RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

NAME OF THE CANDIDATE Ms. SONALI .S

M.Sc NURSING I YEAR
JOSCO COLLEGE OF NURSING
INFANT JESUS BUILDING NO.3590,
CHENNAPPA EXTN.
NELAMANGALA
BANGALORE -562 123

JOSCO COLLEGE OF NURSING

NAME OF THE INSTITUTION INFANT JESUS BUILDING NO.3590,
CHENNAPPA EXTN.
NELAMANGALA
BANGALORE-562 123

COURSE OF STUDY AND SUBJECT M.Sc NURSING I YEAR

PAEDIATRIC NURSING.

DATE OF ADMISSION TO COURSE 26.10.2009

TITLE OF THE TOPIC A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON HOME
CARE MANAGEMENT OF
PNEUMONIA AMONG MOTHERS OF
UNDER FIVE CHILDREN WITH
PNEUMONIA IN SELECTED
HOSPITALS BANGALORE

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BRIEF RESUME OF THE STUDY

6.1 NEED FOR THE STUDY

Pneumonia are very often found in children and is responsible for a large
proportion of morbidity1. This illness is serious and even life threatening, according to
UNICEF-WHO report 2009, 0.28 episodes of pneumonia per child occured2.

Pneumonia is one of the leading causes of death in children as it is known as the

leading killer of under five children in world wide. Approximately 150 million new cases
of pneumonia occur annually. Incidence of community acquired pneumonia reports 11-20
million of which are severe enough to require hospital admission. Worldwide episodes of
clinical pneumonia was more than 95% in young children.3

In India pneumonia is the major cause of childhood mortality there are 450
million case of pneumonia occurring every year and it cause 3.9 million deaths.
Approximately 19% that is about 4,10,000 of under five children deaths in India are due
to pneumonia .India accounts for almost 40% of world wide childhood pneumonia cases.4

The study was conducted in Bangalore on establishment of population based

surveillance for invasive pneumococcal disease in Karnataka. Study showed that there
was 2,219 hospitalizations of under five children in that 967 were with pneumonia. Study
found that 56 under five children died with pneumonia every year.5

The vaccination for pneumococcal disease is considered as the most important

target for childhood. A study was conducted on pneumococcal vaccination for Indian
children, prevention of pneumococcal disease in children has been possible by with the
help of vaccination. Recent data showed a 39% reduction in all cause pneumonia
admissions following the introduction of pneumococcal conjugate vaccines. There were a
reduction of 25% and 37% in radiologically confirmed pneumonia. It was concluded that
based on the available data and policy option, India can take several important steps to
prevent pneumonia and improve child survival through the expanded use of life saving
pneumonia vaccines.6

2
 The frequency of children who are hospitalized with pneumococcal pneumonia
complicated by necrosis, empyema and lung abscess seems to be increasing. The study
identified there was an increased in complication among 368 children. Complication was
also founded in 133 patients who had a chest tube placed. 56 patients underwent
decortications with complicated disease characterized by chest pain.7

A study was conducted on the management of pneumonia complication in

children. The incidence of empyema complicating community acquired pneumonia is
increasing and causes significant childhood morbidity. Pneumococcal infection remains
the most common isolated cause in developed countries with staphylococcus aureus the
predominant pathogen in the developing world. Newer molecular techniques utilizing the
polymerase chain reaction have led to an increase in identification of causative bacteria.
This remains an important epidemiological tool and may help in guiding correct
antibiotic use in the future.8

Identification of modifiable risk factors of severe pneumonia may help in

reducing the burden of disease. A study was undertaken to determine risk factors
associated with severe pneumonia in under five children. It was found that lack of breast
feeding, upper respiratory infection in mother or siblings, severe mal nutrition,
inappropriate immunization of age, history of lower respiratory tract infection, exposure
to cooking fuels, other than liquefied petroleum gas.9

The health education programme on identification of early features and home care
management of pneumonia need to be emphasized. A study was conducted on home care
management of pneumonia. Two hundred mothers of child with pneumonia were enrolled
for the purpose of the study. The most important signs identified the mother is wheezing
80% and cough 14%. The mother’s uses honey 25% and ginger 27% were the most
common home remedies used for relief of cough. The present study highlights the
important health education programme which aims at increasing family recognition of
serious illness in children at an early stage, need to take family perception in to account.10

The investigator has observed many under five children with pneumonia. Most of
the mothers have lack of knowledge regarding home care management of pneumonia and
its complication. Thus it increases the infections, so there is a need of necessary

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information to overcome this disease. By this mothers will have the adequate knowledge
about the home care management of pneumonia and prevents complications so that
investigator is interested to assess the knowledge of mother and provide structured
teaching programme on home care management.

