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G O O D A F T E R N O O N

G O O D A F T E R N O O N. Title Effectiveness of child to adult teaching approach on knowledge, attitude and practice of parents regarding prevention of mosquito-borne diseases at selected community area, Mangaluru. Name of the Candidate: Mrs. Renita Priya Dsouza Assistant Professor

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G O O D A F T E R N O O N

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  1. GOODAFTERNOON

  2. Title Effectiveness of child to adult teaching approach on knowledge, attitude and practice of parents regarding prevention of mosquito-borne diseases at selected community area, Mangaluru

  3. Name of the Candidate: Mrs. Renita Priya Dsouza Assistant Professor Child health Nursing Department Yenepoya Nursing College Deralakatte-575 018 Guide: Dr. Devina E Rodrigues Professor and HOD Community health Nursing Department Yenepoya Nursing College Deralakatte-575 018

  4. INTRODUCTION • Mosquitoes act as vectors to transmit the causative agents of diseases like Dengue, Malaria, ChikunGunya, Filaria, Zika, Japanese encephalitis, etc. (Caraballo and King, 2014) • Morbidity and mortality rates and epidemic outbreaks of mosquito borne diseases in the recent years indicate that the problem is serious in India.(WHO, 2012)

  5. Contd…. • Currently in India annual confirmed cases of malaria are 0.7–1.6 million and the deaths related to malaria range from 400 to 1,000.(Srinivas, 2015) • The status of malaria in Mangaluru indicates it is an endemic disease in most of the areas of the taluk. Number of deaths due to dengue is reduced because of timely treatment, but the disease is spreading to newer geographic areas. (NVBDCP,2015)

  6. Protection from the vector is one of the best strategies to prevent the mosquito-borne illnesses. Personal protective measures like mosquito coils, mosquito repellent liquids and creams, electric rackets, mats, mosquito nets, etc., are available to keep the people safe from mosquito bites.(Pandit, Patel and Bhavsar , 2010)

  7. Contd…. • Globally 50–100 millions dengue cases are found every year and about 40% of the world’s population is at risk for dengue.(Cecilia, 2014) • Mangalore City Corporation(MCC) report shows, in 60 wards of the city 21,271 cases of malaria were reported between January and April in 2017.(Vinobha, 2017)

  8. National Vector Borne Disease Control Programme of India suggests that the people must participate by accepting mosquito control programme as their own programme.(NVBDCP,2016) • To plan and develop any appropriate suitable health education strategy we should have an idea of knowledge of public, their attitudes towards the disease prevention and the practices.(Kumar and Gururaj, 2005)

  9. Children can be highly effective agents for social change if we utilize their creativity and powers of persuasion in a concentrated and directed way. • Child-to-Child began in 1978, when Professor David Morley and some like-minded colleagues met together to discuss what contribution they could make to child health in honour of the International Year of the Child, in 1979.(Child to child trust, 2009)

  10. Need for study • The 17% of the estimated global burden of all infectious diseases is caused by the vector-borne diseases. In 2015, almost 50% of world’s population was at risk with 91 countries and areas having ongoing malaria transmission.(WHO,2014) • 212 million cases of malaria and 429000 deaths were reported in 2015.

  11. In the year 2016 Karnataka reported 8,821 malaria case and 5833 Dengue cases.(NVBDCP,2016) • In areas with high transmission of malaria, more than 70% of all malaria deaths occur in children with age less than five. (WHO,2016)

  12. Active participation of each and every individual in the society plays a major role in prevention and control of mosquito-borne diseases. • To involve the individual in prevention of any disease, continuous motivation is very important.(Mlozi et al, 2006)

  13. Child-to-Child is an approach to health promotion and community development led by children. • It is based on the belief that children can be actively involved in their communities and in solving community problems. • It engages children in activities that enable them to play an active and responsible role in the health and development of themselves, other children, their families and communities. (Cook, Blanchet and Hart, 2011)

  14. Malaria and dengue being the major health problems of India, it calls for effective prevention strategies. • As children can be good health messengers they can be utilized to educate the adults at their homes and community if proper training is given to them. • Personally the investigator has observed the school children in her family and neighbourhood discussing the health topics with their parents which were taught in the school.

