Chapter-1

Introduction

“Health implies a sound mind, in a sound body, in a sound family, in a

sound environment”.
An-ancient view J.E. Park.

The term health and wellness are two major components of life. Health is often
described as an absence of illness. Whereas wellness is often given a more positive
connotation, suggesting that it involves an absence of illness. The term illness refers to
deviation from the normal health. Most of life changes may lead to acute and chronic
illness.
India is an epidemiological, demo-graphical and health transitional country. The
expectancy of life has increased, with consequent rise in degenerative diseases of aging
and life styles. However, communicable diseases are still dominant and constitute major
public health issues. School going children, not only constitute a large group but they
are also vulnerable or high risk group. The risk is connected with growth, development
and survival. Initial five years of life is full of health hazards. Since they are high risk
group, under five children are exposed to many environmental factors leading to several
problems and diseases in children.

Communicable diseases are a danger to everyone. Some have been controlled

with vaccinations and modern technology, while others are emerging or resistant to
drug treatments. Disease prevention and control are a cooperative effort involving
health care providers, local and state health department personnel and members of the
community.

Communicable diseases are the diseases that are because causative organism spreading
from the one person to other or from animals to people. They are among the major
causes of illnesses in developing countries. These diseases affect people of all ages but
more so children due to their exposure to environmental conditions that support the
spread. Communicable diseases are preventable base on interventions placed on various
levels of transmission of the disease.

Health is an essential factor for a happy contended life. If children are healthy then
future generation will be healthy resulting in healthy nation. Today increasing emphasis

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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
program, environmental health program, risk reduction and 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.
.
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 .These pathogens can cause disease in animals and
or 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 any of diverse
pathways including physical contact with infected individuals. These infectious agents
may also transmit through liquids, food, body fluids, contaminated objects, airborne
inhalation or through vector borne spread. Hence the growing prevalence of
communicable diseases and the related cost burden, health promotion and illness
prevention are increasingly important.

Communicable disease crisis of global proportions is today threatening hard won gains
in health and life expectancy. These diseases are now the world’s biggest killer of
children and young adults. 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 those
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 have created the perfect breeding ground for out breaks of disease.

In India almost 74% of people live in rural areas. It is observed that because of illiteracy,
ignorance, misconception and superstition people of rural areas have developed
undesirable health attitudes and practices. About 30-50% of rural school children suffer
from much morbidity like worm infestations, diarrheal diseases, under nutrition etc, but
unless there is genuine understanding about how the disease is caused and carried,
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communicable disease is likely to continue because people are not in born with hygiene
knowledge.
Healthy child is nations pride; hence by curtailing the occurrence of these infectious
diseases of childhood, we can build up a better generation. According to whom
diarrheal disease caused more than 1.7 million deaths in 2004 and 90% of these
occurred among children. Almost 88% of the diarrheal diseases are attributes to unsafe
water supply, inadequate sanitation and hygiene. This preventable disease of childhood
can cause a unique challenge to health care system of the country.

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. The age specific incidence of typhoid may be highest in children <5 years of
age with comparatively higher rates of complications and hospitalization.

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.

Tuberculosis remains the most important chronic infections disease in the world in
terms of morbidity mortality and cost. Cases of tuberculosis for all ages are highest in
urban, low income areas and among non white racial ethnic groups. Tuberculosis is a
major global public health problem with 8 million new cases of pulmonary tuberculosis
in the world per year and 2.89 million deaths. The major roles of the primary care
provider in the control of tuberculosis are evaluating risk of infection, skin-testing
patients with risk factors for tuberculosis disease, treating the infection and initially
evaluating children with possible tuberculosis disease.

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An infectious disease is transmitted from some source. Transmission plays an important
part in understanding the biology of an infectious agent and in addressing the disease
and it causes. General methods to prevent transmission of pathogens may include
disinfection and pest control.

Vaccines are now available to control the majority of diseases that have caused illness
and death in children in the past. Medical treatments help to control many others, but
schools and child care centers must continue to play an important role in controlling the
spread of communicable diseases. By enforcing the state communicable disease
regulations, excluding children who are ill, and promptly reporting all suspected cases
of communicable disease, personnel working with children can help ensure the good
health of the children in their care. Be alert for signs of illness such as elevated
temperature, skin rashes, inflamed eyes, flushed, pale or sweaty appearance. If a child
shows these or other signs of illness, pain or physical distress, he/she should be
evaluated by a health care provider. Children or staff with communicable diseases
should not be allowed to attend or work in a school or child care setting until they are
well. Recommendations for exclusion necessary to prevent exposure to others are
contained in this document.

Certain symptoms in children may suggest the presence of a communicable disease.

Excluding an ill child may decrease the spread of the disease to others in the childcare
and school settings like illness, fever, sore throat, running nose, weakness, diarrhea,
redness ,dental caries etc. Most communicable diseases can be prevented through basic
infection control measures such as regular hand-washing, practicing respiratory
etiquette (covering coughs and sneezes), and proper disinfection of high touch/high
traffic surfaces.

Children are wealth of tomorrow. Children are the major consumers of health care. In
India about 35% of total population is children below 15 years of age. Children always
need special care to survive and thrive. School age years is a time of continued
maturation of child’s physical, social, psychological characteristics. The school age
child values school attendance and school activities. Children spend a lot of time in
recreational activities that require good vision. Good vision is a key to success. Visual
skills are needed for the school success. New research estimates that a million children
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have undetected vision problems, while almost 70% of schools do not have any eye
screening, which was described as “an absolute public health disgrace” by Bob Hughes.

Tooth decay is one of the most common chronic conditions among children.
Approximately 23% of children aged 2–11 years have at least one primary tooth with
untreated decay and 20% of adolescents aged 12–19 years have at least one permanent
tooth with untreated decay . Tooth decay, if left untreated, can cause pain and infection,
and can lead to problems with eating, speaking, and learning . Risk factors for tooth
decay include recent history of cavities, low fluoride exposure, and living in a low-
income household.12 Prevalence of untreated decay in primary or permanent teeth
among children from lower-income households is more than twice that among children
from higher-income households . Prevalence of untreated tooth decay is also higher
among Mexican-American children and non-Hispanic black children than among white
non-Hispanic children . By age 15, approximately 60% of all adolescents will have
experienced tooth decay . An estimated 51.7 million school hours are missed annually
by school-aged children because of a dental problem or visit.

. In India it is estimated that around 2-5% of school children have vision problems. In
Bengaluru it is estimated that around 20% of school children have vision problems. It
is estimated that nearly 25 per cent of school age children have vision problems. Despite
the social, economic and health care advances which have occurred in our society, many
preschool and school age children is not receiving adequate professional eye care. Only
1/3rd of all children have had an eye exam or visual screening prior to entering school.
The American Optometric Association believes that a vision assessment conducted as
a part of school vision screening in the public or private schools cannot substitute for
regular professional care. The warning signs of vision problems in kids are “Refractive
errors” which is the most common cause of vision problems among school age children.
Parents as well as the teachers should be aware of these signs that a child needs
correction that includes consistently sitting too close to television, holding book too
close, using a finger to guide his eye, squinting or tilting the head to see better, frequent
eye rubbing, sensitivity to light and excessive tearing, closing one eye to read, watch
television, avoiding activities that require a near vision such as participating in sports
or recreational activities, receiving low grades than usual.

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NEED FOR THE STUDY:

“Today’s children are tomorrow’s hope, who can constitute a stronger nation.”

Growing children in their tender age are at increased risk of becoming sick especially
children of first ten years. Prevalent problem is a ‘local and focal problem ‘causing
mortality and morbidity at high levels in community especially among children. It is
transmitted through direct contact with infectious pathogens include some viruses,
bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as
prisons. Transmission of pathogens can occur in various ways including physical
contact, contaminated food, body fluids, objects, airborne inhalation and through
vector organisms.

In this era children’s are suffering and dying each year due to malaria, diarrhea,
tuberculosis, pertussis and typhoid fever etc. According to world health statistics in
each year nearly two million children lose their lives due to prevalent problem.

The unique feature of community health nursing as contrasted with other sub-
specialties is its primary focus and dedication to the prevention of disease. 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).

According to WHO’s World Malaria Report ( 2014): In 2014, 97 countries and

territories had ongoing malaria transmission. An estimated 3.3 billion people are at
risk of malaria, of which 1.2 billion are at high risk. In high-risk areas, more than
one malaria case occurs per 1000 population. There were an estimated 198 million
cases of malaria worldwide (range 124–283 million) in 2013, and an estimated
584 000 deaths (range 367 000–755 000). 90% of all malaria deaths occur in Africa.
In 2013, an estimated 437 000 African children died before their tenth birthday due
to malaria. Globally, the disease caused an estimated 453 000 under-ten deaths in
2013. Between 2000 and 2013, an expansion of malaria interventions helped to
reduce malaria incidence by 30% globally, and by 34% in Africa. During the same
period, malaria mortality rates decreased by an estimated 47% worldwide and by

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54% in Africa. In the under-ten age group, mortality rates have declined by 53%
globally, and by 58% in Africa.

National surveys (2014): There are 2 million deaths per year from gastroenteritis in
children under 10 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.

WHO globally (2013): Tuberculosis is the second most common cause of the death
due to disease at the global level. Tuberculosis remains the single largest infectious
disease carrying high deaths annually about 5 deaths every minute. Childhood
Tuberculosis is an important indication of public health success in interrupting and
preventing Tuberculosis transmission. Infection can be reduced with improveent of
environmental hygiene, medicine, high nutritious diet and health education.

WHO (2013): Typhoid fever is a life-threatening illness caused by the bacterium

Salmonella Typhi. In the United States about 400 cases occur each year, and 75% of
these are acquired while traveling internationally. Typhoid fever is still common in
the developing world, where it affects about 21.5 million persons each year. Infection
caused by S. typhi remains an important public health problem, particularly in
developing countries.

National survey (2012): 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 <10 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.

The health functionary ultimately responsible for delivering of health care services.
Most of the childhood diseases can be prevented by giving good, adequate and
reliable information and knowledge to the care givers. Therefore, as the investigator,

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I, found that the caregivers with the help of a on prevention of communicable
diseases can reduce the mortality and morbidity rate among children .

According to WHO reports (2011): Food and water borne diseases are one of the
major causes of childhood mortality and morbidity in developing countries? Central
bureau of health intelligence (CBHI) 2011 report shows that among all reported
communicable diseases 29% shared by diarrheal diseases. Data collected by the CBHI
ministry of health and family welfare, shows that in 2010, there were 10.5 million cases
of diarrhea with 4079 deaths, in the same year there were 2893 cholera cases. India
belongs to high endemic country of enteric fever; there were total 535665 enteric fever
cases in 2010. Recent surveillance studies from India have shown that the incidence
rate of enteric Fever may peak as early as 5-10 years of age

Prevalence of problems
Injuries
Seizure disorder Lameness 2%
1% 1%
Speech disorder
0%
Dental Anemia Rheumatic heart
Tuberculosis** caries 17% disease
3% 11% 0%
Worm
Eye infections infestation Leprosy**
4% 13% 1%

Respiratory Under Congenital

Ear infections infections nutrition* malformations
4% 15% 11% 0%
Skin
infections
Deafness 12% Nutritional skin
1% disorders
7%

Figure – 1 Prevalence of the Problems

In India, according to UNICEF (2008), the prevalence of malnutrition in school going

children varied across states, with Madhya Pradesh recording the highest rate (55 %)
and Kerala shows the lowest prevalence of 27% respectively.

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WHO (2010): Vitamin A Deficiency (VAD) can cause night blindness and reduce the
body's resistance to disease. In children VAD can also cause growth retardation.
Between 100 and 140 million children is vitamin A deficient. An estimated 250,000 to
500,000 VAD children become blind every year; half of them are dying within 12
months of losing their sight. The estimated prevalence of VAD is 23.4%, suggesting
that there are 83 million VAD school-aged children in the region, of whom 10.9% (9
million, at an overall prevalence of 2.6%) have mild xerophthalmia, night blindness and
Bigot’s spot.

Beheraet al.(2008) A study conducted in tribal children of Orissa of age up to 15 years,

the different types of morbidities were fever 24.4%, acute respiratory infections 35.4%,
goiter 14.4%, and diarrhea 5%, 44.1% splenomegaly. As it is a tribal area, 14.4%
suffered from malaria. Singh et al. (2006). In a study conducted in urban slums of
Luckhnow on 400 adolescent girls aged 10–19 years, the various morbid conditions
found were inadequate oral hygiene (55.4%), pediculosis (39.2%), cold & cough
(25.8%), lymphadenopathy (22.2%) , scabies (16.2%) , inflamed tonsils (7.8%) and ear
discharge (7%) of girls.

Food and water borne diseases in children are widely prevalent in many developing
countries especially in tropical and subtropical regions. Young children are especially
at risk because of their hand to mouth activity and uncontrollable fecal habits and are
more likely to suffer from its pathological consequences.

Early identification of vision problems among school children is very important. An

important part of all screening process is following up on referrals to be certain that
school children receive diagnostic care they need. Eye examination for children is
extremely important, because 5 to 10 % of pre scholar and 25% of school-aged children
have vision problems. Early identification of a children’s vision problem can be crucial
because children often are more responsive to treatment. Children who need eyeglasses
should be examined annually or as recommended by their optometrist or
ophthalmologist. Early eye exams are also important because children need the
following basic skills related to good eyesight for learning that includes near vision,

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distance vision, binocular vision (two eyes), coordination Eye movement skills,
focusing skills, peripheral awareness, hand eye co-ordination.

India assessment report 2010, WHO and World Bank: Estimated that around 5 lakh
populations in India die due to diarrhea. Community level study conducted jointly by
WHO and UNICEF, which was published in planning commission. India assessment
report 2010, shows that every child below 10 years of age has 2 -3 episodes of diarrhea
every year. It means many hundred million cases of diarrhea occur every year and only
a small percentage of diarrheal diseases are reported. According to written program for
appropriate technology in health (PATH) estimated 1, 25,000 Indian children die each
year from rotavirus diarrhea. According to the planning commission report (2010) “to
advocate the development of water supply and sanitation infrastructure and increased
efficiency within the sector, health authorities will need to improve their information
base.

Dental caries is the most prevalent and chronic oral disease particularly in childhood
(5-15) years of age. Dental caries is a progressive infectious process with a
multifactorial etiology. Dietary habits, oral microorganisms that ferment sugars, and
host susceptibility have to coexist for dental caries to initiate and develop. Dental caries
has high morbidity potential. Thus, it has been the main focus of dental health
professionals and auxiliary health professionals to prevent dental caries.

Dental caries causes teeth pain, discomfort, eating impairment, loss of tooth and delay
language development. Furthermore, dental caries has effects on children’s
concentration in school and a financial burden on the families. Risk factors such as sex,
age, dietary habits, socioeconomic and oral hygiene status are associated with increased
prevalence and incidence of dental caries in a population.

Although, the trend is not clear in developing countries, the burden of dental caries has
been increasing among children due to the unlimited consumption of sugary substances,
poor oral care practices and inadequate health service utilization. Studies revealed that
the prevalence of dental caries was higher among urban children. Similarly, a study
conducted in Ethiopia was reported 36.5% prevalence of dental caries among urban
children in school. Although, dental caries is more prevalent in school children.

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One of the greatest problems for India is under nutrition among children. The country
is still struggling with this problem. Malnutrition, the condition resulting from faulty
nutrition, weakens the immune system and causes significant growth and cognitive
delay. Growth assessment is the measurement that best defines the health and
nutritional status of children, while also providing an indirect measurement of well-
being for the entire population.

School age is the active growing phase of childhood .Primary school age is a dynamic
period of physical growth as well as of mental development of the child. Research
indicates that health problems due to miserable nutritional status in primary school-age
children are among the most common causes of low school enrolment, high
absenteeism, early dropout and unsatisfactory classroom performance. The present
scenario of health and nutritional status of the school-age children in India is very
unsatisfactory. The national family health survey (NFHS) data show that 53% of
children in rural areas are underweight, and this varies across states. The percentage of
underweight children in the country was 53.4 in 1992; it decreased to 45.8 in 1998 and
rose again to 47 in 2006.

The complex myriad of physiological as well as psychological changes, accompanied

by rapid growth and increase in physical activity, creates special nutritional needs that
are higher during adolescence than at any other time in life. Failure to consume
adequate diet at this time can potentially retard physical growth, intellectual capacity
and delay sexual maturation (WHO 1999). Addressing the nutrition needs of school
going children could be an important step towards breaking the vicious cycle of
intergenerational malnutrition, chronic diseases and poverty. Epidemiological evidence
from both the developed and developing countries indicates that there is a link between
fetal under-nutrition and increased risk of various chronic diseases during adulthood.
Hence heath professional provide education to control these problems.

In India, according to UNICEF (2008), the prevalence of malnutrition in school going

children varied across states, with Madhya Pradesh recording the highest rate (55 %)
and Kerala shows the lowest prevalence of 27% respectively.

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Food and Agriculture Organization (2005): Studies in India and Bangladesh have
shown deficiencies in the intake of all nutrients, particularly iron, calcium, vitamin A
and vitamin C. The reported reasons are mainly the low educational level of parents
and low family income. The nutritional deprivation affects almost all growth
parameters and final adult body size resulting in thinness and stunting. However,
nutritional status of both boys and girls improved with age, showing that the effect of
malnutrition is more pronounced at the time of peak growth. The prevalence of protein
energy malnutrition (PEM) is high in most countries of the SEA region.

Over the past 20 years, obesity rates in US children and youth have skyrocketed. Among
children ages 6 to 11, 15.8% are overweight (≥95th percentile body mass index [BMI]
for age) and 31.2% are overweight or at risk for overweight (≥85th percentile BMI for
age). Among adolescents ages 12 to 19, 16.1% are overweight (≥95th percentile BMI
for age) and 30.9% are overweight or at risk for overweight (≥85th percentile BMI for
age). The rapid increase in the prevalence of obesity in American young people has
occurred concurrently with other disquieting trends. Between 1991 and 2003,
enrollment of high school students in daily physical education classes decreased from
41.6% to 28.4%.3 Physically active transport to and from school has declined from
previous generations; only one third of trips to school ≤1 mile and <3% of trips ≤2 miles
are made by walking or biking, Even recess has been reduced or eliminated in some
elementary schools.

Shatha et al (2003) collected data on adolescents comprising 46% from high socio-
economic area and 54% from low socio-economic area in Baghdad, Iraq. The
prevalence of anemia among adolescents in HSEA was 12.9% compared to 17.6% in
LSEA. Hemoglobin concentration in males was significantly correlated with age and
dietary iron intake while in females it was correlated significantly with years of
education of father and mother, number of pads and age at menarche.

Hall et al (2002): Demonstrated the effectiveness of iron supplementation channeled

through school. Weekly dose of 65 mg of iron along with 0.25 mg of folic acid were
administered by teachers for 10 weeks in thirty schools, covering almost 1100 students
in the age group of 6 – 19 years. Hemoglobin levels rose by an average of 1.8 g/l and

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prevalence of anemia fell by 8.2% both significant at P < 0.001. Young children (< 12
years) and girls benefitted more.

Worms infect more than one third of the world's population, with the most intense
infections in children and the poor. In the poorest countries, the infection is long-term
and chronic, and can negatively affect all aspects of a child's development: health,
nutrition, cognitive development, learning and educational access and achievement
(World Bank report 2003).

A high prevalence of intestinal parasitic infections is closely correlated with poverty

and poor environmental hygiene, namely: a) lack of safe water supply, b) contamination
of the environment by human excreta, c) lack of shoes, and d) poor environmental or
personal hygiene. In the long run, worm infections increase susceptibility to other
infections and diminish learning ability and growth in children.

