INTRODUCTION:

Childhood period is one of the joyful stages that no one can get it back in anyone’s life. As children's early experiences are crucial in shaping their long term health and well-being, it is also critical in improving the health of the whole population. Child healthcare is the most crucial factor to determine the growth of a child.¹ Mother is the primary nurse and important caregiver of a child. Mother’s education and awareness of health promotion activities have remarkable impact on the health of the child.²

Vector-borne diseases (VBD) are a cluster of infectious diseases transmitted by mosquitoes and other vectors. It account for 17% of the estimated global burden of all infectious diseases. Mosquitoes are considered to be one of the most dangerous vectors on earth because of their ability to spread deadly diseases.³ Also the world's fastest growing vector-borne disease is dengue fever, with a 30-fold increase in disease incidence over the last 50 years. VBDs are major killers, particularly of children in developing countries. ⁴

Dengue fever refers to an acute onset of febrile illness that lasts 2 – 7 days, with two or more of the following symptoms: head ache, retroorbital pain, myalgia / arthralgia, maculopapular rash, petechiae and positive tourniquet test.⁵World Health Organization (WHO) currently estimates that there may be 100 million dengue infections worldwide every year. More than 2.5 billion people (40% of the world population) continue to live at constant risk of dengue fever. The South-East Asia region contributes 52% or 1.3 billion cases annually. An estimated 5,00,000 people with severe dengue require hospitalization each year, a large proportion (90%) of them were children. About 2.5 % of those affected die because of this disease. Before 1970 only 9 countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries.⁴Dengue Hemorrhagic Fever (DHF) is a more serious clinical entity. It emerged among children in South-East Asia during the 1950s and has since become a major public health problem worldwide and a significant cause of pediatric morbidity and mortality.⁶

India is one of the seven identified countries in the South-East Asia region regularly reporting incidences of DF/ DHF outbreaks. Dengue fever has become synonymous with the monsoon season in India.⁶According to National Vector Borne Disease Control Programme (NVBDCP) a total of 75,454 people have affected and 167 deaths have occurred by dengue fever across the country in 2013 where as in 2012, there were 50,222 cases and 242 deaths. Dengue fever has become an endemic in Kerala.⁸ NVBDCP reported that in 2013 there were 7897 dengue cases and 25 deaths in Kerala and in 2012 it was 4172 cases and 15 deaths.⁷ Based on the study done by Integrated Disease Surveillance Project (IDSP) about epidemiological situation of communicable diseases in Kerala from 2006 to 2010, in Thrissur district, there were 72 dengue cases in 2006, 89 cases in 2007, 10 cases in 2008, 152 cases in 2009 and 74 cases in 2010. This show dengue virus is growing more aggressive in virulence and magnitude with every outbreak.⁸

A prospective study done by Dhooria et al⁹ on clinical profile of children admitted with DHF/DSS in the pediatric department of Dayanand Medical College and Hospital in Ludhiana, Punjab reported that 81 children with DHF were hospitalized. Children between 10-15 years were most commonly afflicted (59%). Infants were the least affected sub-group (3.7%). Ninety two percent of children were having DHF and 8% cases presented with DSS.

A survey was carried out by Ahmed¹⁰ in Maldives with the objective of determining the state of Knowledge, Attitude and Practices (KAP) of dengue fever prevention. Three hundred and seventy four households were recruited using purposive sampling. The respondents who participated in this study had low level of knowledge in the areas explored (mean= 8.60, Standard Deviation (SD) = 2.45) and 48% had fair practice in preventing dengue fever (mean= 4.75, SD = 1.39). The findings of the study indicated that if people are supplied with accurate knowledge through appropriate channels, they may eventually have good practices in preventing dengue fever. Therefore educational programs should be organized for improving knowledge about dengue fever, ensuring that people are receptive to the messages and to make it easier for them to adopt desired behavioural changes.

