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Indian Journal of Community Medicine

Impact of Child to Child Programme on Knowledge, Attitude Practice Regarding Diarrhoea among Rural School Children

Author(s): P.R. Walvekar, V. A. Naik, A. S. Wantamutte, M.D. Mallapur

Vol. 31, No. 2 (2006-04 - 2006-06)

Abstract:

Background: In India almost 74% of people live in rural areas. It is observed that because of illiteracy, poverty, ignorance, misconception and superstition people of rural areas have developed undesirable health attitudes and practices. About 30- 50% of rural school children suffer from many morbidities like anaemia, worm infestation, under nutrition and dental caries. The vast population in the rural area could be approached through Child to Child programme, for giving health education to protect against common illnesses like diarrhoea, anaemia malnutrition etc. Objectives: To assess the impact of Child-to Child programme in increasing the knowledge, change in the attitude and practice with respect to diarrhoea among rural school children. Study design: Controlled trial. Setting: Government primary school of Mastmaradi and Shindoli village of district Belgaum, Karnataka. Participants: VI standard students of Mastmaradi primary school as study group and Vl standard students of Shindoli School as control group. Study period: June 2000 to October 2001. Statistical analysis: Wilcoxon's signed ranking test Results: Child-to-Child program had made significant improvement in the knowledge, change in the attitude and practice of study group students after the intervention when compared to control group students.

Key Words: Health Education, School Children, Child-to-Child Programme.

Introduction:

In India almost 74% of people live in rural areas1. It is observed that because of illiteracy, poverty, ignorance, misconception and superstition people of rural area have developed undesirable health attitudes and practices2. About 30-50% of rural school children suffer from many morbidities like anaemia, worm infestation, under nutrition and dental caries3. Approaching every individual in the rural area is herculean task with poor sustainability. Mass media have their limitations in such population. Under these circumstances Child-to-Child programme offers most cost effective strategy to approach every family. Through this method it is possible to improve the health and nutrition awareness of the people, change their attitudes and help them to implement basic health principles in practice4.

Health education to school children in their formative age is the most effective method for protection and promotion of their health. Primary school children are more open minded and are likely to be receptive to changes in ideas and agreeable to modifications of their habits5. Health education of school children can be carried out in different ways and settings, through formal and informal teaching in school. Innovative approaches to education for health are essential to gain the interest, support, involvement and commitment of students6.

Diarrhoeal diseases are one of the major causes of childhood mortality and morbidity in developing countries. According to WHO diarrhoeal diseases caused more than 1.7 million deaths in 2004, and 90% of these occurred among children. Almost 88% of diarrhoeal diseases are attributed to unsafe water supply, inadequate sanitation and hygiene. Simple act of washing hands at critical times can reduce the number of diarrhoeal cases by up to 35%. ORT helps save more than 1 million children's lives each year7.

Educating the children through Child-to-Child programme regarding causes, sings, symptoms, treatment and prevention of diarrhoea, has resulted in better knowledge, attitude and healthy practices amongst, the school children and their family members of Malavani Slum of Bombay8. The present study is an attempt to assess the impact of Child-to-Child programme on the knowledge, attitude and practice regarding diarrhoea among rural school children.

Material and Methods

Present study was an interventional study, taken up in the rural field practice area of the Department of Community medicine, J.N. Medical College, Belgaum. 54 students belonging to VI standard (mean age 11.80+0.68) of Govt. primary school, Mastmaradi village formed the study group and 54 students belonging to VI class (mean age 11.95+0.56) of Govt. primary school Shindolli village formed the control group.

Care was taken to see that demographic characteristic of both the groups was matching. Pre tested, pre designed questionnaire was administered to study as well as control group students to know their knowledge, attitude and practice (KAP) prior to starting of the programme. Once a week, one hour, child to child session (total 12 sessions) were conducted for the study group students. During these sessions students were taught about causes, signs, symptoms, treatment and prevention of diarrhoea. Lectures, songs, games, experiments and demonstrations were the different teaching techniques used for the study group. No such sessions were conducted for the control group students.

The questionnaire was structured to get-information regarding definition, causes, signs, symptoms, treatment, ORS and prevention of diarrhoea. Scoring system was developed to assess both pre and post test performance of the study and control group. Correct answer was given score of 1, wrong answer was given score of -1, uncertain answer was given score of 0. For the purpose of analysis the tendency to act in a way that is beneficial to health was considered as positive attitude and tendency to act that is harmful to health was considered as negative attitude. As the distribution of pre and post test scores were not following GAUSSIAN model, Wilcoxon's signed ranking test using SPSS 9.1 software was applied for the analysis of the data. After completing the twelve sessions the data with respect to KAP was obtained from both the study and control group.