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process. The major goal of the
review of the literature is to develop a strong knowledge base to carryout research and
non research scholarly activities.

A literature review is a complication of resources that provide the ground work

for future study.
The literature reviewed has been presented under the following heading.
A) Studies related to incidence and prevalence of pneumonia.
B) Studies related to risk factors for pneumonia
C) Studies related to home care to management of pneumonia.
D) Studies related to complications of pneumonia.
E) Studies related to structured teaching programme

A) Studies related to incidence and prevalence of pneumonia.

A study was conducted on the incidence and prevalence of pneumonia,
According to a UNICEF report over 2 million children die from pneumonia each year
.accounting for almost one in under five children died in world wide. The estimated
incidence of pneumonia in India it was 0.05 episodes per child year. Thus 155 million
episode of pneumonia occurs in under five children annuals.11

A study was conducted on the epidemiology of pneumonia in under five children,

more than 400,000 child deaths from pneumonia each year in India. In that approximately
52% of under five children had severe pneumonia. The present study revealed that up to
19% of children hospitalized with pneumonia die in India12.

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B) Studies related to risk factors of pneumonia
A study was conducted on the factors determining the outcome of children
hospitalized with severe pneumonia. Lack of breast feeding has been reported to be
associated with increase risk of development of severe pneumonia by 1.5 to 2.6 times.
Some hospital stated that lack of breast feeding was associated with 3.2 times more risk
of death from pneumonia. Community acquired non-severe pneumonia showed chest
radiographs as normal in 82% of children. Thus the study revealed that children with
severe community acquired pneumonia lacked the exclusive breast feeding and needed
hospital treatment.13

A study was conducted on the seasonal pattern of pneumonia mortality among

under five children. Human response to weather changes may increase the risk of
infection. This study has investigated the effect of weather patterns especially cold
weather – on the incidence of pneumonia. The mortality was biggest in the second quarts
of the year especially in June from the third quarts there was a sharp decrease in the
mortality. Thus a seasonal pneumonia mortality pattern corresponds to the temperature
pattern throughout the years with high mortality observed during the cold months and
low mortality during the warm months.14

C) Studies related to home care management of pneumonia

A study was done on the effect of home care management on childhood
pneumonia morality in developing countries. The review covered intervention related to
community and home care management as a part of primary care approach for children
with pneumonia who require access to good quality basic first level care. It emphasizes
the importance of active care finding in reducing mortality level through community
awareness generated as maternal education regarding follow up care. The home care
management of pneumonia could result in a 70% reduction in mortality from pneumonia
in 1-5 year old children15.

A study was conducted on effectiveness of home care management of under five

children affected by pneumonia in India. The background of the study showed that
pneumonia infections accounts for about half of under five children deaths in low –
resource setting evidence. Community health worker assessed 80% of the under five care
given within the first year of life and referred children with signs of severe disease. A

5
referral complaint was 34% and home treatment acceptance was 43% respectively.
Parent of severe diseased children with multiple signs consoled to community health
worker by home care management for better outcomes. It concluded that home care
management on pneumonia infected under five children was effective and acceptable in
low-resource setting in India16

D) Studies related to complication of pneumonia

The study was conducted regarding Trends in pneumonia and empyema in under
five children in the past 25 years. Incidence of childhood empyema a complication of
pneumonia was increasing .Results of the study showed there were 217 admissions for
complication of pneumonia occurs in 76 under five children , the study shows that the
incidence of childhood pneumonia has continues to rise independently.17

The study was conducted on the empyema associated with pneumonia: A

pediatric investigator’s collaborative network on infections. It showed that although the
incidence of serious morbidity with childhood pneumonia has decreased over time,
empyema remains as a complication of community-acquired pneumonia. Study
concluded that Empyema occurs most commonly in children under five years and is
associated with considerable morbidity. Enhanced surveillance using molecular methods
could improve diagnosis and public health planning, particularly with regard to the
relationship between immunization programs and the epidemiology of empyema
associated with community-acquired pneumonia in children.18