Video can be an important media for motivation that can present visual information that is difficult to convey in other ways. Video viewing without proper instructional context and planning can have all of the potential weaknesses or deleterious effects of television. Videos can be used to mould positive behaviour and to motivate learners. They are particularly useful for teaching a topic when motivation is a key to the learner involvement in a learning sequence. Videos can provide messages about issues critical to the lives of learners, or to the topic under consideration. Video can also provide visually compelling access to information for many learners with reading difficulties who might miss learning opportunities provided solely by print-based materials.¹¹

Over the past 10-15 years, next to diarrheal disease and respiratory infection, dengue fever had become a leading cause of hospitalization and deaths among children.⁴ Children are dependent on their families or caregivers especially mother for health and wellbeing. Early detection and anticipation of the problem may prevent impairment, disability and fatal outcomes. The common health problems are identified at home and needs immediate interventions.¹²It would be necessary to improve the maternal knowledge about cause, signs and symptoms, management and prevention of diseases and for recognition of early danger signs and prompting them to seek appropriate care. If mothers are equipped with necessary knowledge on diseases and their management, it will help to achieve control of diseases at domiciliary level.¹³ Mothers also are able to manage the cases of dengue fever at home, prevent further deterioration as well as protect them from the risk of getting dengue fever. Today, dengue fever is considered as one of the most important arthropod borne viral disease in humans in terms of morbidity and mortality. So investigator felt it is vital that mothers who are taking care of children should possess knowledge on vector borne diseases especially dengue fever.

OBJECTIVES:

· Assess mothers’ pre-test level of knowledge in prevention and management of selected mosquito borne fever.

· Assess mothers’ post-test level of knowledge in prevention and management of selected mosquito borne fever.

· Determine the effect of video teaching on mothers’ knowledge in prevention and management of selected mosquito borne fever.

· Associate mothers’ socio-demographic and clinical data variables with pre-test level of knowledge in prevention and management of selected mosquito borne fever.

OPERATIONAL DEFINITIONS:

· Effect: Extent to which video teaching changes the mothers’ level of knowledge in prevention and management of selected mosquito borne fever as measured by structured knowledge questionnaire.

· Video teaching: Type of teaching prepared and provided by the investigator on selected mosquito borne fever (dengue fever) - its definition, epidemiology, transmission, features of the vector and its life cycle, pathophysiology, clinical manifestations, diagnosis, management and prevention, to enhance the level of knowledge of mothers. It is implemented on day 1 and day 3 in 1 to 1 basis. Duration of each teaching session was 20 minutes.

· Knowledge: Informations acquired by the mothers on prevention and management of selected mosquito borne fever as measured by structured knowledge questionnaire.

· Prevention: Measures taken to prevent the risk of selected mosquito borne fever among children which includes antilarval measures, antiadult measures and protective measures against mosquito bites.

· Management: Whole system of care and treatment given by mothers at home.

· Selected mosquito borne fever: Dengue fever which is an acute onset febrile illness that lasts 2 – 7 days, with two or more of the following symptoms: head ache, retroorbital pain, myalgia / arthralgia, maculopapular rash and petechiae.

· Mother: Woman having a child of 5 - 15 years of age with fever admitted in pediatric medicine ward of JMMC&RI, Thrissur.

· Children: Children of 5 - 15 years of age with fever (axillary body temperature > 37.5⁰C) admitted in pediatric medicine ward of JMMC&RI, Thrissur.

HYPOTHESES:

H₁: The mean post-test knowledge score of mothers’ in prevention and management in selected mosquito borne fever is significantly higher than the mean pre-test knowledge score.

H₂: There is a significant association between mothers’socio-demographic and clinical data variables and the pre-test level of knowledgein prevention and management of selected mosquito borne fever.

MATERIALS AND METHODS:

Research approach:

A quantitative research approach was used.

Research design:

The research design of this study was quasi experimental, one group pre-test post-test design. It was represented as:

R O₁--------------- X ------------ O₂

Keys:

R- Randomization

O₁- Pre-test to assess the level of knowledge of mothers in prevention and management of selected mosquito borne fever.

X –Video teaching on prevention and management of selected mosquito borne fever.

O₂- Post-test to assess the level of knowledge of mothers in prevention and management of selected mosquito borne fever.

Variables:

· Independent variable: Video teaching on prevention and management of selected mosquito borne fever.

· Dependent variable: The knowledge of mothers’ in prevention and management of selected mosquito borne fever.