Intestinal parasitic infections negatively affect the health status of a high proportion of
school-age children in developing countries, giving rise to general discomfort and acute
symptoms such as abdominal pain, nausea and coughing. More than two billion
children globally are infected by intestinal helminthes, with 155,000 deaths reported
annually. The burden of diseases caused by intestinal helminthes infection (39 million
disability associated life years (DALYs) is higher than that caused by measles (34
million DALYs) or malaria (36 million DALYs). Intestinal helminthes infection affects
the nutritional status of children through intestinal bleeding, mal absorption,
competition for nutrients, loss of appetite and diarrhea. All of these effects are
reversible after treatment. Another benefit of treatment is better digestion of the
sometimes limited food available. 30
Approximately 300-500 million malaria clinical cases and one million deaths due to
malaria occur annually. Over 90% of the disease burden occurs in Africa south of the
Sahara alone. In areas of unstable transmission, malaria accounts for 10 to 20 percent
of all-causes of mortality among school-age children and poorer cognitive abilities
characterize those who have suffered repeated malaria attacks. A Kenyan study has
shown that primary school children miss 11% of school days because of malaria.

Regular de-worming contributes to good health and nutrition for children of school age,
which in turn leads to increased enrolment and attendance, reduced class repetition, and
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increased educational attainment. The most disadvantaged children - such as girls and
the poor - often suffer most from ill health and malnutrition, and gain the most benefit
from de-worming (World Bank Report 2003).

Children are the most important asset and wealth of a nation. Healthy children make a
healthy nation. The children under 15 years of age constitute about 40% of the
population. The child is not a miniature, but an individual in his own right. The quality
of childhood one has lived will determine the ultimate nature of the adulthood. Now a
day, because of the rapid industrialization and urbanization, majority of young couples
are employed, so unavoidably they get less time to look after their children. Under these
circumstances, emotional, behavior and psychiatric problems are on the rise. 6-12 years
of age is considering as the school age period. School children are emerging as creative
persons who are preparing for their future role in society. During the school years the
child develops while some attitude toward self as a person and learn the appropriate
masculine or feminine social role. The school years are a time of new achievement and
experiences in their life so their needs and preferences should be respected. In our
country most of the population is children and they are considered as the future of our
country, so their safety, basic needs and development is our priority that relies great
deal on it is human resource strength. Therefore, it is necessary in the interest of our
country to look after the health and welfare as they form the most endangered segment
of the population. A better tomorrow depend on the safety, wellbeing and development
of children today. So we need to understand proper growth and development of
children.

Scholars are emerging as creative function who are preparing for their future role in
society and development of society in their own way. Success in schools involves being
ever to complete work, stay organized get along with kids and adults, be positive about
their abilities and follow rule and doing best work. Before understand children behavior
we should know their needs Children who suffer from behavioral disorders are at a
higher risk for school failure, suicide, and mental health problems. The early detection
and treatment of children with behavioral problems at an early age may reduce
treatment costs and improve quality of life of those children.

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Healthcare provider-based surveillance has been used to capture typhoid cases for
vaccine studies and to measure typhoid fever incidence. However, such an approach
needs consideration of the healthcare-seeking behavior of the population, existing
healthcare systems, practices of the healthcare providers and precision of surveillance
systems. It could be that we only screened 30% of fever cases identified during
household surveillance, therefore cases were missed. Quick remedies for febrile
illnesses are common and acceptable at community level. Most of the health care
providers had an established system for diagnosing and treating febrile illnesses. Any
alternative system of patient referral requiring further work-up was not a viable option
for their market. This resulted in poor referral from community health providers to the
study clinic. This raises the need to develop integrated models of syndrome-based
management of febrile episodes, especially for primary care physicians lacking the
facility of even basic laboratory tests. Local modifications of algorithms for the empiric
management of febrile patients, e.g., fever module of the World Health
Organization/United Nations Children's Fund guidelines for the integrated management
of childhood diseases, would be helpful.

This study concludes that typhoid fever is endemic in this community with the highest
incidence occurring in children (both girls and boys) of age 5–10 years, especially after
rainfall months. Facility-based surveillance missed a significant proportion of potential
cases raising the need for even more extensive surveillance systems. There is also a
need to conduct studies on the healthcare-seeking behavior of the population, and
practices of the healthcare providers, so that more precise studies can be designed to
capture true incidence. This will ultimately be required in order to take the decision for
the use of mass scale vaccination against typhoid fever in high-risk age groups. 26

Diarrhea is responsible for 17% of all deaths (approximately 2.5 million deaths each
year) among children younger than 5 years old worldwide; this rate is higher than that
of AIDS, malaria, and measles combined. The majority (42%) of these deaths are
concentrated in the Sub-Saharan African countries, including Ethiopia (88 per 1000 live
births).

Recent national estimates have indicated that the two-week prevalence of diarrhea in
children was approximately 13%. Moreover, few local studies have reported that the

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magnitude of diarrhea among children younger than 5 years old in different regions of
the country ranges from 18 to 31%. Although this evidence is available, there has still
been a lack of studies in the country to obtain up-to-date information on the disease and
to prioritize interventions by decision makers to overcome the problem. Therefore, the
aim of this study was to identify the magnitude and to determine the factors that affect
diarrheal disease among children younger than five years.

There are several small iron supplementation studies that have examined its impact on
growth, hemoglobin and morbidity in young children. The studies become clearer when
they are classified by baseline prevalence of anemia. The studies where prevalence of
anemia is greater than 80 % showed significant benefit in linear growth following the
supplementation (median effect size 0.6 SD unit). An Indian study reported a negative
effect in anemic children too (Bhatia & Seshadari 1992).

Recent studies suggest that intestinal parasitic infections negatively affect school
children's cognitive functions. A study in Jamaica showed significant improvements in
the auditory short-term memory of heavily infected children after nine weeks of
treatment. Single oral dose treatment with mebendazole (500 mg) or albendazole (400
mg) is very effective, safe and inexpensive. The direct benefit of chemotherapy is that
the worm burden is removed, which immediately alleviates symptoms and may reduce
the rate of transmission. Furthermore, WHO recommends improved sanitation and safe
water supply as well as health education on the prevention of intestinal parasitic
infections as important strategy.

School-age children typically have the highest intensity of worm infection of any age
group. In addition, the most cost-effective way to deliver de-worming pills regularly to
children is through schools because schools offer a readily available, extensive and
sustained infrastructure with a skilled workforce that is in close contact with the
community.
Drugs for de-worming treatment are highly effective, widely available, inexpensive,
easy to administer during school or general population drug campaigns and without
serious side effects. One caveat is that treatment must be repeated every 6-12 months
because of re-infection.

16
Among the interventions found to be most effective in reducing malnutrition in children
micronutrient supplementation and water and sanitation interventions, de-worming has
been found to be particularly effective intervention for children of school age. Thus
giving high priority to several of these interventions in order to attack malnutrition was
emphasized by the Copenhagen Consensus panel in 2004, 2006 and again in 2008 and
2010.

Problem Statement

“A study to assess the prevalent problems among school going children (5-15years)
and the preventive measures taken by health professionals in selected areas of Ratia in
Fatehabad district of Harayana.”

Purpose

The aim of the study is to assess the knowledge of health professional regarding
prevalent problems and preventive measures at selected health centers in Ratia
(Fatehabad) Haryana.

Objectives of the Study

• To assess the prevalent problems among school going children and preventive
measures taken by health professionals to reduce these problems.
• To find out the co- relation between problems and preventive measures among
school going children.
• To determine the association between health problems and selected demographic
variables.

Operational Definitions
 Assess
In this study it refers to find out the health problems and preventive measures
among school going children.
 Knowledge
It refers to the awareness and understanding of health professionals regarding
prevalent problems and preventive measures among school going children.

17
 Prevalent
It refers to the number of cases in a given statistical population.
 Health problems
Any deviation from normal level of health that is difficult to overcome and cause
Morbidity and mortality.
 School going children
In this study the children of age group between (5-15 Years).
 Prevention
It refers to the efforts and measures which are taken before coming any prevalent
problems such as diarrhea, typhoid, tuberculosis, anemia, scabies, malaria
conjunctivitis etc. It may be primary, secondary and territory.

 Health professionals
It refers to the educated and trained personnel those provide care to the
Individual, family and community and they are working in health centers.

Hypothesis
 H1 – There is significant relationship between problems of school going
children and preventive measures.
 H01 - There is no significant relationship between problems of school going
children and preventive measures.
 H2- There is significant association in knowledge and selected demographic
variables.
 H02- There is no significant association in knowledge and selected demographic
variables

Assumptions
The study assumes that:
• Health professionals have some knowledge regarding prevalent problems among
school going children.
• Health professionals have some knowledge to prevent the prevalent problems in
school going children.

18
• Health professionals will actively participate and give free and frank response to
the questions.
• The knowledge of health professionals is influenced by factors like age,
professional qualification, gender, job experience, economic status ,area of
resident ,source of information etc.
Delimitations

 The study was delimited to selected health centers of District Fatehabad, Haryana.

 The study was delimited to 200 health professional from selected health centers.

 Prevalent problems were concerned with children’s of 5-15years of age.

 Information of health problems and preventive measures attained from records of

Civil Hospital Fatehabad.

 Information of health problems and preventive measures collected from 2016-2018

records.

 All health centers were not included in study.

Conceptual framework
Concept is defined as a complex mental formulation of an object, property or an event
that is derived from the individual’s perception and experiences. Theories and
conceptual models are the primary means of providing a conceptual context for study.

The study is based on the Rosestoch’s, Becker and Maiman’s Health Belief model. This
model was developed to provide a framework for understanding why some people take
specific actions to avoid illness, whereas others fail to protect themselves. The model
was designed to predict which people would and would not use preventive measures
and suggest interventions that might reduce the prevalence of communicable diseases.
There are three major components of the health belief model: individual perceptions,
modifying factors and likelihood of action.

19
The first component was individual perception of susceptibility to prevalent problems
among children and perceive the seriousness of prevalent problems by health
professionals.

The second component was modifying factors which include the demographic
variables and structural variables. The demographic variables include age, professional
qualification, gender, Job experience, economic status ,area of resident, source of
information etc.

The third component is likelihood of action, which includes perceived benefits minus
perceived barriers for preventive action. In this study the benefit will be the gain in
knowledge by the client which will lead to change in behavior. In addition to this the
components on cues to action is the health awareness program which can motivate the
client to take action.

20
Figure -2 Conceptual Framework Based on Rosenstochs 1947 and Becker
and Maiman’s Health Belief model 1975

21
 CHAPTER- 2
REVIEW OF LITERATURE

A literature review is a text written by someone to consider the critical points of current
knowledge including substantive findings as well as theoretical and methodological to
a particular topic.

A review of literature is essential step in the development of scientific research project.

The purpose of review of literature is summarization of new substantive or theoretical
ideas, formation of testing of theory, organization of knowledge from different fields
and integration of knowledge into a new whole. The review is a systematic search of
published works to gain information about a search topic. It is a complication that the
groundwork for a further study. (Talbot, 1995)

Review of work conducted in the area of general interest helped the researcher in the
formulation and classification of research problem, a scrutiny of previous work
acquainted the researcher with what had been done in a field, by minimizing the
possibility of unintentional duplication. It also helps in choosing the specific procedures
and instructions that might be productive in further steps.
( Polit DF HunglerBP;2001)

For the present study an extensive review of research and non-research literature
relevant to the study was undertaken to develop deeper insight into the problem and to
built the foundation of study and is presented under the following sub- headings:

Section A: - Literature related to the prevalent problems among school going children.

Section B: - Literature related to the knowledge of health professional regarding

prevention of prevalent problem among school going children .

22
Section A: Literature related to the prevalent problems among school
going children:

Prevalent problems among school going children below ten years:

Centre for Global Health Research (2015): A study was conducted on the leading
causes of death among children below ten years old in low- and middle-income
countries, including India, are diarrhea, pneumonia, and other infectious diseases. As
part of CGHR’s Million Death Study (MDS), researchers used nationally representative
data from 2015 to estimate that 198,000 children aged under five years died in India in
2014. Diarrhea, pneumonia and malaria were found to be the main infectious causes of
death. One of the most important findings from the study is the strong gender bias in
the deaths studied. For both diarrhea and pneumonia, the mortality rates (deaths per
100,000 live births) among girls were 50% higher than those for boys. A possible
explanation is that parents are less likely to immunize, seek medical attention, use
appropriate antibiotic therapy for girls. 1

A Sinha S Sazawal et el. (2013): A prospective study was conducted on follow-up of

research of residents of a low income urban area of Delhi, India with active surveillance
for case detection. They visited 8172 residents of 1820 households of Kalkaji, Delhi,
twice weekly to detect febrile cases. Blood samples were obtained from febrile patients
and those who tested positive for Salmonella typhi were treated with ciprofloxacin.
Sixty three culture positive typhoid fever cases were detected. Out of these, 28 (44%)
were in children aged under 5 years. The incidence rate of typhoid fever per 1000 person
years was 27.3% at age under 5 years, 11.7 at 5-19 years and 1.1 between 19 and 40
years. Morbidity in those under 5 and in older people was similar in terms of duration
of fever, signs and symptoms and need for hospital admission.4

Dang DT and JB Robbins et el. (2010): A population based surveillance study for
typhoid fever was conducted in three rural communes of Dong. Cases of typhoid fever
were detected by obtaining blood for culture from residents with fever > or = 3 days.
Among 658 blood cultures, 56 were positive for Salmonella typhi with an overall
incidence of 198 populations per year. The study highlighted that typhoid fever is

23
highly endemic in Vietnam and is a significant disease in pre-school and school aged
children. 5

Acharyase Sc A comparative study was conducted on new estimates indicate that over
650,000 children develop tuberculosis every year in the 22 countries with a high burden
of the disease -- almost 25 percent higher than the total number of new cases worldwide
estimated by WHO in 2012. The research also suggests that about 15 million children
are exposed to TB every year, and roughly 53 million are living with latent TB
infection, which can progress to infectious active TB at any time.2

Global Burden of Disease Study (2013) A study was conducted on diarrheal disease
which is the second leading cause of death in children under five years old, and is
responsible for killing around 760 000 children every year. Diarrhea can last several
days, and can leave the body without the water and salts that are necessary for survival.
Most people who die from diarrhea actually die from severe dehydration and fluid loss.
Children who are malnourished or have impaired immunity as well as people living
with HIV are most at risk of life-threatening diarrhea. About 1.7 to 5 billion cases of
diarrhea occur per year. It is most common in developing countries, where young
children get diarrhea on average three times a year. Total deaths from diarrhea are
estimated at 1.26 million in 2013 – down from 2.58 million in 1990. In 2012, it is the
second most common cause of deaths in children younger than five (0.76 million or
11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the
most common cause in those younger than five years of age.

Qureshi .F (2013) Conducted an interview on diarrhea, its prevalence, practices and

awareness of mothers in 120 randomly selected households in rural area of Chandigarh
during monsoons in 2013. The prevalence rate of diarrhea in 181 under five children
was observed to be 23.2%. Majority of 81% children had treatment for diarrhea where
as only half of children 54.8% of children were given ORS.86.7% of the mothers were
aware of ORS. But, only18.7% could tell the correct method of its preparation. The
study concluded the importance of educating mothers regarding the preventive
measures on diarrhea6.

24
S. Mangla (2010): Diarrhea is a prime cause of childhood mortality in the developing
world. It deteriorates the immunity of children, specifically in the age group of two to
three. Diarrhea is responsible for worldwide mortality of 1.5 to 5 million children per
year under the age of five years. Diarrhea undermines the resistance of body, coupled
with dehydration and viciously depreciates the nutritional status of children33.

World health statistics (2010) a study was conducted on communicable diseases each
year nearly childhood communicable diseases are two million children lose their lives
due to this communicable disease. In 2008 malaria killed about 732000 children
and diarrhea killed about 1.3 million children’s.

The National Institute of Cholera and Enteric Diseases, Kolkata (2010) A

study was conducted to assess the crude death rate due to diarrhea in rural India
is 9.3 per 1,000 populations. The total number of deaths due to diarrhea in the
age group of 0–6 years accounted for 22% of total rural deaths. In India Malaria
is still a public health problem and 1.65 million cases with 973 deaths were
reported. In India; the mean episode of scabies/child/year were 10.7 and mean
number of days of illness/child/year were 51.1 .In Karnataka itself 44122 cases
of malaria was reported.14

Tucci, Debara L (2009) Hearing loss and deafness are global issues that affect at least
278 million people worldwide. Two thirds of the people who have HL worldwide live
in developing countries. Importantly, it is estimated that 50% of this HL can be
prevented. In developing countries, funding for prevention, early detection, and
rehabilitative programs is severely limited, and therefore, agencies must compete
against priorities to treat life-threatening, pandemic diseases such as human
immunodeficiency virus, malaria, and tuberculosis. Delays in diagnosis are common,
and social attitudes, local customs, and cultural bias are contributing factors. The study
concluded that the high prevalence of HL in the developing world is due to a variety of
factors, including lack of widespread comprehensive immunization programs and other
medical care, and inadequate funds for intervention once HL is identified. International

25
organizations, governments, and nongovernment organizations have many
opportunities to prevent and treat HL through cost-effective means. 28

Christopher A. Kearney( 2004 ) Absenteeism from school is a serious public health

issue for mental health professionals, physicians, and educators. The prevalence of
unexcused absences from school exceeds that of major childhood behavior disorders
and is a key risk factor for violence, injury, substance use, psychiatric disorders, and
economic deprivation. This article involves a contemporary research review on
absenteeism prevalence, co morbid physical and psychiatric conditions, classification,
contextual risk factors, cross-cultural variables, assessment, intervention, and
outcome. Contextual risk factors include homelessness and poverty, teenage
pregnancy, school violence and victimization, school climate and connectedness,
parental involvement, and family variables, among others. A description of
intervention includes medical, clinical, and systemic interventions. Medical
professionals, community- and school-based mental health professionals, and
educators are encouraged to fully understand the parameters of school absenteeism to
develop better, consensual policies regarding definition, classification, assessment,
and intervention of youths with problematic school absenteeism.

Keller and Lang, (2007) Adolescence is the time to learn and adopt healthy habits to
avoid many health and nutritional problems later in life. Several studies confirmed that
a sedentary lifestyle, unhealthy diet, poor eating habits and physical inactivity are risk
factors for diet related diseases. Regular exercise at least three times a week is
recommended for healthy living. Most NCDs are generally diseases of a lifestyle and
kill more people than any other disease each year and can easily be avoided by the
adoption of a healthy lifestyle. 34

KM Susmitha (2012) A descriptive Cross sectional study was assessed in Nellore city
from 542 adolescent girl’s socio demographic profile, morbidity pattern. Majority of
the girls were from rural background (83.58%). 35.79% were in middle school, 86%
of girls stayed less than five years in the hostel. The major prevalent morbid conditions
among girls were Pediculosis 83.21%, Dysmenorrhea 43.6%, Dental caries 28.04%,

26
Skin disorders 26.4%. Pediculosis, poor personal hygiene and dysmenorrhea were
found to have significance across the age groups. High morbidity was found in 11-13
year age group.

