CHAPTER-I

TITLE OF THE STUDY

Effectiveness of Structured Teaching Programme on knowledge and
attitude regarding Bronchopneumonia and its prevention among care
givers of under five children in Mamata General Hospital, Khammam,
Telangana.

INTRODUCTION
“An ounce of prevention is better than a pound of care”
HENRY DE BRACTON

Children are more prone to get diseases. In their early

stages of life, there is higher risk of infection due to their low
immunity. In today’s world the rate at which children getting infected
are increasing at an alarming rate than ever. One of the best ways to
avoid this situation is to give children an extra care and proper
protection. This extra care and protection has to be taken up by
parents, as they are the world of their child. So proper knowledge
imparted to the parents and care givers on the risks and methods of
prevention could improve the health of the children.1
The bronchi are the large air passages that connect the
windpipe to the lungs. These bronchi then split into many tiny air
tubes known as bronchioles, which make up the lungs. At the end of
the bronchioles are tiny air sacs called alveoli where the exchange of
oxygen from the lungs and carbon dioxide from the bloodstream
takes place. Pneumonia causes an inflammation in the lungs that

1
leads to these alveoli filling with fluid. This fluid impairs normal lung
function, producing a range of respiratory problems.2
Bronchopneumonia is a form of pneumonia that affects
both the alveoli in the lungs and the bronchi. In 2015, worldwide
920,000 children under the age of 5 years died from pneumonia. This
incidence of mortality was predominantly from bronchopneumonia.3
Symptoms of bronchopneumonia can range from mild to
severe. The symptoms may includes cough, grunting, tachypnea,
retractions, and hypoxemia accompanied by chest congestion, fever,
irritability, decreased feeding, eating and drinking. The most common
cause of bronchopneumonia is a bacterial lung infection, such
as Streptococcus pneumonia and Haemophilus influenza type b
(Hib). Viral and fungal lung infections can also causes pneumonia.
Harmful germs can enter the bronchi and alveoli and begin to
multiply. The body's immune system produces white blood cells that
attack these germs, which causes inflammation.4
According to the World Health Organization (WHO)
observing the child’s respiratory rate is important if Child younger
than 2 months the respiratory rate is greater than or equal to 60
breaths/min, Child aged 2-11 months the respiratory rates greater
than or equal to 50 breaths/min, Child aged 12-59 months the
respiratory rate is greater than or equal to 40 breaths/min. Other
diagnostic test may includes oxygen saturation, pulse oximetry,
cultures, serology, complete blood cell count (CBC), Chest
radiography, ultrasonography.5
The majority of children are treated with oral antibiotics.
High - dose Amoxicillin, Second – or - third - generation
cephalosporin’s and macrolide, Azithromycin Combination therapy
(ampicillin and either gentamicin or cefotaxime) is typically used in the

2
initial treatment of newborns and young infants. Children can be
treated with a narrow-spectrum penicillin such as Ampicillin.6
Untreated or severe bronchopneumonia can lead to
complications like Respiratory failure, acute respiratory distress
syndrome, Sepsis, Lung abscess.7
Vaccination is the primary mode of prevention. Influenza
vaccine is recommended for children aged 6 months and older. The
pneumococcal conjugate vaccine (PCV13) is recommended for all
children younger than 59 months old. The 23-valent polysaccharide
vaccine (PPV23) is recommended for children 24 months or older
who are at high risk of pneumococcal disease.8
Safe drinking water and sanitation, practicing good hand
hygiene, vaccination, Avoid passive smoking, reduced household air
pollution can helps to prevent the spread of bronchopneumonia.9
Bronchopneumonia is accounted for approximately 16 per
cent of the 5.6 million under-five deaths, killing around 880,000
children in 2016. Most of its victims were less than 2 years old.
Mortality due to child hood pneumonia is strongly linked to poverty-
related factors such as under nutrition, lack of safe water and
sanitation, low socio economic status, low birth weight, non-exclusive
breastfeeding. Overcrowding, parental smoking, zinc deficiency,
mother’s experience as a caregiver, mother’s age, lack of education
in the mother, humid conditions, high attitude, vitamin deficiency, birth
order, outdoor air pollution and indoor air pollution and inadequate
access to health care. An integrative approach is urgently needed to
tackle this important public health issue.10
Around half of childhood pneumonia deaths are
associated with air pollution. The effects of indoor air pollution kill
more children globally than outdoor air pollution. At the same time,