· Socio-demographic and clinical data variables: It includes age, education, occupation, religion, type of family, housing facility, area of living, monthly family income, type of admission to the hospital and previous exposure to information on information on dengue fever.

Setting of the study:

The research was conducted in the 100 bedded paediatric medicine ward of JMMC&RI, Thrissur.

Population:

Target population of the present study was all the mothers of children with fever. Accessible population was mothers of children with fever admitted in paediatric medicine ward of JMMC&RI, Thrissur and who fulfills the inclusion criteria.

Sample and sampling technique:

In this study, sample constitutes mothers of children with fever admitted in paediatric medicine ward of JMMC&RI, Thrissur during the period of data collection. Simple random sampling technique was done using lottery method to draw 40 samples from the population.

Inclusion criteria :-

· Mothers of children between the ages of 5-15 years admitted with fever in the paediatric medicine ward of JMMC&RI, Thrissur.

· Mothers who are able to understand Malayalam.

Exclusion criteria :-

· Mothers of children having previous history of selected mosquito borne fever.

· Mothers who are physically (deaf / blind) or mentally challenged.

Tools /Instruments:

The tools used for the study was a structured knowledge questionnaire. Tool consists of section A and B

Section A:-Socio-demographic and clinical data variables of mothers and children.

It consist of 10 items such as age, education, occupation, religion, type of family, housing facility, area of living, monthly family income, type of admission to the hospital and previous exposure to information on dengue fever. The samples were instructed to write their answer in the given column. There was no scoring for these items. This sectionwas intended to determine the association of these variables with pre-test level of knowledge of mothers’ in prevention and management of selected mosquito borne fever.

Section B:- Structured knowledge questionnaire in prevention and management of selected mosquito borne fever.

It consists of 35 multiple choice questions which covered 5 areas about selected mosquito borne fever such as

· Definition and epidemiology of dengue fever (5 items)

· Features of aedesegypti mosquito and its life cycle (5 items)

· Pathophysiology, clinical manifestations and diagnosis of dengue fever (5 items)

· Home management of dengue fever (5 items)

· Prevention of dengue fever (15 items )

Scoring:

The correct response was scored 1 and the wrong response was scored 0. The maximum score was 35 and minimum score was 0.

The obtained score was interpreted as follows:

Level of knowledge	Score	Percentage
Excellent	28- 35	80 – 100
Adequate	21-27	60- 79
Moderately adequate	14-20	40- 59
Inadequate	< 13	< 39

Content validity:

The tool was given to 5 experts to clarify the vital aspect of the tool. The experts were requested to judge the items for accuracy, relevance and appropriateness.

Reliability:

The reliability of the structured knowledge questionnaire in prevention and management of selected mosquito borne fever was tested by Cronbach’s alpha. The reliability score obtained for the structured knowledge questionnaire was r = 0.92. Hence the tool was reliable for the study.

Pilot study:

Pilot study was conducted in paediatric medicine ward of JMMC&RI, Thrissur with 4 samples. During the pilot study investigator found difficulty in providing video teaching to a group having 4 mothers at a time due to the inconvenience of samples to be available at a pre fixed time. The investigator decided to give video teaching in 1 to 1 basis for 20 minutes in each teaching session. Apart from that the study was found to be feasible and practicable. No modification was made in the tool after the pilot study.

Data collection process:

The investigator obtained permission from the concerned authorities of JMMC&RI, Thrissur and the data collection was done at the paediatrics medicine ward of JMMC&RI, Thrissur. Samples were selected from mothers of children with fever who met the inclusion criteria using simple random sampling technique (lottery method). After a brief self-introduction, investigator explained the purpose of the study and obtained informed consent from participants.

Pre-test:

Pre-test was conducted on the 1^stday using a structured knowledge questionnaire to assess the pre-test level of knowledge of mothers in prevention and management of selected mosquito borne fever. Maximum time allotted to complete the questionnaire was 35 minutes.

Intervention:

Video teaching was given to mothers of children with fever in paediatric medicine ward regarding prevention and management of selected mosquito borne fever after pre-test on day 1 and day 3 in 1 to 1 basis for 20 minutes in each teaching session. It was provided at a separate area near to the nurses’ station.