Vinod Wasnik (2012) Cross sectional study was conducted from June 2010 to
September 2010 among children residing in two social welfare hostels for scheduled
Caste girls. A total of 420 girl's children formed the study subjects. Height- weight,
BMI was recorded of total 420 girls and that 37.4% (157) were in the age group 13
years. Followed by 26.9% were in age group 14 years, 18.6% were in age group 12
years, 9.8% were in age group 15 years and very few that is 5% and 2.4% in the age
group 11 and 10 years., 56.4% (237/420) girls were under-nourished Department of
Home Science Govt. Kamlaraja Girls P.G. (Autonomous) College, Gwalior (M.P.)
(BMI [less than or equal to] 18.5). The girls suffering from chronic energy deficiency
grade I, II and III were 25.2%, 15.2% and 16 % respectively. 12 (2.9%) was found to
be overweight and none of the girls was found to be obese. According to the new
guidelines by the Government of India as per the diagnostic cut-off values the 56.4 %
was found to be undernourished while 5.8 % was found to be overweight31.

Dr. R. Balasubramaniyan (2013) The information relating to adolescent period of

school-going children was collected from leading schools in Chennai city. A total of 50
respondents consisting of school going children (boys and girls) of the adolescence age
(13 – 18) years represented the Subject size of the study. Each school represented 25
respondents of school going children. Major findings of the study suggested that about
42 percent of school going children are having underweight problem in Chennai city.
About 2 percent of school going children is affected with overweight problem in the
study area. Further, the study revealed the fact that about 20 percent of respondents
have opined lack of time as one of the main reason for skipping meal33.

Soumyajit Maiti1 (2011)The study was conducted to ascertain the growth and
nutritional status of adolescent school girls in rural area who are studying in 5th to 8th
standard (age group of 10 to 14 years) of Government school in Dantan-II block,
Paschim Medinipur district, West Bengal. The extent of malnutrition of adolescent girls
was evaluated by well-to-do Indian and NCHS median value. The results revealed that
the weights and heights of these girls were below those of standard value. As regards
27
weight for age index, only 28.2% subjects were in the normal category and the
percentage of subjects suffering from Grade I (25.7%), Grade II (30.4%), Grade III
(13.7%) and Grade IV (1.9%) malnutrition was quite prevalent22.

H.R. Shivaramakrishna (2011) A community-based cross-sectional study was carried

out over a period of two months. 230 adolescent girls of age 10–19 years were selected
randomly. Data was collected by interviewing the adolescent girls using predesigned
and pre tested performa.. The prevalence of wasting and stunting was 54.79% and
32.17% respectively as per water loss classification and the trend of wasting and
stunting declines with the age. The prevalence of thinness was found to be 73.5% as
per Indian standards. Prevalence of anemia was 34.8% percent and it was more among
menstruating girls than compared to non-menstruating girls. It is concluded that there
is a high prevalence of under nutrition among adolescent girls in the rural area of the
selected villages. Health education and nutrition interventions are needed on priority
basis35.

B Krutarth (2012) The present study was undertaken to study the magnitude of
overweight/obesity and find out the associations of obesity among adolescents in
Ahmedabad city in Western India and suggest interventions. A total of 900 subjects,
aged 10-19 years were includes. Height and weight was measured and BMI was
calculated. Overweight and obesity was assessed by Body Mass Index (BMI) for age.
Adolescents who had BMI for age >85th and < 95th percentile of reference population
were classified as overweight and BMI for age >95th percentile of reference population
were classified as obese. Interventions the study suggested should be done at
adolescence period to prevent the obesity in adulthood. Life style modification can play
very important role not only in preventing obesity among adolescents but also
inculcating good habits for adulthood.

Dr. Ajeet Jaiswal (2011): A cross – sectional study was carried out targeting 208
school going post- pubescent girls. Using the body mass index as an index of adiposity,
33.7 and 15.9% of government and matriculation school girls respectively were found
to be severely undernourished. Further, 17.4 and 25% were found to be normal and 20
and 37 % of them were obese. Anthropometric measurements of the selected girls were
lower when compared with National Centre for Health Statistics as a reference
28
population. A significant difference was observed between selected girls and Indian
adolescent girls with respect to weight, except girls in the age group between 12 and
15years from matriculation school31.

Anupriya .M (2013): The study was undertaken with an objective to analyze the meal
patterns, faulty dietary practices, eating disorders and activity patterns of underweight
adolescent girls. According to WHO classification body mass index <18.5 is considered
as underweight and the subjects assigned to this category were selected for the study
with their consent. Information was elicited from the underweight adolescents using a
questionnaire. The findings of the study revealed that majority of the subjects were non-
vegetarians. Skipping of meals was practiced by 84 percent of the adolescent girls.
Carbonated beverages were consumed by all the adolescents and 19.3 percent of the
subjects consumed them daily. Prevalence of anorexia nervosa and bulimia nervosa
with weight conscious, fear of gaining weight, disgusted feeling after eating and
induced vomiting that the underweight adolescent girls were predisposing themselves
to general weakness, fatigue and iron deficiency anemia.

Dr SunetraKaviraj (2013) The study was conducted at the Bag bazaar slum of Urban
Field Practice Area of R.G . Kar Medical College. A total of 107 girls from 10 to 15
years of age residing in this slum participated in this study. A pre-designed, pre-tested
questionnaire was used for data collection. For determining physical activity status
Global Physical Activity Questionnaire (GPAQ) was used and the results were
compared with the WHO guidelines for physical activity for adolescents, only 14.28%
of girls in the age group 10 to 13 years and 67.56% of girls above 13 years had physical
activity above recommended guidelines. Fifty seven percentage of girls had no
recreation involving physical activity of any kind. 47.7% of girls were not satisfied with
their body image17.

Johnn EM (2014) This cross-sectional study included 330 high school-going early
teens aged 13-15 years using a pretested questionnaire. Details regarding food habits,
physical activity, and family history were collected along with anthropometric
measures and blood pressure recordings. The prevalence of at least one risk factor in
the population was 48.5%. Family history with prevalence of at least one coronary
artery disease risk factor was of 27.4%, diabetic parents 12.2%, hypertension 17.6%,
29
and heart disease was 1.8%. Physical inactivity as a risk factor showed an overall
prevalence of 73%. Nearly 50% of the students consumed some junk food every day.
Only 18.2% consume 3-5 servings of fruits per day, 11.2% do not take any fruits
at all. Prevalence of overweight was 11.2% and 4.6% of them were obese. Hypertension
was seen in 20.1% of subjects. The present generation of early teens is at high risk of
future cardiovascular disease and schools and society need to address these issues
urgent.

Anju Ade (2014) :This cross-sectional study was carried out in a field practice area of
RHTC. Total 340 adolescents in the age group of 11 to 16 years of three Government
high-schools formed the study subject. Results revealed that only 0.3% had good level
of knowledge regarding the lifestyle risk factors. Daily consumption of fast food is low
(6.8 %). Majority of students (93.2%) play games daily. As many as (68.5%) students
consumed fruits and vegetables every day. Majority of them (62.6%) had no idea about
the prevention of NCDs. Only 127 (37.4%) students felt non-communicable diseases
are preventable. Knowledge regarding communicability of these lifestyle diseases was
good among students, about 65.6% students knew that they are non-communicable
34.4% .

Chaitanya Gujjar lapudi( 2013): The objective of the study is to assess selected risk
factors for Non-Communicable Diseases among High School children in Guntur city
of Andhra Pradesh. A total of 925 high school children participated in the study. The
prevalence of overweight and obesity in the present study are 4.3% and 1.7%
respectively. A high prevalence of factors for Non-communicable diseases have been
observed i.e. taking carbonated drinks > three times per week (30.2%), exposure to
cigarette smoke (75.5%), no physical activity (21.8%). The study suggests that
awareness regarding risk factors by health education and interventions promoting
healthy life style are important to prevent NCD’s in future23.

A recent report by the United Nations says that more than three million people in the
world die of water-related diseases due to contaminated water each year, including 1.2
million children. In India, over one lakh people die of water-borne diseases annually. It
is reported that groundwater in one-third of India’s 600 districts is not fit for drinking
as the concentration of fluoride, iron, salinity and arsenic exceeds the tolerance levels.
30
About 65 million people have been suffering from fluorosis, a crippling disease due to
high amount of fluoride and five million are suffering from arsenicosis in West Bengal
due to high amount of arsenic. A World Resources Report says about 70 per cent of
India’s water supply, is seriously polluted with sewage effluents. The UN reported that
India’s water quality is poor - it ranks 120th among the 122 nations in terms of quality
of water available to its citizens.

Section B: Literature related to the knowledge of health professional

regarding prevention of prevalent problem among school going
children
Prevention of prevalent problems among school going children (10-
15):

Renjini MR( 2014) : The present study was conducted to assess the nutritional
knowledge of the adolescent girls participating in the nutritional awareness program in
Anganwadis of Changanacherry Taluk of Kottayam district and to educate the girls and
parents about the importance and the ways to achieve optimum nutrition during
adolescence. Data on the dietary pattern and anthropometric assessments like height
and weight were collected using a pre-structured interview schedule. It is clear from the
results that majority of the subjects were assessed to have either poor or fair levels of
awareness about the importance of nutrition. Hence during nutrition education,
emphasis was given to the dietary guidelines during adolescence as diet influences the
future nutritional status17.

Gaikwad Surekha Ramrao (2013) the present study was undertaken to the knowledge
of adolescent girls about reproduction, healthcare, nutritional awareness. About 240
adolescent girls, in the age group of 11 to 15 were selected at random, divided into 12
various batches of 20 girls in each batch. The nutrition education and package of
activities were provided to these subjects. It is clear from the results that majority of the
Subject adolescent girls assessed to have either poor or fair levels of awareness about
the component included on reproductive health care and nutritional awareness.
However, after receiving training by health professionals regarding reproductive health
care, nutritional awareness for a period of 2 months, highly significant improvement

31
was noticed in their awareness and behavior in respect to the components dealt in
training their percentages increased significantly in fair and good categories of
awareness. 19

Daijiworld Mangalore (2012): A study reported that one among the many common
behavioral disorders seen among children in the recent times is Attention
Deficiency/Hyperactivity Disorder. Though the disorder affects millions of children all
over the world many believe that that the disorder has not got the attention it deserves
in India and it continues to haunt children and parents alike. According to the latest
survey conducted by Associated Chambers of Commerce and Industry in India, the
details of which were released recently, prevalence of children diagnosed with
Attention Deficiency/Hyperactivity Disorder in India has gone up from 4% to 11% in
the last six years23.

Dr. Anoop S Sebastian (2009) A comparative study was conducted on the prevalence
of tuberculosis infection in BCG vaccinated school age children in a lower primary
school Palakkad. It was determined by tuberculin testing in 418 school children. The
results shown that tuberculin positivity rate in unvaccinated children (24%) was
significantly higher than in the vaccinated (9.7%). Overall prevalence rate of
tuberculosis infection was 15.5%. The study concluded that the BCG vaccination is
associated with significant protection against the acquisition of Mycobacterium
tuberculosis infection in childhood.

Shubhangna Sharma (2009) A study was undertaken to see the awareness of 112
adolescent girls in the age group of 12 to 15 years regarding health aspects through an
intervention study. The study adopted a pretest – post test design with an intervention
for a specific period. The intervention was given for nine months to the girls though
lectures, discussions and demonstrations by health professionals. Result showed a
considerable increase in the awareness levels of girls with regard to knowledge of health
problems, environmental health, nutritional awareness and reproductive and child
health. Thus informative and educational interventions seem to have a positive effect
on awareness levels which would eventually encourage expansion of knowledge and
positive health habits. 25

32
Nath .A (2008): A study was conducted in Department of Home Science Govt.
Kamlaraja Girls P.G. College, Gwalior (M.P.) Adolescents account for almost one third
of India's population. They are prone to suffer from reproductive and sexual health,
nutritional, mental and behavioral problems. Health services which cater exclusively to
the needs of adolescents are scanty and concentrated in urban areas. Adolescent
Friendly Health Services (AFHS) which provide a broad range of preventive, promotive
and curative services under one roof can help to ensure improved availability,
accessibility and utilization of health services. AFHS is being initiated by
governmental, private and non-governmental organizations. Lessons to improve the
quality of AFHS could be further learnt from evaluation of pilot projects and success
stories of similar initiatives in other countries. 13

Prabhuswami M et al (2007): A study was conducted study on outcome of children

with school refusal. In that 33 subjects (8-16 year old) presenting with school refusal
were evaluated. Results showed 87.9% had a psychiatric diagnosis at baseline.
Depression was seen among 63.6% and phobias in 30.3%. The study concluded that
psychiatric morbidity is high in youngsters with school refusal. As review literature
shows that the evidence of behavioral problems is increasing day by day in children.
Primary school teachers are having some knowledge regarding behavioral problems.
Primary school teachers and school health nurses need more knowledge regarding
behavioral problems. Teachers and school health nurse’s plays very important role in
early diagnosis and promotion of behavioral problems among children in their schools.

B.Thanuja (2007): A study on impact of nutrition education and carbohydrate

supplementation on performance of 30 boys of high school football players (14-15
years) in Dharwad district was carried out by Metiand Saraswati( 2006). The study
revealed that nutrition education and carbohydrate supplementation for a period of 3
months improved their nutrition knowledge and practice, physical and field
performance during the competition. The study was conducted, on two hundred
adolescent girls between sixteen to eighteen years. Their nutritional knowledge was
assessed with the help of questionnaire. So it can be concluded that nutrition education

33
plays a vital role in improving the nutritional knowledge, which in turn will improve
the nutritional status of the respondents and their family members14.

Kaur (2007): The study conducted on impact of nutrition education on nutrient

adequacy of 60 adolescent girls (13-19 years). Nutrition education for a period of 3
months was imparted to the subjects after assessing their basic nutrition knowledge.
Nutrition education improved their mean nutrition knowledge scores significantly (P £
0.01) from 11.17 ± 1.42 to 19.16 ± 1.8. The average contribution of carbohydrate,
protein, fat, vitamin and minerals increased significantly after imparting nutrition
education. 7

Hall et al (2002):A study was conducted to demonstrate the effectiveness of iron

supplementation channeled through school. Weekly dose of 65 mg of iron along with
0.25 mg of folic acid were administered by health professionals for 10 weeks in thirty
schools, covering almost 1100 students in the age group of 6 – 19 years. Hemoglobin
levels rose by an average of 1.8 g/l and prevalence of anemia fell by 8.2% both
significant at P < 0.001. Young children (< 12 years) and girls benefitted more.

Sungthong et al, (2002): In Thailand study average increase in hemoglobin in daily

group (6.5 ± 6.0 g/l) was similar to weekly group (5.7 ± 6.3 g/l). However, the average
increase in serum ferritin was greater in daily group compared to weekly group. Weekly
group was found to have greater impact on height gain then daily group. These means
that daily schedule was better in improving iron status than weekly one. The results of
these studies are more or less similar to the once obtained from a research done in Peru
.

C.V. Gopalakrishnan (2002): A survey covering 12 out of 250 households in

Alapuzha by revealed that the middle class and the rich have turned over to cornflakes,
cookies and other easy to make fibreless food products which the study regards as ‘junk
foods’. The advent of preserved and junk food into the daily diets of locally available
nutritious items may have far reaching consequences on the health of the younger
generation(10-15). The demonstration effect of such practices may soon affect the
dietary habits of poor households too.

34
A study focused on symptoms, severity and asthma control in 5-14 years old Lebanon
school children. A Subject size of 5544 children were selected by cross sectional study,
applied on school children with physician diagnosed asthma, divided into two groups:
those who were on controllers and those who were not. The result shown that out of
5544 children, 275 had physician diagnosed asthma. The controller’s (32.7%) group
had higher mother’s education than the non-controller group (45.9%). The study that
concluded with treatment of physician diagnosed asthma in 5-14 years school children
was quite adopted according to the recommendations2.

A study carried out to assessing the efficacy of a school based asthma education
program for children. This study sought to explore the effect of a school based asthma
education program on quality of life. A Subject size of 100 children with asthma who
attended grades 1-5 at two selected schools were requested to participate were selected
by questionnaire method. There were clinically important improvement in the school
based asthma education program group in quality of life, especially in the symptoms
sub domain. The study that concluded with the air force school based asthma
educational program appears to result in a favorable trend in quality of life for children.

A study focused on asthma management and prevention current perspective. The

continuing evolution of asthma treatment and prevention are reflected in updated
guidelines from the National asthma Education and prevention program and Global
initiative for asthma. A Subject size of 150 school children were selected by
questionnaire method. Study that concluded with written action plans as part of self-
management processes appear to improve physician-patient communication and
disease status tracking other considerations in successful asthma management include
patient education and monitoring of adherence to treatment regiments2.

A study focused on prevalence of allergic disease in primary school children in Edirne,

Turkey. A Subject size of children aged 7 to 12 in primary schools in the Municipality
and 24 villages of Edirne were surveyed via a questionnaire completed by the parents.
The result shows that a total of 5412 children were enrolled. The cumulative and the
current prevalence of all allergic diseases were 24.6% and 9.9% respectively. The
cumulative prevalence of bronchial asthma 16.4%, and the current prevalence were

35
5.6%. The study that concluded with the allergic diseases are a major health burden
for primary school children and health professionals are playing a vital role to control
these problems.13

A study was conducted in Maharashtra in 2007, to find out the prevalence of intestinal
parasites among rural Indian school going children(6-14 years) and the effect of
focused, need based child to child hygiene education on personal hygiene of school
children. A triangulated research design was used in the study for need assessment
before initiating formal hygiene education.118 children were examined under the study.
Out of the 118 children who were examine ,21(25.9%) had intestinal parasite infection.
Among the 118 children, 88 (74.6%) were not using sanitary latrines, 38(32.2%) were
with unhygienic untrimmed nails and 30(25.4%) were not using foot wear. The
prevalence of parasitic infection was significantly high among children having dirty
untrimmed nails (OR=23.1; 95% CI: 5.6-110.4) followed by those having poor hand
washing practices(OR = 8.3;95% CI: 2.5-29.1). The study concluded that community
motivation, involvement and control, successfully reduced the prevalence helminthes
infection14.

A prospective, longitudinal screening, intervention and follow-up study was

conducted to implement an intervention program for reducing the prevalence of scabies
in a large Northern Territory Aboriginal community. Participants were all children aged
5 years, total population was approximately 2,200. After screening the prevalence of
scabies, infected scabies and non-scabies pyoderma before intervention were 35%, 12%
and 11%, respectively. At 6 weeks post intervention these had decreased to 3%, 1% and
4%, respectively. The study concluded that intervention, which was based on
community motivation, involvement and control, successfully reduced the prevalence
of scabies. Continuing community health education and regular screening will be
crucial in controlling scabies.

A survey on scabies was conducted in 14 primary-and 2 high schools of one rural block
of Dakshina Kannada district on the west coast of Karnataka. A total of 5,128 (84.9%)
out of the 6,041 registered children were examined. Prevalence of scabies among
children aged 6 to 15 years was 8.2%, prevalence was higher among boys than girls;
higher among children of backward communities than those of other communities- and
higher among Muslims than among Hindus. History of another case of scabies at home
36
was found in 37.37 of the cases. Secondary pyoderma was observed in 16.59' of the,
cases. Distribution of Lesions conformed to the pattern described in other studies.
Results of follow-up after 3-5 weeks of treatment with 25% benzyl benzoate are also
reported.25

A population based study was conducted to assess the knowledge of public regarding
Scabies and its management in Tamil Nadu, India. The study found that among 1260
Subjects only 20.6% had adequate knowledge regarding scabies and its management.
Around 14.56 % individuals had previous exposure to scabies. 33.4% of the Subjects
wrongly reported that scabies is a non curable disease. The study also analyzed the
attachment of the victims towards various scabies treatment strategies. Researcher
realized that around 46.7% victims are currently following appropriate anti - scabies
prophylaxis that includes allethrin, permethrin and ivermectin. The study concluded
that rural communities require more information and education regarding skin related
contagious diseases and their management measures. Community health nurses can
play an important role to prevent and control of these contagious diseases.25

Mohammed Set.et.el (2012): A cross sectional study was conducted on Morbidity and
associated factors of diarrheal diseases among children .The objective was to determine
the morbidity and associated factors of diarrheal diseases among children in Arba-
Minch District. Result showed that prevalence of diarrhea among children was 30.5%,
which was significantly associated with child’s being from mothers of not attended
formal education, age of the mother, poor hand washing practices. The study concludes
that the level of diarrheal morbidity is high in the research study area. As significant
number of the mothers do not have adequate knowledge on the occurrence and risk
factor of diarrheal disease. Enhancing community based behavior change
communications using multiple channels and community health workers is
recommended to reduce the occurrence of childhood diarrhea and associated
consequences among children6.