Results:

Overall improvement in the knowledge of the study group students was observed, pre test mean score was 1.44 and post test mean was 23.57 respectively. Whereas pre test mean was 4.04 and post test mean was 3.20 in control group

Prior to the intervention average of 50% of study group students knew that eating contaminated food (51.85%), drinking contaminated water (46.29%), eating food exposed to flies (46.20%) and dust (53.70%) causes diarrhoea. After the intervention more than 90% of study group students came to know about these causes. (Table 1)

Table I: Percentage of students giving correct answers for definition and causes of diarrhoea

Definition & Causes Study group (N=54) Control group (N=54)
Pre test Post test Pre test Post test
Passing stools > 3 times a day 40.74 100 55.55 75.92
Eating -contaminated food 51.85 96.29 51.85 51.85
Drinking contaminated water 46.29 98.14 48.14 46.29
Bottle feeding the infant 9.25 92.59 14.81 11.11
Eating food exposed to flies 46.20 96.29 55.5 48.14
Eating food exposed to dust 53.70 96.29 66.66 51.85
Caused by micro- organisms 27:77 87.05 51.85 50.00
Seasonal variations cause diarrhoea 40.74 68.51 37.03 35.18
Hot / spicy food 44:44 79.62 25.92 24.07

Table II shows that overall improvement occurred among study group students in identifying signs and symptoms of diarrhoea after the intervention. Maximum improvement was for recognising sunken eyes as one of the signs of diarrhoea (20.30% to 96.24%). No such improvement was observed among control group.

Table II: Percentage of students giving correct answers for signs & symptoms of diarrhoea.

Signs & symptoms Study group Control group
pre test Post test pre test Post test
Pain abdomen 62.96 98.14 74.07 64.81
Vomiting 31.48 100.00 40.74 38.88
Thirst 38.88 85.18 53.70 46.20
Sunken eyes 20.30 96.24 59.25 68.51
Depressed anterior fontanelle 37.03 100.00 27.77 35.18
Decreased urine out put 29.19 70.37 37.03 27.77

Overall improvement was observed in the knowledge of study group students regarding treatment of diarrhoea, maximum was for correct method of preparation of ORS (0% to100%). After completing the Child-to-Child programme 100% of study group students developed the attitude that ORS should be given during diarrhoea. Such improvement was not observed with respect to control group (Table III).

Table III: Percentage of students giving correct answers and showing positive attitude regarding treatment of diarrhoea.

Treatment Study group Control group
Pre test Post test Pre test Post test
Must give ganji, tea, butter milk etc. 74.04 98.14 75.92 72.22
Breast feeding to be continued 51.85 100.00 57.40 53.70
ORS should be given 38.88 100.00 40.74 38.88
ORS available in PHC/s 7.40 88.88 16.66 20.37
An anwadi ORS can be prepared at home 3.70 98.14 5.55 11.11
Correct method of preparation of 0.00 98.14 3.70 0.00
ORS By giving ORS death due to dehydration can be prevented 29.62 98.14 18.51 18.51

Maximum improvement occurred among study group students for identifying washing fruits and vegetables before eating as one of the preventive methods of diarrhoea, after the intervention, i.e. from 46.25% to 100% (Table IV).

As far as practices are concerned 100% of study group students started washing their hands with soap and water after attending toilet and washing vegetables and fruits before eating. Surprisingly in the control group this practice decreased from 81.48% to 70,09% and 66.66% to 57.40% respectively (Table IV).

Discussion:

Child-to-Child programme, which is an original approach to education for health, applies to school age children. It makes children feel responsible for their own health. This approach uses active teaching methods in which learning takes place through the dynamics of investigations, group work and play. What they learn in classroom is immediately applied to every day life at school and home.

Diarrhoea being common health problem in rural area, it is not surprising that 40.70% of study and 55.50% of control group students were aware of definition of diarrhoea prior to the intervention. After the Child to Child program 100% of study group children came to know about it and also 75.90% of the control group children came to know about it. Better knowledge among control group children could be the effect of health education provided by the health workers. In a similar study conducted at Municipal school of Mumbai, the knowledge of the study group children about the definition of diarrheoa increased from 95.95% to 100% and that of control group was from 96.67% to 98.31% 9.

Table IV: Percentage of students giving correct answers and following correct practices regarding prevention of diarrhoea.

