INTRODUCTION:

Today, it is the poor, the poorest of the poor, living in the slums of the developing world, who bear the full brunt of the mortality and morbidity-216 000 deaths and about 21 million cases a year—wrought by Salmonella typhi.¹“Enteric fever” is a global major public health problem. “Typhoid fever”, an acute systemic infectious disease seen only in humans. Enteric fever is also known as typhoid. It is a common worldwide bacterial disease transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the A bacterium Salmonella typhi². An estimated 16–33 million cases of typhoid fever occur annually. Its incidence is highest in children and young adults between 5 and 19 years old. These cases as of 2010 caused about 190,000 deaths up from 137,000 in 1990³. Enteric fever is transmitted via the fecal oral route or urine.^4,5,6 Almost 80 per cent of cases and deaths occur in Asia. Annual incidence as high as 1,100 cases per 100,000 population has been documented in developing countries ⁷.

Diagnosis is made by any blood, stool cultures and Widal test. The treatment of choice is a fluoroquinolone such as ciprofloxacin. A third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice⁸.At 2 years typhoid vaccine is given (repeat after every 3 years). One single dose of 0.5 ml (subcutaneous or intramuscular administration). Oral- One capsule on day 1, 3& 5. Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Careful food preparation and washing of hands are crucial to prevent typhoid ⁹

Morbidity and mortality due to high incidence of typhoid fever favors the introduction of typhoid vaccine in routine immunization in India. This vaccine should be given at the age of 2 years with Vi antigen vaccine and at least one more dose be given at 5 years of age ¹⁰.

NEED OF THE STUDY:

Enteric fever is a life-threatening illness caused by the bacterium Salmonella Typhi. In the United States, it is estimated that approximately 5,700 cases occur annually. Enteric fever is still common in the developing countries, where it affects about 21.5 million persons each year¹¹. Enteric fever (typhoid and paratyphoid fever) is a major human bacterial infection. Hospital-based studies and outbreak reports from India indicate that enteric fever is a major public health problem in this country, with Salmonella enteric serovar Typhi (S. Typhi) the most common aetiologic agent but with an apparently increasing number of cases due to S. Paratyphi A (SPA)¹². Because risk factors such as poor sanitation, lack of a safe drinking water supply and low socio economic conditions in resource-poor countries are amplified by the evolution of multidrug resistant salmonellae with reduced susceptibility to fluoroquinolone, treatment failure cases have been reported in India, which is associated with increased mortality and morbidity¹³. Study done at a low income community of Delhi, the incidence of typhoid fever was 27.3/1000 person years in children under 5 years of age, 11.7 at 5-19 years and 1.1 between 19-40 years¹⁴. While working in the clinical area, the researcher observed that the mothers of numerous children who were admitted in hospital had inadequate knowledge regarding enteric fever. The researcher felt that the mothers need adequate information about enteric fever because they play a vital role in the prevention and management of enteric fever in children which cannot be neglected. Hence, this created interest in researcher to undertake this study to assess the knowledge of mothers regarding enteric fever whether they are aware about this or not. By improving the knowledge of mothers, the researcher would help in reducing the complications due to enteric fever in children.

RESEARCH PROBLEM:

A Descriptive Study to assess the knowledge regarding enteric fever in children among mothers in a Selected Hospital, Ludhiana, Punjab.

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge among mothers regarding enteric fever in children.

2. To find out the relationship of knowledge regarding enteric fever with selected variables like age, religion, education, occupation, income, type of family, type of residence, source of information.

3. To find out the deficit areas of knowledge and to prepare information booklet to enhance awareness among mothers regarding enteric fever.

OPERATIONAL DEFINITIONS:

Knowledge:

Refers to respondent’s ability to respond to specific items in a questionnaire regarding enteric fever.

Mothers:

Refers to women in child care areas who have children between 2-18years of age.

Enteric fever:

Typhoid fever refers to an acute illness with fever caused by gastrointestinal infection with the Salmonella typhi bacteria contracted from ingestion of contaminated water and food.

Assumption

Mothers may have some knowledge regarding enteric fever.

Review of Literature

For the easy compilation the review of literature has been placed under following headings:-

· Literature related to Enteric Fever.

· Literature related to Knowledge of Mothers regarding Enteric Fever

MATERIAL AND METHODS:

A descriptive research approach and non-experimental research design with analysis and interpretation of data done by using inferential statistics.