Launching of the National Diarrheal Diseases Control Program in 1978, has

reduced child mortality from diarrhea by 50% between 1981 and 1990. In 1985-1986,
the focus shifted to strengthening case management of diarrhea for children under age
of 5 years and national ORT program was introduced. Subsequently, it became part of

37
child survival and safe motherhood program in 1992 and reproductive and child health
(RCH) program in 1997. Integrated Management of Neonatal and Childhood Illnesses
has been implemented under RCH phase II, in 223 of India's 640 districts, and more
than 200,000 workers had been trained since 2003. NRHM reaches out to underserved
areas through health programs such as the Village Health and Nutrition Days. During
these nutrition and health education sessions organized by the auxiliary nurse midwife
and anganwadi workers, use of ORT is popularized among the community members33.

A prospective survey conducted on incidence of urinary tract infection and causative

organism. A total of 11,308 urine Subject were collected from the patients and analyzed
for UTI. The results revealed that there was the incidence of 1,020 of UTI out of 11,308
urine Subject. A causative organism identified from collected urine Subject was E. coli
with 620 cases, Klebsiella pneumonia with 115 cases, staphylococcus aurous with 175
cases, Cocci Entercoccus with 110 cases. Out of 1,020 patients 227 were male and 793
were female. The study concluded that as a female are highly exposed to UTI than
males. So the action towards prevention can be focused on female population.
A prospective cross sectional study conducted on prevalence of UTI among adolescent
females. The study Subject size is 211 adolescent girls aged between 13 to 18 years.
The result revealed that 120 Subject (57%) had UTI. In which 107 (69%) had culture
conformed UTI, remaining 13 were under diagnosed. This 13 people had a co-infection
with STIs and UTI. The researcher concluded that adolescent girls presenting with
urinary symptoms should be tested for STIs and UTI to ensure timely diagnosis and
treatment.17
A Cross-sectional descriptive study was conducted to assess the risk factor profiles of
lower urinary tract symptoms among adolescent girls, house wives and working
women. House to house survey was done in two villages and one urban ward. 75
housewives, 75 working women and 180 adolescent girls were asked about the risk
factors due to lower urinary tract symptoms. Three teams of adolescent girls were
utilized to bring about behavioral modifications. The study results revealed that overall
prevalence of lower urinary tract symptoms among the three groups is 18.5%. Improper
anal washing technique, malnutrition, presence of vaginal discharge, use of unsanitary
menstrual pads, pinworm infestation and use of unhygienic toilets were the significant
causes among adolescent girls. The researcher concluded that through educating the
adolescent regarding risk factors of UTI helps a lot in reduction of UTI morbidity.17

38
Swapna Chaturvedi (1996) :The study was conducted to assess the nutrient intake of
adolescent girls belonging to low socioeconomic group of rural Rajasthan.941
adolescent girls of age 10-15 years. Anthropometric measurements for height, weight,
mid-upper arm circumference, triceps skin fold and chest circumference; 24 h recall
method to assess nutrient intake. Nutrient intake was compared with Indian Council of
Medical Research recommended dietary allowances. The diets were deficient in
calories by 26 to 36%, and in proteins by 23 to 32%. Nutritional status as assessed by
body mass index revealed that 8.1% of adolescent girls suffered from chronic energy
deficiency (CED) grade I, 6.6% grade IICED, and 78.8% grade III CED. About 73.7%
of subjects suffered from anemia and 43.6% had signs of vitamin B complex deficiency.
Intervention strategies are needed to improve the dietary intake of adolescent girls so
that their requirements of energy, protein, vitamins and minerals are met.
Summary:. The literature of the studies concluded that that prevalence of diarrhea,
tuberculosis, scabies, typhoid ,vision problems, dental caries, jaundice, obesity,
helminthes infection ,anemia, urinary tract infection are one of the main reason for
millions of deaths in our country . Anemia is more common in adolescent’s girls.
Health education program should be implemented by health care professional in
schools and health centers to reduce the burden of diseases .The above literature
concluded that community motivation, involvement and control, successfully reduced
the prevalence of prevalent problems. During these nutrition and health education
sessions organized by the auxiliary nurse midwife and anganwadi workers, use of ORT
is popularized among the community members to reduce diarrheal problem It will
contribute to the health of Nation.

39
Figure 3. Research Methodology

40
 CHAPTER- 3
MATERIAL & METHODS

“Thinking well is wise; planning well is wiser, doing well is best of all.”

Oscar Wilde

Research methodology is a plan of research study that gives guidelines, which direct
the research steps, the research study process and enables in the systematic data
collection, logical data organization and accurate data and data interpretation. It is a
way to solve problems with systematic procedure in which researcher starts from initial
identification of the problem to find the conclusion. It may be understood as a science
of study to know how research is done scientifically. It organize all components of
study in such a way that is most likely to lead a valid answer to the sub problems that
have been proposed. It includes:

Research Approach
The selection of research approach is the basic procedure for the conduct of research.
A research approach tells the researcher so as to what data to collect and how to analyze
it. It also suggests possible conclusion to be drawn from the data. In view of nature of
problem selected for the study the objectives to be accomplished. Quantitative research
approach was adopted in this study to find out the prevalent problems and related
measures taken by health professionals.

Research Design

Research design is the arrangement of conditions for collection and analysis of data in
a manner that aims to combine relevance to the research purpose with economy in
procedure. Non-Experimental Co-relational (retrospective research design) was used in
this study. The term ‘Research’ Design refers to the plan or organization of scientific
investigation (Polit and Hungler, 2004). Designing a research study involve the
development of a plan or strategy that will guide the collection and analysis of the data.
A research design is arrangement conditions of collection and analysis of the data in a
matter that aims to combine relevance to the research purpose with economy in
procedure. “

41
 In present study, a retrospective survey research design was adopted to assess the
prevalent problems among school going children (5-15years) and the preventive
measures taken by health professionals in selected areas of Ratia to accomplish the
following objectives:

• To assess the prevalent problems among school going children and preventive
measures taken by health professionals to reduce these problems.
• To find out the co- relation between problems and preventive measures among
school going children.
• To determine the association between knowledge of health professionals and
selected demographic variables.

Variables Under Study

A variable is an attribute or characteristic of a person or object that varies with in the

population under study. Variables are measurable characteristics of a concept and
consist of logical group of attributes.

Demographic Variables: Age, Educational qualification, Gender, Area of residence,

Economic status, Job experience, sources of information .

Setting of the Study

The physical location and condition in the data collection that take place in a study is
known as setting. The present study was conducted in General Hospital and various
health centers of district Haryana, Fatehabad. These are as follows:
 GH Ratia
 Civil hospital Fatehabad
 Community Health Center Bhuna
 Polyclinic Fatehabad

42
Selection of hospital and community health centers
 The primary reasons for selecting hospitals and health centers were:
 Availability of subjects
 Feasibility of conducting study
 Investigator’s convenience
 Familiarity of investigator with setting
 Administrative support and approval
 Expected co-operation for conducting the study

Subject Size and Subject Technique

Subject and Subject size

Subject is a subset of population selected in a study .The Subject of the study comprised
of 200 health professionals (Medical ,Nursing ,Para-medicals).

Sampling technique
Purposive sampling technique was used to select the Subject. Subjects were selected
from pediatric ward, medicine and surgical or causality ward and various health centers.

SELECTED HOSPITALS NO. OF SUBJECTS SELECTED

/COMMUNITY HEALTH CENTERS

GH Ratia 50

Civil hospital Fatehabad 100

Community Health Center Bhuna 30

Polyclinic Fatehabad 20

Population

43
Population refers to the entire aggregate or totality of all objects, subjects, or members
that confirm to set of specifications. The accessible population is the population of the
subjects available of this particular study.

The target population is the total group of subjects about whom the investigator is
investigated and to whom the results could be reasonably generalized. In the present
study, target population consist all health care professionals working in various health
centers of district Fatehabad in Haryana. The accessible population is the health
professional working in various health centers of district Fatehabad.

The Accessible population is the health professionals working in various health

centers such as GH Ratia, Civil hospital Fatehabad, Community Health Center Bhuna,
Polyclinic Fatehabad available during data collection period.

Criteria for selection of Subjects

Inclusion criteria
1. Health care professionals who were working in various health centers.
2. Health care professionals who were willing to participate.

Development and description of data collection tools

The instrument selected in research should be as far as possible a vehicle that should
best obtain data for drawing conclusion and pertinent to the study . Tool is a device that
a researcher uses for data collection .The major task of researcher is to develop the tool
that accurately and precisely measure variable of interest.

Development of the tools

Following tools were developed to assess the knowledge of health professionals
regarding prevalent problems:
1. Demographic profile data sheet
2. Structured knowledge questionnaire

The preliminary drafts of tools were developed by:

44
  An extensive and systematic review of literature like books ,journals, articles,
periodicals, and published material
 Investigator’s personal experience
 Consultation and discussion with experts in field of nursing, research
pediatricians and statisticians.

Description of the Tool (s)

PART-A
1. Subject Demographic profile data sheet
It consists of information related to identification and other variables such as age,
gender, professional qualification, job experience, income status, area of residence,
previous source of information.

PART -B

2. Structured Knowledge questionnaire

A Structured Knowledge questionnaire was developed to assess the knowledge of study
subjects regarding prevalent problems. A blue print of this questionnaire was prepared.

45
Table No . 1 Blue Print of Questionnaire
It consist of 30 multiple choice question on various aspects as:

No. of
Knowledge Domain Blue Print Percentage
Questions

1,3,4,11,12,16,
1. General (introductory) 8 26.67
24,27

2. Causes of Prevalent
5 2,18,26,28,29, 16.67
problems
3. Risk factors 6 5,9,10,13,14,17 20
4. Management of prevalent
5 7,8,15,19,20, 16.66
problems
5. Prevention of prevalent 6,21,22,23,25,
6 20
problems 30
Total 30 30 100

Scoring and interpretation

Each multiple question has four options is the correct answer . Subjects were asked to
tick mark only one alternative answer. Each correct answer carries one mark/ score and
for wrong ‘zero’ marks were given. Thus maximum total score for the knowledge was
30, ranging between , 0-30. Interpretation of knowledge score is as follows:

CRITERIA MEASURE OF KNOWLEDDGE SCORE

Score Level Percentage %

Poor (0-15) 0%

Average (16-21) 65%

Good (22-30) 35%

46
Content Validity of the Tools
 Validity refers to the degree to which an instrument measures what it is suppose to
measure.
 Content validity of the tool was confirmed by expert’s opinion regarding the
relevance of items.
 The tool was validated by the research committee of NIMS college of Nursing
Jaipur and 15 more experts.
 The recommendation and suggestions of the experts considered to modify the items
of the tools. Modifications were made according to suggestions given by them. The
tool was edited by language expert to rule out distortions in original meaning.

Reliability of Tools
 Reliability of measuring tool is a major criterion for assessing the quality and
adequacy of tool. It is the degree of consistency with its measures that attributes it
is supposed to measuring.
 In present study , the reliability of ‘ demography Profile Data Sheet’ was established
by applying ‘test and retest method’. The tool was administered to 10 subjects who
were not included in study. The tool was again administered at the interval of seven
days to gather the same information . Reliability co-efficient was calculated by Karl
Pearson’s co-efficient .The reliability obtained is 0.88 indicating is tool is reliable
and found to be significant.
 The reliability of ‘structured knowledge questionnaire’ was also tested on 20
subjects, who were not the part of the study and were the part of the pilot study ;
and was computed by using split –half using spearman Brown Prophecy formula.
The reliability of knowledge was0.90 .The tools were found reliable.

Pilot Study
Pilot study is small scale version or trail run done in preparation for a major study. The
pilot study was conducted in the month of 14 March 2017 with the purpose:
 To find out the feasibility of the study
 To refine methodology
 To assess reliability of the tool
 To find out means for analysis and interpretation of data.

47
A written permission was obtained from the CMO from community health centre
Ratia, Fatehabad, to conduct pilot study. The pilot study was conducted from 14 /03/17
to 17/06/17 in selected Health center PHC Birdhana, District Fatehabad Haryana .The
Subject size was twenty .Informed consent was taken from subjects. Structured
knowledge questionnaire was administered to assess the knowledge of Health
professionals regarding prevalent problems among school going children.

Ethical considerations
With the view of ethical consideration:
 The researcher has taken the permission from ethical committee.
 Written permission was taken from Chief Medical Officer of Government
Hospital, District Fatehabad Haryana.
 Informed consent was taken from Health Professional who are willing to
participate in the study.
 Participants were assured that information that their responses will be kept
confidential and will for research purpose only.
 The purpose of the study was explained to the study participants.
 They will also inform about their right to refuse from participation in the study.

Data Collection Procedure

Data collection was done in month of March 2017 to July 2018.
The Subject consisted of 200 subjects. Purposive sampling technique was used to select
the Subjects from population. Data was collected in the following manner:
First of all I obtained permission from CMO of civil Hospital Fatehabad. I went in
Government Hospital Ratia, Civil hospital Fatehabad, Community Health Center
Bhuna, Polyclinic Fatehabad . I administered structured knowledge questionnaire to
health professionals after taking consent. Self-introduction and establishing rapport
with subjects. Setting up of conductive atmosphere for data collection .Structured
knowledge questionnaire was administered. Duration of one hour was given for each
subject to complete the tool. It was making sure that questionnaire is filled completely
by each subject. I went to pediatric outpatient department and wards for collection of
common problems in children.

48
Analysis and Interpretation

Data analysis is the systematic organization of research data and the testing of the
hypothesis of the study to compute. The investigator prepared master data sheet. The
collected was coded and transformed to master sheet for statistical analysis. The
collected, organized, tabulated and analyzed by using descriptive and inferential
statistics by using Microsoft Excel SPPS version 21.0.
1. Demographic data is analyzed using frequency and percentage
2. Data related to knowledge on prevalent problem is analyzed in terms of frequency,
percentage, range, mean standard deviation and mean percentage.
3. Relationship between prevalent problem and preventive measures score is
calculated by Karl Pearson’s correlation test.
4. Association of knowledge score of health professionals with their selected
demographic variables is analyzed using chi-square test.

Methods of Data Collection

Questioning method was chosen to gather information related to knowledge of health
professionals regarding prevalent problems and preventive measures.

Summary
This chapter deals with the approach, research design, target population, Subject and
sampling technique, inclusion and exclusion criteria, selection and development of the
tool, description of tool, validity of the tool, reliability of the tool, pilot study/try out,
data collection procedure, ethical consideration and plan of data analysis.

49
 CHAPTER- 4
RESULTS

This chapter deals with analysis and interpretation of the data collected. In order
to find a meaningful answer to the research problem, the data must be processed,
analyzed in systematic and some orderly coherent fashion so that pattern and
relationship can be discerned. A co-relational retrospective research study to
assess the knowledge of health professionals regarding prevalent problems and
preventive measures among school going children at selected health centers in
Ratia, Fatehabad district of Haryana.

A total 200 health professionals including males and females medical and nursing
staff working in the selected health centers of district Fatehabad Haryana ,
selected with purposive sampling technique were enrolled in study after meeting
the inclusion criteria after getting permission from appropriate authority. Consent
was taken from each study participants and anonymity and confidentiality was
assured at the time of data collection.

The data was collected through self developed structured knowledge questionnaire
to collect information regarding knowledge of health care professional on
prevalent problems. A co-relational retrospective research study to assess the
knowledge of health professionals regarding prevalent problem and preventive
measures among school going children at selected health centers in Ratia,
Fatehabad district of Haryana.

The data collected from respondents was tabulated and analyzed. Analysis and
interpretation is done in accordance with the objectives laid down for the study.
Data was analyzed manually, by using MS Excel and SPSS. The statistical tests
like mean, standard deviation etc. were applied. In inferential statistics like chi
square was used to compare the groups according to their background data.
Relationship between prevalent problems and preventive measures is derived from
karl Pearson’s co-relation coefficient formula(r). The finding of study are
administration in tables and graphs.

50
The collected data was organized, tabulated, analysis and interpreted by using
descriptive and inferential statistic. The analysis and interpretation was based on
the data collected through the demographic variables and structured knowledge
questionnaire.
Analysis is the process of organizing and synthesizing data, so as to answer
research question and test hypothesis.

Objectives of the Study

• To assess the prevalent problems among school going children and preventive
measures taken by health professionals to reduce these problems.
• To find out the co- relation between problems and preventive measures among
school going children.
• To determine the association between knowledge of health professionals and
selected demographic variables.

Organization of data for analysis

The analyzed data was organized according to the objectives and hypotheses
presented in the study. Data collected from study Subjects was tabulated, analyzed,
interpreted and finding obtained were presented in the form of table and diagram
represented under following section.

Section-1: Description of demographic variables of study Subject.

Section-2: Finding related to knowledge of health professional regarding prevalent

problems and preventive measures among school going children.

Section-3: Correlation between prevalent problems and preventive measures

among school going children.

Section-4: Association of knowledge of health professional regarding prevalent

problem and preventive measures among school going children with their selected
demographic variables.

51
Hypothesis

 H1 – There is significant relationship between problems of school going

children and preventive measures.
 H01 - There is no significant relationship between problems of school going
children and preventive measures.
 H2- There is significant association in knowledge and selected demographic
variables.
 H02- There is no significant association in knowledge and selected demographic
variables

52
 Section-1

Description of demographic characteristics of health professionals

Table- 2 Description of socio demographic variable

N=200
Variables Category Frequency Percentage (%)
21-30 Years 60 30
31-40 Years 80 40
Age
41-55 Years 60 30
Above 56 Years -- --
Nursing 160 80
Professional Para-medical -- --
Qualification
Medical 40 20
Male 20 10
Gender
Female 180 90
Family
40 20
members
Source of Mass Media 10 05
information Health team 140 70
Any other 10 05
0-10 years 120 60
11-20 years 40 20
Job Experience 21-30 years 30 15
30 years or
10 05
above
Area of Urban 160 80
residence Rural 40 20
Good
120 60
(>4 lac Rs/ year)
Average
Economic status (1.5 - 80 40
4lacRs/year)
Poor
-- --
(<1.5 Rs /year)

53
 Section-1

Description of Demographic Characteristics of health professionals

Figure - 4. Distribution of Subject according to age of health professionals under

study (n=200)

40 %
Subjects n = 200
40
30% 30%
%35
a
g
30
e
.
. 25
.
. 20
Series1
.
. 15
.

10

0
21-30 Years 31-40 Years 41-55 Years Above 56 Years
Age
in years

Figure -4 Depicts that age wise distribution of health care professionals under study.
The data revealed that majority of subjects i.e 80 (40%) of subjects are in age group 31-
40 years and the least number i.e 60 (30%) in the age range 31-40 years and same in
41-55years of age group.