Post-test:

Post-test was done on the 5^th day using the same questionnaire.

At the time of discharge: A booklet prepared by the investigator on selected mosquito fever was provided for the mothers.

RESULTS:

Table 1: Distribution of mothers of children with fever based on socio-demographic variables (n = 40)

Variables	Characteristics	Frequency(N)	Percentage(%)
Age	21- 25	5	12.5
	26- 30	13	32.5
	31- 35	12	30
	36- 40	7	17.5
	>40	3	7.5
Education	No formal education	0	0
	Primary	2	5
	High School	6	15
	Plus two	11	27.5
	Diploma	10	25
	Graduate and above	11	27.5
Occupation	Housewife	22	55
	Labourer/ Coolie	2	5
	Technical employee	4	10
	Professional	12	30
	Any other	0	0
Religion	Hindu	10	25
	Christian	18	45
	Muslim	12	30
	Any other	0	0
Type of family	Joint	18	45
	Nuclear	21	52.5
	Extended	1	2.5
Housing Facility	Thatched house	0	0
	Tiled house	14	35
	Concrete house	26	65
Area of living	Urban	23	57.5
	Urban slum	0	0
	Rural	17	42.5
Monthly family income( in rupees)	≥ 31,507	0	0
	15,754 – 31,506	19	47.5
	11,817 – 15, 753	7	17.5
	7,878 – 11,816	5	12.5
	4,727 – 7,877	8	20
	1,590 - 4, 726	1	2.5
	≤ 1589	0	0
Type of admission	Direct admission	25	62.50
to the hospital	Referred cases	15	37.50
Previous information on dengue fever	Yes. if yes,	31	77
	- Friends	3	7.5
	- Mass media	14	35
	- Family members	4	10
	- Health professionals	10	25
	No	9	22.5

Table 2: Distribution of mothers of children with fever based on pre-test level of knowledge in different components of selected mosquito borne fever. (n = 40)

Sl. No.	Components	Excellent		Adequate		Moderately adequate		Inadequate
Sl. No.	Components	f	%	f	%	f	%	f	%
I	Definition and epidemiology.	6	15	16	40	4	35	4	10
II	Aedesegypti mosquito and its life cycle.	4	10	11	27.50	16	40	9	22.50
III	Pathophysiology, clinical manifestations and diagnosis.	9	22.50	9	22.50	19	47.50	3	7.50
IV	Home management.	7	17.50	13	32.50	8	20	12	30
V	Prevention.	3	7.50	11	27.50	20	50	6	15
VI	Over all.	-	-	13	32.50	19	47.50	8	20

As overall, in the pre-test, 47.50% had moderately adequate level of knowledge on selected mosquito borne fever.

Table 3: Distribution of mothers of children with fever based on post-test level of knowledge in different components of selected mosquito borne fever (n = 40)

Sl. No.	Components	Excellent		Adequate		Moderately adequate		Inadequate
Sl. No.	Components	f	%	f	%	f	%	f	%
I	Definition and epidemiology.	25	62.50	11	27.50	4	10	-	-
II	Aedesegypti mosquito and its life cycle.	22	55	15	37.50	2	5	1	2.50
III	Pathophysiology, clinical manifestations and diagnosis.	30	75	7	17.50	3	7.50	-	-
IV	Home management.	35	87.50	3	7.50	2	5	-	-
V	Prevention.	37	92.50	3	7.50	-	-	-	-
VI	Over all.	31	77.50	9	22.50	-	-	-	-

As overall, in the post-test, 77.50% of the mothers of children with fever had excellent level of knowledge on selected mosquito borne fever.

