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JSS COLLEGE OF NURSING

1st MAIN SARASWATHIPURAM, MYSORE

SYNOPSIS SUBMISSION

BY:

Mrs.RASHMI N. T.

1ST YEAR M.Sc NURSING

CHILD HEALTH NURSING

JSS COLLEGE OF NURSING

1ST MAIN, SARASWATHIPURAM

MYSORE- 570009

GUIDE:

Mrs. AMBIKA.K

ASSISTANT PROFESSOR

DEPT. OF CHILD HEALTH NURSING

JSS COLLEGE OF NURSING

1ST MAIN, SARASWATHIPURAM

MYSORE – 570009

BATCH: 2013 – 2015
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION


1.

NAME OT THE CANDIDATE (IN BLOCK LETTERS)


MRS. RASHMI N. T.

1st YEAR M.Sc.(N)

JSS COLLEGE OF NURSING

1st MAIN, SARASWATHI PURAM,

MYSORE-570009


2.

NAME OF THE INSTITUTION


JSS COLLEGE OF NURSING SARASWATHI PURAM,

MYSORE-570009



3.

COURSE OF THE STUDY AND SUBJECT


1st YEAR M.Sc. NUESING

CHILD HEALTH NURSING



4.

DATE OF ADMISSION OF THE COURSE


14-08-2012

5.

TITTLE OF THE TOPIC

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON KNOWLEDGE OF CARETAKERS OF SCHOOL CHILDREN REGARDING IDENTIFICATION, MANAGEMENT AND PREVENTION OF SELECTED SKIN DISEASES AMONG PRIMARY SCHOOL CHILDREN IN SELECTED RESIDENTIAL SCHOOLS AT MYSORE, KARNATAKA


6. BRIEF RESUME OF THE INTENTED WORK

6.0 INTRODUCTION

Those who educate children well are more to be honored than they who produce them; for these only gave them life, those the art of living well”



  • Aristotle

A child is a precious gift which has lots of potential within, which can be the best resource for nation if raised and moulded in good manner. Healthy children can become healthy citizen constituting a healthy nation. Healthy children are also successful learners. School age children represent about 25% of total population, so it indicates that health care of the school children can contribute to the overall health status of the country1.Preservation of their lives will always be a priority and child health includes the care of the children from infancy to adolescence2.

Most of the children experience one or more episodes of illness. Skin disorders are the most common health problems among children. The skin is the largest body organ in surface area and is a sensitive indicator of child’s general health3. The patterns of skin disease in India are affected by various factors like ecological, environmental, racial, social, mental and literacy level1. In our country 100-150 million children are of school going age4.

Skin diseases are a common cause of morbidity, especially among school children, worldwide. A variety of skin infections may occur in children in the school age group. As children are inquisitive and mobile, they come into contact with a variety of people and animals. The close proximity in the school setting provides opportunity to be exposed to infectious agents (viruses, bacteria, fungus, insects and animals) in addition; children tend toshare personal items. However, when assessing risk factors for skin disease, there are many other ecological and environmental considerations. Children are often exposed to climatic and social conditions that predispose them to develop skin infections and suffer from minor skin injuries5. Skin disorders affect 20-30% of general population in the world. Since prevalence of skin diseases is more among school children from low socioeconomic classes and developing countries like India6. School going children are more vulnerable and constitute special risk group in any population deserving Special health care. It is in this age their personality develops. Also they are exposed to various environmental factors which might cause problems and require health, guidance and care. The various acute and chronic conditions which can be encountered during school period anywhere in the world include scabies, dermatitis, impetigo, pediculosis, warts, furuncle, molluscum contagiosum7.

Scabies is a skin disease commonly found among school children which is caused by SarcoptesScabicissp.Hominis. In older children itch is the predominant feature especially at night. The presence of burrows confirms the diagnosis but is not always evident. Treatment is usually with topical permethrin5% cream and all family members and regular contact should be treated at the same time8.

Pediculosis is also called as lice manifestation. It is common infestation in children.Head lice are passed from child to child by direct contact or indirectly by contact with combs, head gear or bed linen. Lice, particularly head lice, are a common reoccurring problem, worldwide. The problem of head louse control has arisen in several communities and schools. Girls are two times more frequently infested than boys. Malathion (ovide) is effective in treating lice and lits. Use of lindane shampoo have been one of the most commonly used treatment for many years and is usually safe9.