54
Figure-5 Distribution of health professional according to professional
qualification

80%

%
80
a
g
70
e
.
60
.
.
.
50
.
.
40 Series1
.
20%
30

20
0%
10

0
Nursing Para-medical Medical
Professional Qualification

.
Figure 5 Show distribution of health professionals according to professional
qualification. The data shows that majority of study subjects i.e 160 (80%) subjects
from nursing domain and 40 (20%) study subjects are with Medical domain and none
of subjects are with Para- medical side.

55
 Figure no. 6 Distribution of Subject according to Source of information

70%

70

%
a
60
g
e
.
. 50
.
.
. 40
.
.
30
20%

20

5%
10 5%

0
Family Mass Media Health team Any other
members
Source of information

Figure.6 Shows that majority of subject 70% were health team, 05% were mass
media, 20% were from family member and only 05% were any other.

56
Figure no. 7 Distribution of subjects according to job experience

% 60
a
60
g
e
.
. 50
.
.
. 40
.
.

30
20
15
20

10

0
0-10 years 11-20 years 21-30 years 30 years or
above
Experience

Figure 7 Show the distribution of subjects according to their job experience.Data

revealed that out of 200 subjects, majority of subjects i.e 120 (60%) were having job
experience up to 0-10 years, 40 (20%) were having job experience up to 11-20 years,
rest 30 (15%) were having job experience between 21-30 years and 10 (05%) having
job experience above 30 years respectively

57
Figure 8 Distribution of subjects according to Economic status ( N=200)

Poor 0
Economic status

Average 40

Good 60

0 10 20 30 40 50 60 70

Figure 8 Depict the distribution of subjects according to Economic status. Data revealed
that majority of subjects 120 (60%) of the subjects have good income, 80 (40%) of the
subject have average income, on one belongs to poor income.

58
 Figure no. 9 Distribution of subjects according to Gender

10%

Gender Male
Gender Female

90%

Figure 9 shows that majority of 180 (90%) of subjects were belong to female group
and 20 (10 %) of the subject were belong to male group.

59
 Figure-10 Distribution of subjects according to area of residence

80%
80

70

60

50

40

30 20%
20

10
Series1
0
Urban Rural
Area of residence

Figure 10 Show that majority of 160 ( 80%) subjects from urban and 40 (20% ) of
subject were taken from rural area.

60
 Section – 2
Analysis of level of knowledge of health professionals regarding prevalent
problems and preventive measures taken by them among school going children

Table No: 3 Aspect wise analysis of knowledge to assess the prevalent problems among
school going children (5-15years) and the preventive measures taken by health
professionals in selected areas of Ratia (Fatehabad).

Criteria to measure of Knowledge Score

Score Level (N= 100)
%
Poor (0-15)
--
Average (16-21)
65%
Good (22-30)
35%
Maximum Score=30 Minimum Score=0

Table 3 shows that 65% of health professionals having Average knowledge regarding
prevalent problems and preventive measures taken by them among school going
children and 35% of health professionals having good knowledge regarding prevalent
problems and preventive measures taken by them among school going children .

CRITERIA MEASURE OF KNOWLEDDGE

SCORE
65%
70%
60%
50% 35%
40%
30%
20% 0%
10%
0%
Low (0-15) Average (16-21) High (22-30)

Figure 11 Aspect wise analysis of knowledge

61
 Overall Knowledge questionnaire to assess prevalent problems and preventive
measures among school going children

Table No: 4 Descriptive statistics comparison N=200

Table
Chi P
Mean Median S.D. Value at Result
Test value
0.05

Knowledge
66.66 73.33 6.41 42.800 <0.001 1.98 Significant

Maximum = 30
Minimum = 0

Table no. 4 shows that knowledge mean score for the test of Subject is 66.66 and
median score is 73.33. The calculated standard deviation shows value is 6.41 Overall
Chi-test calculation is 42.800, (p< 0.001, as per chi-square) which shows the highly
significant result.

Knowledge
73.33%
80
66.66%
70

60
42.8%
50

40 Knowledge

30

20
6.41%
10

0
Mean Median S.D. Paired T Test

Figure12- Descriptive statistics comparison

62
 SECTION -3

Table 5 To assess the prevalent problems among school going children

(5-15years)

(n = 1000)

Morbidity Number Percentage

Anemia 170 17

Worm infestation 126 12.6

Under nutrition 105 10.5

Nutritional skin disorders 66 6.6

Skin infections 117 11.7

Respiratory infections 151 15.1

Eye infections 36 3.6

Ear infections 42 4.2

Tuberculosis 30 3

Leprosy 7 0.5

Dental caries 106 10.6

Deafness 6 0.6

Congenital malformations 3 0.3

Lameness 8 0.6

Rheumatic heart disease 1 0.1

Seizure disorder 5 0.5

Injuries 20 2

Speech disorder 1 0.1

* This was calculated only in children between 5-12 years of age (n=1000)

63
 20
40
60
80

0
140
160
180

100
120
Anemia
Worm infestation
Under nutrition*
Nutritional skin disorders

Figure 13 To assess
Skin infections
Respiratory infections
Eye infections
Ear infections
Tuberculosis**
Leprosy**
Dental caries

64
Deafness
Congenital malformations

(5-15years)
Lameness
Rheumatic heart disease
Seizure disorder
Injuries
Speech disorder
Number

the prevalent problems among school going children

Percentage
 Co- relation between health problems and preventive measures
among school going children.

Table 6 To assess the prevalent problems among school going children

(5-15years) and preventive measures taken by health professionals.

(N = 1000)

Morbidity Number Preventive measures

Anemia 170 120

Respiratory infections 151 110

Worm infestation 126 90

Skin infections 117 85

Dental caries 106 100

Under nutrition 105 90

Nutritional disorders 66 45

Ear infections 42 04

Eye infections 36 20

Tuberculosis 30 26

Injuries 20 --

Lameness 08 --

Leprosy 07 --

Deafness 06 --

Seizure disorder 05 --

Congenital malformations 03 --

Rheumatic heart disease 01 --

Speech disorder 01 --

65
Table 6 Depicts that to assess the prevalent problems among school going children
(5-15years) and preventive measures taken by health professionals. Majority of the
children’s were suffering with Anemia, Respiratory infections, Worm infestations,
Skin diseases, Nutritional disorders etc.

co- relation between problems and preventive measures among school going
children.

X-prevalent problem=1000
x̅mean=55.55
y preventive measures=701
y̅ mea=38.94

karl pearsons correlation coefficient (r) =⅀(x-x̅ )(y-y̅)

⎷⅀(x-x̅ )² (y-y̅)²

r =5.1x272.66
⎷26.1 x 74343

r =1390.56 = 1390.56 =1
⎷1933673 1390.56

Correlation determine the relationship between two variables. It is computed by using

karl pearsons correlation coefficient (r) formula that there is perfect positive correlation
(r=+1). Here x is directly proportional to y. Both variable are rise and fall in the same
proportion. E.g. prevalent problems and preventive measures.

66
 180
160
140
120
100
80
60
40
20
0

Nutritional skin…

Congenital…
Lameness
Leprosy**

Injuries
Eye infections
Ear infections

Dental caries
Anemia

Under nutrition*

Skin infections
Respiratory infections

Deafness

Rheumatic heart disease

Tuberculosis**
Worm infestation

Seizure disorder

Speech disorder
Figure 14 -To assess the prevalent problems among school going children
(5-15years) and preventive measures taken by health professionals.

Preventive Measures

Anemia: Above table shows that out of thousand, one hundred seventy children are
suffering from anemia. One hundred twenty children have taken preventive measures.
In health care settings iron and folic acid tablets are distributed. Health teachings are
administered regarding iron rich diet e.g jaggery.
Respiratory Infections: Health professionals teach children regarding respiratory
etiquettes (covering mouth by using masks, while loud taking, coughing sneezing),
teaching to mothers how to use steam inhalation in homes. Immunization is also
effective way to reduce diseases.
Worm Infestations: De- worming is the common procedure to reduce the worm-
infestations by distribution of albendazole , albendazole syrup is given below 5years of
age and tablet is given to adults.
Skin Infections: Health professionals teach the mothers for personal hygiene of the
children such as clothes should be properly washed and dried in sunlight. Anti-scabies
lotions are provided to them.

67
 SECTION- 4

Association of knowledge scores regarding prevalent problem in school going

children with selected demographic variables

H0: There will be no significant association between knowledge scores on prevalent

problems among health professional and selected demographic variables.

Table No.7: Association of knowledge of Health professionals with

their selected socio-demographic variables

Association of Knowledge scores with selected socio-demographic variables.
Socio Opts Good Average Poor Chi P Df Table Result
demographic Test Value Value
Variables
Age 21-30 10 20 -- 19.30 0.934 3 9.84 Not
years Significant
31-40 15 25 --
Years
40-55 12 18 --
Years
Above 55 -- -- --
Year
Professional Nursing 15 65 -- 52.31 0.980 2 7.82 Not
Qualification Para- -- -- -- Significant
medical
Medical 05 15 --
Source of Family 05 15 -- 170.25 0.934 3 9.84 Not
information members Significant
Mass 02 03 --
Media
Health 20 50 --
team
Any 01 04 --
other
Experience 0-10 20 40 --
years
11-20 05 15 -- 92.40 0.934 3 9.84 Not
years Significant
21-30 05 10 --
years
30 years 02 03 --
or above
Economic Good 20 40 -- 38.3 0.934 3 9.84 Not
status Average 15 25 -- Significant
Poor -- -- --
Area of Urban 25 55 -- 49.74 0.999 1 5.41 Not
residence Rural 05 15 -- Significant
Gender Male 08 12 -- 48.25 0.999 1 5.41 Not
Female 25 55 -- Significant

P> 0.05 (NS) = Non Significant

68
Table no.7 Result reveals that there is no significant association of knowledge score
with selected demographic variables (P > 0.05, as per chi-square).The calculated value
19.30, 52.31, 170.25, 92.40, 38.30, 49.74 and 48.25 for age, professional qualification,
source of information, experience, economic status ,area of residence, gender
respectively shows that the association knowledge scores with age, professional
qualification , experience, economic status, area of residence and gender are higher
than 9.84.

69
8 Association of knowledge scores of subject with selected socio-demographic
variable according to age

Association of Knowledge scores with selected socio-demographic variables.

Socio
P
demograp Goo Avera Po Chi Table
Opts Valu df Result
hic d ge or Test Value
e
Variables

21-30 years 10 20 -- 19.3 0.93 3 9.84 Not

0 4 Significa
31-40 years 15 25 -- nt
Age
40-55 years 12 18 --

Above 55 00 0 --
years

Table n. 8 shows 10% of subjects having good knowledge, and 20% of subject having
average knowledge and none of the study subjects having poor knowledge from age
21-30 year, 15% of subjects having good knowledge, and 25% of subject having
average knowledge and none of the subjects having poor knowledge from age of 31-40
years and 12% of subjects having good knowledge, and 18% of subject having average
knowledge and none of subjects having poor knowledge from age of 40-50 years of age
and none of the subjects above 55 years.
30

25
25
20%
20 18%
15%
15 Good
12%
10% Average
10

5
0
0
21-30 Years 31-40 Years 41-55 year

Figure 15 Association of knowledge scores of subject with selected socio-

demographic variables -Age

70
 Table.9 Association of knowledge scores of subject with selected socio-
demographic variables-according to professional qualification

Association of Knowledge scores with selected socio-demographic variables.

Tabl
Socio
Go Averag Poo Chi P D e
demographic Opts Result
od e r Test Value f Valu
Variables
e
Professional Nursing 15 65 -- 52.3 0.98 2 7.82 Not
Qualificatio Para- -- -- -- 1 0 Significan
n medical t
Medical 05 15 --

Table no: 9 shows 15% of subjects having good knowledge, and 65%of subject having
average knowledge and none of the subjects having poor knowledge from Nursing, 05%
of subjects having good knowledge, and 15% of subject having average knowledge and
none of the subjects having poor knowledge from Medical and none of the subjects
from Para medical.

70 65%

60

50

40
Good
Average
30

20 15% 15%

10 5%
0% 0%
0
Nursing Para-medical Medical

Figure 16 Association of knowledge scores of subject with selected socio-

demographic variables – Professional Qualification

71
 Table no.10 Association of knowledge scores of subject with selected socio-
demographic variables-

Source of information

Association of Knowledge scores with selected socio-demographic variables.

Tabl
Socio
Goo Averag Poo Chi P d e
demographic Opts Result
d e r Test Value f Valu
Variables
e
Source of Family 05 15 -- 170.2 0.93 3 9.84 Not
informatio member 5 4 Significan
n s t
Mass 02 03 --
Media
Health 20 50 --
team
Any 01 04 --
other

Table No.10 shows 5% of subjects having good knowledge, and 15% of subject having
average knowledge and none of the subjects having poor knowledge from Family
members, 02% of subjects having good knowledge, and 03% of subject having average
knowledge and none of the subjects having poor knowledge from mass media , 20% of
subjects having good knowledge, and 50% of subject having average knowledge and
none of the subjects having poor knowledge from health team and 01% of subjects
having good knowledge, and 04% of Subject having average knowledge and none of
the subjects having poor knowledge from any other sources.

50%
50

40
30 15%
20 20% Good
3%
10 5% 4% Average
2%
0 Average
1%
Family Good
members Mass Media Health team
Any other

Figure no. 17 Association of knowledge scores of subject with selected socio-

demographic variables – Source of information

72
 Table 11 Association of knowledge scores of subjects with selected socio-
demographic variables Job Experience
Association of Knowledge scores with selected socio-demographic variables.
Socio
Chi P Table
demographic Opts Good Average Poor df Result
Test Value Value
Variables
0-10
20 40 --
years
11-20 05 15 --
years
Job 21-30 05 10 --
Experience years Not
92.40 0.934 3 9.84
30 02 03 -- Significant
years
or
above

Table 11 shows 20% of subjects having good knowledge, and 40% of subject having
average knowledge and none of the subjects having poor knowledge from 0-10 year of
experience, 05% of subjects having good knowledge, and 15% of subject having
average knowledge and none of the Subjects having poor knowledge from 11-20 year
, 05% of subjects having good knowledge, and 10% of subject having average
knowledge and none of the subjects having poor knowledge from 21-30year experience
and 02% of subjects having good knowledge, and 03%of subject having average
knowledge and none of the subjects having poor knowledge from above 30 year of
experience.

70
40%
60

50

40
Average
30
15% Good
20 20% 10%

10 3%
5% 5%
0 2%
0-10 years 11-20 years 21-30 years 30 years or above

Figure 18 Association of knowledge scores of subject with selected socio-

demographic variables – Job Experience

73
 Table 12 Association of knowledge scores of subject with selected socio-
demographic variables- Economic status

Association of Knowledge scores with selected socio-demographic variables.

Socio
Chi P Table
demographic Opts Good Average Poor Df Result
Test Value Value
Variables
Good 20 40 00 38.3 0.934 3 9.84 Not
Economic Significant
Average 15 25 00
status
Poor 00 00 00

Table 12 Shows 20% of subjects having good knowledge, and 40% of subject having
average knowledge and none of the subjects having poor knowledge from Good
economic status, 15% of subjects having good knowledge, and 25% of subject having
average knowledge and none of the subjects having poor knowledge from average
economic status and none of the subjects having poor economic status.

40%

40
35
25%
30
25 20%
20 Good
15%
15 Average
10
5 0%
0% Average
0
Good
Good
Average
Poor

Figure 19 Association of knowledge scores of subject with selected socio-

demographic variables – Economic status

74
 Table 13 Association of knowledge scores of subject with selected socio-
demographic variables-

Area of residence
Association of Knowledge scores with selected socio-demographic variables.
Socio
Chi P Table
demographic Opts Good Average Poor df Result
Test Value Value
Variables
Urban 25 55 --
Area of Rural 05 15 -- Not
49.74 0.999 1 5.41
residence Significant

Table 13 Shows 25% of subjects having good knowledge, and 55%of subject having
average knowledge and none of the subjects having poor knowledge from urban area
of residence and 5% of subjects having good knowledge, and 15%of subject having
average knowledge and none of the subjects having poor knowledge from rural area of
residence.

60
55%
50

40
25%
30
Urban
20 Rural
5% 15%
10

Good
Average

Figure 20 Association of knowledge scores of subject with selected

socio-demographic variables – Area of residence

75
 Table 14 Association of knowledge scores of subject with selected socio-
demographic

Variables-Gender
Association of Knowledge scores with selected socio-demographic variables.
Socio
Table
demographi Goo Averag Poo Chi P D
Opts Valu Result
c d e r Test Value f
e
Variables

Male 08 12 --
Not
48.2 0.99
Gender 25 55 -- 1 5.41 Significan
5 9
Femal t
e

Table 14 shows 08% of subjects having good knowledge, and 12% of subject having
average knowledge and none of the subjects having poor knowledge from Male and
25% of subjects having good knowledge, and 55%of subject having average knowledge
and none of the subjects having poor knowledge from female gender.

60
55%

50

40

30 25%
Male
Female
20
8% 12%
10

Good
Average

Figure 21 Association of knowledge scores of subject with selected socio-

demographic variables – Gender

76
 CHAPTER- 5
DISCUSSION

There is no end to education. It is not that you read a book, pass an examination, and
finish with education. The whole of life, from the movement you are born to the
movement you die, is a process of learning.
(Jiddu Krishnamur)

According to United Nations Children’s Fund (UNICEF) 2014 report, India accounts
for 29% of global deaths of newborn on their very first day of life. Deaths on first day
are becoming a hurdle for the country in achieving millennium development goal
number four of reducing child mortality by two-thirds. India’s target is bringing down
infant mortality rate (IMR) to 27/ 1000 live births.
The health professionals are the source of health care and health information as they
hold an important role in caring children. The need to improvement in quality of
training of all categories of health workers has been documented.
High power committee on nursing and nursing profession, highlighted the need for
training nurses as health care providers . “A study to assess the prevalent problems
among school going children (5-15years) and the preventive measures taken by health
professionals in selected areas of Ratia in Fatehabad district of Harayana.”The findings
of the study have been discussed with objectives, 1) To assess the prevalent problems
among school going children and preventive measures taken by health professionals
to reduce these problems. 2) To find out the co- relation between problems and
preventive measures among school going children. 3) To determine the association
between health problems and selected demographic variables.

Non-experimental retrospective research design was used in present quantitative study.

The data was gathered from pediatrics units/wards and outpatient departments of
general/civil hospitals and community health centers of district Fatehabad, Haryana.
After meeting the inclusion criteria 200 health professionals were enrolled as study
subjects by using non-probability purposive sampling technique. Data was collected
through questionnaire method to assess the knowledge of health professional.

77
Feasibility of study is checked by conducting of pilot study. Permission was obtained
from ethical committee and appropriate authority. Informed consent was taken from
study subjects.
Both descriptive and inferential statistics was used to analyze the data collected.
Analysis of data completed according to study objectives. Descriptive statistics such as
percentage, mean and standard deviation and inferential statistics Chi-square, to
compare and interpret data. The master sheet was prepared and calculation were carried
out manually, using calculator and with the help of Microsoft Excel (2007) and SPSS.
The level of significance chosen was p<0.05.

ORGANIZATION OF DATA FOR ANALYSIS

The analyzed data was organized according to the objectives and hypothesis
presented under the following sections:
Section-1: Description of demographic variables of study Subject.

