Download These Are Only Ways To Avoid Common Cold, Since

“A STUDY TO
TEACHING
EVALUATE
THE EFFECTIVENESS OF STRUCTURED
PROGRAMME REGARDING
COMMON COLD AND ITS
PREVENTION AMONG MOTHERS OF UNDER FIVE CHILDREN IN A
SELECTED ANGANWADI SCHOOLS, BELLARY DISTRICT KARNATAKA.”
PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MANOJ .A.GABBUR
CHILD HEALTH NURSING
INDIAN COLLEGE OF NURSING
TILAK NAGAR
BELLARY
2010- 2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
Name of the candidate and
:
MANOJ .A.GABBUR
1ST YEAR M.Sc. Nursing
address
INDIAN COLLEGE OF NURSING
TILAK NAGAR
BELLARY
2.
Name of the institution
:
INDIAN COLLEGE OF NURSING
TILAK NAGAR
BELLARY
3.
Course of study and subject
:
1ST YEAR M.Sc. Nursing
4.
Date of admission
:
31-5-2010
5.
Title of the topic
:
“A study to evaluate the effectiveness of
structured teaching programme regarding
common cold and its prevention among
mothers of under five children in a selected
anganwadi schools, Bellary district
Karnataka.”
1
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
:
“Children are unpredictable. You never know what inconsistency they're going to
catch you in next.”
- ‘Franklin P. Jones.’
The common cold or acute nasopharyngitis is the most common respiratory infection in
infants &children .In addition to the nasopharynx, the accessory paranasal sinuses &middle `ear
are generally are involved. this infection can spread quickly ,and serious complication can result
especially if malnutrition is present 1
The common cold is a disease of the upper respiratory tract .The common cold virus is
transmitted mainly from contact with saliva or nasal secretions of an infected person, either
directly, when a healthy person breathes in the virus-laden aerosol generated when an infected
person coughs or sneezes, or by touching a contaminated surface and then touching the nose or
eyes.
The common cold is self-limiting, and the host's immune system effectively deals with the
infection. Within a few days, the body's humoral immune response begins producing specific
antibodies that can prevent the virus from infecting cells. Additionally, as part of the cellmediated immune response, leukocytes destroy the virus through phagocytosis and destroy
infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the
common cold resolves in seven days on average.
The common cold (viral upper respiratory tract infection (VURTI), acute viral
rhinopharyngitis, acute coryza, or cold) is a contagious, viral infectious disease of the upper
respiratory system, caused primarily by rhinoviruses and coronaviruses.[1] Common symptoms
include a cough, sore throat, runny nose, and fever. There is currently no known cure; however,
2
symptoms usually resolve spontaneously in 7 to 10 days, with some symptoms possibly lasting
for up to three weeks.
The common cold is owing to a viral infection of the upper respiratory tract. The most
commonly implicated virus is a rhinovirus (30–50%), a type of picornavirus with 99 known
serotypes. Others include: coronavirus (10–15%), influenza (5–15%), human Para influenza
viruses, human respiratory syncytial virus, adenoviruses, enteroviruses, and metapneumovirus.
The common cold is the most frequent infectious disease in humans [3] with on average two
to four infections a year in adults and under five years of age. Collectively, colds, influenza, and
other infections with similar symptoms are included in the diagnosis of influenza-like illness.
They may also be termed upper respiratory tract infections (URTI). Influenza involves the lungs
while the common cold does not.2
Roy V, et al., (2010) A study was conducted about to determine the number and
composition of the various cough and cold formulations available in the Indian market
and to study their pharmacological rationale over a period of 7 years. Data for the study
was collected from an annual Drug Compendium entitled 'THE DRUG TODAY' of the
years 2001, 2004, and 2007. Medications were assessed for total number, different
formulations, and number of constituents present in each formulation, their
pharmacological group and amount of each constituent per dose. Rationality of available
preparations was assessed on a seven-point scoring criteria. There are over thirteen
hundred drug products for cough and cold in the Indian market, which is an increase of
71.2% from the year 2001. More than 90% of the preparations were fixed-dose
combinations (FDCs). Majority of the cough and cold preparations had 3-4 constituents.
Many preparations contained more than one constituent of the same pharmacological
group. Some preparations had constituents with opposing action. A wide variation in the
amount of each constituent present per dose in different formulations was observed. The
3
number of banned drug combinations for cough and cold showed an increase from 9 in
2001 to 27 in 2007. Rationality assessment of the FDC preparations revealed that most of
the preparations were irrational and had no documented benefit in the treatment of
common cold. Availability of such a large number of irrational FDCs for cough and cold
requires serious review of the legal provisions in India for drug manufacturing and
marketing3.
