"Prevention is better than cure"
"Cleanliness is next to godliness"
Today increasing emphasis is based on health, health promotion, wellness and self-care. Health is seen as resulting from a lifestyle that is oriented towards wellness. The result has been the evolution of a wide range of health promotion strategies including lifetime health monitoring programmes, environmental health programmes, risk reduction, nutrition and health education. Dissemination of health information is one of the ways of increasing knowledge on health and modification of behavior which is directed towards promotion of health and prevention of disease.
The entry of the causative agent of the disease into the human body and its multiplication is known as the infection. A disease is caused due to a specific organism or by its toxic products. It is transmitted from man, animal, or from environmental agents like food wastes, air, soil and dust, fluid, flies, feces and fomite which is called 'communicable disease'.
An infectious disease is a clinically evident disease resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa and multi cellular parasites and absent proteins known as prions. These pathogens are able to cause disease in animals and plants. Infectious pathologies are usually qualified as contagious disease (also called communicable disease) due to the potential transmission from one person or species to another. Transmission of an infectious disease may occur through one or more of diverse pathways including physical contact with infected individuals.
These infectious agents may also transmit through Feces, Fingers, Food, Fluids and Fomites are the spread of diseases. As a result of the growing prevalence of communicable diseases and the related cost burden, health promotion and illness prevention is increasingly important.
Communicable disease crisis of global proportions is today threatening hard won gains in health and life expectancy. They are now the world’s biggest killer of Under-five children. They account for more than 13 million deaths a year over the next hour alone, 1500 people will die from an infectious disease over half of them children under five. Most deaths from infectious disease occur in developing countries, the countries with the least money to spend on health care. Meanwhile, the growth of densely populated cities with unsafe water, poor sanitation and widespread poverty has created the perfect breeding ground for out breaks of disease.
Every three seconds a young child dies. It is currently estimated that over 21.7 million typhoid cases occur annually, with the vast majority of cases in Asia, with over 2, 00,000 deaths. Additionally an estimated 5.4 million cases occurs due to paratyphoid in most developing countries. The incidence of typhoid fever is <15 cases per 1,00,000 population with most cases occurring in travelers as isolated cases of expense to carriers. There may be also differences in age distribution and population at risk. The age specific incidence of typhoid may be highest in children <5 years of age with comparatively higher rates of complications and hospitalization. Direct or indirect contact with an infected person is a prerequisite for infection. So people must be counseled regarding the risk for disease transmission and given advice on hand washing, safe water, safe food, cleanliness of fomite and preventive strategies.
Children are among the most vulnerable to infectious disease and childhood infections, demand rapid and effective treatment. Gastroenteritis is an inflammation of the digestive tract that is frequently associated with infection by bacteria or viruses. Rotavirus is the major cause of watery diarrhea in children less than 5 years old. It is responsible for significant disease and death among children in underdeveloped countries. Many developing countries struggle with huge disease burdens of diarrhea where a wider approach to diarrhea prevention may be required. Preventive strategies may be of relevance to both developed and developing countries.
An infectious disease is transmitted from some source. Transmission plays an important role in understanding the biology of an infectious agent and in addressing the disease and its cause. General methods to prevent the transmission of pathogens may include disinfection and pest control.
SIGNIFICANCE AND NEED FOR THE STUDY:
The unique feature of Community health nursing as contrasted with other sub-specialties is its primary focus and dedication to the prevention of disease.10 One of the ways to prevent or slow down the transmission of infectious disease is to recognize the different characteristics of various diseases. In all countries effective implementation of preventive strategies requires the involvement of a range of sectors (e.g.: health, agriculture, water supply & sanitation).Infectious disease is defined as one which is being communicated or transmitted, directly or indirectly, from man to man, animal to animal, man to animal, animal to man, from the environment [through fluid, soil, food, air etc.] to man or animal. The main diseases transmitted through these channels are cholera, diarrhoea and common cold.
Worldwide, there are 2 million deaths per year from gastroenteritis in children under 5 years old. Infants and those with immunological compromise are more likely to have more severe disease and to require admission to hospital for rehydration. In severe cases hypovolemic shock and even death can occur. Gastroenteritis is a less severe illness than formerly but remains a significant cause of pediatric morbidity.
Disease caused by bacteria, viruses, fungi and other parasites are major causes of death, disability, social and economic disruption for millions of people. In the case of cholera 317534 cases were reported in 2010 to WHO. Deaths due to cholera were reported globally in 2010 as 7543. In India, the assumption is that 1280 cases of diarrhoea disease are reported within an area in one year, amongst a total of 17900 children. Young children, whose immune systems are vaive to the viruses, are the most vulnerable to cold, though adults still catch an average of 2-3 per year.
Infectious disease transmission of organisms causing disease occurs mostly through contamination of food, fluid, and finger. Very small amounts of feces can carry enough organisms to establish infection. Seemingly sparkling clear water may be dangerously polluted. Contaminated food may smell, look and taste normal and yet harbor infective organisms. Clean-looking hands may carry and transmit enough micro-organisms to spread disease.
An evaluator study was conducted to assess knowledge, positive attitude and healthy practices of diarrhea among children in order to assess the impact of child to child programme in increasing the knowledge, healthy practices and positive attitude among rural primary school children at Belgaum. The data were collected from 54 students belong to 6th students using a knowledge questionnaire. The analysis revealed that the post-test mean score [23.57] was significantly higher than pre-test mean knowledge score [1.14]. The post-test mean attitude score [2.96] was significantly higher than mean test attitude score, the mean post-test practice score [4.17] was significantly higher than mean pre-test practice score [.65]. The study recommended for continuous and special health education to the children to improve the knowledge, practice and attitude on healthy practices to prevent the communicable disease.