Dermatitis is inflammation of the skin (i.e. rash). Dermatitis derives from Greek word ‘derma’ "skin" + -itis "inflammation". There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called dermatitis eczema and eczematous dermatitis. An eczema diagnosis often implies atopic dermatitis (which is very common in children and teenagers)10.

Atopic dermatitis is a chronic and relapsing inflammatory condition of the skin. Children with atopic dermatitis often have skin barrier dysfunction which causes dry, itchy, scaly skin. They can also have associated environmental and food allergies. Of children who have atopic dermatitis, 65 percent show signs in the first year of life and 90 percent show signs within the first five years. Half of all affected children are between ages 5 to 15years. Parents with atopic dermatitis are more likely to have children with atopic dermatitis11.

Impetigo is a superficial skin infection mostly caused by S.aureus, but occasionally by Streptococcus pyogens. It tends to occur more frequently in hot humid climatesand is most commonly spread by close contact. Impetigo in children generally recognized by its honey color crusted plaques. It can be localized to a small area of skin. Flucloxacillin isusually the antibiotic of choice and topical antibiotic such as Mupirocin8.

A wart is generally a small, rough growth, typically on a human’s hands or feet but often other locations that can resemble a cauliflower or a solid blister. They are caused by a viral infection, specifically by one of the many types of Human PapillomaVirus (HPV). There are as many as 10 varieties of warts; the most common considered being mostly harmless. It is possible to get warts from others; they are contagious and usually enter the body in an area of broken skin. They typically disappear after a few months but can last for years and can recur12.

Molluscumcontagiosum is a common, benign, self-limiting viral infection of the skin. It generally affects children and is caused by a human specific poxvirus. Infection is rare in children under 1 year of age and typically occurs in the 5-8 year age group10.

The best prevention and management of skin infections among school children include, early identification of infections, isolating and immunizing the affected children, maintaining good hand washing technique with antibiotic soap, avoidance of skin to skin contact with infected persons, application of skin emollients, routine use of antiseptics and anti-microbial creams, maintaining healthy life styles. When child is in school its teacher’s responsibility to handle the infected child to prevent spread of infection to others, and teacher has to educate the family members about care of child with infections.
6.1 NEED FOR THE STUDY:

Children are the wealth of tomorrow; take care of them if you wish to have a strong India, every ready to meet various challenges.

PanditJawaharlal Nehru

School children are vulnerable section of population by virtue of their physical, mental, emotional and social growth during this period. It is in this age their personality develops7.40% of India's population is below the age of 18 years which at 400 million is the world's largest child population.One in every 100 children in India between age group of 0-14 years suffers from acute respiratory infection and dermatologic conditions. Almost one in every 500 children in India below the age of 14 suffers from one or other type of skin infections13.Skin diseases are a major health problem affecting a high proportion of the population and causing distress and disability. They are more frequent among primary-school children in bothdeveloping and industrialized countries14.Skin diseases are a common cause of morbidity, especially among school children, worldwide.Though skin infections are not responsible for mortality they do cause significant morbidity in school age children. Although skin disease is rarely lethal, it can have a significant impact in terms of treatment cost, days absent from school, and psychological distress. It is often stated that overcrowding and poor living conditions favor the development of many skin diseases. However, when assessing risk factors for skin disease, there are many other ecological and environmental considerations5.Children are often exposed to climatic and social conditions that predispose them to develop skin infections and suffer from minor skin injuries. There is variation in the pattern andpresentation ofdermatoses, with eczemas being the most common skin disorder in developed countries and infections and infestations in the developing countries13.

The incidence of pediatric dermatological conditions is on a gradual increase day by day but still adequate attention is not being paid to it as compared to systemic disorders in children. Dermatologic conditions constitute at least 30% of all outpatient visits to pediatricians, and 30% of all visits to dermatologists involve children15.The pattern of skin disease in India is affected by various factors like ecological, environmental,racial, social, mental and literacy level.Health education and personal hygiene will definitelyhelpto improvehealthstatusofschool children13.

Several epidemiological studies in pediatric age group have been undertaken across the World. Most of the studies have shown atopic dermatitis as the most common dermatoses, followed by viral infections, and pigmented nevi, while studies from developing countries have infections and infestations as the most common pediatric dermatoses.A study from South India of children of < 14 years showed that infections and infestations (54.5%) were the most common pediatric dermatoses. Secondary pyodermas were more common than primary pyodermas. Pediatric patients constituted 20% of total dermatology OPD patients. Other common dermatoses were eczemas (8.6%), pigmentary disorders (5.7%), insect bite reactions (5.2%), miliaria (4.1%), nutritional deficiency-associated dermatoses (2.8%), urticaria (2.5%), genetic disorders (2.1%), psoriasis (1.4%), collagen vascular diseases (0.5%), hemangiomas (0.5%), drug eruptions (0.3%) and pityriasis (0.2%)16.