Subjects:

The sample for the present study were 100 mothers selected by purposive sampling technique in Christian Medical College& Hospital, Ludhiana. Independent variables are Age, religion, education, occupation, income, type of family, type of residence, source of information. Dependent variable are knowledge of mothers regarding of Enteric fever in children. Inclusion criteria was mothers of children 2-18 years of age and mothers of children who were willing to participate in the study. Exclusion criteria was mothers whose children suffered with enteric fever recently. Prior to the data collection, researcher first got written permission from the Medical Superintendent and Head of Departments of Paediatric Medicine and Obstetrics and Gynaecology departments of Christian Medical College and Hospital, Ludhiana, Punjab.The data collection procedure was conducted in Paediatric Out Patient Department, Antenatal outpatient department &Well Baby Clinic of Christian Medical College and Hospital, Ludhiana, Punjab.The sample subjects were selected using a purposive sampling technique and were given a self structured knowledge questionnaire. The researcher first introduced herself to the mothers and explained the purpose of gathering the information. The mothers were assured that their responses would be kept confidential and used only for research purpose. An informed verbal consent was taken from all the mothers. The time spent for collecting the data from a sample was 25-30 minutes. The sample chosen for pilot study were not considered for the final study.

Selection and Development of tool

Tool was selected or developed based on the review of literature, professional experiences and guidance of experts. A self structured knowledge questionnaire was developed which consisted of a; knowledge questionnaire to assess the knowledge of mothers regarding enteric fever in children. An intensive review of literature, expert’s opinion, suggestions of the research panel, researcher’s professional experience provided construction of self structured knowledge questionnaire.

Description of tool

The tool consists of the following two parts:

Part-1: Sample Characteristics:

This part consists of 8 items for obtaining personal information i.e. age, education, occupation, type of family, religion, income, type of residence and source of information

Part -2: Structured Questionnaire

This part consists of self structured knowledge questionnaire multiple choice questions regarding different aspects of mother’s knowledge regarding enteric fever in children of age group 2-18 years. This questionnaire consists of 30 multiple choice items, each item consists of one correct answer among the four choices and each correct answer carries one mark.

Validity of the tool

Content validity of the tool was determined by expert’s opinion on the relevance of the items. Tool was given to experts from the areas of Child Health (Pediatric) Nursing, Obstetrical and Gynecological Nursing, Community Health Nursing and Mental Health (Psychiatric) Nursing. Changes had been made in the questionnaire, some items were deleted from the prevention & control part and the language of questions were modified according to their valuable suggestions.

Analysis and Interpretation of data

Section 1-Frequency and Percentage distribution of subjects according to sample characteristics

Distribution of subjects depicts that maximum number of (29%) mothers in the sample were in the age group 31-35 years followed by (28%) in the age group of 26-30 years, (24%) mothers in the age group 20-25 years and (19%) mothers in the age group 36-40 years.

As per education (29%) mother’s maximum espondents were 10+2, followed by (28%) mothers who were 10^th pass, (24%) mothers were illiterate and (19%) were graduate & above.

According to occupation (61%) mothers were housewives, followed by (29%) mothers who were doing service, (9%) mothers who were laborer and (1%) mothers in business.

(72%) mothers were from joint family respondents in comparison to (28%) mothers from nuclear families. Maximum (57%) mothers belong to Hindu religion, followed by (34%) Sikh mothers, (7%) Christian mothers and lastly (2%) Muslim mothers.

(41%) mothers had income/month of Rs. ≤ 5000, followed by (35%) mothers who had income/month of Rs. 5001-10,000, (14%) mothers had income/month of Rs. 10,001-20,000 and (10%) mothers had income/month of Rs. > 20,000.

(67%) mothers were from urban area in comparison to (33%) mothers from rural area. (62%) mother’s source of information was TV/newspaper/magazine followed by (20%) Family/friends and (18%) mother’s source of information were health professionals respectively.

Hence, it was concluded that maximum mothers were in the age group of 31-35 years, who were 10+2, mostly housewives, Hindu, belonged to joint families, having family income Rs.≤5000, from urban area and source of information was TV/Newspaper/Magazine respectively.

Section 2

Objective 1- to assess the level of knowledge of mothers regarding enteric fever in children

TABLE 1

Frequency and percentage distribution of Knowledge regarding Enteric Fever in children among mothers according to level of knowledge N=100

Level of knowledge	Score	n	Mothers	%
Good	>20	13		13
Average	10-20	60		60
Below Average	<10	27		27

Maximum score= 30

Minimum score=0

Table 1-depicts that majority of mothers obtained average knowledge score (60%), followed by (27%) below average knowledge score and (13%) of the mothers had good knowledge score respectively.

Fig 1 - Percentage distribution of mothers regarding Enteric Fever in children according to level of knowledge

Section 2

Objective 2- To find out the relationship of knowledge regarding enteric fever with selected variables like age, religion, education, occupation, income, type of family, type of residence, source of information.

The mean knowledge score was highest (17.11) in mothers of age group 36-40 years had highest and least mean knowledge score (11.71) in 20-25 years respectively.

Mothers who were graduate & above had highest (16.84) mean knowledge score and least (11.17) who were illiterate.

Mothers who were doing service had highest (16.03) mean knowledge score and least (13.00) who were in business. Mothers who were from nuclear families had highest (15.14) mean knowledge score and least (13.67) who were from joint families.