Section-11: Finding related to knowledge of health professional regarding

prevalent problems among school going children and preventive measures.

Section-111: Correlation between prevalent problems and preventive measures

among school going children.

Section-1V: Association of knowledge of health professional regarding prevalent

problem and preventive measures among school going children with their selected
demographic variables.

HYPOTHESIS
Hypothesis at the level of 0.05% significance

 H1 – There is significant relationship between problems of school going

children and preventive measures.
 H01 - There is no significant relationship between problems of school going
children and preventive measures.
 H2- There is significant association in knowledge and selected demographic
variables.
 H02- There is no significant association in knowledge and selected demographic
variables

78
 MAJOR FINDINGS

Finding related to demographic data

 Shows 30% of Subjects from age 21-30 year, 40% of 31-40 years and 30% of 40-
50 years of age and none of the of above 55 years.

 Shows that 80% subjects from nursing. None of subjects from Para medicals, 20%
from Medical.
 Shows that majority of subjects (70%) were health team, 05% were mass media,
20% were from family member and only 05% were any other.

 Shows that majority of subjects 60% were having experience 0-10 year, 20% were
having experience between 11-20, and 15% were having experience between

21-30 and 05% having experience above 30.

 Shows that majority 60% of the subjects having good income, 40% of the subject
having average income, none of the having poor income.

 Shows that majority of 90% of subjects were belong to female and 20% of the
subject were belong to male.
 Shows that majority of 80% subjects from urban and 20% of subjects were taken
from rural area.
Findings related to knowledge of health professionals regarding
prevalent problems and preventive measures taken by them among
school going children
Table 2.1 shows knowledge mean score for the test of subject is 66.66 and median
score is 73.33. The calculated standard deviation shows value is 6.41. Overall paired T-
test calculation is 42.800, P value is <0.001 which shows the significant result.
Table 2.2 shows that 65% of health professionals has average knowledge regarding
prevalent problems and preventive measures taken by them among school going
children and 35% of health professionals having good knowledge regarding prevalent
problems and preventive measures taken by them among school going children . Table

79
3.2 depicts that to assess the prevalent problems among school going children (5-
15years) and preventive measures taken by health professionals. Majority of the
children’s were suffering with Anemia, Respiratory infections, Worm infestations,
Skin diseases, Nutritional disorders etc.

Preventive Measures
Anemia: Above table shows that out of 1000 170 children are suffering from anemia
.120 children have taken preventive measures. In health care settings iron and folic
acid tablets are distributed. Health teachings are administered to mothers regarding iron
rich diet e.g jaggery.

A Similar Study Done by Sanjeev M Chaudhary and Vasant R Dhage :

The prevalence of anemia was found to be 35.1%. A significant association of anemia
was found with socio-economic status and literacy status of parents. Mean height and
weight of subjects with anemia was significantly less than subjects without anemia.

Respiratory Infections: Health professionals teach children regarding respiratory

etiquettes (covering mouth, using masks, while loud taking, coughing sneezing),
teaching to mothers how to use steam inhalation in homes. Immunization is also
effective way to reduce diseases.
Worm Infestations: De- worming is the common procedure to reduce the worm-
infestations by distribution of albendazole, albendazole syrup is given below 5years of
age and tablet is given to adults.
Skin Infections: Health professionals teach the mothers for personal hygiene of the
children such as cloths should be properly washed and dried sunlight. Anti-scabies
lotions are provided to them.
Correlation determine the relationship between two variables. It is computed by using
karl pearsons correlation coefficient (r) formula that there is perfect positive correlation
(r=+1).Here x is directly proportional to y.Both variable are rise and fall in the same
proportion. E.g. prevalent problems and preventive measures. Means there was
decrease in health problems with more adoption of preventive measures by health
professional.

80
  Findings related to association of knowledge scores of health
professionals with selected socio-demographic variables

Table no.4 Reveals that there is no significant association of knowledge score with
selected demographic variables( P >0.05, as per chi-square). The calculated value
19.30, 52.31, 170.25, 92.40, 38.30, 49.74 and 48.25 for age, professional qualification,
source of information, experience, economic status , area of residence, gender
respectively shows that the association knowledge scores with age, professional
qualification , experience, economic status, area of residence and gender are higher
than 9.84.

Mamta Rajput Nebhinani (2015): Worm infestation is the common problem among
children especially in rural areas. The annual incidence of worm infestation in India is
estimated from 51% to76%. Worm infestation is the common but neglected problem
especially among school children. Keeping this view in mind the present study was
undertaken in government high school Kubheri, Mohali with an objective to assess the
effectiveness of health education program on prevention of worm infestation.

The structured teaching programme was found to effective in increasing the knowledge
of school children regarding prevention of worm infestation. More than 80% of the
children scored within good category after implementation of STP. The mean gain
difference between posttest and pretest knowledge scores was 2.83 which was
statistically significant.

Similar studies were conducted by Geeta Panwanda (2011) and Sheeja (2009) in
different parts of the country which also showed increase in the knowledge scores of
school children after implementing structured teaching programme on prevention of
worm infestation.

Knowledge scores of students were found to have significant association with certain
socio demographic variables such as class and mode of defecation whereas one of the
other study conducted by Geeta Panwanda (2011) reported that there was no
significant relationship between the posttest knowledge score and selected demographic

81
variables. The different results of study can be due to the small sample size and different
research setting.
Table n. 4.1 shows 10% of subjects having good knowledge, and 20% of subject having
average knowledge and none of the study subjects having poor knowledge from age
21-30 year, 15% of subjects having good knowledge, and 25% of subject having
average knowledge and none of the subjects having poor knowledge from age of 31-40
years and 12% of subjects having good knowledge, and 18% of subject having average
knowledge and none of subjects having poor knowledge from age of 40-50 years of age
and none of the subjects above 55 years.

Table no: 4.2 shows 15% of subjects having good knowledge, and 65%of subject
having average knowledge and none of the subjects having poor knowledge from
Nursing, 05% of subjects having good knowledge, and 15% of subject having average
knowledge and none of the subjects having poor knowledge from Medical and none of
the subjects from Para medical.

Table n.4.3 shows 5% of subjects having good knowledge, and 15% of subject having
average knowledge and none of the subjects having poor knowledge from family
members, 02% of subjects having good knowledge, and 03%of subject having average
knowledge and none of the subjects having poor knowledge from mass media ,20% of
subjects having good knowledge, and 50%of subject having average knowledge and
none of the subjects having poor knowledge from health team and 01% of subjects
having good knowledge, and 04% of subject having average knowledge and none of
the subjects having poor knowledge from any other sources.

Table no 4.4 shows 20% of subjects having good knowledge, and 40%of subject having
average knowledge and none of the subjects having poor knowledge from
0-10year of experience, 05% of Subjects having good knowledge, and 15% of subject
having average knowledge and none of the subjects having poor knowledge from 11-
20 year , 05% of subjects having good knowledge, and 10% of subject having average
knowledge and none of the subjects having poor knowledge from 21-30year
experience and 02% of subjects having good knowledge, and 03% of subject having
average knowledge and none of the subjects having poor knowledge from above 30
year of experience.
82
Mohammed Sultan Al-Darwish (2016) Oral diseases present a major public health
problem. About 90% of school children worldwide and most adults have experienced
caries, with the disease being most prevalent in Asian and Latin American countries.
Recent research in Qatar showed that caries prevalence is very high (85%) among
school children. To overcome the high prevalence of dental caries in Qatar, the need
for community-oriented preventive programs is emphasized. Oral health education is
an integral part of these programs. Oral health education is believed to be a cost-
effective method for promoting oral health if done through schools, where all school
children irrespective of their socioeconomic status or ethnicity can be reached.

Table n.4.5 shows 20% of subjects having good knowledge, and 40% of subject having
average knowledge and none of the subjects having poor knowledge from good
economic status, 15% of subjects having good knowledge, and 25% of subject having
average knowledge and none of the subjects having poor knowledge from average
economic status and none of the subjects having poor economic status.

Table no. 4.6 shows 25% of subjects having good knowledge, and 55% of subject
having average knowledge and none of the subjects having poor knowledge from
Urban area of residence and 5% of subjects having good knowledge, and 15% of subject
having average knowledge and none of the subjects having poor knowledge from rural
area of residence.
Table n 4.7 shows 08% of subjects having good knowledge, and 12% of subject having
average knowledge and none of the subjects having poor knowledge from Male and
25% of subjects having good knowledge, and 55% of subject having average
knowledge and none of the subjects having poor knowledge from female gender.
Peter J Dodd (2014) -A comparative study was conducted on new estimates indicate
that over 650,000 children develop tuberculosis every year in the 22 countries with a
high burden of the disease -- almost 25 percent higher than the total number of new
cases worldwide estimated by WHO in 2012. The research also suggests that about 15
million children are exposed to TB every year, and roughly 53 million are living with
latent TB infection, which can progress to infectious active TB at any time.

83
 CHAPTER- 6
SUMMARY & CONCLUSION

Growing children in their tender age are at increased risk of becoming sick especially
children of first ten years. Prevalent problem is a ‘local and focal problem causing
mortality and morbidity at high levels in community especially among children. It is
transmitted through direct contact with infectious pathogens include some viruses,
bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as
prions. Transmission of pathogens can occur in various ways including physical
contact, contaminated food, body fluids, objects, airborne inhalation and through
vector organisms.
Children are the delicate flower who wilt away before they bloom due to the life
threatening diseases. These diseases are responsible for mortality among school going
children.

The present study was undertaken with an objectives to assess the prevalent problems
among school going children and preventive measures taken by health professionals, to
find out the co- relation between problems and preventive measures among school
going children and to determine the association between knowledge score of health
professionals and their selected demographic variables.

Ethical approval was obtained from the Ethics committee of NIMS University, Jaipur.
Written permission was taken from Chief Medical Officer of Government Hospital,
District Fatehabad Haryana. GH Ratia, Civil hospital Fatehabad, Community Health
Center Bhuna and Polyclinic Fatehabad four hospitals were selected for study.
Purposive sampling technique was used to select the health professionals and records
were taken from all selected hospitals. Total 200 health professionals were enrolled in
the study and data obtained about 1000 School- going children’s health problems. Tools
for data collection consist of Structured Knowledge Questionnaire related to Socio-
demographic profile of health professionals, Records of hospitals of District Fatehabad
regarding prevalent problems and preventive measures.

The content Validity of the tool was established with the help of 15 experts in the field
of Medical and Nursing. The necessary correction and modifications were made as per

84
suggestions from the experts. The changes were incorporated in the final tool
accordingly for the data collection. A pilot study was conducted on Community Health
centre’s Ratia on 10% of sample for assessing the feasibility of the study. The reliability
of the tool was checked.

Data was collected from selected district hospital’s such as GH Ratia, Civil hospital
Fatehabad, Community Health Center Bhuna, Polyclinic Fatehabad by Structured
Knowledge Questionnaire related to Socio-demographic profile of health professionals,
records of hospitals of District Fatehabad regarding prevalent problems and preventive
measures

The data was analyzed using both descriptive and inferential statistics. Calculation was
done with the help of Microsoft excel and statistical package for social sciences (SPPS)
version 21.0. The analyzed data was represented in the form of tables and figures.
Results revealed that there was highly significant knowledge of health professionals
regarding prevalence problems and preventive measures among school going children’s
i.e. more than half 65% Subject were having average knowledge and 35% were having
good.

Hence the Null hypothesis (H02) i.e. there is no significant association between
knowledge and selected demographic variables at 0.05 level of significance was
rejected and the Research Hypothesis (H1) there is significant relationship between
prevalent health problems of school going children and preventive measures at 0.05
level of significance is accepted.
The study concluded that majority of the children are suffering from anemia, worm
infestation. Apart from this some other like worm infestation, diarrhea, typhoid fever,
scabies, eye problems etc. and preventive measures taken by the health professional are
distribution of vitamin – A, deworming, immunization etc. A study can be conducted
to find out the practices of care givers and public on improving the health standard of
children.

85
Conclusion: The study concluded that majority of the children are suffering from
anemia and respiratory infections. Apart from this worm infestations, skin diseases,
dental caries, diarrhea, typhoid fever, scabies, eye problems etc. Preventive measures
taken by the health professional are distribution of iron and folic acid tablets,
vitamin –A, deworming, immunization and health teachings to the mothers ,family
members regarding prevention of infection and weaning process.

Recommendations
• Same study can be repeated with larger subjects to generalize the findings.
• A same study can be carried out on other subjects.
• A comparative study can be carried out on rural and urban health professionals.
• A same study can be conducted on long term basis to determine the
improvement in knowledge of health professional.
• Planned teaching practices related topic could be implemented in nursing
homes, rehabilitation centers, schools and community health centers.
• A study can be conducted to find out the practices of care givers and public on
improving the health standard of children.
• An experimental studies can be conducted on beneficial effects on health
standard of health of school going children.
• Follow–up studies can be conducted to evaluate the effectiveness of an
information guide sheet on health professional’s o prevalent problems.

Implications
The study findings have certain implications on nursing profession i.e. Nursing
Education, Nursing Administration, Nursing Practice and Nursing Research.

Nursing practice
 Planned teaching program on prevalent problems can be used in hospitals by nurse
educators to teach nurses working in pediatric units to improve their knowledge
and practice.
 The content on prevalent problems and preventive measures can be utilized as
ready reference for health professionals working in pediatric units can be revised
time to time.

86
  Knowledge questionnaire and practice checklist can be used by health
professionals to evaluate their own knowledge and practices regarding prevalent
problem and preventive measures among school going children.
 Nurses can utilize planned teaching program on prevalent problem and preventive
measures in school going children to teaching mothers.

Nursing Education
 Organization and use of different teaching strategies by nurse educator at
hospital level and implement program to enhance knowledge level of health
professional regarding prevalent problems.
 Encourage development of formal training on prevalent problem so that nursing
students become more knowledgeable and skilled in the prevention of common
prevalent problems like malaria, scabies, vision problems, diarrhea, cholera,
TB, etc.
 Incidental teaching, health talk should be conducted on prevalent problem by
giving emphasis on health education and awareness among health professionals
regarding preventive measures of prevalent problem so as to reduce mortality
and morbidity rate.
 The nursing education must give more emphasis to include more content about
children’s health in basic nursing curriculum.
 Nursing students should gain clinical experience in assessing, diagnosing and
implementing the care in pediatric ward or in schools.
 Nursing educator have the responsibility to improve the knowledge of health
professional on prevention of prevalent problems by arranging in service
education in hospital.
 Nurse administrator should provide opportunities for nurses to attend training
program on prevalent problems so that they can protect school age children.

87
Nursing Administration
 Nursing services personnel needs to assess the knowledge and practices of
health professionals in pediatric areas periodically to identify needs for planning
in-service education program.
 Nurse administrator should make it mandatory for the nurses working in
pediatric areas to undergo pediatric training before posting to these areas to
render quality care.
 Nurse administrator can develop protocols, manual, standing instructions and
standard practice guidelines regarding essential care of children and must be
reviewed by the team members.
 There must be periodical audit for adequate resources available in pediatric
departments with trained staff.

Nursing Research
 The findings of present study has provided evidence regarding knowledge of
health professionals working in hospitals, health centers in pediatric
departments regarding prevalent problems and preventive measures.
 The study findings can serve as a basis for nurse administrator and educator to
plan and implement planned teaching in current topic for nurse.
 Study provided great scope for further studies on different group and other
methods of teaching nurses and students in clinical areas regarding prevalent
problems.
 The studies can be conducted to prepare various educational material for nurses
to improve knowledge and practices regarding prevalent problems.

Scope of the Study

The challenge of reducing prevalent problems requires solution through research to
program innovation and action oriented policies designed to improve the health of
school children. In these programs nurses play a vital role. The community health nurse
can educate the mothers and the teachers regarding quality care of school children
through proper guidance and education regarding prevalent problems.
Since health professionals are close to care of children around the clock in pediatric
care department and more vulnerable to criticism regarding their knowledge and

88
competency, there is a need to prepare a set of standards. In the absence of any standard
or nursing audit, it is difficult to approve the quality of nursing care. With advancement
of technology in health care area, the issues of quality assurance and standards of care
have affected the entire health care system, including nursing as a part of its
commitment to improve the quality care to children and pediatric areas of nursing need
to be developed. Nurses are working in the pediatric areas with or without special
training and according to laid down policies in some hospitals.
Evidence also shows that excellent care by the health care providers can prevent most
of the problems of school going children. For that the adequate knowledge, attitude,
skills and practices are necessary. This study on knowledge and practices provide useful
evidences and the informational booklet can be prepared and further education
programs can be planned to update their knowledge and practices.
The findings of the study can be disseminated through conferences, seminar and
publishing in nursing journals, public mass media and promote utilization of research
in the prevention and management of prevalent problems among school going children.

89
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Management of Diarrheal Diseases’, Indian Journal of Pediatrics, Springer
India Publications, Volume 68. No 5 pages 393-397. 2013
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26. Siva Eswari, ‘Incidence and Prevalence Practices Regarding Pulmonary T.B,
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Preventing T.B Among Children Younger Than 5 years Of Age’, Journal of
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 LIST OF ANNEXURES /APPENDICES

Annexure
S. No

Letter for Study Participants

Section A :- Demographic Variables

I
Section B:- Structured knowledge questionnaire

II scoring key

Copy of informed consent form

III

Letter requesting for experts opinion and suggestion for content validity
IV
of the research tools

V List of Experts

VI Certificate of validation

VII Letter for approval for ethical clearance

Letter seeking permission to conduct main study

VIII

Letter for participation in seminars ,conferences , publish research papers

IX

94
 ANNEXURE –I

Letter for Study Participants

Tittle
“A Study to Assess The Prevalent Problems Among School Going Children (5-
15years) And The Preventive Measures Taken By Health Professionals In Selected
Areas of Ratia in Fatehabad District of Haryana ”.

Objectives of the Study

• To assess the prevalent problems among school going children and preventive
measures taken by health professionals to reduce these problems.
• To find out the co- relation between problems and preventive measures among
school going children.
• To determine the association between health problems and selected demographic
variables.

Instructions: Following items are meant for assessing the knowledge of Health care
Providers regarding prevalent problems and preventive measures:

 Your responses will be kept confidential and will be merely used for research
purpose therefore you are requested to give frank and correct answers.

 Please provide the information asked and place the tick mark on the appropriate
item.

 Each question has only one correct answer and carries one marks each.

95
 SECTION -A

SOCIO-DEMOGRAPHIC VARIABLES

Instructions: Following items are meant for assessing the knowledge of Health care
Providers regarding prevalent problems and preventive measures:

 Your responses will be kept confidential and will be merely used for research
purpose therefore you are requested to give frank and correct answers.

 Please provide the information asked and place the tick mark on the appropriate
item.

 Each question has only one correct answer and carries one marks each.

Q1- Age of the health professionals (in years)

a) 21-30 years
b) 31- 40 years
c) 41-55 years
d) 56 years and above

Q2- Professional qualification of Health Professionals

a) Nursing
b) Para-medical
c) Medical

Q3- Gender
a) Male
b) Female

Q4- Source of information

a) Family members
b) Mass Media
c) Health team or health conferences
d) Any other

96
Q5- Job Experience

a) 0-10 years
b) 11-20 years
c) 21-30 years
d) 30 years or above

Q6 -Area of residence

a) Urban
b) Rural

Q7- Economic status

a) Good
b) Average
c) Poor

97
 SECTION -B

A STRUCTURED KNOWLEDGE QUESTIONNAIRE ON

PREVALENT PROBLEMS

 Put the Tick mark on the most correct answers

 Each correct answer carries one mark.
 Your response will be kept confidential

QUESTIONNAIRE ON PREVALENT PROBLEMS

1) What do you mean by prevalent problems?

a) Diseases that occur in animals.
b) Diseases more common in humans.
c) Diseases that occur in pets.
d) Sexually transmitted diseases.

