1 (1.6) | 60 (100) | 56 (93.3) | – | 3 (5.0) | – |
| Washing hand after defecation | 55 (91.6) | 60 (100) | 5 (8.3) | – | – | – |
| Washing raw food with water | 6 (10.0) | 21 (35.0) | 46 (76.6) | 38(63.3) | 8 (13.3) | 1 (1.6) |
| Boil drinking water if clean drinking water not available | 1 (1.6) | 9 (15.0) | 25 (41.6) | 45 (75.0) | 34 (56.6) | 6(10.0) |
| Using chlorinated water for drinking. | 6 (10.0) | 59 (98.3) | 7 (11.6) | – | 47 (78.3) | 1 (1.6) |
| Cover drinking water with lid | 35 (58.3) | 60 (100) | 23 (38.3) | – | 2 (3.3) | – |
| Dispose waste properly | 24 (40.0) | 58 (96.6) | 26 (43.3) | – | 10 (16.6) | 2(3.3) |
The effectiveness of planned health teaching was assessed by find out the mean difference in their score. Data found that mean post-test score (23.2) of knowledge of mothers were higher than mean pre-test knowledge(9.5)score and mean post test score (25.3)of practices were also higher than pre-test knowledge of practices score(15.4) as shown in table no.5.
This difference was statistically significant as per t test (P<0.01)
This indicated that planned health teaching was effective in increasing the knowledge and improving the practices of mother’s regarding prevention and management of diarrhoea.
Table no 5: Pre-test and Post-Test Knowledge and practice Score
| Mean (X) | S.D. (s) | Std. Error of mean | D. F. | t | Significance | ||
| Knowledge score | Pre-test | 9.51 | 3.98 | 0.54 | 59 | -25.31 | P<0.001 |
| Post-test | 23.20 | 2.06 | |||||
| Practices score | Pre-test | 15.48 | 4.21 | 0.48 | 59 | -20.38 | P<0.001 |
| Post-test | 25.36 | 1.60 |
Discussion
Diarrhoea is potentially serious as it leads to dehydration or electrolyte imbalances. This is true especially in infants, children, the elderly, or other at risk groups. Many of these deaths can be prevented with the use of oral rehydration therapy, exclusive breast feeding and proper hygienic practices.
In the present study mothers were educated about prevention and management of children with diarrheal diseases and findings revealed that planned health teaching is an effective tool in increasing the knowledge and practices of mothers in this aspect. Kaur P and Singh J7 also found that after administration of health education programme, mothers started giving homemade fluids to the children during diarrhoea.
The present study revealed that knowledge of major signs of dehydration (sunken eyes, dryness of mouth and tongue, skin pinch goes back slowly ) was known to only 10% mothers and ORS should be provided to the child after each episode of diarrhoea was known to only 38% mothers. More than half of mothers (55%) knew that breast feeding should be continued to child having diarrhoea. These findings were similar to the study of Kaatano et al which revealed that Typical symptoms of severe dehydration (sunken eyes, loss of skin turgor, dry tears) were poorly recognised as characteristics of severe diarrhoeal diseases. Over 85% of the practiced appropriate dietary measures or increased fluid intake for a child who had diarrhoea. Use of anti-diarrhoea (40.8%) and antibiotic medications (34.8%) were
common in the treatment of diarrhoeal diseases.8
Mothers knowledge related to definition of diarrhoea, its causes, major signs and symptoms, signs of dehydration, prevention and management of dehydration and use of ORS was increased significantly after implementation of planned teaching programme. These findings were consistent to the findings of Mangala et al9 which showed that mothers knowledge significantly increased related to definition of diarrhoea, signs of dehydration, awareness of ORS solution, preparation of ORS solution, shelf life of ORS solution, seeking health care and rational drug use during diarrhoea.
ORS solution is important for prevention of dehydration which is major cause of death during diarrhoea. In present study 35% mothers never prepared ORS solution and 50% prepared it sometimes only. These findings were consistent with the study of Ahmed et al that only 33% mothers out of 420 could demonstrate correct method of ORS preparation, 10% never prepared ORS and rest 56% prepared it incorrectly.10
The findings of the study emphasis that planned health teaching is highly effective in increasing the knowledge and practices of mothers regarding prevention and management of Diarrhoea. On the basis of the present study, it is recommended that nurses and other health professionals working in community should incorporate its findings in their routine practice. The study can be replicated on a larger sample to validate and generalize the findings.
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