The traditional folk theory is that a cold can be "caught" by prolonged exposure to
cold weather such as rain or winter conditions, which is where the disease got its name.
Common colds are seasonal, with more occurring during winter. The experimental
evidence for this effect is uneven: many experiments have failed to produce evidence that
short-term exposure to cold weather or direct chilling increases susceptibility to infection,
implying that the seasonal variation is instead due to a change in behaviors such as
increased time spent indoors at close proximity to others. However, other experiments do
find such an effect for both body chilling and cold air exposure, and a number of
mechanisms by which lower temperatures could compromise the immune system have
been suggested, while other experiments have shown that exposure to cold temperatures
may instead stimulate the immune system.2
What is referred to as “a cold” can be caused by 200 different viruses? These
viruses spread easily from person to person both through the air and by touching germladen surfaces then touching your nose, mouth or eyes. That’s why hand-washing—for
you and your child—is so important.4
Prevention includes the primary and secondary measures the common cold is self-limiting,
and the host's immune system effectively deals with the infection. Within a few days, the body's
humoral immune response begins producing specific antibodies that can prevent the virus from
4
infecting cells. Additionally, as part of the cell-mediated immune response, leukocytes destroy the
virus through phagocytosis and destroy infected cells to prevent further viral replication. In
healthy, immunocompetent individuals, the common cold resolves in seven days on average.2
6.1 NEED FOR THE STUDY
The common cold is a contagious viral infection of the upper respiratory tract. A
large variety of viruses are associated with common cold and that is why the body does
not seem to be developing immunity against them. It commonly infects school-going
children and the incidence of cold lessens with age. It is normal for a child to have cold
eight or more times a year. This is because there are hundreds of different viruses and
young children are meeting each one of them for the first time. Gradually they build up
immunity and get fewer colds. Colds are caused by viruses and not bacteria, so antibiotics
do not help.
As the common cold mainly affects the upper respiratory tract, i.e. the nose, throat
and the wind pipe, the symptoms mainly relate to them only. A cold often starts with a
"tickle" in the throat, a runny or stuffy nose and sneezing. Children with colds may also
have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of
appetite. Cold usually takes seven to 14 days in recovery. In case of an added infection by
the bacteria or complications like sinusitis, ear infection, laryngitis or bronchitis occur,
the illness will be prolonged.5
A study was conducted about respiratory illness in preschool children with different
forms of day care. The incidence of respiratory tract disease was investigated in three
groups of Swedish children and those in 14 day-care centers with 18 to 68 children each;
those in home care (usually no siblings); and those in family day-care homes (average,
5
four children). In family day-care homes a mother cared for her own and one to four other
children during the day. A preliminary nine month study of 41 preschool children
attending a day-care center and 41 comparable children in home care showed that
children under 2 years of age in the center had more days with respiratory symptoms and
more febrile illnesses (four per child) than those in home care (one per child). In a
subsequent eight-month study of children under 2 years of age, children in day-care
centers and home care were compared with children in family day-care homes. The 108
children in centers had more febrile illness (five per child) than the 57 children in home
care (two per child), but the 42 children in family day-care homes had as many illnesses
as those in day-care centers. The data suggest that increasing the number of contacts of an
infant in day care beyond four to six children does not increase remarkably the incidence
of respiratory tract disease.6
The common cold is the most common types of infectious diseases. In children, it
is estimated that each child in the United States experiences two to four respiratory
infections annually. The morbidity of these infections is measured by an estimated 75
million physician visits per year, almost 150 million days lost from work, and more than
$10 billion In costs for medical care. Serotypes of the rhinoviruses account for 20 to 30
percent of episodes of the common cold. However, the specific causes of most upper
respiratory infections are undefined. Pneumonia remains an important cause of morbidity
and mortality for non hospitalized adults despite the widespread use of effective
antimicrobial agents.2
Respiratory illnesses are common in children under 5 years of age. Most children
will develop three to eight colds or respiratory illnesses a year. This number may even
be higher in children who attend day care or are exposed to tobacco smoke. Most cases
6
are mild, but about one-third of all hospitalizations in this age group are due to
respiratory problems, including asthma and pneumonia. Follow this guide to recognize
which respiratory symptoms are caused by illness or infection and which are caused by
non-respiratory conditions —and when your child needs medical attention.4
COHEN S, et al., (2008) objective and subjective socioeconomic status and
susceptibility to the common cold. They ask whether subjective socioeconomic status
(SES) predicts who develops a common cold when exposed to a cold virus and 193
healthy men and women ages 21-55 years were assessed for subjective (perceived rank)
and objective SES, cognitive, affective and social dispositions, and health practices.
Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and
monitored in quarantine for objective signs of illness and self-reported symptoms. The
main outcome measures- Infection, signs and symptoms of the common cold, and clinical
illness (infection and significant objective signs of illness) and the study results that,
Increased subjective SES was associated with decreased risk for developing a cold for
both viruses. This association was independent of objective SES and of cognitive,
affective and social disposition that might provide alternative spurious (third factor)
explanations for the association. Poorer sleep among those with lesser subjective SES
may partly mediate the association between subjective SES and colds.7
A study was conducted on respiratory pathogens in respiratory tract illnesses
during the first year of life: a birth cohort study. Respiratory virus infections are the most
important trigger of respiratory illnesses in childhood. Data on the occurrence and the
clinical impact of respiratory pathogens in the general population of infants are scarce.
Therefore, they described the occurrence and clinical impact of respiratory pathogens in
infants with respiratory tract infections during the first year of life. In a prospective birth
cohort study, infants were followed from birth through the first year of life with daily
7
questionnaires about respiratory symptoms. Nose and throat swabs were collected during
episodes with respiratory symptoms. Polymerase chain reaction was used to detect an
extensive panel of respiratory pathogens. The parents reported a median of 5 respiratory
episodes per infant per year. A total of 668 respiratory samples were collected in 305
infants. One or more respiratory pathogens were detected in 85% of the samples. The
most common respiratory pathogens were human rhinovirus (HRV) (73% of the
samples), respiratory syncytial virus (RSV) (11%), and coronavirus (8%). HRV infections
were associated with a prolonged period of symptoms compared with RSV (P = 0.03).
Infections with RSV were associated with more physician visits than HRV infections (P =
0.06). they found a high prevalence of respiratory pathogens among infants with parentreported respiratory illnesses in the first year of life, with HRV being the most prevalent.8
As described earlier because of the huge number of viruses that can cause common
cold, it has not been possible to develop an effective vaccine for this. Therefore
prevention remains the best cure for common cold.2
8
Since there is no valid treatment from common cold, prevention is the best way.
The prevention measures can be adopted are:
-
Washing hands to minimize the contamination.
-
Avoid close contact with patient.
-
Avoid touching mouth and face.
-
Alcohol-based hand gels.
-
These Are Only Ways To Avoid Common Cold, Since Successful Immunization
Has Not Yet Been Possible2
For the above reason investigator felt that there is need to evaluate the effectiveness of
structured
teaching programme regarding
mothers of under five children.
9
common cold and its prevention among
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature refers to an
extensive, exhaustive and systematic examination of publications relevant to the research project.
The Review of literature is related to the structured teaching programme on common cold.9
A study was conducted on children. Rhinitis in under five children and school age
children has been shown to be a predictor for children- and –onset of childhood asthma.
These findings suggest an interaction between the upper and lower airways. Whether
rhinitis is a predictor for childhood-onset asthma is unknown. They sought to investigate
whether rhinitis in early childhood is an independent predictor for wheezing between the
ages of 2 and 5 years in the German Multicentre Allergy Study birth cohort. The German
Multicentre Allergy Study cohort initially included 1314 healthy children. They were
followed from birth to the age of 5 years with regular questionnaires and interviews.
Specific IgE levels were measured at yearly intervals. Airway hyper responsiveness was
assessed at 7 years. Allergic rhinitis until the age of 5 years was found to be a predictor
for developing wheezing between the ages of 5 and 13 years, with an adjusted relative
risk of 3.82 (P < .001). This association was not attributable to the type of sensitization,
the severity of sensitization, or atopic dermatitis during the first 2 years of life. In this
group of children, 41.5% of all new cases of wheezing occurred among children with
preceding allergic rhinitis. The first manifestation of allergic rhinitis occurs in preschool
children in whom it is a predictor for subsequent wheezing onset. Preschool children with
rhinitis might thus benefit from early assessment of allergic sensitization to identify the
children at high risk of wheezing.10
A study was conducted to assess the relationship of empathy in medical office visits
to subsequent outcomes of the common cold. A total of 350 subjects? Under 5 years of
age received either a standard or enhanced physician visit as part of a randomized
10
controlled trial. Enhanced visits emphasized empathy on the part of the physician. The
patient-scored Consultation and Relational Empathy (CARE) questionnaire assessed
practitioner-patient interaction, especially empathy. Cold severity and duration were
assessed from twice-daily symptom reports. Nasal wash was performed to measure the
immune cytokine interleukin-8 (IL-8) This Study Results that,.84 individuals reported
perfect (score of 50) CARE scores. They tended to be older with less education but
reported similar health status, quality of life, and levels of optimism. In those with perfect
CARE scores, cold duration was shorter (mean 7.10 days versus 8.01 days), and there was
a trend toward reduced severity (mean area under receiver-operator characteristics curve
240.40 versus 284.49). After accounting for possible confounding variables, cold severity
and duration were significantly lower in those reporting perfect CARE scores. In these
models, a perfect score also correlated with a larger increase in IL-8 levels.