2) What are the common diseases in children?

a) Sore throat and dental caries
b) Childhood Tuberculosis
c) Diarrhea & Typhoid fever
d) All of the above

3) Why is it necessary to prevent prevalent problems in children?

a) For the growth of nation

b) Prevention of diseases
c) Promotion of health
d) Rehabilitation

4) Why children are more vulnerable to health problems?

a) Innocent behavior
b) Weak immune system
c) Ignorance
d) Illiteracy

98
 5) What measures should be taken by health professional to prevent
the six killer diseases?

a) Meeting with parent

b) Advise to school children
c) Immunization
d) Hospitalization

6) Which type of diet is recommended with treatment of

tuberculosis?
a) Liquid diet
b) Spicy food
c) Bland diet
d) High protein diet

7) Which is most effective way to prevent measles?

a) Immunization
b) Balanced diet
c) Isolation
d) Play therapy

8) Which vaccine is used for the prevention of measles?

a) DPT
b) MMR
c) BCG
d) DT

9) What is the vaccine schedule for measles?

a) At the age of 9 months

b) Two doses at 12-15 months & 4-6 years respectively
c) Both a & b
d) None of the above

99
10) Which is the prime step to be taken to prevent dental caries?
a) Bathing
b) Brush teeth twice
c) Proper diet
d) Dental check up

11) How to prevent blindness in children?

a) Use spectacle
b) Eye check up
c) Green lea fly vegetables
d) Provide Vitamin A solution

12) Which is the best method to prevent the spread of scabies?

a) Avoid contact with infected animals
b) Close contact with infected persons
c) Avoid contact with infected persons
d) Both a and d

13) Which vaccine is used for the treatment of pertussis?

a) MMR
b) T.T
c) OPV
d) Tdap

14) What is supervised by health professionals in DOTS center.

a) Duration of TB treatment schedule.
b) Direct observation
c) The spots that appear on the skin during treatment.
d) Drugs of TB short course.

15) What is the duration of the treatment of tuberculosis?

a) 6 months -12 months
b) 13 months -24 months
c) months -36 months
d) Life long

100
16) Which vaccine is used for the prevention of tuberculosis?

a) MMR
b) DT
c) OPV
d) BCG

17) When BCG vaccine is given?

a) At birth
b) 1 year of age
c) 2 years of age
d) Anytime

18) What is advised to prevent eye problems?

a) Never put foreign body
b) Periodical check -up
c) Never rub the eyes
d) All of the above

19) What is the treatment of choice for diarrhea at home?

a) Rice water
b) Chapatti
c) Dhal
d) ORS

20) What should be done if diarrhea is not controlled with ORS therapy?
a) Liquid diet
b) Semi-solid
c) Intravenous fluid
d) Bland diet

21) What is advised by you to prevent airborne disease?

a) Take plenty of water
b) Cover mouth with hand kerchief
c) Take nutritious diet
d) Loud taking or coughing

101
 22) What should be done to prevent diarrhea?

a) Spicy food
b) Early detection of disease
c) Proper sanitation
d) Adequate treatment

23) How tetanus is prevented?

a) Injection of gentamycin
b) Vaccine of BCG
c) Vaccine of T dap
d) Vaccine of tetanus toxoid

24) What is the prevention of typhoid fever?

a) Personal hygiene
b) Hand washing before taking meal
c) Consumption of junk food
d) Excessive use of oil in cooking

25) What should be distributed in health centers to control

worm infestation?

a. Tablet paracetamol
b. Tablet meftal spasm
c. Tablet lasix
d. Tablet albendazole

26) What is given to reduce the fever after vaccination?

a) Gentamycin
b) Paracetamol
c) Pencillin
d) Acylovir

102
 27) What health measures should be done to prevent the
communicable diseases?
a. Regular hand washing
b. Practicing respiratory etiquette
c. Proper disinfection
d. All of the above
28) How tuberculosis transmission can be reduced?

a) Improvement of environmental hygiene

b) High nutritious diet
c) Appropriate medicine and health education
d) All of the above

29) What is the preventive prophylaxis for malaria?

a) Chloroquin 2 tablets once in a week

b) Chloroquin 4 tablets in a week
c) Chloroquin 6 tablets in a week
d) Chioroquin 8 tablets in a week

30) Which of the following is the drug of choice for cholera?

a) Septran
b) Erythromycin
c) Metrogyl
d) Tetracycline

103
 ANNEXURE-II

ANSWER KEY FOR STRUCTURED KNOWLEDGE

QUESTIONNAIRE

QUESTION No. CORRECT RESPONSE

1 B
2 D
3 A
4 B
5 C
6 D
7 C
8 B
9 A
10 B
11 D
12 D
13 D
14 C
15 A
16 D
17 A
18 D
19 D
20 C
21 B
22 C
23 D
24 B
25 D
26 B
27 D
28 D
29 A
30 D

104
 ANNEXURE-III
CONSENT LETTER FROM STUDY SUBJECTS

Dear Participants
I, Kulbir kaur student of Ph.D nursing, Nims College of Nursing for
the partial fulfillment of Phd program to submit dissertation to Nims
University, Jaipur, I have selected the following topic“A study to assess
the prevalent problems among school going children (5-15years) and the
preventive measures taken by health professionals in selected areas of
Ratia in Fatehabad district of Harayana.”
The goal of the study is to assess the prevalent problems and preventive
measures by health professional.

I will not disturb the daily routine of the Community Health Center.
This information provide will be kept confidential and anonymity will be
maintained throughout and after the study.
Signature of the researcher
( Kulbir kaur)
I am willing to participate in the study and I am sure that the information
provided will be kept confidential and used for the study purpose. You can
leave the study at any time. It will not affect your routine work.

Signature of the participants

105
 ANNEXURE-IV
Letter seeking expert’s opinion and suggestions for the content
validity of the tools used for the study.
From
Kulbir Kaur
Ph.D Scholar
Nims University
Jaipur, Rajasthan
To
……………………………
…………………………….
Respected Sir/Madam

Subject: content validation of the research tool.

I, Kulbir Kaur, Ph.D Scholar Nims University Jaipur, Rajasthan, request

your good self, if you would kindly accept to validate my research tools on
the topic, “A study to assess the prevalent problems among school going
children (5-15years) and the preventive measures taken by health
professionals in selected areas of Ratia in Fatehabad district of Harayana.”
I would be obliged if you would kindly affirm your acceptance to the
undersigned with your valuable suggestions about appropriateness of the
items adequacy, organization, language, clarity and simplicity of the tools.
Study details are enclosed.
Thanking you in anticipation
Yours sincerely,
Kulbir Kaur
Nims Ph.D Scholar

106
 ANNEXURE-V
1. Dr. D.R.Gaur
HOD, Community Medicine
MAMC Agroha, Hisar

2. Dr. Manohar
HOD, Preventive and social Department
NIMS University,Jaipur

3. Dr. Tapti Bhattacharjee

NIMS College of Nursing
Jaipur

4. Dr. Nirpal Chand

M.O.Govt. Hospital
Fatehabad, Haryana

5. Professor Lalita Bhat

Principal ,College of Nursing
MAMC Agroha, Hisar

6. Mrs. Shanmuga Meenakshi G.

Principal, Shaheed Baba Deep Singh
College Of Nursing

7. Dr. Manav Sethi

M.O. Govt. Hospital
Fatehabad, Haryana

8. Dr. Vidya Deswal

Principal
College Of Nursing
PGIMS Rohtak

107
 9 .Dr. J.P Singh
Biostatistician
Shaheed Baba Deep Singh CON
Ratia

10. Dr. Lata Sagwan

M.O.Govt. Hospital
Fatehabad, Haryana

11. Dr. Harsharan kaur

Phd .Nursing

12. Dr. Sumit Kamboj

M.O. CH Ftd.

13. Dr. Narinder Nadha

M.O. MAMC Agroha

14. Dr. Rama Bansal

Dermatologist
Govt. Hospital
Fatehabad, Haryana
15. Dr. Harmesh Bansal
Dermatologist
Govt. Hospital Fatehabad, Haryana

108
 ANNEXURE-VI

Certificate of validation

I hereby certify that I have validated the tool of Kulbir Kaur, Nims Ph.D
Scholar , Nims University Jaipur, Rajasthan, who is undertaking the study
titled, “A study to assess the prevalent problems among school going
children (5-15years) and the preventive measures taken by health
professionals in selected areas of Ratia in Fatehabad district of Harayana.”

Place : Signature :…………………….

Date: Name……………………………
Designation…………………….

109
ANNEXURE-VII

110
ANNEXURE-VIII

ANNEXURE-IX

111
112
113
114
115
116
 A STUDY TO ASSESS THE PREVALENT PROBLEMS
AMONG SCHOOL GOING CHILDREN (5-15 YEARS) AND THE
PREVENTIVE MEASURES
TAKEN BY HEALTH PROFESSIONALS IN SELECTED AREAS OF RATIA
(FATEHABAD) HARYANA
Ms Kulbir Kaur *| Prof. (Dr) Tapti Bhattacharjee **
* Ph.D. Scholar, NIMS University, Jaipur, Rajasthan, India
** Professor at College of Nursing in NIMS University, Jaipur, Rajasthan, India

ABSTRACT
The present study was undertaken to assess the prevalent problems among school going children (5-
15years) and the preventive measures taken by health professionals in selected areas of Ratia
(Fatehabad)”. The descriptive exploratory study was conducted on purposively selected health
professionals, who were from different health centres of Ratia Fatehabad. A structured knowledge
questionnaire was prepared to assess the knowledge of health professionals regarding preventive
measures of prevalent problems. Moreover common problems are assessed by the records of Civil
Hospital Fatehabad. Objectives of the study are to assess the prevalent problems among school going
children and preventive measures taken by health professionals to reduce these problems. Other
objectives were to find out the correlation between prevalent problems and preventive measures among
school going children and to determine the association between health problems and selected
demographic variables. Prevalent diseases are a danger to everyone. Some have been controlled with
vaccinations and modern technology, while others are emerging or are resistant to drug treatments.
Disease prevention and control is a cooperative effort involving healthcare providers, local and state
health department personnel and members of the community.
Key words: exploratory, prevalent problem, preventive measures, epidemiological, demographic
transition.
About the Author: The Author, Kulbir Kaur is a PhD Scholar (Enrolment No. 124964) in NIMS
University, Jaipur (2015-16), is doing research on the above written topic under supervision of Prof.
(Dr.) Tapti Bhattacharjee, Professor at College of Nursing in NIMS University, Jaipur.
The author can be reached at ― C/o Dhot Hospital, Tohana Road, Ratia, Tehsil Ratia, Fatehabad,
Haryana, Pin Code: 125 051, E-mail: cnirpal@yahoo.com, Phone: 9813512283, 9467252959
INTRODUCTION
“Health implies a sound mind, in a sound body, in a sound family, in a sound environment.”
― An ancient view
(J.E. Park)
The term health and wellness are used interchangeably. Health is often described as absence of illness.
Whereas wellness is often given a more positive connotation, suggesting that it involves more than
absence of illness. The term illness refers to deviation from normal health. A large number of life changes
may cause illness. India is undergoing an epidemiological, demographic and health transition. The
expectancy of life has increased, with consequent rise in degenerative diseases of aging and life-styles.
Nevertheless, communicable and prevalent diseases are still dominant and constitute major public health
issues. School going children, not only constitute a large group but they are also a vulnerable or high risk
group. The risk is connected with growth, development and survival. First five years are full of health
hazards. Since they are high risk group, under-five children are exposed to many environmental factors
leading to several problems and diseases in children.
Children are wealth of tomorrow. Children are also major consumers of healthcare. In India about 35%
of total population is of children below 15 years of age. Children always need special care to survive and
thrive. School-age years are a time of continued maturation of a child’s physical, social, psychological
characteristics. The school age child values school attendance and school activities. Children spend a lot
of time in recreational activities that require good vision. Good vision is a key to success. New researches

117
estimate that a million children have undetected vision problems, while almost 70% of schools do not
have any eye screening, which was described as “an absolute public health disgrace” by Bob Hughes.
Growing children in their tender age are at increased risk of becoming sick, especially children of under-
five years. Communicable disease is a ‘local and focal problem ‘causing mortality and morbidity at high
levels in community, especially among under-five children. In this era children are suffering and dying
each year due to the prevalent communicable diseases like malaria, diarrhoea, childhood tuberculosis,
pertussis and typhoid fever etc. According to world health statistics, these childhood communicable
diseases account for nearly two million children losing their lives each year.
According to WHO’s World Malaria Report (2014): In 2014, 97 countries and territories had ongoing
malaria transmission? An estimated 3.3 billion people are at risk of malaria, of which 1.2 billion are at
high risk. In high-risk areas, more than one malaria case occurs per 1000 population. There are 2 million
deaths per year from gastroenteritis in children. Infants and those with immunological compromise are
more likely to have more severe disease requiring admission to hospital for rehydration. Childhood
Tuberculosis is an important indication of public health success in interrupting and preventing
Tuberculosis transmission. Infection can be reduced with improvement of environmental hygiene,
medicine, high nutritious diet and health education. 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. Food and water borne diseases are one of the major causes of childhood
mortality and morbidity in developing countries. Dental caries and scabies are the most prevalent and
chronic oral diseases particularly in childhood age.
OBJECTIVE OF THE STUDY
1. To assess the prevalent problems among school going children.
2. To find out the correlation between problems and preventive measures among school going children.
3. To associate the knowledge score with selected demographic variables.
MATERIALS AND METHODS
A quantitative research approach with non-experimental one group exploratory research design was used.
Dependent variable was knowledge and demographic variables are age, academic qualification,
experience and previous sources of information. Study was conducted in CHC’s, PHC’s and sub centres
in Ratia, Fatehabad (Haryana). Target population was health professionals working in health centres.
Non-probability purposive sampling technique was chosen for the study. Hypothesis for the study
showed significant relationship between problems of school going children and preventive measures.
There is significant association between knowledge and selected demographic variables. Reliability is
degree of consistency or accuracy with which an instrument measures the attribute which it is designed
to measure. The “r” value is calculated using Split-half Formula. Thus the tool was considered reliable
for the study. Knowledge questionnaire was distributed to health professionals. Tool validity was
obtained from ten experts and their suggestions were considered too in constructions. Data collection
took around one hour. The data collected was grouped and analysed. It provided the evidence that the
tool was feasible, reliable and practicable.
Description of tools: Tool was prepared under two sections: ―
Section A:
This section had information regarding demographic data of health professionals, such as age,
educational status, experience and previous sources of information.
Section B:
This section consists of structured knowledge questionnaire on thirty items. Each item had multiple
choices in nature with four responses to each question. There was one correct response carrying one
mark and the wrong response carried zero mark. The score was 30 for 30.

118
Demographic data of health professionals:
Table – 1: Description of socio-demographic variables
n=100
Variables Opts Frequency Percentage
Age 21-30 Years 40 40

31-40 Years 40 40

41-55 Years 20 20

Above 56 Years 00 00
Professional Qualification Nursing 60 60

Para-medical 20 20

Medical 20 20
Gender Male 30 30

Female 70 70
Source of information Family members 10 10

Mass Media 20 20

Health team 60 60

Any other 10 10
Experience 0-10 years 30 30

11-20 years 40 40

21-30 years 30 30

30 years or above 00 00
Area of residence Urban 80 80

Rural 20 20
Economic status 5000-10000 Rs 00 00

10001-30000 40 40

30001-50000 30 30

Above 50000Rs 30 30

119
 Table – 2: Assessment of the prevalent problems among school going children (5-15years)*
(n = 1000)

Morbidity Number Percentage

Anaemia 170 17

Worm infestation 126 12.6

Under nutrition* 105 10.5

Nutritional skin disorders 66 6.6

Skin infections 117 11.7

Respiratory infections 151 15.1

Eye infections 36 3.6

Ear infections 42 4.2

Tuberculosis** 30 3

Leprosy** 7 0.5

Dental caries 106 10.6

Deafness 6 0.6

Congenital malformations 3 0.3

Lameness 8 0.6

Rheumatic heart disease 1 0.1

Seizure disorder 5 0.5

Injuries 20 2

Speech disorder 1 0.1

* This was calculated only in children between 5-12 years of age (n=1000)
It was concluded from the records of civil hospital at Fatehabad that the most prevalent problem is
anaemia, followed by worm infestations, respiratory problems, skin diseases, dental issues besides under-
nutrition and ear infections which are also very common health issues.

120
 Table – 3: Overall Knowledge questionnaire to assess prevalent problems and
preventive measures among school going children

Sample no. Percentage of Correct answer Mean Median SD

1 66.66
2 77.3
3 70.00
4 86.60
5 90.00
6 60.00
78.06 77.66 10.12
7 73.33
8 80.00
9 83.33
10 93.33

N = 10 780.64

Table – 3 shows the overall Knowledge questionnaire to assess prevalent problems and preventive
measures among school-going children, where mean=78.06, median=77.66 and SD=10.12 .

121
 Table – 4: Analysis of knowledge, to assess the prevalent problems among school going children
(5-15years) and the preventive measures taken by health professionals in selected areas of Ratia
(Fatehabad)

CRITERIA MEASURE OF KNOWLEDDGE SCORE

Score Level (N = 100) PRE-TEST (F %)
Low (0-15) 0 (0%)
Average (16-25) 70 (70%)
High (26-30) 30 (30%)
Maximum Score = 30, Minimum Score = 0

Table – 4 shows that 30% of the samples had high level of knowledge, 70% of the samples had average
level of knowledge and 0% sample had poor knowledge regarding prevalent problems among school-
going children (5-15 years) and the preventive measures taken by health professionals respectively.