Regarding the fact that two thirds of children's life passes in school, it is important for teachers to have enough knowledge about skin infections which occur in school children and its management, prevention and how to encounter the disease.

A cross-sectional study was carried out to determine the prevalence of different dermatologic diseases in infant and children in Sharkia Governorate Egypt.1860 patients of both sexes aged from one month to twelve years with different skin diseases chosen by random sample from Dermatology and Pediatric Out-patient Clinics of Zagazig University Hospitals. And the results of the study shows that,the group with bacterial skin infection had the highest prevalence rate (23.4%) of which impetigo (22%) was the commonest. Parasitic infestations group had a rate of (20.9%) with pediculosiscapitis forming the majority (17.5%). Superficial fungal infections were (16.3%), followed by eczema/dermatitis group (12.7%), then viral infections (11.2%),urticaria (6.1%), sweat gland disorders(4.8%), papulosquamous disorders (1.5%), pigmentary disorders (1.1%), alopecia areata(0.6%), genodermatoses (0.4%).Other skin disorders were recorded (0.8%). Study concluded that bacterial infections were a major problem particularly among school age group17.

A prospective cross sectional study was conductedto determine the prevalence of skin disorders and associated socioeconomic factors among school children in 4 (2 government and 2 private) schools of Lucknow.The students of classes 1 to 5 were examined to search for diseases of the skin and its appendages. The data was tabulated and analyzed using chi square test to study the association between various factors.Result of the study shows thatthe overall prevalence of skin disorders was 42.3%. Of them 32.9% students had only one skin disorder while 11.3% students had at least one transmissible skin disorder. The commonest skin disorder was Pityriasis Alba with an overall prevalence of 14.3%. Pediculosiscapitis was the commonest transmissible skin disorder with an overall prevalence of 6.5%. There was statistically significant difference in the prevalence of skin disorders especially infections and infestations in students from different socio-economic classes18.

An epidemiologic survey was conducted in a population of 1,727 persons living in 253 households in a semi-urban area of Goa, India. The prevalence of scabies was 9.7% by persons, 22.5% by households and 22.8% by families. Prevalence of scabies was highly associated with age. The highest prevalence (23.7%) was in school-age children. Prevalence was higher for females than males age 25 or older, but there was no significant difference in prevalence by sex for all ages. Prevalence rate by persons was approximately the same in Hindus and Christians but prevalence rate between families was higher for Hindus, although prevalence within families was higher for Christians. First to contact scabies in the family was generally a school child19.

A study was conducted to determine the prevalence of skin disease among school children of South India in the year 2003. All children <14 years were selected for this study. A total of 2410 children were included, in which 2100 children with skin diseases. Among this dermatitis and eczema was identified in 184 cases (8.65%) and impetigo in 124cases (5.8%), scabies in 304 cases (14.8%) and tineacapitis in 66 cases (3.1%). The conclusion of the study was skin disorders are more common in school children16.

So prevalence of various types of skin infections is common among school children particularly in primary school children.As children are inquisitive and mobile, they come into contact with a variety of people and animals. The close proximity in the school setting provides opportunity to be exposed to infectious agents (viruses, bacteria, fungus, insects and animals) in addition; children tend to share personal items.School teachers play an important role in identifying, management and prevention of skin infections among school children and this will prevent further incidence of skin infections among school children.
6.2REVIEW OF LITERATURE

Review of literature is organized under following headings.



  1. Studies related to incidence and prevalence of selected skin diseases among primary school children (6-12years).

  2. Studies related to management and prevention of skin diseases among school children.

  3. Studies related to knowledgeof caretakers of school children regarding identification and management of skin diseases among school children.

  4. Studies related to effectiveness of structured teaching programme.



  1. Studies related to incidence and prevalence of selected skin diseases among primary school children (6-12years).

A cross-sectional survey was conducted to determine the prevalence of skin diseases among primary-school children in Baghdad, Iraq, a total of 2160 schoolchildren were randomly selected from 30 primary schools. Socio-demographic data were collected from each pupil and exposed parts of the body of each child were clinically examined. A result of the study shows that, the overall prevalence of skin diseases was 40.9%. A significant association between the prevalence of skin diseases with education level ofparents was demonstrated. The prevalence rates of transmissible and non-transmissible skin diseases were 8.8%and 33.7% respectively14.