The investigator during her under graduate programme had conducted a visit to an orphanage and came to know that most of the children were affected by diseases. The investigator perceived that because of lack of individualized care, children living in orphanages are more prone to get communicable disease. Thus the investigator felt the need to provide health education of these children, so that they may improve their knowledge and healthy practices, which will eventually, help to reduce communicable disease like diarrhea, cholera and common cold.
Enteric fever remains endemic in many developing countries. Population based studies from South Asia indicate that the age specific incidence of typhoid may be highest in children <5 year of age, with comparatively higher rates of complications and hospitalization. So efforts should be made to make the parents of children aware of regarding preventive strategies of typhoid fever.
A prospective study was conducted by S P Con Way, R.R Philips; S Pandey over a one year period examined preadmission illness and its treatment, social characteristics and referral patterns and inpatient illness progression in 1148 children admitted with a primary diagnosis of gastroenteritis. Admissions were predominantly from socially disadvantaged families 712 (62%) from social classes. A quarter were referred with minimal symptoms only 12 (1%) with moderate to severe dehydration and eight with hypernatremia. One third had received no treatment and one third inappropriate antibiotics, anti-diarrheal. Gastroenteritis is a less severe illness than formerly but remains a significant cause of pediatric morbidity. Suboptimal treatment is common. This study addresses the need for improving the health services and preventive intervention for control of gastroenteritis.
A population based prospective surveillance study of typhoid fever was conducted by WHO in five Asian countries to inform the policy makers about introduction of preventive interventions against typhoid. A total of 441435 persons were under surveillance, in that 21874 episodes of fever were detected. Salmonella typhi was isolated from 475 blood cultures. The annual typhoid incidence (per 100000 person years) varied from 24.2 and 29.3 in sites in Vietnam and China and 412.9 and 493.5 in Pakistan and India. The study concluded that the incidence of typhoid being high in India and Pakistan. These findings highlight the importance of evidence on disease burden in making policy decision about interventions to control this disease.
As a researcher I felt that communicable diseases are one of the major causes of morbidity and mortality among under-five children. Mothers play a crucial role in improving the health of children. So this study aims to improve the knowledge level of mothers of under-five children regarding the prevention of selected communicable diseases and promote the knowledge about the Role of 5f’s of disease transmission.
STATEMENT OF THE PROBLEM
"A study to evaluate the effectiveness of a planned teaching program on knowledge and attitude of Mothers of Under five children regarding the role of 5F’s in oral-fecal disease transmission in a selected rural area at Madurai district."
Assess the existing knowledge and attitude of mothers of under-five children regarding the role of 5F’s in oral-fecal disease transmission.
Evaluate the effectiveness of planned teaching program on knowledge and attitude of mothers of under five children regarding the role 5F’s in oral-fecal disease transmission.
Find out the correlation between knowledge and attitude of mothers of under-five children regarding the role 5F’s in oral-fecal disease transmission.
Find out the association between knowledge and selected demographic variables
Find out the association between attitude and selected demographic variables
H01: There will not be a significant difference between the pre-test and post-test knowledge score regarding the role 5F’s in oral-fecal disease transmission among college students.
H02: There will not be a significantly association of the mean post-test knowledge score of mothers of under-five children regarding role 5F’s in oral-fecal disease transmission with selected demographic variables
H03: There will not be a significantly association of the mean post-test knowledge score of mothers of under-five children regarding role of 5F’s of disease transmission with selected demographic variables
H04 : There will not be a significant association between the post-test knowledge and the post-test attitude with the selected demographic variables like age in years, religion, education status, occupation, number of children, type of water facilities, type of latrine facilities and source of information regarding role of 5F’s in oral-fecal disease transmission.
In this study it refers to the output of planned teaching programme in terms of improvement in the knowledge and attitude among the mothers of under-five children as measured by a structured questionnaire and three point Likert scale.
Planned teaching programme on role of 5F’s in oral-fecal disease transmission
Planned teaching programme refers to a planned events, series of studies and lectures. In this study it refers to the systematically developed teaching aid designed to provide information about the role of 5F’s in oral-fecal disease transmission of selected diseases, such as diarrhea, cholera, typhoid fever and dysentery
In this study it refers to the level of understanding regarding the role of 5F’s in oral-fecal disease transmission of selected disease as expressed through correct verbal responses from the mothers of under-five children as measured by a structured questionnaire.
In this study it refers to the way of thinking, belief and feeling regarding role of 5F’s in oral-fecal disease transmission among the mothers of under-five children as measured by three point Likert scale.
Role of 5f’s
The causative organisms have to pass through the environment from the feces of an infected person to the gastro-intestinal tract of a susceptible person. This is known as the fecal-oral transmission route. Oral-oral transmission occurs mostly through unapparent fecal contamination of food, Fluid, Finger, Flies and Fomite.
In this study mothers refer to those who are having under-five children and their age groups within 20-40 years of age in a selected rural area at Madurai.
The study assumes that,
The knowledge and attitude of the mother of under-five children regarding role of 5F’s in oral-fecal disease transmission can be assessed by structured knowledge.
The under five children are highly prone to get communicable disease due to the lack awareness of mothers regarding unhygienic practice.
The study is limited to;
The mother who could converse in Tamil
The mother with under-five children
Those who are present at the time of data collection
This study will bring awareness in the minds of mothers of under-five children regarding the role of 5F’s in oral-fecal disease transmission and the root of special attention in hygienic practices.
This study will help the mothers of under-five children to impart the knowledge gained regarding the role of 5F’s in oral-fecal disease transmission to the neighbors and relatives.
The findings of the study can be used as a reference for various researchers working in the field of growth and development of children especially the welfare of under-five children.