Table – 5: Association of knowledge scores of sample with selected socio-demographic variables

Association of Knowledge scores with selected socio-demographic variables
Hig Averag Chi P Table
Variables Opts Poor Df Result
h e Test Value Value
21-30 years 15 25
31-40 Years 20 20 Not
Age 3.644 0.934 3 9.84 Significant
40-55 Years 5 15
Above 55 Year 00 0
Nursing 15 45
Professional Not
Para-medical 4 16 0.242 0.980 2 7.82 Significant
Qualification
Medical 5 15
Family members 2 8
Source of Mass Media 10 10
10.970 0.934 3 9.84 Significant
information Health team 10 50
Any other 0 10
0-10 years 15 15
11-20 years 15 25
Not
Experience 21-30 years 10 20 1.908 0.934 3 9.84 Significant
30 years or
00 0
above
Rs. 5000-10000 00 0
10001-30000 16 24
Economic Not
30001-50000 10 20 1.418 0.934 3 9.84 Significant
status
Above Rs.
8 22
50000
Area of Urban 25 55 Not
0.295 0.999 1 5.41 Significant
residence Rural 5 15
Male 12 18 Not
Gender 1.260 0.999 1 5.41 Significant
Female 20 50

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Table - 5 Reveals the results of statistical analysis to check the association of knowledge scores with
selected demographic variables. The calculated chi- square values were 3.644, 0.242, 10.97, 1.908, 1.418,
0.295, and 1.26 for age, professional qualification, source of information, experience, economic status,
area of residence, gender, respectively, showing that the association of knowledge scores with age,
professional qualification, experience, economic status, area of residence and gender is not significant at
5%. The calculated chi- square value of source of information is higher than 9.84, showing that the
association of knowledge scores is significant at 5%.
Table - 6: Co-relation between prevalent problems and preventive measures
taken by health professionals among school going children

Morbidity Number Preventive measures

Anemia 170 120
Worm infestation 126 90
Under nutrition* 105 85
Nutritional skin disorders 66 45
Skin infections 117 90
Respiratory infections 151 110
Eye infections 36 20
Ear infections 42 4
Tuberculosis** 30 30
Leprosy** 7 7
Dental caries 106 100
Deafness 6 0
Congenital malformations 3 0
Lameness 8 0
Rheumatic heart disease 1 0
Seizure disorder 5 0
Injuries 20 0
Speech disorder 1 0

𝟏𝟑𝟗𝟎. 𝟓𝟔 𝟏𝟑𝟗𝟎. 𝟓𝟔
𝒓= = =𝟏
√𝟏𝟗𝟑𝟑𝟔𝟕𝟑 𝟏𝟑𝟗𝟎. 𝟓𝟔

Table - 6: Correlation determines the relationship between two variables. It is computed by using Karl
Pearsons correlation coefficient (r) formula that there is perfect positive correlation (r=+1). Here x is
directly proportional to y. Both variables rise and fall in the same proportion, e.g., prevalent problems
and preventive measures, meaning there was decrease in health problems with more adoption of
preventive measures by health professional.
RESULTS
Demographic data of health professionals
40% of samples were from age group of 21-30 years, 40% were in the age group of 31-40 years, 20%
were in the age group of 40-50 years and 0% was in the age group of above 55 years. As for professional
qualification, 60% samples belong to nursing field, 20% of samples from paramedical field, 20% samples
were from medical field. As for the source of information, majority of samples 60% were health team,
20% were from mass media, 10% were from family members and only 10% were others. According to
experience, 40% were having experience of 11-20 years, 30% samples were having experience between

123
0-10, 30% were having experience between 21-30 and 0% had experience 30 or above. It was found that
40% of the samples were having income 10001-30000, 30% of the sample having income 30001-50000,
30% having income above 50000 and 0% of the sample had income 5000-10000. According to gender,
70% of samples were females and 30% males. Area wise 80% samples were from urban area and 20%
were from rural areas.
Assessment of problems and knowledge among health professionals
It was concluded from the records of civil hospital, Fatehabad that the most prevalent problem was
anaemia followed by worm infestations; respiratory, skin and dental issues; under nutrition and ear
infections were also quite common. This study also revealed that 30% of the samples were having high
knowledge, 70% of them were having average knowledge and 0% of sample had poor knowledge
regarding prevalent problems among school going children (5-15 years) and the preventive measures
taken by professionals, respectively.
Correlation between prevalent problems and preventive measures
Correlation determines the relationship between two variables. It can be computed by using Karl
Pearsons correlation coefficient (r) formula that there is perfect positive correlation (r=+1) between
prevalent problems and preventive measures. Here x is directly proportional to y. Both variables rise and
fall in the same proportion. Means there was increase in health problems with more adoption of
preventive measures by health professional.
Association of knowledge score with selected demographic variables
Results of statistical analysis to check the association of knowledge scores with selected demographic
variable show the calculated chi- square values were 3.644, 0.242, 10.97, 1.908, 1.418, 0.295, and 1.26
for age, professional qualification, source of information, experience, economic status, area of residence,
gender, respectively and that the association knowledge scores with age, professional qualification,
experience, economic status, area of residence and gender are not significant at 5%. The calculated chi-
square value of source of information, are higher than 9.84, showing the association of knowledge scores
are significant at 5%.
DISCUSSIONS
It was concluded from the records of civil hospital at Fatehabad that the most prevalent problem is
anaemia followed by worm infestations, respiratory problems, skin diseases, dental issues besides under-
nutrition and ear infections which are also very common health issues. This study also revealed that 30%
of the samples were having high knowledge, 70% of the samples having average knowledge and 0%
sample had poor knowledge regarding prevalent problems facing school going children (5-15years) and
the preventive measures taken by professionals, respectively.
CONCLUSION
Prevalent problem are widespread around the globe. School children are more vulnerable to these
problems. Health professional are taking effective measures. India is rapidly stepping towards
industrialisation, urbanisation along with change in lifestyle factors. These factors possibly contributed
to a rapid increase in incidence of prevalent problems in the country. It is difficult to provide all the
preventive measures to the children due to less manpower. Study concluded that there is need to provide
more detailed information to health professionals regarding prevalent problems.
RECOMMENDATIONS
On the basis of the study, it is recommended that the study can be replicated with large sample.
Comparative studies may be conducted on common problems of urban and rural groups. Effective
information, education and communication packages can be prepared to improve the knowledge and
practice of health professionals.
ETHICAL CONSIDERATION
Formal permission will be obtained from ethical committee through Principal, NIMS College of nursing.
Formal permission will be obtained from health centres. Informed consent will be obtained from all study
subjects. Study subjects will be assured that information collected from them shall be kept confidential.
ACKNOWLEDGEMENT

124
I am extremely grateful to NIMS College of Nursing, Jaipur, Rajasthan, for providing me an opportunity
to pursue my study in this institution. I express my sincere thanks to “ocean of patience, mountain of
wisdom, bridge of kindness” who is our beloved Dr. (Mrs.) Tapti Bhattaacharjee of NIMS College of
Nursing, Jaipur, Rajasthan. All teachers for their constant support, guidance, precious advice, inspiration
and encouragement on shaping my research work as a guide. I express my sincere thanks to Dr. Nirpal
Chand, Medical Officer, Fatehabad Haryana for his constant support, guidance and valuable advice
during research study. I am thankful to all the participants and friends for extending their cooperation
without which it would have been impossible to conduct the study.

LIST OF REFERENCES
1. Park , Preventive and social medicine.19th edition, 2007, Jabalpur, page No: 182 –186
2. Whaley and Wongs, Essentials of Paediatric Medicine, –1st edition, Harcourt private Ltd., Publishers
2001, Page No: 806 - 808
3. Basanthappa B.T., Community health nursing, 2003, New Delhi, Page No: 194 to 196.
4. Suraj Gupte, the short text book of paediatrics, 9th edition, Jaypee brothers, medical publishers, New
Delhi, 2001, Page No: 325 to 328.
5. Paruldatta, Paedeatric Nursing, 1st edition, New Delhi, Page No: 286 to 288.
6. Donna .L. Wong Marilyl Hocken Berry Eaton, the text book of Paediatric Nursing, 6 th edition,
Harcourt Private Limited publishers, 2001, page No: 288 to 300.
7. Brunner and Suddarth’s, ‘Text Book of Medical Surgical Nursing’, 10 th edition. Lippincott Williams
& Wilkins, Page no. 6
8. Gulani K.K., Principles and Practice Community Health Nursing. 1 st edition. Delhi: Kumar
Publishing House; 2007; 244-245.

125
PREVALENT PROBLEMS AMONG SCHOOL GOING CHILDREN (5-
15YEARS) AND
THE PREVENTIVE MEASURES TAKEN BY HEALTH PROFESSIONALS: A
REVIEW
Ms Kulbir Kaur *| Prof. (Dr) Tapti Bhattacharjee **
* Ph.D. Scholar, NIMS University, Jaipur, Rajasthan, India
** Professor at College of Nursing in NIMS University, Jaipur, Rajasthan, India

ABSTRACT
The descriptive exploratory study was conducted on purposively-selected health professionals, who were
from different health centres of Ratia Fatehabad. A structured knowledge questionnaire was prepared
to assess the knowledge of health professionals regarding preventive measures of prevalent problems.
Moreover common problems are assessed by the records of Civil Hospital at Fatehabad. Prevalent
diseases are dangerous to everyone. Some have been controlled with vaccinations and modern
technology, while others are emerging or are resistant to drug treatments. Disease prevention and
control is a cooperative effort involving healthcare providers, local and state health department
personnel and members of the community.

Key words: Exploratory, Prevalent problems, Health professional, Demographic-transition, Integrated

Management of Neonatal and Childhood Illness (IMNCI), Reproductive and Child Health (RCH).

About the Author: The Author, Kulbir Kaur is a PhD Scholar (Enrolment No. 124964) in NIMS
University, Jaipur (2015-16) is doing research on the above written topic under supervision of Prof.
(Dr.) Tapti Bhattacharjee, Professor at College of Nursing in NIMS University, Jaipur.

The author can be reached at ― C/o Dhot Hospital, Tohana Road, Ratia, Tehsil Ratia, Fatehabad,
Haryana, Pin Code: 125 051, E-mail: cnirpal@yahoo.com, Phone: 9813512283, 9467252959

INTRODUCTION
“Health implies a sound mind, in a sound body, in a sound family, in a sound environment.”
― An ancient view
(J.E. Park)

The term health and wellness are used interchangeably. Health is often described as absence of illness.
Whereas wellness is often given a more positive connotation, suggesting that it involves more than
absence of illness. The term illness refers to deviation from normal health. A large number of life changes
may cause illness. India is undergoing an epidemiological, demographic and health transition. The
expectancy of life has increased, with consequent rise in degenerative diseases of aging and life-styles.
Nevertheless, communicable and prevalent diseases are still dominant and constitute major public health
issues. School going children, not only constitute a large group but they are also vulnerable or high risk
group. The risk is connected with growth, development and survival. First five years are full of health
hazards. Since they are high risk group, under-five children are exposed to many environmental factors
leading to several problems and diseases in children.

126
Children are the wealth of tomorrow. Children are the major consumers of healthcare. In India about
35% of total population is of children below 15 years of age. Children always need special care to survive
and thrive. School-age years are a time of continued maturation of child’s physical, social, psychological
characteristics. The school age child values school attendance and school activities. Children spend a lot
of time in recreational activities that require good vision. Good vision is a key to success. New researches
estimate that a million children have undetected vision problems, while almost 70% of schools do not
have any eye screening, which was described as “an absolute public health disgrace” by Bob Hughes.

NEED FOR THE STUDY

“Today’s children are tomorrow’s hope, who can constitute a stronger nation.”

Growing children in their tender age are at increased risk of becoming sick especially those children of
under-five years. Communicable disease is a ‘local and focal problem ‘causing mortality and morbidity
at high levels in community especially among under-five children. In this era, children are suffering
and dying each year due to communicable diseases which are prevalent like malaria, diarrhoea,
childhood tuberculosis, pertussis and typhoid fever etc. According to world health statistics, due to
childhood-communicable-diseases nearly two million children lose their lives each year.

REVIEW OF LITERATURE
A review of literature is essential step in the development of scientific research projects. The purpose of
review of literature is summarisation of new substantive or theoretical ideas, formation of testing of
theory, organisation of knowledge from different fields and integration of knowledge into a new whole.
The review is a systematic search of published works to gain information about a search topic. It is a
complication that the groundwork for a further study. (Talbot, 1995)

Section - A

Literature review related to the prevalent diseases among school going children ―
A recent report by the United Nations says that more than three million people in the world including 1.2
million children die of water-related diseases due to contaminated water, each year. In India, over one
lakh people die of water-borne diseases annually. It is reported that groundwater in one-third of India’s
600 districts is not fit for drinking as the concentration of fluoride, iron, salinity and arsenic exceeds the
tolerance levels. About 65 million people have been suffering from fluorosis, a crippling disease, due to
high amount of fluoride and five million are suffering from arsenicosis in West Bengal due to high
amount of arsenic present in water. The UN reported that India’s water quality is poor - it ranks 120th
among the 122 nations in terms of quality of water available to its citizens.
Water-borne diseases like cholera, gastroenteritis, diarrhoea erupt every year during summer and rainy
seasons in India due to poor quality drinking water supply and sanitation. Here is a list of the most
dangerous water related diseases that occur in India, described as follows: Cholera: Cholera is a water
related disease, and is diarrhoeal in nature. It can kill in hours if left unattended. Diarrhoea: Diarrhoeal
infection is spread through food and drinking water that has been contaminated. A diarrhoeal attack can
last up to 2 weeks and leave the person completely dehydrated. Malaria: Malarial fever caused by
Plasmodium parasite is carried and spread by the Anopheles mosquito that breeds in water bodies like
lakes, paddy fish and stagnant water. Typhoid: Fluctuating high fever, exhaustion, sleepiness, diarrhoea

127
etc are the signs of typhoid. The infection spreads through contaminated food and water or through close
contact with an infected person. Scabies: Most common disease can cause serious infection if it is left
untreated. Dental carries: Also prevalent in school going children due to neglected habits. Worm
infestation: Physical growth is delayed due to worm infestation and children cannot concentrate on
studies due to abdominal pain with cramps and diarrhoea.
A Sinha S Sazawal (2013): A prospective study was conducted on follow-up of research among
residents of a low income urban area of Delhi, India with active surveillance for case detection. They
visited 8172 residents of 1820 households of Kalkaji, Delhi, twice weekly to detect febrile cases. Blood
samples were obtained from febrile patients and those who tested positive for Salmonella typhi were
treated with ciprofloxacin. 63 culture-positive typhoid fever cases were detected. Of these, 28 (44%)
were in children aged under 5 years. The incidence rate of typhoid fever per 1000 person-years was
27.3% at age under 5 years, 11.7% at 5-19 years and 1.1% between 19 and 40 years.
The Global Burden of Disease Study (GBD 2013): A study was conducted on the largest ever
systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries,
and health risk factors. The results show that infectious diseases, maternal and child illness, and
malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer
children are dying every year, but more young and middle-aged adults are dying and suffering from
disease and injury, as non-communicable diseases, such as cancer and heart disease, which have become
the dominant causes of death and disability worldwide.
DT Dang and JB Robbins (2010): A population based surveillance study for typhoid fever was
conducted in three rural communes of Dong. Cases of typhoid fever were detected by obtaining blood
for culture from residents with fever > or = 3 days. Among 658 blood cultures, 56 were positive for
Salmonella typhi with an overall incidence of 198 per 10 5 populations per year. The study highlighted
that typhoid fever is highly endemic in Vietnam and is a significant disease in pre-school and school
aged children.
UNICEF (2010) Diarrhoea is a prime cause of childhood mortality in the developing world. It
deteriorates the immunity of children, specifically in the age group of two to three. Diarrhoea is
responsible for worldwide mortality of 1.5 to 5 million children per year under the age of five years.
Diarrhoea undermines the resistance of body, coupled with dehydration and viciously depreciates the
nutritional status of children.
Peter J Dodd (2014) A comparative study conducted on new estimates indicate that over 650,000
children develop tuberculosis every year in the 22 countries with a high burden of the disease -- almost
25 percent higher than the total number of new cases worldwide estimated by WHO in 2012. The research
also suggests that about 15 million children are exposed to TB every year, and roughly 53 million are
living with latent TB infection, which can progress to infectious active TB at any time.
V. Bhattia (2013) conducted an interview on diarrhoea, its prevalence, practices and awareness among
mothers in 120 randomly selected households in rural areas of Chandigarh during monsoons in 2013.
The prevalence rate of diarrhoea in 181 under-five children was observed to be 23.2%. Majority of 81%
children had treatment for diarrhoea whereas only half (54.8%) of children were given ORS. 86.7% of

128
the mothers were aware of ORS. But, only18.7% could tell the correct method of its preparation. The
study concluded the importance of educating mothers regarding the preventive measures on diarrhoea.

Section - B

Literature review related to the prevention of common prevalent diseases

International Journal of Biological & Medical Research (2014): In this comparative and
observational study, the prevalence of tuberculosis among HIV/ AIDS patients in Obafemi Awolowo
University Teaching Hospital Complex, Ile-Ife was investigated. In the study early morning specimens
were collected at the clinic between 9 am 12 noon and gave the highest positive result of 13.9% while
samples I and III were 10.5% and 9.3% respectively. This work confirms that there is a close link existing
between active tuberculosis and HIV/ AIDS infection in Ile-Ife, Nigeria.
Zhong J ( 2013) – A study was conducted on prevention of complications in diarrhoea. The study
expresses that the source of infection is the consumption of selfish [polluted by sewage] and astroviruses,
caliciviruses and reoviruses can cause mini epidemics in families. Hospital wards are potentially very
dangerous to seriously ill hospital patients. They also have economic consequences for fishermen and
food industry. The conclusion of the study is  these viruses contribute massive mortality caused by
infantile diarrhoea in developing countries and are responsible for uncounted millions of deaths each
year.

WHO (2011): The WHO report estimated that 158,000 deaths were caused by measles. This is down
from 630,000 deaths in 1990. As of 2013, measles remains the leading cause of vaccine-preventable
deaths in the world. In developed countries, death occurs in 1 to 2 cases out of every 1,000 (0.1% -
0.2%). In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can
be as high as 10%. In cases with complications, the rate may rise to 20–30%. In 2012, the number of
deaths due to measles was 78% lower than in 2000 due to increased rates of immunisation among UN
member states.
Dr. Anoop S Sebastian (2009): A comparative study was conducted on the prevalence of tuberculosis
infection in BCG vaccinated school-age children in a lower primary school Palakkad. It was determined
by tuberculin testing of 418 school children. The results showed that tuberculin positivity rate in
unvaccinated children (24%) was significantly higher than in those vaccinated (9.7%). Overall
prevalence rate of tuberculosis infection was 15.5%. The study concluded that the BCG vaccination is
associated with significant protection against the acquisition of Mycobacterium tuberculosis infection in
childhood.
Shubhangna Sharma (2009): A study was undertaken to see the awareness among 112 adolescent girls
in the age group of 14 to 18 years, regarding health aspects through an intervention study. The study
adopted a pre-test ― post-test design with an intervention for a specific period. The intervention was
given for nine months to the girls though lectures, discussions and demonstrations. Post-testing was done
on the girls after the period of intervention. Results showed that the knowledge of girls regarding health
aspects improved significantly after intervention. There was a considerable increase in the awareness
levels of girls with regard to knowledge of health problems, environmental health, nutritional awareness

129
and reproductive and child health.
Renjini M R( 2014): The present study was conducted to assess the nutritional knowledge of the
adolescent girls participating in the nutritional awareness programme in Anganwadis of Changanacherry
Taluk of Kottayam district of Kerala and to educate the girls and parents about the importance and the
ways to achieve optimum nutrition during adolescence. Data on the dietary pattern and anthropometric
assessments like height and weight were collected using a pre-structured interview schedule. It is clear
from the results that majority of the subjects were assessed to have either poor or fair levels of awareness
about the importance of nutrition.
Launching of the National Diarrheal Diseases Control Programme in 1978 has reduced child
mortality from diarrhoea by 50% between 1981 and 1990. In 1985-1986, the focus shifted to
strengthening case management of diarrhoea for children under the age of 5 years and the National Oral
Rehydration Therapy (ORT) programme was introduced. Subsequently, it became part of child survival
and safe motherhood programme in 1992 and reproductive and child health (RCH) programme in 1997.
Integrated Management of Neonatal and Childhood Illnesses has been implemented under RCH phase
II, in 223 of India's 640 districts, and more than 200,000 workers had been trained since 2003.

CONCLUSION
Prevalent problems are widespread around the globe. School children are more vulnerable to these
problems. Health professionals are taking effective measures. India is rapidly stepping towards
industrialisation, urbanisation along with change of lifestyle patterns. These factors possibly contributed
to a rapid increase in incidence of prevalent problems in the country. It is difficult to provide all the
preventive measures to the children due to less manpower. The study concluded that there is need to
provide more detailed information to health professionals regarding prevalent problems.

LIST OF REFERENCES
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17. Black Joyce.M, ‘Text Book of Medical Surgical Nursing’, W.B Saunders Company, 7 th edition. Page
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