E) Studies related to structured teaching programme

A study was conducted on the effect of a structured discharge education plan on
pneumonia readmission rates. Structured knowledge questionnaire was used and its
included medications activity, diet and follows up care. It was found over a 12 months
period that pneumonia readmission rate for all causes dropped to 7.8% with a clinical
stability of 95% teaching on day 1 and day 2 varied from 66% to 90%. Respectively.19

A study was conducted to evaluate the effectiveness of Structured Teaching

Programme on knowledge of home care management of pneumonia and its utilization
among mothers of under five children. The finding showed that mean post test
knowledge scores were 83% pretest knowledge was 44% with an enhancement score
found to be 38 %. It can be inferred that the knowledge score of the mothers regarding

6
the reproductive child health services and its practice were in adequate during the pre
enhancement in the knowledge of mothers of under five children on home care
management of pneumonia utilization.20

STATEMENT OF PROBLEM
A study to assess the effectiveness of structured teaching programme on home
care management of pneumonia among mothers of under five children with pneumonia in
selected hospitals Bangalore

6.3 OBJECTIVES OF THE STUDY

1. Assess the pre test knowledge scores on home care management of pneumonia

among mothers of under five children with pneumonia.

2. Determine the effectiveness of structured teaching programme on home care

management of pneumonia by comparing pretest and post test knowledge scores.

3. Find out the association between knowledge scores and selected demographic

variables

6.4 OPERATIONAL DEFINITIONS

1. Effectiveness: Refers to the differences obtained in post test knowledge scores

with that of pretest knowledge scores on home care management of pneumonia

among mothers of under five children with pneumonia.

2. Structured Teaching Programme (STP): Refers to the systematic structured

teaching activities designed to provide information on home care management. It

is the description of diet, exercise, psychological factors, environmental factors

and medication using lecture method assisted with variety of AV aids for duration

of one hour.

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 3. Home care management: Refers to it is a health care a supportive care provided

in the patient’s home which would be executed 5 areas such as exercises, diet,

psychological factors, environmental factors and medication.

4. Pneumonia: Refers it is a acute lower respiratory tract infections due to the

infections and inflammation occurring in the lung parenchyma.

5. Mothers of under five children: Refers to the married females having with 1-5

year children of age diagnosed to have pneumonia.

6.5 HYPOTHESIS

H1: There will be significant difference in the post test of knowledge scores than

the pretest knowledge scores on home care management of pneumonia among mothers of

under five children with pneumonia.

H2: There will be significant association with the knowledge scores among

mothers of under five children with pneumonia and their selected demographic variables.

6.6 DELIMITATIONS

1. The study is limited in the assessment of knowledge scores only.

6.7 VARIABLES

 Dependent Variables – knowledge of mothers related to home care

management.

 Independent Variables - Structured Teaching Programme.

7. Material and Methods

7.1 Sources Of Data The data will be collected from the mothers of

under five children with pneumonia.

7.1.1 Research Approach The Research approach adopted for the study is
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 evaluation research , is an applied from of

research that involves finding out how well a

specific program, practice, procedure or policy

is working.
7.1.2 Research Design The research design adopted for present study is

pre experimental, one group pre test and post

test design only.

7.1.3 Setting of The Study The study will be conducted in selected

pediatric hospitals, Bangalore.

7.1.4 Population The population for the present study comprises

mothers of 1-5 years children who have

admitted in selected pediatric hospitals,

Bangalore.
7.1.5 Sampling Technique The proposed sampling technique adopted for

the present study is purposive sampling

technique.
7.1.6 Sample Size The proposed sample size of this study consists

80 mothers of under five children with

pneumonia.
SAMPLING CRITERIA

7.1.7 Inclusion Criteria 1. Mothers with of children 1-5 years old

admitted with pneumonia in selected

hospitals, Bangalore.

2. Mothers who are willing to participate

3. Mothers who are available during data

collection.

4. Mothers who know English and

Kannada only.

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7.1.8 Exclusion Criteria 1. Mothers who had attended teaching

programmes related to home care.

2. Mothers who are not willing to

participate

3. Mothers who are unavailable during the

child.