3
around 2 billion children 0-17 years of age live in areas where outdoor
air pollution exceeds international guideline limits.10
A descriptive study was conducted about the childhood
pneumonia and under-five morbidity and mortality at the University of
Teaching Hospital, Nigeria. A total sample size was 592 children. The
aim of the study the quarterly distribution showed a peak during north
east wind their ages ranged from <1-168 months mean age 13.2
months, Neonates accounted for 24.5% of all cases. While 66.9%
were infants and under-fives were 97.1%.They were 333 (56.3%)
males and 251(42.4%) females. Pneumonia alone was the diagnosis
in 127 (54.7%) while 106 (45.7%) had pneumonia plus other
associated conditions, the commonest being malaria. Heart failure
was the commonest complication 69 (29.7%).The children who
completed their immunization in infancy according to the National
program on immunization schedule were 61.2% of cases, those who
were exclusively breast feeding for the first six months of life -31.9%,
while HIV/AIDS was observed in 9.1%. The case fatality rate was
9.0% with 79.2% of them as infants. The study concluded that
Pneumonia which is still prevalent in under-fives in this environment
is associated with significant morbidity and mortality especially among
infants. Efforts to address this contribution to under five morbidity is
required if MDG4 is to be attained.3
In 2016, India managed to achieve improvement of
7 percentage points in the GAPPD score. The GAPPD (Global Action
Plan for the Prevention and control of pneumonia and diarrhoea)
score measures the use of interventions that protect, treat and
prevent pneumonia and diarrhea. India’s 2016 score was 41 percent,
a major improvement achieved by improving exclusive breastfeeding

4
rates and the Hib vaccine, but well short of its target score of 86
percent.11
A new vaccine to protect children was introduced in India
this year as part of the Universal Immunization program called the
pneumococcal conjugate vaccine (PCV), the vaccine will be available
to children who need it, especially the underprivileged. Millions of
children will receive the vaccine for free. The vaccine protects
children from pneumococcal diseases like pneumonia and
meningitis.12
The aim of this vaccine is to reduce the death of children
from pneumococcal pneumonia. No child should die from the vaccine-
preventable disease, said the Union Minister for Health and family
Welfare in India. To fight pneumonia, a threefold strategy needs to be
incorporated: Protection: Exclusive breastfeeding for six months,
vitamin A and zinc supplementation and adequate nutrition,
Prevention via vaccination: Pneumococcus, HIV Protection,
promotion of washing and hygiene, reduction of indoor air pollution,
Treatment: improving care-seeking behavior, community case
management and health facility case management. India has taken
significant initiatives to fight against this disease. Through
implementing this threefold strategy, overcoming pneumonia in India
is hopeful.3,10,12

5
 NEED FOR THE STUDY

‘’Care is an absolute, prevention is ideal.”

- CHRISTOPHER HOWSON

Bronchopneumonia is the most common clinical manifestations of

pneumonia in pediatric population and leading infectious cause of
mortality in children under five years since pediatric population is
vulnerable and specific.

Global scenario:-
According to the World Health Organization (WHO), one
in three deaths in India is caused by pneumonia. Pneumonia in India
is the leading cause of infant deaths. Every year almost 200,000
children under five die of pneumonia in India.13
September 2018, globally pneumonia is responsible for
high morbidity and mortality among children under 5 years of age.
The world health organization has estimated an incidence of 0.37
episodes per child 1 year for clinical pneumonia.14
November 2017, Globally, pneumonia claimed the lives of
more than nine lakh under-5 children .Of these deaths, about 1.8 lakh
occurred in India. On a global level, pneumonia kills around 900,000
children in the world every year.15
In 2017 pneumonia is the number one infectious killer of
children under age 5 globally, killing an estimated 935, 0002 children
each year, that’s more than 2500 per day. Pneumonia causes 15% of
all deaths in children under age 5 worldwide -2% of which are
newborns. Ethiopia is among 15 top under five pneumonia high
6
burden countries. Pneumonia is the single leading cause of death
among children younger than five years Ethiopia. It was estimated
that 3,370.000 children encounter pneumonia annually which
contributes to 20% of all causes of death killing over 40,000 under
five children every year and leading cause of death during postnatal
period.16
Bronchopneumonia is the leading single cause of
mortality in children aged less than 5 years. The incidence in this age
group is estimated to be 0.29 episodes per child-year in developing
and 0.05 episodes per child-year in developed countries. The infant
mortality rate is 5.77 deaths per 1000 live births. This translates into
about 156 million new episodes each year worldwide, of which 151
million episodes are in the developing world. Most cases occur in
India (43 million), China (21 million) and Pakistan (10 million), with
additional high numbers in Bangladesh, Indonesia and Nigeria (6
million each). Of all community cases, 7-13% are severe enough to
be life-threatening and require hospitalization. Substantial evidence
revealed that the leading risk factors contributing to
bronchopneumonia incidence are lack of exclusive breastfeeding,
under nutrition, indoor air pollution, low birth weight, over Crowding
and lack of measles immunization3.
Pneumonia is responsible for about 19% of all deaths in
children aged less than 5 years, of which more than 70% take place
in sub-Saharan Africa and south-east Asia14. Although based on
limited available evidence, recent studies have identified
Streptococcus pneumonia, Haemophilus influenzae and respiratory
syncytial virus are the main pathogens associated with childhood
pneumonia.17