Clinician empathy, as perceived by patients with the common cold, significantly predicts
subsequent duration and severity of illness and is associated with immune system
changes.11
A study was conducted to assess the efficacy of nasal decongestants at reducing the
symptom of nasal congestion in adults and children with the common cold and to identify
possible adverse effects associated with their use. In this updated review in 2006, the
following databases were searched: the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library, 2006, issue 3); MEDLINE (January 1996 to
September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006).
We contacted known principal investigators and pharmaceutical companies. The selection
criteria is randomised, placebo controlled trials of single-active oral and topical nasal
decongestants in adults and children suffering from common cold, and Two review
authors (DT, GJL) independently extracted data. All outcomes variables were continuous.
11
Subjective outcomes were normalised to a common scale and a weighted mean difference
(WMD) was calculated. A standardised mean difference (SMD) was calculated for the
objective outcomes.This Study Reports That: Seven studies in adults, but none in
children, fitted all inclusion criteria. There was a small but statistically significant 6%
decrease in subjective symptoms after a single dose of decongestant compared with
placebo. This was supported by a significant decrease in nasal airways resistance. With
repeated doses, nasal decongestants produce a very small statistical benefit of 4% over
three to five days, again supported by a decrease in nasal airways resistance. Two studies
provided safety data for this meta-analysis, showing a relatively small number of adverse
events and only a small increased risk of insomnia with pseudoephedrine compared to
placebo. AUTHORS’. And a single oral dose of nasal decongestant in the common cold is
modestly effective for the short term relief of congestion in adults, and these drugs also
provide benefit in some individuals after regular use over three to five days. Adverse
events in adults are rare and mild. There is insufficient data on the use of these
medications in children and therefore they are not recommended for use in children
younger than 12 years of age with the common cold.12
A prospective hospital-based cohort study conducted on June-October 2006 in
children <5 years hospitalized at The Children's Hospital at Westmead with ILI (fever and
respiratory symptoms). Influenza and other viral infections were diagnosed either by
antigen detection using immunofluorescence or nucleic acid amplification testing of
nasopharyngeal
aspirates.
Data
were
collected
using
researcher-administered
questionnaires. Main outcome measures include proportion of hospitalizations with
influenza, vaccination and treatment, risk factors for influenza and associated medical and
social burdens. Data on 275 children with ILI aged <5 years were analyzed. Thirty-one
(11%) children with ILI had influenza (22 had influenza A and 9 had influenza B).
12
Thirty-five percent were under 6 months of age and 61% under 1 year. Twenty-nine
percent of children with influenza A were born prematurely. The mean duration of
hospital stay for influenza was 2.8 days (95% confidence interval 2.1-3.4) and 26% had a
lumbar puncture. Although 68% received intravenous antibiotics, only 3% (one case) was
given an antiviral. Eighty-four percent had visited their local doctor before admission and
all came through the emergency department. On average, in one-third (32%) of families
of children with influenza a parent developed, ILI during admission or soon after hospital
discharge resulted in an average of 3.2 days of work absenteeism. Only 3.5% (7/199) of
children older than 6 months with ILI received any influenza vaccination. Both the
burden of influenza in childhood morbidity and its social impact are substantial. There is
considerable room for improvement in both the prevention and early recognition (trigger
treatment with antiviral) of influenza. Our data will inform decisions regarding the value
of a universal influenza vaccine programme.13
A study was conducted about symptom profile of common colds in school-aged
children. Signs and symptoms of a common cold reported in young children are those
perceived by caretakers. Objective signs include cough, fever, and sneezing. Subjective
symptoms include nasal congestion, feverishness, headache, and sore throat. School-aged
children may provide a more accurate picture of the symptom profile during colds
because they can self-report. Using preprinted diary sheets listing common signs and
symptoms, diaries were kept for school-aged children for 10 days after onset of a cold.