A study was conducted to determine the spectrum of pediatric dermatoses in Cairo, Egypt. The medical records of children attending the dermatology outpatient clinics of Ain Shams University hospital for the year 2001 were retrieved. Data of 3049 patients were included. Demographic data (age and gender) and diagnoses were extracted, coded and analyzed. Result of the study shows that Patients’ attendance peaked in summer (42.57%) and revealed female predominance (1.3:1). Infections constituted most of dermatoses (52.87%) and impetigo was most common (12.04%). Hypersensitivity came after (18.6%), and contact dermatitis prevailed (6.03%). Females predominated in most dermatoses. Most dermatoses peaked in summer except urticarial and chicken pox that peaked in spring20.

A cross-sectional study was designed to find the prevalence of skin disorders among school going children between age group of 6-19 years in Kashmir valley of North India. Educational institutions were stratified as per levels of education, i.e. primary, middle, secondary, higher secondary and college. Each stratum was sub-grouped sex-wise. From each educational institution, 10% of students were selected through the systematic random sampling. A specially designed questionnaire was framed and information regarding any of dermatological ailments was noted. A total of 5000 students were examined and prevalence of all types of skin disorders was noted.And the result of the study shows, eczemas formed the largest group followed by acne vulgaris. In the eczema group, PityriasisAlba was most frequent type followed by hand eczema, irritant and allergic contact dermatitis taken together. Individually, acne vulgaris was the most prevalent skin disorder in the study group. The study concluded that skin disorders were more common in males than females, in urban than in rural dwellers, in students from government schools than private schools and in students belonging to the low socioeconomic group21.

A school based cross sectional study was doneto find the prevalence of common skin diseases among the primary school children in 19 Government Schools and the factors associated with the skin diseases in Pulianthope Zone of Chennai.From the 19 schools, 450 children were selected by simple random sampling method. Skin examination was done in the Schools in sunlight and the data was collected from the parents or available family members by home visits. The association between various factors and skin diseases were analyzed by using Chi Square test. Result of the study revealed that the overall prevalence of skin diseases was59.3% (95% C.I 54.2% to 63.7%). Pediculosiscapitis was the commonest one which contributed 27% (68), followed by Miliariarubra 21% (53), Impetigo 15 %( 38), Pityriasis alba 14% (35), Scabies 11 % (28), TineaVersicolor 5%(13), Insect bite allergy 4%(10), Viral warts3% (7).There was significant association between Mothers education, Socio economic status, overcrowding and, bathing habit and wearing washed clothes and toilet facility in the house. Conclusion of the study was regular health checkup should be provided to identify and treat skin diseases. Health education should be given to both teachers and parents regarding skin diseases among the children22.

A study was conducted with the aim to find out the incidence and pattern of presentation of various pediatric dermatoses in children and adolescents in Punjab, India.Patients and methods 1387 children and adolescents (831 boys and 556 girls) in the age group of 6-15 years with single dermatological disorders were selected from Dermatology and Venereology and Pediatrics Outpatient Departments of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar (Punjab), India. They were divided into 2 groups depending upon their age: Group A: Children (6-10 years) and Group B: Adolescents (11-15 years). Results shows that Infections and infestations were the most common dermatoses (30.8%) followed by dermatitis (27.3%), acne (12.5%), pigmentary disorders (6.9%), urticaria/angioedema (5.0%), hair disorders (2.2%), drug reaction (1.5%), sweat gland disorders (1.4%), and miscellaneous group (4.7%). Amongst infections and infestations, the most common were scabies (11.9%), fungal infections (6.9%), and bacterial infections (5.6%). The findings of the present study highlight the need to diagnose pediatricsdermatoses at early stages by training general practitioners and pediatricians and by increasingawareness in thepublic regardinghealth and hygiene of children15.

A study was conducted to estimate the burden and relative frequency of dermatologic diseases among children in the 12,586 Indian school children ages 6-14 years inChandigarh, India.The overall point prevalence of one or more identifiable/apparent skin conditions was 38.8%. Of those studied, 3786 children (30%) had only one skin disease, 765 (6%) had two, and 336 (2.7%) had three skin pathologies. The most common skin conditions and their respective point prevalence’s were skin infections (11.4%), pityriasis alba (8.4%), dermatitis/nonspecific eczemas (5.2%), infestations (5.0%), disorders of pigmentation (2.6%), keratinization disorders (mostly keratosis pilaris) (1.3%), and nevi/hamartomas(1.1%). This study shows that skin conditions are common in children and about one-third of them are affected at any given time23.