Table 4: Mean, mean difference, standard deviation, standard error and t value of pre-test and post-test knowledge score of mothers in prevention and management of selected mosquito borne fever. (n=40)

Sl. No.	Components		Mean	MD	SD	SE	t value	df	p value
I	Definition and epidemiology.	Pre-test	2.65	1.10	0.98	0.15	7.73	39	0.001***
I	Definition and epidemiology.	Post-test	3.75		0.93	0.15
II	Aedesegypti mosquito and its life cycle.	Pre-test	2.12	1.50	1.14	0.18	10.82	39	0.001***
II	Aedesegypti mosquito and its life cycle.	Post-test	3.62		0.93	0.15
III	Pathophysiology, clinical manifestations and diagnosis.	Pre-test	2.62	1.40	1.08	0.17	8.02	39	0.001***
III	Pathophysiology, clinical manifestations and diagnosis.	Post-test	4.02		0.93	0.15
IV	Home management.	Pre-test	2.20	2.20	1.44	0.23	11.00	39	0.001***
IV	Home management.	Post-test	4.40		0.85	0.13
V	Prevention.	Pre-test	7.90	5.62	2.27	0.36	11.61	39	0.001***
V	Prevention.	Post-test	13.52		1.38	0.22
VI	Overall.	Pre-test	17.50	11.82	4.56	0.72	21.83	39	0.001***
VI	Overall.	Post-test	29.32		2.86	0.45

^***Highly significant, p = 0.001

Table 4 depicts that the overall mean post-test knowledge score (29.32 + 2.86) was significantly higher than the mean pre-test knowledge score (17.50 + 4.56). The calculated paired t test value on overall pre-test and post-test knowledge score is 21.83 which was higher than the table value (1.684, df- 39, p = 0.001). Hence H₁ was accepted. This shows that video teaching was effective for improving the knowledge of mothers in prevention and management of selected mosquito borne fever.

Association between mothers’ socio-demographic and clinical data variables and pre-test level of knowledge in prevention and management of selected mosquito borne fever.

The calculated p value of socio-demographic and clinical data variables such as occupation (p = 0.011), area of living (p = 0.019) , type of family (p= 0.049), monthly family income (p = 0.001), type of admission to the hospital (p = 0.028) and previous exposure to information on dengue fever (p = 0. 008) were less than 0.05.So H₂: There is a significant association between mothers’ socio-demographic and clinical data variables and the pre-test level of knowledge in prevention and management of selected mosquito borne fever was accepted. The calculated p value of socio-demographic and clinical data variables such as age (p = 0.225), education (p = 0.128), religion (p = 0.307) and housing facility (p = 0.40) were more than 0.05. So these variables had no significant association between these variables and the pre-test level of knowledge in prevention and management of selected mosquito borne fever.

DISCUSSION:

Major findings of the study were as follows

· The mean post-test knowledge score (29.32 + 2.86) was significantly higher than the mean pre-test knowledge score(17.50 + 4.56).

· The calculated paired t test value on overall pre-test and post-test knowledge was 21.83 which was higher than the table value (1.684, df- 39, p = 0.001 level). Hence H₁was accepted. This shows that video teaching was effective for improving the mothers’ knowledge in prevention and management of selected mosquito borne fever.

· The calculated p value of socio-demographic and clinical data variables such as occupation (p = 0.011), area of living (p = 0.019), type of family (p= 0.049), monthly family income (p = 0.001), type of admission to the hospital (p = 0.028) and previous exposure to information on dengue fever (p = 0.008) were less than 0.05. So H₂was accepted. It indicates that the above mentioned socio-demographic and clinical data variables had association with pre-test level of knowledge of mothers on prevention and management of selected mosquito borne fever.

The findings of the present study have been discussed under various sections with reference to the objectives and hypotheses.

Determine the effect of video teaching on mothers’ knowledge in prevention and management of selected mosquito borne fever.

It was evident from the results that the overall mean pre-test knowledge score was found to be 17.50 + 4.56 which is higher than the mean post-test knowledge score of 29.32 + 2.86. The calculated paired t test value on overall pre-test and post-test knowledge score was 21.83 which was higher than the table value (1.684, df- 39, p=0.001 level). Hence H₁was accepted. The findings revealed that video teaching was effective in improving the knowledge on prevention and management of mosquito borne fever. These findings were consistent with a study done in 2013 by Madhu¹⁴ to assess the effectiveness of video assisted teaching programme (VATP) on prevention of dengue fever among students in selected high schools at Chintamani, Karnataka. Simple randomized sampling method was adopted to select 60 students of selected high schools as the study samples. In that study, the mean post-test knowledge score was (23.61) was apparently higher than the mean pre-test knowledge scores (7.81). The calculated paired ‘t’ test value (t₅₉═31.76, p < 0.05) was greater than the table value (t _tab ═ 3.46) which represents significant gain in knowledge through the video assisted teaching program.