Nasopharyngeal aspirates were analyzed for respiratory viruses and potential bacterial
pathogens. This study reports that, Out of 81 colds studied, the most common signs were
cough and sneezing, although the most common symptoms were nasal congestion and
runny nose. Other symptoms, including feverishness and headache, were each reported in
15% of children at onset. The majority of children (73%) continued to be symptomatic 10
13
days after onset. Rhinovirus was detected in 46% and 1 or more potential bacterial
pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) in
29% of episodes. Symptom profiles for rhinovirus illnesses and those in which potential
pathogenic
bacteria
were
detected
were
not
different
from
the
rest14
A study was conducted about dynamics of human respiratory virus-specific CD8+
T cell responses in blood and airways during episodes of common cold. They determined
the dynamics of CD8 (+) T cells specific for influenza virus and respiratory syncytial
virus in blood and tracheostoma aspirates of children during the course of respiratory
infections. They showed that during localized respiratory infections the ratio of activated
effector CD8 (+) T cells to resting memory/naive CD8 (+) T cells in peripheral blood
increased significantly. Furthermore, the number of effector/memory T cells specific for
respiratory viruses declined in blood and increased in the airways, suggesting that these T
cells redistributed from blood to airways. T cells specific for the infecting virus were
present in the airways for longer periods at increased levels than nonspecifically recruited
bystander T cells. After clearance of the infection, the ratio of resting memory and naive
CD8(+) T cells normalized in peripheral blood and also memory T cell numbers specific
for unrelated viruses that declined during the infection due to bystander recruitment were
restored. Taken together, these results showed a significant systemic T cell response
during relatively mild secondary infections and extensive dynamics of virus-specific and
nonspecific Ag-experienced T cells.15
A study was conducted on wheezing due to rhinovirus infection in infancy:
bronchial hyper responsiveness at school age. Characteristics related to decreased lung
function and increased bronchial responsiveness after early childhood wheezing requiring
hospitalization are not fully established. Seventy-nine children with wheezing requiring
14
hospitalization at age <2 years were prospectively followed up and re-investigated at age
5.6-8.8 years when the measurements of baseline lung function and bronchial
responsiveness to exercise were performed. At early school age, 23% of children had
decreased lung function, and 13% had increased bronchial responsiveness to exercise.
Predictors of decreased lung function were maternal history of smoking during pregnancy
(odds ratio [OR], 12.8; 95% confidence interval [CI]: 1.2-139.6), parental history of
asthma (OR, 4.3; 95%CI: 1.1-17.1), and female gender (OR, 4.0; 95%CI: 1.2-13.7).
Increased bronchial responsiveness was associated with rhinovirus infection-induced
wheezing in infancy (OR, 6.5; 95%CI: 1.2-36.3), and early cat or dog exposure leading to
sensitization (OR, 26.6; 95%CI: 1.3-525.2). Inhaled anti-inflammatory therapy was
common in children with rhinovirus infection-induced wheezing in infancy (n = 13/19; P
= 0.001 vs children with other/no confirmed virus infection etiology for wheezing in
infancy, n = 16/60), which may have improved lung function and attenuated bronchial
responsiveness in them. After early childhood wheezing requiring hospitalization, onefourth of children will have decreased lung function and one-eighth of children will show
increased bronchial responsiveness at school age. Gender, heredity of asthma, and
antenatal exposure to tobacco smoke are predictors of decreased lung function, whereas
rhinovirus infection etiology of wheeze and early animal.16
Rhinovirus transmission within families with children: incidence of symptomatic
and asymptomatic infections rhinoviruses are the most common cause of respiratory tract
infections, but the transmission in families has not been studied using sensitive and
specific molecular detection methods. Children hospitalized for any infection were
screened for rhinoviruses. Eight families with a rhinovirus-positive index child and 16
families with a rhinovirus-negative index child were monitored for 3 weeks for disease
symptoms, and the presence and quantity of rhinoviruses in nasal swab samples were
15
determined by quantitative reverse transcription-polymerase chain reaction. Rhinoviruses
were further identified by melting temperature and partial sequence analysis. The rates of
rhinovirus infection were 1.00 cases per person among the 17 siblings and 0.50 cases per
person among the 14 parents of rhinovirus-positive index patients; the rates were 0.54
cases per person among the 24 siblings and 0.23 cases per person among the 30 parents of
rhinovirus-negative index patients. Symptomatic infections were associated with an age
of <7 years but not with a high copy number of rhinovirus genomes. Virus typing
revealed the transmission routes of the viruses and showed that several virus types could
circulate in the families simultaneously. Rhinoviruses are frequently transmitted from
children to other family members. Most rhinovirus infections in young children are
symptomatic, but secondary infections in adults are often asymptomatic. Multiple virus
types circulate simultaneously in families.17
A study was conducted about inflammatory changes during the 'common cold' are
associated with platelet activation and increased reactivity of platelets to agonists
Epidemiologic studies have shown increased rates of myocardial infarction after upper
respiratory tract infections. They hypothesized that changes in platelet activation and
reactivity and inflammation occur during the 'common cold'. Previously healthy
individuals with viral upper respiratory tract infections were studied (n = 18). Venous
blood samples were obtained during the time of infection and again after 6 weeks. Platelet
reactivity was higher during the 'common cold' as measured by low-dose ADP-induced
aggregation (46 +/- 28 versus 27 +/- 21% 6 weeks after presentation, P = 0.003) and was
higher than control individuals (22 +/- 8%, P = 0.003). Platelet P-selectin expression
increased during illness (2.3 +/- 0.2% CD62-positive platelets versus 1.8 +/- 0.1% at 6
weeks after presentation, P = 0.017; and 1.7 +/- 0.2% in the control group, P = 0.03). Creactive protein (3.7 +/- 1.3 versus 2.2 +/- 1.5 mg/l, P = 0.004) and tumor necrosis factor16
alpha (27.6 +/- 28 versus 12.7 +/- 9 pg/ml, P = 0.03) were increased during the 'common
cold'. There were no significant differences in levels of soluble P-selectin (P = 0.18),
soluble vascular adhesion molecule-1 (P = 0.59) and soluble intercellular adhesion
molecule-1 (P = 0.23). Increased platelet reactivity and activation during the 'common
cold' are associated with inflammation as measured by increased levels of C-reactive
protein and tumor necrosis factor-alpha, but not increased levels of endothelial markers.