2. Studies related to management and prevention of skin diseases among school children.

A controlled trial involving four intervention madrasahs (total students 2359) and four control madrasahs (total students 2465) in Dhaka Metropolitan Area was conducted to assess the effectiveness of a scabies control programme in reducing the prevalence of scabies inurban Bangladesh madrasahs. A baseline scabies sample survey was carried out on 40 and 44 students of four intervention and four control madrasahs, respectively. Another 40 students of the intervention madrasahs were administered a pre-intervention test on scabies knowledge. This was followed by mass treatment of all students, teachers and staff of the eight madrasahs with topical 5% permethrin cream. The subsequent intervention involved daily monitoring of students for five key personal hygiene practices, weekly 10-min scabies health education classes, supply of simple and inexpensive products to students to prevent cross-infestation to/from peers (e.g. plastic bags, clothes hangers), and chemotherapy of new students detected with scabies. And result of the study shows that after 4 months of the intervention, the prevalence of scabies, personal hygiene practices and scabies knowledge were assessed in students of the intervention madrasahs. Before the intervention, the prevalence of scabies was 61% and 62% in intervention and control madrasahs, respectively (P = 1.00). After mass scabies treatment in all eight madrasahs and 4 months of intervention, the prevalence of scabies was reduced to 5% and 50% in intervention and control madrasahs, respectively (P < 0.001). There were significant improvements in all five personal hygiene practices at the intervention madrasahs. Mean test scores for scabies knowledge was 40% before the intervention and 99% after the intervention in the four intervention madrasahs24.

An experimental study was conducted in Egypt on sixty heavily lice-infested male and female children (4–15 years) who were selected and subjected to the treatment with a neem seed extract shampoo. Twenty to thirty milliliter of the shampoo were thoroughly mixed with completely wet hair and rubbed in to reach the skin of the scalp. After 5, 10, 15 and 30 min, the shampoo was washed out and the hair basically combed. Head lice were collected and examined. The neem seed extract shampoo proved to be highly effective against all stages of head lice. No obvious differences regarding the efficacy of the shampoo were observed between an exposure time of 10, 15 or 30 min. No side effects, such as skin irritation, burning sensations, or red spots on the scalp, forehead or neck, respectively, were observed25.

An observational study of households was conducted in two scabies-endemic Aboriginal communities in northern Australia in which a community-based skin health programme was operating. Permethrin treatment was provided for all householders upon identification of scabies within a household during home visit. Households were visited the followingday to assess treatment uptake and at 2 and 4 weeks to assess scabies acquisition among susceptible individuals. All 40 households in which a child with scabies was identified agreed to participate in the study. Very low levels of treatment uptake were reported among household contacts of these children (193/440, 44%). Household contacts who themselves had scabies were more likely to use the treatment than those contacts who did not have scabies (OR 2.4, 95%CI 1.1, 5.4), while males (OR 0.6, 95%CI 0.42, 0.95) and individuals from high-scabies-burden households (OR 0.2, 95%CI 0.08, 0.77) were less likely to use the treatment. Among 185 susceptible individuals, there were 17 confirmed or probable new diagnoses of scabies recorded in the subsequent 4 weeks (9.2%). The odds of remaining scabies-free was almost 6 times greater among individuals belonging to a household where all people reported treatment uptake (OR 5.9, 95%CI 1.3, 27.2, p = 0.02). And study concluded that, there is an urgent need for a more practical and feasible treatment for community management of endemic scabies. The effectiveness and sustainability of the current scabies programme was compromised by poor treatment uptake by household contacts of infested children and high ongoing disease transmission26.

A retrospective, nested, case-control trial was conductedto compare the clinical effectiveness of mono therapy with β-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of non-drainednon-cultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region. With a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region, all subjects were treated as outpatients with oral monotherapy for non-drainednon-cultured SSTIs. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, and change in antibiotic or second antibiotic prescription within28 days. Result shows that of 2096 children with non-drained non-cultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with β-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess. And it is concluded that Compared with β-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with non-drained non-cultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, β-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections27.