  15. The children were able to change some of the unhealthy practices of parents like hand washing, keeping the food covered, eliminating the stagnant water sources etc. • Hence the investigator is interested to conduct the study by involving children as change agents and find how effectively children can influence the knowledge, attitude and practice of their parents related to prevention of mosquito-borne diseases.

  16. Aim of the study • To evaluate the effectiveness chid to parent teaching approach on knowledge, attitude and practice of parents regarding prevention of mosquito-borne diseases.

  17. Review of literature • Literature related to Knowledge regarding Malaria and Dengue • A descriptive survey conducted in Karnataka, to assess the knowledge and practices regarding commonly occurring mosquito borne diseases using a semi-structured questionnaire found that out of the 247 studied population, 69.23% knew that malaria is transmitted by mosquito followed by 27.53% Filaria, 22.91% dengue and14.98%, Chikungunya. • Majority respondents (85.02%) participants answered dirty stagnant water as mosquito breeding place. (Tengliker et al,2016)

  18. A community-based cross-sectional study conducted to assess the knowledge and practices of community about prevention of mosquito borne diseases among 350 adults in Delhi. • The study revealed that 67.6% subjects in rural and 63.6% in urban area were able to name at least one mosquito borne diseases but no significant difference was found in two areas. • A total of 65.1% participants were aware of malaria, 62.3% named dengue, 10% named Chikungunya and only 0.3% were aware of Japanese encephalitis and yellow feveris transmitted by mosquitoes. • Only a small number of participants were aware that fever with chills or rigor is the major symptom of malaria both in rural 59 (28.1%) and urban 26 (18.6%) areas. (Kohli et al, 2015)

  19. A cross sectional survey was conducted in Ondo State, Nigeria to assess the knowledge and practice of malaria prevention among nonmedical students of higher institutions. • Among 1420 subjects 97.1% knew that malaria can be prevented; 48.3% reported that malaria is more common in the tropical region and 88.0% reported malaria mosquitoes breed more during the rainy season. • Only 27.0% knew that vector that causes malaria is female Anopheles mosquito.(Usman et al, 2015)

  20. Literature related to effectiveness of child to child approach • A study was conducted in Kerala, to assess the effectiveness of child to child concept on prevention of helminthic infestation among 100 primary school children . • The data were collected in two phases in first phase knowledge of all 100 subjects on prevention of worm infestation were assessed using a questionnaire. • In the second phase with the help of random sampling technique 10 children were selected from the study participant group and were given health education regarding prevention of worm infestation using educational package. These children were encouraged to disseminate their knowledge using flash cards and videos. • Post-test was conducted on 7th day. • The mean pre test knowledge was 47.56%, and mean post-test knowledge was 88.7% and the difference between pre-test and post-test score was statistically significant with the calculated ‘t’ value 29.78. • Investigator concluded that children can be involved as mediators to spread the health messages in the community.(Maliyakal , 2015)

  21. A quasi experimental study was conducted to evaluate the effectiveness child to child approach of health education over traditional teaching method among primary school children. • 100 school children were selected by cluster sampling technique. • One group of children received health education through traditional method. • To another group health education was provided by peers who were trained and motivated by the investigator to carry out peer interaction. • The results revealed that the difference was found between the mean values of knowledge scores of children with the traditional health education group (t=5.61, p<0.05) and child to child group (t=6.42, p<0.05). The post test difference between the two methods was significant (t=2.06, p<0.05). (Leena and Dsouza, 2014)

  22. A School-based malaria education was conducted at Lao PDR to show the influence of school-based malaria education on the knowledge, attitudes, and practices of people in the community toward malaria. • Samples: 130 school children in grades 3–5 at two primary schools, 103 guardians of these children, and 130 married women who did not have children in the target grades. • The school children educated parents at home by using flipchart as well as 1-day campaign was conducted by them at the community. • To assess the knowledge of women about malaria, a questionnaire-based survey was conducted before and after the intervention. • The major finding of the study was at the end of one month, significant improvement in the mean knowledge, attitudes and practice scores of married women without children (Nonaka et al, 2008)

  23. Lacunae in literature • Most of the studies conducted in the past were aimed at assessing the knowledge, attitude and practice of adults regarding mosquito- borne diseases. Only a few studies Included children as study subjects. • Very few earlier studies were aimed at evaluating the effectiveness of child to parent teaching and utilizing the children as health messengers to their parents and families . • This study aims to fill this gap by involving children as effective health messengers who can influence the knowledge, attitude and practices of parents regarding mosquitobornediseases.