7
National scenario:-
India continues to have the highest burden of pneumonia
and diarrhea child deaths in the world, with 158,176 pneumonia and
102,813 diarrhea deaths in 2016.This was stated in the ‘Pneumonia
and Diarrhea Progress Report’ related on Friday by the International
Vaccine Access Centre (IVAC) at the Johns Hopkins Bloomberg
School of Public Health.18
In India 2016 the report, titled “Fighting for Breath”, by non-
profit save the Children. The number of death of children below the
age of five years due to bronchopneumonia in 2016 was 1, 78,717
this means that every hour, 20 children died of the disease in the
country. The study also highlighted the poor primary healthcare
services in the country, which limits access to treatment for
pneumonia. Although incomes in India are almost double those in
Bangladesh, the report said.15
India has a higher death rate for child pneumonia. 7
children for every 1,000 live births recorded in India die of pneumonia
even though antibiotics to treat the disease cost as less as Rs. 26.
Doctors said improving nutrition can lower the chances of children
developing bronchopneumonia and dying of it between April 2015
and March 2016, about 38% of Indian children were found to be
stunted (too short for their age) as a result of under-nutrition. “Poverty
and malnutrition can make pneumonia worse,” said Dr. Jacob Puliyel,
a pediatrician from Delhi.13
In 2016 Fifty percent of the world’s pneumonia deaths
occur in India which means approximately 3.7 lakh children die of
pneumonia annually in India.10

8
 In India 2015 estimated mortality due to severe pneumonia
and pneumococcal pneumonia by combining incidence estimates with
case fatality ratios from multi – centric hospital – based studies. Our
results suggest that in 2010, 3.6 million (3.3-3.9 million) episodes of
severe pneumonia and 0.35 million (0.31 – 0.40 million) all cause
pneumonia deaths occurred in children younger than 5 years in India. The
state that merit special mention include Uttar Pradesh where 18.1%
children reside but contribute 24% of pneumonia cases and 26%
pneumonia deaths, Bihar (11.3% children, 16%cases, 22%deaths)
Madhya Pradesh (6.6% children,9%cases, 12%deaths), and Rajasthan
(6.6% children, 8%cases, 11%deaths). Further, we estimated that 0.56
million (0.49 -0.64 million) severe episodes of pneumococcal pneumonia
and 105 thousand (92 -119 thousand) pneumococcal deaths occurred in
India. The top contributors to India’s pneumococcal pneumonia burden
were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan.20
In South Asian Countries, including India, the report found
that girls with severe pneumonia cases are far less likely to receive care in
the region, and they are more likely to die as a result.

Local scenario:-
According to study published in 2017, there were an
estimated 564,200, cases of pneumococcal pneumonia episodes in
children under 5 years in India and 23,000 cases Telugu states.21
In Telangana Dr. Sanjay Srirampur, chief consultant
paediatrician, Aditya Hospital Hyderabad said, “pneumonia should not
be allowed to take as many lives as it does, because we now have
vaccines that can help protect millions of children from this life -
threatening disease. More than 140 countries have introduced the
same pneumococcal conjugate vaccine in their immunization

9
programme as India has recently done in areas where the vaccine
may not be available under the UIP, we advise parent to consult their
paediatrician about alternative solution that can offer broad
coverage.21
Around half of childhood pneumonia deaths are
associated with air pollution. The effects of indoor air pollution kill
more children globally than outdoor air pollution. At the same time,
around billion children -0-17 years of age live in areas where outdoor
air pollution exceeds international guideline limits10.
Nurses are the professionals who deal with patient round
the clock so they need to have a adequate knowledge and skill to be
competent. Bronchopneumonia is strongly linked to poverty related
factors such as under nutrition, lack of safe water, sanitation and
indoor air pollution. Now it become life threatening disease so
government introduced pneumococcal conjugate vaccine to reduce
under 5 mortality in India, so the investigator decided to conduct
study on assessment of knowledge and attitude regarding prevention
of Bronchopneumonia among caregivers of under-five children.10,12

10
 PROBLEM STATEMENT
A Study to assess the effectiveness of Structured Teaching
Programme on knowledge and attitude regarding Bronchopneumonia
and its prevention among care givers of under five children in Mamata
General Hospital, Khammam, Telangana.