A study was conducted to find the effectiveness of scabies intervention by public health education. In 59 households (96.7% of village) containing 313 persons including children, an educational session was held and a leaflet distributed to them. Thirteen persons (4.2%) from eight households (13.6%) had scabies. After 2 weeks, 7 persons (2.2%, 2 persisting and 5 new cases) from 5 households (8.5%) were infested. Thus a case rate of 85% was obtained through the prevalence rate showed the statistically significant difference. Among the under 15 year’s olds, the numbers infected decreased from 10 to 3 while among the over 15 years old, the numbers infected increased from 3 to 428.


3.Studies Related to knowledge of Care Takers of School Children regarding Identification and Management of Skin Diseases among School Children

A cross-sectional study was conducted to determine the prevalence of head lice among school children and ascertain relevant teacher’s knowledge about head lice infestation in Viana. The171 children attending school inVianawere randomly selected and examined for presence of head lice by visual inspection. In addition, a questionnaire was used to assess teachers’ and children’s knowledge about this ectoparasite. Results of this study shows that overall prevalence of head lice was 42.1%, with a significance difference between the genders (girls [95.8%] versus boys [4.2%,] P, (0.001). Self-reported history of being in contact with another person infested with head lice was the main risk factor for becoming infested. Conclusion of the study was, a high rate of head lice infestation was demonstrated. Female gender and history of contact with someone already infested were the main risk factors. Teachers demonstrated knowledge of the biology and clinical signs of head lice, but did not have adequateknowledge about its treatment,suggesting a need for increased competence on the part of teachers to be able to teach children about preventative measures. However, further systematic epidemiological studies are required to increase understanding of ectoparasitosis29.

A cross-sectional survey and rapid appraisal methods were performed,to compare the effect of health education provided by teachers, in three primary schools of Guerrero, Mexico, on the prevalence of head louse infestation, including a child questionnaire and qualitative data from teachers and focus groups of mothers in the same schools. Result of the study shows that, Nine hundred and forty-four students and 33 teachers were interviewed; a focus group discussion with 6–8 mothers per school was performed. In the self-diagnosis of pediculosis, the prevalence was 22% (range, 18%–33%) with a sensitivity of 68% and a specificity of 86%, In one school, 100% of the teachers applied a health program, whereas in the other two schools this percentage was only 20%. A child under 9 years of age who attended a school without information on health was 3.6 times more likely to have head louse infestation (OR=3.6, CI95%=2.1–6) than a child of the same age who attended a school where information was given. In older children the effect and potential impact were lower. Conclusion of this study emphasizes the potential value of simple, but effective, health education provided by school teaching staff through liaison with patents in the amelioration of endemicdisease30.
4. Studies related to effectiveness of structured teaching programme

An experimental study with pretest – posttest control group design was carried outto find out the effectiveness of structured teaching programme in improving knowledge and attitude of School going adolescents on reproductive health in four selected schools with similar settings in Dharan town of Nepal.All the subjects were divided into two groups:experimental and control, each comprising of two subgroups of 50 boys and 50 girls. Structured teaching programme consisting of information on human reproductive system was used as a tool of investigation for the experimentalgroup, whereas conventional teaching method was used for the control group. Results shows that total200 Adolescent school students were included in this study. The mean (±SD) pretest score of theexperimental group on knowledge of reproductive health was 39.83 (± 16.89) and of the control group was 39.47(±0.08). The same of experimental group after administration of the structured teaching programme (84.60±10.60) and ofthe control group with conventional teaching method (43.93±10.08) was statistically significant (p<0.001).Similarly, the post-test scores of knowledge of the groups on responsible sexual behavior and their attitude towardsreproductive health were better in the experimental group than in the control group (p<0.001). Study was concluded that, the knowledge of adolescent school students on reproductive health is inadequate. The use ofstructured teaching programme is effective in improvingknowledge and attitude of the adolescents on reproductive health31.

A quasi experimental research design Study was conducted to assess the effect of planned teaching among the school teachers regarding behavioral problem in the selected schools of Kurukshetra city of State of Haryana.The sample comprised of 60 people. A structured questionnaire knowledge regarding behavioral problem was prepared to study the sample. Descriptive and inferential statistics had been used to analyze the data obtained through interviews. This study indicates that the planned teaching is effective in increasing the knowledge of teachers regarding behavioral problem32.