These findings support a pro-aggregatory state that, in part, explains the thrombotic
events shown by epidemiological studies.18
The study was designed to analyze factors potentially influencing children's return
visits to physicians for symptoms of acute otitis media (AOM) within 14 days after being
diagnosed with nasopharyngitis (NP), and the impact of recent antibiotic use. A
controlled population-based pharmaco-epidemiological trial in 3- to 6-year-old children
conducted from January to May 2000. Three different geographical regions in France.
Among 2507 eligible children, 2456 could be analyzed and 505 children had 634 officebased physician visits (OBPV) for NP symptoms. The statistical associations between
antibiotics prescribed for NP and an OBPV for AOM within 14 days in a populationbased study were analysed along with risk factors of AOM Clinical events and antibiotic.
During the 2 weeks following physician-diagnosed NP, antibiotic use, especially a betalactam, significantly decreased the risk of OBPV for AOM in children (odds ratio=0.2;
95% confidence interval=0.09-0.7; P=0.0.Antibiotics prescribed to children for NP seem
to protect during the following 2 weeks against the risk of OBPV for AOM. It remains to
be determined whether a subgroup at high risk of developing AOM after a viral infection
exists and what might be the best strategy to adopt for NP in a national programme of
optimal antibiotic use.19
17
A study was conducted about current and futures therapeutic approaches to the
common cold, investigators have strived to elucidate the pathogenesis, and hence a
treatment, for the common cold. Therapy has been tried with a variety of agents, ranging
from anecdotal folk remedies, to well-designed medications. Measures primarily directed
to relieve the symptoms of the common cold, rather than specific antimicrobial agents,
are the current main stay of therapy. Millions of patients would benefit from an easy-toperform diagnostic test and specific therapy that works quickly, shortening the duration of
illness and preventing further spread of infection.20
A study was conducted about rhinovirus infections in hospitalized children: a 3-year
study Rhinoviruses (RH) are responsible for acute respiratory illnesses, mainly in the
upper respiratory tract and 3,152 children aged under 16 years, admitted to the Paediatrics
department of the University Hospital Centre of Poitiers from January 1, 1993 to
December 31, 1995 with ear, nose and throat (ENT) and/or respiratory symptoms were
systematically investigated. One hundred and forty-five RH strains were isolated from
nasopharyngeal secretions of 87 boys and 58 girls (mean age: 20.3 months). Among
these, 92 (63.4%) were less than 1 year of age. Bacteriological investigations were done
for 29 patients when a concomitant bacterial infection was suspected. This study reports
that RH infection rate was maximum before 1 year of age (median age: 6.5 months) and
decreased with age. RH were isolated throughout the 3 years, with a first peak from
February to April, and a second one in autumn. The main symptoms were sibilants
(27.6%) and cough (24.1%). Sibilants were more frequently associated in children under
12 months of age (P = 0.01). Sometimes, ophthalmologic or digestive symptoms were
present. Three children with respiratory distress were transferred to the reanimation ward.
In addition, a RH strain was isolated from a child who died of sudden infant death.
Thirty-four children (23.4%) were co-infected by one or several viruses; the most
18
frequently detected were the respiratory syncytial virus (41.2%) and the adenoviruses
(35.3%). Twenty-nine children were infected by two viruses and five by three. Associated
bacterial infections were diagnosed in 23 children, especially conjunctivitis due to
Haemophilus influenzae (21.7%). Among these children, eight had a multiple viral
infection.21
Above studies suggest that was knowledge deficit on common cold among mothers. In
India fever studies have been conducted to assess the mothers knowledge on common
cold. So researcher felt this study is suitable for research.