  24. Objectives • To determine the knowledge, attitude and practices of the children regarding prevention of mosquito borne diseases before the administration of health training. • To determine the pretest knowledge, attitude and practice of the intervention and control group parents regarding prevention of mosquito borne diseases. • To determine the pretest knowledge, attitude and practice of the intervention group children regarding prevention of mosquito borne diseases after the administration of health training.

  25. Contd... • To determine the knowledge, attitude and practice of the parents regarding prevention of mosquito borne diseases after the administration of health teaching by their children on the 7th day and at the end of one month of the teaching. • To compare the post test knowledge, attitude and practice scores of the control and experimental groups regarding mosquito borne diseases. • To find the association between pre-test knowledge, attitude and practice scores regarding mosquito borne diseases of parents and selected demographic variables. • To find the correlation between knowledge, attitude and practice scores of children regarding prevention of mosquito borne diseases before and after the health teaching

  26. Social relevance of the work • Helpful to the society to reduce the incidence of mosquito-borne diseases and controlling the mosquito growth. • Children will be motivated as change agents and will use the knowledge they gained in their future life too. • The number of new cases of dengue and malaria may reduce and which in turn reduces the burden of mosquito-borne diseases on public health system.

  27. Operational definitions: • Effectiveness:the significant improvement in the knowledge, attitude and practice scores of parents regarding mosquito borne diseases after the child to parent teaching measured in terms of knowledge, attitude and practice scores. • Knowledge: information/facts that children and parents know regarding mosquito-borne diseases which is measured by using structured questionnaire prepared by the investigator.

  28. Attitude: attitude of children and parents towards prevention mosquito-borne diseases measured by using 5 point Likert scale prepared by the investigator. • Practice: responses given by the children and parents to the self reported practice 3 point rating scale prepared by the investigator. • School children: Children in age group of 10-12 years studying in 5th, 6th or 7th standard at selected rural Kannada medium school.

  29. Parent: Parent refers to either mother or father of the school children involved in the study who is of 25- 50 years of age. • Mosquito-borne diseases: In this study mosquito-borne diseases refer to Malaria and Dengue fever which are the major diseases transmitted by the mosquitoes.

  30. Child to adult teaching approach:the interaction between the child and parent and the child educating the parent regarding selected Mosquito-borne diseases using the information booklet provided by investigator. Before the interaction between child and parent regarding the Mosquito-borne diseases, health education will be given to the school children about mosquito breeding, diseases caused by mosquitoes, name of the mosquitoes transmitting Malaria and Dengue, timings of mosquito biting, signs and symptoms of malaria and dengue, elimination of mosquito breeding habitats, use of personal protective measures and prevention of mosquito-borne diseases. Training of children extends until the children gain the 75% knowledge scores in the post test assessed by the questionnaire. Once the children are ready they are motivated to educate parents and interaction and teaching between the child and parent takes place.

  31. Material and methods • Sampling method: Probability sampling Method- two stage random sampling technique • Sample size – Statistical power analysis program software G*Power is used to estimate the sample size. Two group comparison independent ‘t’ test was considered while estimating the sample size with effect size 0.3 and power 80% at 0.05 level of significance. The obtained estimated sample size is as follows: • Experimental group:180 children and corresponding 180 parents • Control group : 180 corresponding parents of the control group children

  32. Sampling technique: • Step 1: Random selection of Kannada medium schools from the convenient rural area . • Step 2: Random allocation of schools into intervention and control groups. • Step 3: Random selection of school children aged between 10-12 years into control group and intervention group. • Selection of parents: Purposive sampling

  33. Sampling Plan

  34. Subject Selection Criteria Inclusion criteria • Children • The children those who are studying in Kannada medium Higher Primary school. • Children in the age group of 10-12 years • Parents • Parents in the age group between 25-50 years • Those who are able to read & write in Kannada

  35. Exclusion criteria • Those who are not willing to participate • Parents and children with hearing impairment, blindness and mental impairment

  36. Delimitations The study will be delimited to: • School children studying Kannada medium of selected rural area. • Parents who are having children in the age group 10-12 years.