A quasi experimental one group pretest posttest design was used to assess the effectiveness of structured teaching programme on knowledge regarding bronchial asthma and its management among mothers of asthmatic children. Samples of 60 mothers of asthmatic children were selected for the study using non probability convenient sampling technique. A structured knowledge questionnaire was used to collect the data from the mothers before and after the administration of the structured teaching programme on knowledge regarding bronchial asthma and its management among mothers of asthmatic children. The data collected were tabulated and analyzed using frequency distribution, percentage, mean, standard deviation, chi-square test and paired‘t’ test.The findings reveals that, in the pretest 36(60%)had moderate knowledge and 24(40%) had inadequate knowledge regarding Bronchial Asthma and its Management. And in the post test, majority of them 56(93.33%) had adequate knowledge, 4(6.67%) had moderate knowledge and none of them had inadequate knowledge regarding Bronchial Asthma and its Management.The findings depict that, the enhancement between pretest and posttest was 10.03 and obtained paired‘t’ test value was 6.56, it was highly significant at 5% level p< 0.001. This showed the effectivenessof structured Teaching Programme33.


6.3 STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of Structured Teaching Programme(STP)on knowledge of caretakers of school children regarding identification, management and preventionof selected skin diseases among primary school children in selected residential schools at Mysore, Karnataka”.




    1. OBJECTIVES

  1. To assess the level of knowledge of care takers of school children regarding identification, management and prevention of selected skin diseases among primary school children among experimental and control group.

  2. To determine the effectiveness of structured teaching programme (STP) in terms of gain in knowledge of care takers of school children regarding identification, management and prevention of selected skin diseases among primary school children in experimental group.

  3. To find the association of level of knowledge of care takers of school childrenregarding identification, management and prevention of selected skin diseases among primary school children with their selected personalvariables.


6.4.1 CONCEPTUAL FRAME WORK

Conceptual frame work based on Imogene king’s goal attainment theory



6.4.2 OPERATIONAL DEFINITIONS

Effectiveness: In this study, it refers to gain in the knowledge score of the care takers of school children regardingidentification, management and prevention of selected skin diseases among primary school children after structured teaching programme.

Care takers of school children: In this study, it refers to people who are taking care of children in schools; mainly the school teachers and hostel wardens are responsible for taking care of children in residential schools.

Structured teaching programme: In this study, it refers to well-planned teaching intervention given to the care takers of school children, to improve the knowledge regarding identification, management and prevention of selected skin conditions among primary school children.

Knowledge: In this study, it refers to correct response given by care takers of school children to the knowledge items regarding identification, management and prevention of skin problems in the structured knowledge questionnaire and is expressed in terms of knowledge score.

Selected Skin diseases: In this study, skin diseases refer tothe infectious diseases of the skin which includes impetigo, eczema, pediculosis, scabies, warts and dermatitis which occurs in primary school children.

Primary School children: In this study, it refers to a boy or girl children who are in the age group of6-12 years, attending residential schools in Mysore.

Residential schools:In this study, it refers to, a setting which gives both learning and boarding facilities for primary school children in Mysore.

Selected personal variables:In this study, selected personal variables are age, sex, education religion, income, marital status and previous exposure to any educational programme regarding the identification, management and prevention of selected skin diseases

6.5 HYPOTHESIS

The following hypotheses are formulated for the study and will be tested at 0.05 level of significance.



H1: The mean posttest knowledge score of care takers of school children regarding identification, management and prevention of selected skin diseases among primary school children will be significantly higher than the mean pretest knowledge scores in experimental group.

H2: The mean gain in posttest knowledge score of care takers of school children regarding identification, management and prevention of selected skin diseases among primary school children among experimental group will be significantly higher than the mean gain in posttest knowledge score of care takers of school children among control group.

H3: There will be significant association between knowledge of care takers of school children regarding identification, management and prevention of selected skin conditions among primary school children and their selected personal variables.


    1. ASSUMPTIONS

  1. Structured teaching programme is an effective method to teach the care takers of school children to improve their knowledge regarding identification, management and prevention of selected skin diseases among primary school children.

  2. Improvement in knowledge of care takers of school children may result in easy identification, management and early prevention of selected skin diseasesamong primaryschool children.

  3. Improvement in knowledge of care takers of school children may result in prevention of furtherincidence andprevalence of skin diseases among primary school children.




    1. DELIMITATIONS

  1. The study is delimited to the care takers of school children at selected residential schools in Mysore.

  2. In this study, knowledge of care takers of school children regarding theidentification, management and prevention of selected skin diseases among primary school children will be assessed only through structured knowledge questionnaire.