6.3 STATEMENT OF THE PROBLEM
“A STUDY TO
TEACHING
EVALUATE
THE EFFECTIVENESS OF STRUCTURED
PROGRAMME REGARDING
COMMON COLD AND ITS
PREVENTION AMONG MOTHERS OF UNDER FIVE CHILDREN IN A
SELECTED ANGANWADI SCHOOLS, BELLARY DISTRICT KARNATAKA.”
6.4 OBJECTIVES OF THE STUDY
 To assess the level of knowledge among mothers of under-five children regarding
common cold and its prevention in children before the structured teaching
programme.
 To evaluate the effectiveness of the structured teaching programme on Knowledge
of mothers of under-five children regarding common cold and its
prevention in children
 To compare the pretest and post test level of knowledge among mothers of underfive children
 To associate the level of knowledge among mothers of under-five Children with
their selected demographic variables.
19
6.5 OPERATIONAL DEFINITIONS
Evaluate: Refers to the mothers under - five children responses to before and after structured
teaching programme regarding common cold and its prevention.
Effectiveness: In this study effectiveness means improving the knowledge regarding common
cold in children among mothers by structured teaching programme which may result differences
between pre test and post test score.
Structured teaching programme: it refers to the well planned instruction module through
lecture cum discussion methods on selected aspects of common cold, causes, signs & symptoms,
treatment, complication and prevention.
Knowledge: it refers to the correct response of mothers to knowledge items on common cold in
children as achieved by knowledge score.
Common cold: The common cold generally involves a runny nose, nasal congestion, and
sneezing. You may also have a sore throat, cough, headache, or other symptoms. Over 200 viruses
can cause a cold.
Mothers: In this study mother refers to those who provides care to their under five children
during conditions of common cold
Under five children: It refers to child who is having age below five years.
6.6 ASSUMPTIONS: The study will
 Enlighten the knowledge of mothers on common cold in children of under five
years.
 Promote the knowledge of mothers regarding the Causes, signs & symptoms,
treatment for common cold and its prevention among children of under five years.
6.7 RESEARCH HYPOTHESIS:
H1. There will be significant difference between pre-test and post-test of
Knowledge score on common cold among mothers of under –five children.
H2. There will be a significant association between Knowledge scores among
mothers of under five children with selected demographic variables.
20
7. MATERIALS AND METHODS:
7.1. SOURCES OF DATA
 Research Design
Quesiexperimental research design one pre-test
and post test design
 Setting of the study
:
 Sample Technique
:
Purposive sampling technique.
 Sample size
:
50 Mothers of under five children in
Selected Anganwadi, Schools, in Bellary.
Selected Anganwadi Schools in Bellary.

Selected Variables
Independent Variables
:
Structured teaching programme
Dependent Variables
:
Knowledge of mothers of under.
Five Children regarding common cold
Population
:
All the mothers who fulfil
the inclusion criteria and the
Mothers those present at the time
Of study at selected Anganwadi
Schools in Bellary.
 Sample Criteria
Inclusion criteria
:
All the mothers of children
Of under five years age.
Mothers who are willing
to participate in study.
Exclusion Criteria
:
Mothers who are not
Willing to participate.
Mothers who are not available
21
at the time of data collection.
7.2 Methods of Data collection
Data collection technique
:
Tool for data collection
:
Self Administered Questionnaire
Structured questionnaire.
Method of data analysis
and Interpretation
:
The data obtained was analyzed
By using both descriptive and
Inferential statistics, the plan for
Data analysis was divided as
Follows.

Frequency and percentage
Distribution of samples on
Demographic variables.

Chi-square test to determine the
Association between knowledge
With demographic variables in
Pre-test and post-test.

‘t-‘test to determine the effect of
Structured teaching programme in
Pre-test and post test.

Co-relation co-efficient on
Knowledge of mothers of
Under five children regarding
Common cold.
Duration of the study
:
Six weeks.
22
7.3
DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATIONS
TO
BE
CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?
IF SO PLEASE DESCRIBE BRIEFLY.
NO- Data includes only verbal response. No interventions are carried out.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3?
Informed consent will be obtained from institution, authorities and subjects, privacy
confidentially and anonymity will be guarded. Scientific objectively of the study will be
maintained with honesty and impartiality.
23
8. LIST OF REFERENCES:
1. Dorothy R.Marlow. Barbara. A. Redding. “Text book of Pediatric Nursing “Sixth
edition, Elsevier publication, 2010.p 607-608.
2. Macnair, Dr. Trisha et al.,“The common cold “bbc.Co.uk .Health .BBC.
http: //www.bbc.co.uk/health /conditions /common cold .shtml. Retrieved 30 September
2009.