OBJECTIVES:
 To assess the pre-test levels of knowledge and attitude
regarding Bronchopneumonia and its prevention among care
givers of under five children.
 To assess the effectiveness of structured teaching programme
on knowledge and attitude regarding Bronchopneumonia and its
prevention among care givers of under five children.
 To find out the association between the post-test knowledge
levels and attitude scores of care givers with their selected
socio-demographic variables.
 To develop and distribute an information booklet regarding
Bronchopneumonia and its prevention to care givers of under
five children.

OPERATIONAL DEFINITIONS:
Assess:
To determine the levels of knowledge and attitude of care givers
regarding bronchopneumonia and its prevention.

11
Effectiveness:
The extent to which the structured teaching programme regarding
Bronchopneumonia and its prevention has achieved the desired out
come in knowledge and attitude levels of care givers of under five
children.
Structured Teaching Programme:
It is systematically planned and organized explanatory sessions
which includes definition, incidence/risk factors, causes, types, clinical
manifestations, diagnostic evaluation, management and prevention of
Bronchopneumonia which enhance the knowledge and attitude
regarding Bronchopneumonia.
Knowledge:
Responses given by the care givers of under five children regarding
bronchopneumonia and its prevention.
Attitude:
General opinions and feelings expressed by the care givers of under
five children regarding bronchopneumonia and its prevention.
Bronchopneumonia:
It is a form of pneumonia that affects both the alveoli in the lungs and
the bronchi characterized by fever, cough, chest congestion, nasal
flaring and retractions.
Prevention:
It refers the measures taken to reduce indoor air pollutants (cooking
with firewood, avoid dust mites, pet animals fur, talcum powder,
mosquito coil), practice good hand hygiene, administration of
pneumococcal conjugate vaccine at 2 months, 4 months and 6
months.

12
Caregivers:
Parents/family members who are in the age group of 21-55 years who
regularly take care of under five children .
Under five Children:
Children who are less than five years old.
HYPOTHESES:
H1 - There is a significant difference between pre and post test
knowledge levels and attitude score regarding bronchopneumonia
and its prevention among care givers of under five children.
H2- There is a significant association between post test knowledge
levels and attitude scores of care givers of under five children with
their selected socio demographic variables.
ASSUMPTIONS:
It is assumed that,
 Care givers of under five children may have some
knowledge and positive attitude regarding
bronchopneumonia and its prevention.
 Structured teaching programme may help to improve the
knowledge and attitude regarding bronchopneumonia and
its prevention.
 The Knowledge and attitude among care givers of under
five children regarding bronchopneumonia and its
prevention may vary according to their selected socio
demographic variables.

13
DELIMITATIONS:
The study is delimited to
 care givers of under five children who are in the age group
between 21-55 years.
 the period of six months.
 60 care givers of under five children.

14
 CHAPTER II

REVIEW OF LITERATURE

A review of literature related to bronchopneumonia and its prevention

enables one to get an insight into various aspects of the problem
under study. It covers promising methodological tools how to increase
effectiveness of data analysis and interpretation. Review of literature
is an essential step in the development of the research project.

A descriptive study was conducted to assess the risk

factors of pneumonia in children at Mohamed Al-Amin Hamid
paediatric Hospital; Sudan, Northern Africa in February 2017 .The
sample was parents of 40 children less than 5 years. The data was
collected by using structured interview questionnaire after obtaining
informed consent from each of them .The result shows that children
27(57.50%) were males and 13 (42.5%) were females. Factors found
to have association with pneumonia includes low socio- economic
status and low educational level of mothers. The study concluded that
the pneumonia is more prevalent in children less than one year. It
was recommended to have an early diagnosis and treatment of
pneumonia. Community health education and completion of the
immunization programme are recommended to decrease the
infection.22

The Cross sectional study was conducted to assess the

prevalence and factors associated with pneumonia among under- five
children in Este town rural kebeles, Northwest Ethiopia, Africa . A

15
total of 286 households with under five children were selected. 222
samples from rural and 64 samples from the urban kebeles. Two rural
and one urban kebeles households were selected by systematic
random sampling technique. Trained nurses collected the data
through face to face interview. Two health officers supervised the
data collection process. Data were analysed by stepwise binary
logistic regression model. The overall two weeks prevalence of
pneumonia among under-five children was 16.1%.Stunting using
charcoal for cooking, carrying the child on back during cooking,
keeping cattle inside the main house and living in crowded house
were the most important variables found associated with pneumonia
among under-five children in this study. The Study concluded that the
prevalence of pneumonia among under-five children was high.
Nutrition interventions and introducing improved stoves to households
may reduce pneumonia among children. Health education should be
given for senior household members on the possible risk factors for
pneumonia23.