7.0 MATERIALS AND METHODS

RESEARCH APPROACH AND DESIGN

Research design of this study is Quasi experimental (pre-test post- test control group) design



SYMBOLICREPRESENTATION OF THE RESEARCH DESIGN

E O1 X O2

C O1 O2

Keys

E- Experimental group

C- Control group

O1- Pretest

O2- Post test

X- Intervention.


SCHEMATIC REPRESENTATION OF RESEARCHDESIGN

GROUP

DAY 1

DAY 8

POST TEST

PRE TEST

INTERVENTION

Experimental group

Control group



SKQ

SKQ


STP


SKQ

SKQ


Keys:

SKQ – Structured Knowledge Questionnaire

STP – Structured Teaching Programme

VARIABLES OF THE STUDY

1. RESEARCH VARIABLES


  • Independent variable - Structured teaching programme regarding identification, management and prevention of selected skin diseases among primary school children.

  • Dependent variable -Knowledge of care takers of school children regarding the identification , management and prevention of selected skin diseases among primary school children

  • Selected personalvariable – Age, sex, education religion, income, marital status and previous exposure to any educational programme regarding the identification, management and prevention of selected skin diseases.

7.1 SOURCES OF THE DATA

SETTING

The setting selected for the present study isselected residential schools in Mysore, Karnataka



POPULATION

Care takers of school children


7.2 METHOD OF DATA COLLECTION

SAMPLE AND SAMPLING CRITERIA

Inclusion criteria:

Care takers of school children who are



  1. Available during the period of data collection

  2. Willing to participate in study.

  3. Comprehend in English or Kannada

Exclusion criteria:

  1. Care takers of school children who are absent at the time of data collection.

SAMPLING TECHNIQUE:

Nonprobabilityconveniencesampling.



SAMPLE SIZE:

In the present study, the sample size is 60(30 in each control and experimental group)



DATA COLLECTION TECHNIQUE:

Section A -Personal proforma

Section B -Structured knowledge questionnaire to assess the knowledge of care takers of school children regardingthe identification, management and prevention of selected skin diseases among primary school children.

METHOD OF DATA COLLECTION

  1. Approval from the authority.

  2. Select samples as per criteria

  3. 60 care takers of school children

  4. Collect data as per plan

PLAN OF DATA ANALYSIS

Descriptive statistics:

  1. Frequency, percentage will be computed for describing selected personal variables.

  2. Mean, Median, range, standard deviation will be computed to analyze the knowledge scores of care takers of school children regarding the identification, management and prevention of selected skin diseases among primary school children.

Inferential statistics:

  1. Independent‘t’ test will be computed to compare pretest and posttest knowledge scores of care takers of school children among experimental and control group.

  2. Paired‘t’ test will be computed to compare the pretest and posttest knowledge scores of care takers of school children regarding the identification, management and prevention of selected skin diseases in primary school children among experimental group.

  3. Chi square test will be computed to analyze the significance of association between knowledge of care takers of school children regarding the identification, management and prevention of selected skin diseases in primary school children and their personal variables.

7.3 Does the study require any investigations or intervention to be conducted on patients or other human or animal? If so please describe briefly.

Yes, the study requires intervention in the form of a Structured Teaching Programme(STP).



    1. Has ethical clearance being obtained from your institution?

Yes.

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9.0 SIGNATURE OF THE CANDIDATE:
10.0 REMARKS OF THE GUIDE

RECOMMENDED AND FORWARDED


11.1 NAME AND DESIGNATION OF GUIDE (IN BLOCK LETTERS)

Mrs. AMBIKA K.

Asst. PROFESSOR

DEPT.OF CHILD HEALTH NURSING

JSS COLLEGE OF NURSING

1ST MAIN, SARASWATHIPURAM

MYSORE-570009
11.2 SIGNATURE:
11.3 HEAD OF THE CHILD HEALTH NURSING DEPARTMENT

Mrs. AMBIKA K.

Asst. PROFESSOR

DEPT.OF CHILD HEALTH NURSING

JSS COLLEGE OF NURSING

1ST MAIN, SARASWATHIPURAM, MYSORE-570009


11.4 SIGNATURE:
12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL:

RECOMMENDED AND FORWARDED

Prof. SHEELA WILLIAMS

PROFESSOR CUM PRINCIPAL

DEPT. OF MEDICAL SURGICAL NURSING

JSS COLLEGE OF NURSING



1ST MAIN, SARASWATHIPURAM, MYSORE-570009

12.2 SIGNATURE:
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