Prevention Study group Control group
Pre test Post test Pre test Post test
Washing hands with soap before eating 64.80 98.18 74.07 70.37
Washing hands with soap after attending toilet 64.80 100.00 81.48 70.09
Fruits and vegetables washed before eating 46.25 100.00 66.66 57.40
Nails to be kept short & clean 50.00 98.14 38.88 40.74
Garbage-disposed properly 7.40 64.81 55.55 55.55

Table V: Mean score of students regarding different aspects of diarrhoea.

Variables Study group Control group
Pre test score Post test score Pre test score Post test score
Mean SD Mean SD Mean SD Mean SD
Definition 0.18 0.99 1.00 0.00* 0.25 0.93 0.57 0.79**
Causes -0.77 3.43 4.96 1.77* 0.37 3.34 0.04 2.87
Signs & symptoms -0.24 2.78 5.98 1.52* 0.96 2.66 0.85 2.44
Treatment 0.91 2.01 7.41 1.17* 1.33 2.32 0.50 2.23
Prevention 0.65 2.90 4.17 1.24* 1.83 2.33 1.48 2.42
Attitude 1.24 1.36 2.96 0.37* 1.43 1.33 1.07 1.30**
Practice 0.65 2.90 4.17 1.24* 1.83 2.33 1.48 2.42
*PC 0.01 + P < 0.05

In a study conducted for VI standard students of a village of Belgaum district, none of the students knew about the causes of diarrheoa before the Child to Child programme. After the programme 65.00% of students came to know about it10. In our study knowledge of different causes of diarrhoea ranged from 9.25% to 53.70% amongst study group before the intervention. After the intervention percentage of students knowing about different causes of diarrheoa ranged from 88.50% to 98.0%.

Overall improvement of knowledge with respect to signs and symptoms of diarrhoea was observed among study group children, maximum was for identifying vomiting and sunken eyes i. e. from 31.48% to 100:00% and 20.30% to 96.24% respectively. Study conducted in Mumbai Municipal School, where improvement in study group children was from 0.81+0.23 to 1.73+0.40 (p < 0.5). Similar significant improvement was observed in Malavani study conducted for slum children of Bombay8.

In our study it was encouraging to know that more than 75% of both study and control group children knew that liquids like Ganji, Buttermilk, Tea should be given during diarrhoea. However only about 40% of students of both groups knew that ORS should be given during diarrhoea prior to the intervention. 7% of study and 11 % of control group students knew prior to the intervention that ORS packets are available free of cost at primary health centre and anganwadi. After the intervention 100% of study group children came to know about giving ORS during diarrhoea. About 90% of them came to know about availability of ORS. No such improvement was observed among control group children.

Our study has shown that, not only study group children developed positive attitude towards treatment of diarrhoea, but also started following healthy practices to prevent diarrhoea like, washing hands before eating and after attending toilet, washing vegetables and fruits, cutting nails regularly. Development of positive attitude was observed in a study conducted for Municipal School Children in Mumbai, where pre test score was 1.24±7.38, post test score was 2.96±0.27 (p<0.000)9.

In our study development of positive attitude was observed among study group children with pre test score of 1.24±1.36 to 2.96±0.27 (p<0.0001). No such change was observed in the control group.

Conclusion

Our study shows that Child to Child programme has resulted in significant improvement in the knowledge, development of positive attitudes and healthy practices among study group students. Therefore special and continuous health education of school children, like Child to Child programme in their formative years improves their knowledge and helps to develop positive attitude and healthy practices, which will eventually help to reduce diseases like diarrhoea, anaemia, malnutrition etc. not only amongst the children but also amongst their family members.

References

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  3. Anantkrishnan S, Dani SP, Nalini PA. A comparative study of morbidity in school age children. Indian Journal of Paediatrics 2001; 38:1009-16.
  4. Shah PM, Health Education of Children, Swasth Hind 1976; 20(2):347-51.
  5. Kulkarni V, Pratinidhi A, Garad SG, Study of knowledge of school children in a health education programme. Indian Journal of Community Medicine 1997; 3:129-33.
  6. Mohpatra SC, Sankar H, Mahapratra P, Child to Child the programme in survival and development of children. Indian Journal of Maternal and Child Health 1993; 4:118-21.
  7. Water, sanitation and hygiene links to health www.who.int/ water-Sanitation health/publications/facts/2004/en/index: html
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  9. Narasimhan R. A study of a school health education package and it's effect on the awareness of the school students. Dissertation submitted to the University of Mumbai, unpublished 1998.
  10. Naik VA. Child to child and child to community. A student project submitted to Karnataka state Council of Science and Technology, Bangalore, P 20-21, 1994.

Deptt. of Community Medicine,
J.N. Medical College, Belgaum, Karnataka
Received: 26.5.2004

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