A cross sectional study was conducted regarding the

symptoms of bronchopneumonia among caretakers of under-five
children in Mukono district, Uganda, Africa. The sample size was
interviewed 278 care takers whose under five children had suffered
from probable bronchopneumonia two weeks prior to the evaluation.
The findings revealed lower chest wall in drawing was mentioned by
only 9.4% of the caretakers. Among the integrated management of
childhood illness standard general danger signs, inability to feed was
the most commonly cited danger sign(37.8%) followed by incessant
vomiting(10.1%). No caretaker mentioned all the four standard
general danger signs. In terms of actions taken, most caretakers

16
offered drinks (49.6%) and traditional herbs (45.3%) white, 31.7%
gave antibiotics. The study concluded that caretaker’s knowledge
about danger signs was inadequate in relation to the IMNCI
guidelines. Caretakers used both modern and traditional forms of
treatment to manage bronchopneumonia. Comprehensive
interventions geared at increasing symptoms recognition and
improving health-seeking behaviour is needed to reverse this trend.24

The cross sectional study was conducted to determine the

knowledge of caregivers about danger signs of pneumonia and the
socio demographic factors that influence knowledge and care seeking
behaviour among caregivers in a developing in Enugu state Nigeria.
The sample size was 466 care givers. The study findings revealed
that there is poor knowledge of the etiology and danger signs of
pneumonia among care givers. Higher maternal educational
attainment and residence in semi urban area were significantly
associated with knowledge of etiology, danger signs and vaccination
of their children against pneumonia. Fast breathing and difficulty in
breathing were the commonest known and experience WHO
recognized danger signs while fever was the commonest perceived
danger signs among caregivers. The study concluded that the
knowledge of danger signs and health seeking behaviour among
caregivers is inadequate. There is need for intensified public and
hospital based interventions targeted at mothers to improve their
knowledge about pneumonia24

A study was conducted the effect and safety of

oxygen-driving and atomized Mucosolvan inhalation combined
with holistic nursing in the treatment of children severe bronchial

17
pneumonia. Totally 90 children with severe bronchial pneumonia
who were treated in pediatrics hospital of Zhengzhou University,
China from March 2013 to November 2013 were selected as
the samples. Based on randomized controlled principle, those
children were divided into control group, test group I and test
group II according to the time to enter the hospital, 30 in each
group. Patients in control group was given conventional therapy
test group I was given holistic nursing combined with conventional
therapy, test group II was given oxygen-driving and atomized
Mucosolvan inhalation combined with holistic nursing on the basis
of conventional therapy.
After test, the difference of main symptoms in control group, test
group I and II was of no statistical significance (P>0.05). Test group
II was found with the best curative effect, secondary was test
group I and control group was the last. The study concluded that
oxygen-driving and atomized Mucosolvan inhalation combined with
holistic nursing has certain effect in the treatment of children
severe bronchial pneumonia and is better than holistic nursing
only.25
A Cross- sectional descriptive study was conducted to
determine care seeking patterns prior to hospitalization on case
management of bronchopneumonia in under five children morbidity
and mortality between 2 months and 5 years who were admitted in any
of 3 referral hospitals for 4 months in Jebel Awlia locality in Khartoum
Sudan, Northern Africa. A Sample size was 224 children and
Structured interview questionnaires were used. The study finding
revealed that one of the 3 hospitals was the provider at which 61% of
the caretakers sought care at first. 30% percent of the caretakers
bypassed a health center or another hospital within 5km of their homes

18
in a third of those unavailability of services at facilities bypassed was
the reason for this bypass. Of the children reaching the hospitals after
being referred from other facilities, 53% were given a pre-referral
treatment. At the hospitals, pneumonia constituted 38% of children
under five admitted. Incomplete assessments of children's signs,
particularly danger signs lead to 90% of the children to have an
inadequate classification and to a discrepancy between classification
and treatment. Monitoring of the children's progress was inadequate.
The study concluded that areas to improve case management at
hospitals include training health workers on assessment, classification,
inpatient treatment and monitoring in addition to complete recording of
findings.26
A Study was conducted prevention of pneumonia during
Humanitarian emergencies cost- effectiveness of hemophilic
Influenzae Type B Conjugate vaccine on cohort in Somalia, Africa . A
study performed comparing an impact and cost effective analysis of
no vaccine, Hib vaccine only, Pneumococcal conjugate vaccine
(pcv10) only, and both together administered through supplemental
immunization activities. The study revealed that would that avert a
substantial number of cases and deaths. Compared with no vaccine,
the DALY’s averted by two SIA’s for doses of Hib vaccine was
US$161.51($107.20-214.42).Variables that influenced the cost
effectiveness for each strategy most substantially were vaccine
effectiveness case fatality rates (CFRs), and disease burden. The
study concluded that effective intervention as costing one to three
times the per capita gross domestic product. SIAs are cost-effective
risk is low, prevention in this setting is more feasible than treatment,
the vaccine duration probably is sufficient for the vulnerable period of
the child’s life, cost is reasonable, and herd immunity is possible27