  37. Assumptions • School children and their parents may have some knowledge regarding selected mosquito borne diseases. • Knowledge of mosquito borne diseases may have its influence on attitude and preventive practices. • Children may be effectively utilized as the change agents of the society. • Child- to– adult teaching approach is an effective measure to bring the behavioural change in the community. • Preventive practices to control mosquitoes may be inadequate in rural areas

  38. Hypotheses Hypothesis will be tested at 0.05 level of significance • H1: There will be a significant difference between the pre-test and post test knowledge, attitude and practice scores of the children regarding prevention of mosquito borne diseases. • H2: There will be a significant difference between the pre-test and post test knowledge, attitude and practice scores of the parents regarding prevention of mosquito borne diseases.

  39. H3: There will be a significant difference between the post test knowledge, attitude and practice scores of the control and experimental group parents regarding mosquito borne diseases. • H4: There will be a significant association between the pretest knowledge, attitude and practices of the parents and selected demographic variables • H5: There will be a significant correlation between the knowledge, attitude and practices of the parents regarding prevention of mosquito borne diseases before and after the child to parent teaching.

  40. Variables • Dependent variables: Knowledge, attitude and practice of children and parents regarding prevention of mosquito borne diseases. • Independent variable: Child to parent teaching regarding prevention of mosquito borne diseases. • Demographic variables: Age, gender, religion, education, occupation, area of living, type of family, previous information on mosquito borne diseases.

  41. Research Methodology • Research approach:Quantitative evaluative approach • Research design:Quasi experimental pre-test post test design with control group. • Research Setting: • Selected schools and corresponding living area of subjects under Permannur and Pilar area. • Data collection and training of the school children by the investigator will be at the respective schools in which they are studying. • Child to parent teaching will be at their respective homes. • Data collection from the parents will be at their respective homes.

  42. Research plan Developing the tool Selecting samples and assigning into control and experimental group Data collection Anaysis and preparation of report Dissemination of findings

  43. Tools • Part 1: Demographic data of parents • Part 2: Knowledge questionnaire regarding prevention of mosquito-borne diseases • Part 3: Five point Attitude scale towards prevention of mosquito-borne diseases • Part 4: Three point rating scale on practices pertaining to mosquito control

  44. Validity • Content validity will be tested by giving to the 9 experts and modification will be done according to suggestions and recommendations. • Item level content validity index (I-CVI) above 0.78 and Scale-level content validity index(S-CVI) above 0.90 will be accepted and included in the final tool.

  45. Reliability • The tool will be administered to 10 parents and 10 school children. • The reliability of knowledge questionnaire will be tested for internal consistency using split half technique. • Attitude scale will be tested for homogeneity using Chronbach’s Alpha and practice checklist will be tested for stability using test -retest method.

  46. Pretesting: Pretesting of the tool will be done by administering it to the 2 school children and their parents. • Plan for pilot study:The pilot study will be conducted in Ullal area to assess the feasibility of the study.

  47. Plan for data collection Phase 1: • Data will be collected from one of the parents who is selected as study subject. • Data will be collected from school children. • Training of students regarding prevention of mosquito borne diseases using flash cards,video and charts in their respective school settings. They will be trained in groups, each group comprising 10 children. The duration of training will be 1 hour each day for 4 days. • Posttest will be conducted after 7 days.

  48. Phase 2: • Children will be provided with adequate AV aids regarding prevention of mosquito-borne diseases and they will be asked to spread information at their homes and to teach the parents. • Posttest data will be collected from the same parent from whom the pretest data were collected and it is done using the same structured knowledge questionnaire, attitude scale and practice rating scale after one week, and at the end of month after the child to parent teaching.

  49. Statistical analysis • The data will be analyzed using descriptive and inferential statistical method • Organization of data in master sheet • Frequencies and percentage for analysing demographic characteristics • Calculation of mean, median and standard deviation of knowledge scores, attitude scores and practice scores.

  50. Application of Chi square to find association between demographic variables and knowledge, attitude and practice scores. • The relationship between the research variables will be elicited by Karl Pearson’s correlation coefficient test • The effectiveness of child to parent teaching will be analysed by using paired ‘t’ test. • Comparison between two groups will be done by using ‘independent ‘t’ test • Homogeneity between experimental and control group will be elicited by using post hoc Bonferonni test.

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