Associate mothers’ socio-demographic and clinical data variables with pre-test level of knowledge in prevention and management of selected mosquito borne fever.

Findings of present study showed that there was significant association between socio-demographic and clinical data variables such as occupation ( p = 0.011), type of family( p = 0.049), area of living( p = 0.019), monthly family income( p = 0.001 ), type of admission to the hospital ( p = 0.028) and previous exposure to information on dengue fever( p = 0.008) and the pre-test level of knowledge of mothers in prevention and management of selected mosquito borne fever. That is, hypothesis (H₂) was accepted.

The study findings were in par with a quasi experimental study by Vasumathi¹⁵to assess the impact of education on parents on prevention of dengue fever in selected urban slum, Coimbatore in 2011. Chi square test showed that there was a significant relationship between pretest knowledge scores and education (p < 0.01) and family income (p < 0.05) of the respondents. The study findings were also supported by a study done by Paul¹⁶ to assess the knowledge and practice of women dengue fever, Bangalore. The study showed that there was significant association between pre-test level of knowledge of samples and demographic variables such as occupation (p<0.001), family income (p<0.01), type of house (p<0.01) and concept of dengue fever (p<0.001).

NURSING IMPLICATIONS:

The investigator has drawn the following implications from the studies which are of vital concern to the field of nursing education, nursing service, nursing administration and nursing research.

Nursing service:

· Nurses have a major role in preventive aspects than the curative aspect. As in key position, a paediatric nurse can take initiation to provide training programme to mothers so that they can do early identification, prompt home care and prevention of dengue fever.

· Health education programmes can be conducted among various groups (parents, family members) to foster their preventive measures in dengue fever by utilizing video and booklet developed in this study

Nursing education:

· Students should be encouraged to conduct health education programmes by utilizing the video in hospitals and community health centres.

· Nurse educator can help the student nurses to update their knowledge on dengue fever with recent advancement.

· This study serves as a reference material for students in the library.

· The nursing curriculum should include the preparation and usage of various self - instructional modules, video-assisted teaching programmes, information booklets, pamphlet on dengue fever to educate the nursing students during their training periods.

· In community areas student nurse can periodically conduct mass education programmeson dengue fever.

· The study findings can be utilized by the nurse educators while conducting staff development programmes

Nursing administration:

· The nurse administrator can influences the staff nurses to incorporate video teaching / pamphlet on dengue fever along with discharge planning.

· Nurse administrator should organize in-service education and training programmes on dengue fever and can utilize the video as educational material while organizing classes and workshops.

· Nurse administrator should assume leadership roles in educating regarding dengue fever by incorporating the nurses.

Nursing research:

· Study serves as a reference material and good source of related literature for future investigators.

· The nurse investigators can publish the study findings in various regional, national and international journals.

· The study findings can be utilized by the paediatric nurse and also the community health nurse as resource for evidence based practice.

· Nurse investigator can disseminate the findings of the study for further use.

· Critiquing of the recent research findings related to the effect of video teaching on prevention and management of selected mosquito borne fever among mothers can be done to assess the best practice to be incorporated.

CONCLUSION:

The findings of the study showed that 20% of mothers had inadequate level of knowledge and 47.50% had moderate level of knowledge in prevention and management of selected mosquito borne fever during pre-test. Majority (77.50%) of the mothers had excellent level of knowledge in the post-test. There was significant increase in the knowledge of mothers after video teaching with a mean difference of 21.83, (p=0.001). Socio-demographic and clinical data variables such as occupation, area of living, type of family, monthly family income, type of admission to the hospital and exposure to previous information on dengue fever had association with pre-test level of knowledge of mothers on prevention and management of selected mosquito borne fever.

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Received on 16.01.2016 Modified on 17.02.2016

Asian J. Nur. Edu. and Research.2017; 7(1): 35-42.

DOI: 10.5958/2349-2996.2017.00009.X