3. Roy V, et al., (2010) “Fixed- dose combinations for cough and common cold in India;
and assessment of availability and rationally”.Fundam clin pharmacol. 2010 Jun 22.
4. http;//www.aanma.org /publication/special-pubs/aanmanhealth care survey 2010
5. “The common cold” Indian Journal of pediatrics.
6. Strangert k “Respiratory illness in preschool children with different forms of day care
“PMID: 1250654 [pub-Med- Indexed for MEDLINE]
7. Cohens, et al., (2008) “Objective and subjective socioeconomic status and
susceptibility to the common cold “Health psychology; official journal of the Division of
Health psychology. American psychological Association [2008.27(2); 268-74]
8. van der Zalm MM (2009) “Respiratory pathogens in respiratory tract illnesses during the
first year of life: a birth cohort study.”
The Pediatric Infectious Disease Journal [2009, 28(6):472-6]
9. BT Basavanthappa “Text book of Nursing Research”. Second Edition
JAYPEE publication. 2007. p 92-103.
24
10. Rochat MK, et al., (2010) “Allergic rhinitis as a predictor for wheezing onset in
school –age children”. Copy right © 2010 American Academy Of Allergy, Asthma And
Immunology Published By Mosby Inc All Rights Reserved.
11. Rakel DP, et al.,(2009) “ Practitioner empathy and duration of the common cold.”
Type journal article, family medicine [2009,41(7): 497-501]
12. Taverner D, et al., (2009) “Nasal decongestants for the common cold.” Cochrane
Database of systematic Reviews (on line) [2009(2); CD 001953] Type: Journal Article,
Review.
13. Iskander M, et al., (2009) “The burden of influenza in children under 5 years admitted
to the Children's Hospital at Westmead in the winter of 2006.” J Paediatr Child Health.
2009 Dec; 45(12):698-703. Epub 2009 Nov 4.
14. Pappas DE et al (2008) “symptom profile of common colds in school aged children.”
Pediatric Infect Dis J.2008 Jan: 27(1): 8-11
15. Heidema J, et al. , (2008) “Dynamics of human respiratory virus – specific CD8+ T
cell responses in blood and airways during episodes of common cold” Journal of
Immunology ( Baltimore ,Md:1950) [2008,181(8);555-9]
16. Kotaniemi –syrjanen A, et al, (2008) “wheezing due to rhinovirus infection in
infancy: Bronchial hyperresponsiveness of at school age.” Pediatrics International:
Official journal of the Japan pediatric society [2008, 50 (4): 506 -10]
25
17. Peltolav, et al., “Rhinovirus transmission within families with children: incidence of
symptomatic and symptomatic infections “. The Journal of Infectious Disease [2008,
17(3); 382-9]
18. Kreutz RP, et al., (2007) “Inflammatory changes during the ‘common cold’ are
associated with platelet activation and increased reactivity of platelets to agonists”. Blood
Coagulation and Fibrinolysis: an International Journal In Haemostasis And Thrombosis
[2007, 18(8):713-8]
19. Salomon J. et al ., (2009) “ Antibiotics for nasopharyngitis are associated with a lower
risk of office- based physician visit for acute otitis media within 14 days for 3 to 6 year
old children “ INSERM,0657 ,paris,France .jsalomon @ Pasteur.fr.
20. Mossad SB. (1998) “Current and future therapeutic approaches to the common cold”
Arch pediatr; 1998 Jan: 5(1): 9-14.
21. Pierrès-Surer N, et al., (1998) “Rhinovirus infections in hospitalized children: a 3-year
study” Arch 1998 Jan; 5(1):9-14.
26
9
10.
SIGNATURE OF THE STUDENT
:
REMARKS OF THE GUIDE
:
THE RESEARCH TOPIC
SELECTED FOR THE STUDY IS
RELEVANT AND FORWARDED
FOR THE NEEDFUL ACTION.
11.
NAME AND DESIGNATION OF
:
11.1 GUIDE NAME AND ADDRESS
:
MRS. SUSHEELA MARGRET
INDIAN COLLEGE OF NURSING
BELLARY.
11.2 SIGNATURE OF GUIDE
:
11.3 CO – GUIDE (IF ANY)
:
11.4 SIGNATURE
:
11.5 HEAD OF THE DEPARTMENT
:
MRS. SUSHEELA MARGRET
:
M.SC. NURSING
ADDRESS
MS. A. UMADEVI
(PEDIATRIC NURSING)
INDIAN COLLEGE OF NURSING,
B
E
L
L
A
R
Y
11.6 SIGNATURE OF H.O.D
:
12.
:
REMARKS OF THE CHAIRMAN
AND PRINCIPAL
12.1 SIGNATURE OF PRINCIPAL
:
27