19
 The retrospective study was conducted to determine the
most commonly used antibiotics at the Pediatric Clinic in Sarajevo,
America and concomitant therapy in the treatment
of bronchopneumonia. A total sample of 104 patients, hospitalized in
the period from July to December 2014. The result showed that First
and third generation of cephalosporin and penicillin antibiotics were
the most widely used antimicrobials, with parenteral route of
administrateion and average duration of treatment of 4-3 days.
Concomitant therapy included antipyretics, corticosteroids,
leukotriene antagonists, agonists of β2 adrenergic receptor. In
addition to pharmacotherapy, hospitalized patients were subjected to
a diet with controlled intake of sodium, which included probiotic-rich
foods and adequate hydration. Recommendations for further
antimicrobial treatment include oral administration of first-generation
cephalosporins and penicillin antibiotics. The study concluded that It
is necessary to establish a system for rational use of antimicrobial
agents in order to reduce bacterial resistance.28
A retrospective cohort study was conducted to analyze
the effectiveness of the 7- and 13-valent PCV for the prevention of all-
cases of pneumonia of children younger than 5 years of age with
congenital heart disease (CHD) and different vaccination schedules
was analyzed. History of vaccination was confirmed with verifiable
records. Protocol was approved by the Institutional Review Board,
Pernambuco State, Brazil . A total sample size was 348 patients were
enrolled the study. 196 patients receive with two or more doses of
PCV (considered the vaccinated group), and 152 patients in the
unvaccinated group. There was a statistically significant difference for
pneumonia events (p < 0.001) between the vaccinated (26/196) and

20
unvaccinated (51/152) groups. The study result showed that the
relative risk reduction was 60.5%, and the absolute risk reduction
20.3%. There were no differences between patients who received
two, three or four doses. The number needed to vaccinate to prevent
one event of pneumonia was 5 children. The study concluded that at
least two doses of PCV in children with CHD reduced the risk of all-
cases of pneumonia.12

A Cross sectioal study was conducted to assess the

prevalence and risk factors of Bronchopneumonia in under five
children living in two slums of Dibrugarth town, Assam State, India
from February 2015 to September 2015. A total of 624 members of
children were examined by house to house visit. `The participants
selected per slum were based on probability convenience sampling
technique. The interview schedule was field tested and then data was
collected by interviewing the caregivers who was mostly the mothers
in many of the participants. The study findings revealed that the
Prevalence of pneumonia was 16.34%. Socio economic status (p =
0.005), education of mothers (p = 0.000), timely initiation of
complementary feeding (p = 0.006), complete immunization (p =
0.000) and indoor air pollution (p = 0.000), were significantly
associated with occurrence of pneumonia. In multivariate analysis,
pneumonia is significantly associated with indoor air pollution. The
study concluded that high prevalence of pneumonia and its
association with different preventable risk factors needs to be
addressed. Different community based intervention can be
implemented to reduce this preventable morbidities.29
The study was conducted to identify the various
predisposing factors for pneumonia, departments of paediatrics,

21
TATA Main Hospital, Jamshedpur, India on February 2014.The
sample size was 60 pneumonia cases age group of 1 month to 5
years in the potential predisposing factors were assessed by a
predesigned proforma. The study revealed that the predisposing
factors for pneumonia were overcrowding (p value<0.001),lack of
exclusive breastfeeding for first 6 months in babies less than 1 year
old (p value<0.05), incomplete immunization for age (p value <0.001)
and malnutrition (p value<0.001).On logistic regression analysis,
overcrowding and malnutrition were significant independent risk
factors. The study concluded that pre disposing factors for pneumonia
which can be tackled by effective health education of the community
and appropriate initiatives taken by the government.30

A study was conducted microbiological profile of

Childhood Pneumonia in a Tertiary Care Hospital, Hyderabad for 1
year. The sample size was 113 cases and processed by conventional
methods. The Study findings revealed antibiotic sensitivity testing of
these isolates was done as per CLSI guidelines. Bacterial pathogens
were isolated in 44.25% of cases from both sputum and pleural fluid.
Klebsiella pneumonia was the predominant isolate 28% followed by
Pseudomonas aeruginosa 24% and staphylococcus aureus 22%.72%
of Staphylococcus aureus strains were methicillin Resistant. Candida
albicans was the most common isolated fungi 6.2% followed by Non
albicans candida from sputum samples. Pleural fluid cultures for
fungi were negative. The study concluded that respiratory tract
infections are a significant public health problem in developing
countries. Timely detection followed by expeditious identification of
pathogens and determination of susceptibility to antimicrobial agents
can have a great diagnostic and prognostic importance.5