4. Mothers of under five children admitted

in ICU.
7.2 DATA COLLECTION METHOD
7.2.1 Tools For Data The tool for the proposed study is structured

Collection knowledge questionnaire which would be

developed by investigator with the help of

extensive literature and experts opinions.

7.2.2 Procedure Of Data The plan of data collection for the proposed

Collection study is as follows.

 Permission will be obtained from the

hospital authorities and respondents.

 Mothers meeting criteria inclusion

would be selected using purposive

sampling technique and pretest will be

conducted using structured knowledge

questionnaire Subsequently, Structured

Teaching Programme will be given on

same day.

 On the fifth day, post test will be

conducted using same structured

knowledge questionnaire.

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  Proposed data collection period will be

30 days.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED

ON PATIENTS, OR OTHER HUMANS OR ANIMALS?

Yes, the structured teaching programme will be administered to mothers on home care

management of pneumonia.

7.4 ETHICAL CLEARANCE

The main study will be conducted after the approval of research committee

permission will be obtained from the concerned will be obtained from the concerned head

of the institution. The purpose and after details of the study will be explained to the study

subjects and as informed consent will be obtained from them. Assurance will be given to

the study subject on the confidentiality of the data collection from them.

Information consent will be taking from the mothers who are willing to participate

in the study.

8. LIST OF REFERENCES

1. Aswathi S, Agarwal G, Kabraa SK, Singhi S e tal. Oral amoxyallin benefit

children of non-severe pneumonia with wheeze. 2008; 469-474.

2. Chandrashekar T, Sree ramareddy, Ravi P Shankar, Cema Ramachandran.

Case seeking behavior for childhood pneumonia a questionnaire survey in India

2009: 1186-1472.

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3. Sona Chowdhar, Jacob PUliyel. Incidence of Pneumonia is not reduced by

Pneumococcal conjugate Vaccine. 2006 June: 28-34.

4. Levine Os. Defining the Burden of Pneumonia in children preventable by

Vaccination agains Haemophilus influenzae. 2006; 1060-1064.

5. Shah AS, Nisarga R, Ravi Kumar KL. Establishment of population based

surveillance year invasive pneumococcal disease in Bangalore. Indian Journal

MEB, 2009 (63):498-507.

6. Thomas Cherian. Pneumococcal vaccination for Indian children. Indian pediatrics

2007 (144):491-496.

7. William.J Barson, Tina Q, Tain Md, Ramyogeu, et al. Clinical characterstics of

children with complicated pneumonia. 2007 (110): 1-6.

8. Smith PG. The management of pneumonia complication in children. 2006(40):

148-156.

9. R.M.Pandey, Rakesh Lodha. Risk factors associated with respiratory infections in

under five children, 2007 August 22 (38): 249-255.

10. Sudhir Mishra, Harish kumar, Daya sharma. Home care management of

pneumonia 2007 (7): 742-743.

11. Singhal T, Kabrask, Pandey RM. Incidence and prevalence of pneumonia, 2009:

1186-1471.

12. George H, Victora CG. Epidemiology of pneumonia in under five children,

2008(113): 701-707.

13. Rakesh Lodha, Shobha Bloor, S.R.Khan. Factors determining the outcome of

children hospitalized with severe pneumonia. BMC pediatrics. 2009:1186-1471.

14. Eliya Zulu, Benedict Olindi, Eliya Zulu. Seasonal pattern of pneumonia mortality

among under five children. 2009 July 10: 226-234.

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15. Sherene GEdvin, John Miton. Trends in Pnumonia and empymea in under five

children in the past 25 years. 2007 Nov:15-26.

16. Ben Jan James D kellness. Empyema associated with community acquired

pneumonia, a pediatric investigator’s collaborative network on infections in India

study. 2008:429-437.

17. Salin Sadeuddin, Harry comphbell. Effect of case management on childhood

pneumonia mortality in developing counties. 2008: 410-427.

18. Gary L, Abdullah H. Effectiveness of home based management of newborn

infection by community health workers in India. 2009 April(28): 304-310.

19. Leisa Kelly. The effect of structured discharge education plan on pneumonia

readmission rates. 2009: 57-61.

20. John Milton. The effectiveness of structured teaching programme on knowledge

of home care management of pneumonia and its utilization. 2009 Nov(11): 314 –

317.

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