22
 CHAPTER-III

RESEARCH METHODOLOGY

RESEARCH APPROACH:
Quantitative Evaluative approach
RESEARCH DESIGN:
Pre-experimental research design (One group pretest and post test
research design)
Group Pre-test Intervention Post-test
Study
O1 X O2
Group

Key words:
O1 X O2
O1- Pre test
X - Structured teaching Programme
O2- Post test.
SETTING OF THE STUDY:
NICU, PICU and Pediatric wards at Mamata General Hospital,
Khammam, Telangana.
POPULATION:
Target Population:
Care givers of under five children who are in the age group between
21-55 years

23
Accessible population:
Care givers of under five children who are in the age group between
21-55 years who is attending to children in NICU, PICU and Pediatric
wards at Mamata General Hospital, Khammam, Telangana.
Sample:
Care givers of under five children who are in the age group between
21-55 years who is attending to children in NICU, PICU and Pediatric
wards at Mamata General Hospital, Khammam, Telangana, and who
fulfills inclusion criteria.
Sample size:
60 care givers of under five children.
Sampling Technique:
Non-probability convenience sampling technique.
Method of data collection:
Interview technique.
Tool used for data collection:
Structured interview schedule.
CRITERIA FOR SAMPLE SELECTION:
Inclusion criteria:
The study includes the care givers of under five children.
 who are in the age group between 21- 55 Years.
 who are willing to participate in the study.
 who are admitted NICU,PICU, Pediatric wards at Mamata
General Hospital, Khammam.
 who are available at the time of data collection.
 Who are admitted with bronchopneumonia.
 who can speak and understand Telugu languages.
Exclusion criteria:
The study excludes the care givers of under five children,

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  who are admitted with other disease condition
 who are having more than 5 years
VARIABLES OF THE STUDY:
Independent variables:
Structured teaching programme regarding Bronchopneumonia and its
prevention.
Dependent variables:
Knowledge and attitude of care givers of under five children regarding
Bronchopneumonia and its prevention.
Socio demographic variables:
Base line information of care givers such as age of the care giver,
age of child, religion, educational status of care giver, occupation,
type of family, family income per month, any history of previous
illness and source of information regarding bronchopneumonia and
its prevention.
Content validity of the tool:
The content validity of the tool will be obtained from experts in various
fields like pediatric medicine and other nursing department. The
suggestions given by the experts will be incorporated and tool will be
finalized.
Ethical considerations:
 Permission will be obtained from the ethical committee of
Mamata College of Nursing, Khammam, Telangana.
 Permission will be obtained from the higher authorities of
Mamata General Hospital, Khammam, Telangana.
 Informed consent will be obtained from the care givers who are
willing to participate in the study.
Pilot study:

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The pilot study will be conducted on 10 percent of sample to find out
reliability of the tool and feasibility of the study.
Reliability:
Split half method will be used to find out the reliability of the tool.
DEVELOPMENT AND DESCRIPTION OF THE TOOL:
The research tool will be developed after doing extensive literature
review from primary and secondary sources. Suggestions from
experts will be incorporated and the tool will be finalized. The
research tool will be organized into 3 sections.
SECTION: A
Deals with socio demographic data.
SECTION: B
Deals with questions on knowledge regarding bronchopneumonia and
its prevention among care givers of under five children.
SECTION: C
Deals with attitude three point likert rating scale among care givers of
under five children regarding bronchopneumonia and its prevention.
SCORE INTERPRETATION:

Obtained score
Formula using for Scoring = x100
Total Score

SCORING KEY:
FOR KNOWLEDGE:
 Inadequate knowledge :- 0 ≤ 33.3%
 Moderately adequate knowledge:- 33.46% - 66.6%
 Adequate knowledge :- 66.7% -100%

FOR ATTITUDE:

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  Unfavourable attitude : - 0 ≤ 33.3%
 Moderately favourable attitude :- 33.4%- 66.6%
 Favourable attitude:- 66.7%- 100%

PLAN FOR DATA ANALYSIS:

The collected data will be analyzed by using descriptive and
inferential statistics.
STATISTICAL TEST PURPOSES
S.NO. METHOD

1 Descriptive Frequency, To analyze the socio

statistics percentage demographic variables
distribution. and levels of knowledge
and attitude scores.
Mean and To find out the difference
Standard between the pretest and
deviation post test knowledge
levels and attitude
2 Inferential Paired ‘t’ test To find out the
statistics effectiveness of
structured teaching
programme.
Chi-square test To find out the
association between post
test knowledge and
attitude scores with their
Selected socio-
demographic variables.

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REFERENCES:
1. Aswathi. S, Children early stages of Pneumonia. Indian
Journal of Pediatrics, 2012; 6(1): 469-474.
2. Archang Lakshmanaswamy. “Text book of Pediatrics, 14th
Edition,2012,SS Wolters Kluwers Publication, 389-390.
3. Lucy Eberechuyaglo Ide. Childhood Pneumonia in under five
years morbidity and mortality. The Nigerian Health Journal,
2011; 2(11):3.-15.
4. Suraj Gupte. Text Book of Peadiatrics, 11th Edition, Jaypee
Publishers 2009, 327-328.
5. Vipparthi Haritha, V.V Shailwa. Microbiological Profile of
Child hood Pneumonia. International Journal of Pediatrics
Nursing, 2017; (6): 1899-1911.
6. Svjetlana, Kenansel manovic. Evalution of drug treatment of
Bronchopneumonia. American Journal of Pediatrics Nursing,
2016;70(3): 177-181.
7. Prajapati. B,Talsanio. Complication of Brochopneumonia.
Journal of Global health, 2017; 3(2) 65-68.
8. Solarzano-santosl. Types of Pneumococcal Conjugate
Vaccine. International Journal of Pediatrics infectious
disease, 2014; 33: 109-118.
9. Qazis. Prevention and Control of Pneumonia, Journal of
Public health, 2015; (1):3 -7.
10. Preethi Srinivas, Asitkumar Mishra. Mortality due to
childhood pneumonia poverty related factors. Indian Journal
of Lung disease, 2015; 1(1): 1 -12.
11. Johns Hopking bloom berg. Points of GAPPD Score
measures research. UNICEF Data 2018.
http://data.unicef.org/topic/child- health/pneumonia/.

28
12. Solórzano – Santos Pneumococcal Conjugate vaccine.
International Journal of Pediatrics Nursing. 2014; 33(5):109-
118.
13. Chowdary P. Leading cause of death in children (WHO).
Indian Journal of Pediatrics Nursing, 2015; 2 (44):567-568.
14. Rudan. Globally pneumonia morbidity and mortality under
five children. Bull (World health Organization), 2018; 2(2):
895-903.
15. David E Bloom. Global Pneumonia level. National Academy
of Pediatrics Nursing, 2018; 51(3):115.
16. Teshom Abuka. Prevalence of pneumonia in school of Public
and environmental health. Current journal of peadiatrics,
2017 1(1):19-25.
17. Duke. Causes of Viral infections. Journal of Public health,
2015; 361: 763-773.
18. Johns Hopkins bloom berg. Pneumonia and diarrhea deaths
in the world research in World Health Organization,
2016;10:3-4.
19. Habib Farooqui, mark jit. Severe Pneumonia deaths in Indian
states. Public library of science, 2016; 10 (6): 137-140.
20. Joseph, Mathew. Report that severe pneumonia with girls.
Journal of Global health, 2015; 5(2): 123-125.
21. Dr. Sanjay, Indian academy of pediatrics. Elsevier
publications Nov 2017; 11:1-2.
22. Siham M.O. Gritl. The risk factors of Pneumonia in Children.
International Journal of Medical Research and Health
Sciences, 2018; 7(4): 60-68.
23. Dorcen Tuhebue. Symptoms of Bronchopneumonia. Journal
of African Health Science, 2014; 14(4): 993-1000.

29
24. Nabanita Nirmoliaa. The Prevalence and risk factors
Bronchopneumonia in under five children. Journal of Global
health, 2018; (6):1-4.
25. Gedefaw. Factors associated with Pneumonia among under
five children. Journal of Science and Public health, 2014; 2
(3): 150-155

26. Ikenna K. Nadu. Danger Signs of Child hood Pneumonia.

International Journal of Pediatrics Nursing, 2015; 2(4): 1-7.

27. Yang F. Oxygen – driving and atomized mucosolvn

inhalation combined with holistic nursing in the treatment of
children .Journal of pharmaceutical science, 2015;
28(4):1477- 1480.
28. Almubrak Re. Case management of bronchopneumonia in
under five children. International journal of Pedatrics Nursing,
2011; 2(9): 77 – 86.
29. Zecsl. Evaluation of Drug treatment of Bronchopneumonia.
Journal of medical Science, 2016; 70(3): 177-181.
30. Gargano LM. Pneumonia prevention during a Humanitarian
Emergency Vaccine. National Library of Medical sciences,
2015; 30(40):402-411.

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