Mothers who were Christian had highest (17.71) mean knowledge score and least (13.18) who were Hindu. Mothers whose income/month was >20,000 had highest (21.00) mean knowledge score and least (12.66) with income/month ≤5000.

Mothers who were from urban area had highest (14.84) mean knowledge score, and least (12.55) who were from rural area.

Mothers whose source of information was health professionals had highest (15.89) mean knowledge score followed by (14.19) and least (12.10) for family/friends respectively.

As per demographic variables, occupation, type of family had no significant relationship while age of the mother, education, area of residence and source of information had significant relationship with the knowledge of mothers regarding Enteric Fever in children.

Section 3

Objective 3- To find out the deficit areas of knowledge and to prepare information booklet to enhance awareneamong mothers regarding enteric fever.

This depicts the items which are having maximum false responses by the mothers regarding enteric fever in children. Hence, it was concluded that maximum deficit area in knowledge for mothers is item no.11 i.e. danger sign of Enteric Fever and minimum deficit area is for item no.25 i.e take the child with enteric fever to whom.

DISCUSSION:

Objective 1- To assess the knowledge of mothers regarding enteric fever in children.

The findings of the present study depicts that majority of mothers obtained average knowledge score (60%), followed by (27%) below average knowledge score and (13%) of the mothers had good knowledge score respectively. Similar findings were reported by Wang YY (2007)⁴³who found that majority of mothers in low socio economic group participating in the study had low knowledge regarding childhood immunization.

Objective 2- To find out the relationship of knowledge regarding enteric fever with selected variables like age, religion, education, occupation, income, type of family, type of residence, source of information.

According to age, mothers of age group 36-40 years had highest (17.11) mean knowledge score, followed by (14.14) in 31-35 years, (14.00) in 26-30 years and least mean knowledge score (11.71) in 20-25 years respectively. Similar to the findings reported by Kaur P. (2011)⁴⁷ who found that age has impact on knowledge of mothers regarding enteric fever in children.

According to education, mothers who were graduate and above had highest (16.84) mean knowledge score, followed by (14.55) who were 10+2, (14.21) for 10^thand least (11.17) who were illiterate respectively. Education was found to have impact on the knowledge of mothers regarding enteric fever in children. These findings are supported by Ivanovic D (2006)⁴⁸ who found in this study that mother’s knowledge about food and nutrition is directly related to their schooling.

Similar findings given by Mahesh C. Gupta (2012)⁴⁹ who found that maternal knowledge is significantly associated with child’s malnutrition.

CONCLUSION:

Major findings shows that the majority of mothers (60%) obtained average knowledge score, followed by (27%) below average score and (13%) of the mothers had good knowledge score respectively. As per demographic variables, occupation, type of family had no significant relationship while age of the mother, education, area of residence and source of information had significant relationship with the knowledge of mothers regarding Enteric Fever in children.

IMPLICATIONS:

The implications of the present study can be implicated in the area of nursing education, nursing services, nursing administration, nursing research, community health nursing and general education.

Nursing Education:

The findings of this study can be used as an example by the tutor in the classroom for giving importance to health education. Nursing education should prepare nurses with the potential for imparting health information effectively and assist the people in community in developing self care potentials. It should emphasize more on prospective nurses to impart education regarding infectious disease and there prevention.

Nursing Services:

It includes preventive, promotive and rehabilitative services. The findings of this study can be used by the nurses themselves to become more knowledgeable in providing effective information. Nurses play an important role in giving supportive educative care to the people in the hospital especially mothers. They should also participate in giving health education to patients under their care, and properly educate the mothers of children admitted in the hospital and that attending outpatient department.

Nursing Administration:

Nursing has a direct impact on the society and the health of the children. The findings of the study could be used by the nurse administrators to take steps in formulating policies to sensitize people through awareness programmes in the community and hospital settings. Nurse administrators can involve nursing students as change agents to create awareness programmes in the community.

Nursing Research:

The findings of the study can be used to further justify the need for education of the people in the awareness and preventive aspects of the health. The information contained in the study can be a source of data for further researchers.

General education:

There should be nationwide network for health education programme for prevention and control of communicable diseases. So the people become aware of causes, prevention and control of these illnesses. TV, newspaper, health magazines should help in spreading awareness among women regarding hygienic practices and preventive measures for prevention of enteric fever.

LIMITATIONS:

The size of sample was only 100 mothers of children who are having children between 2-18 years of age group; hence it was difficult to make broad generalizations. Purposive sampling was done from a selected hospital Ludhiana which restricts the generalization of the study of particular setting.

RECOMMENDATIONS:

Based on the findings of the study, following recommendations are offered:

1. The study can be replicated on a larger sample to validate and generalize its findings.

2. Similar study can be conducted in different settings.

3. An experimental study can be done to assess knowledge of students and staff nurses regarding prevention of enteric fever.

4. There should be provision of regular health teaching programme for community people on prevention of various communicable and water borne diseases.

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Received on 07.06.2020 Modified on 13.07.2020

Asian J. Nursing Education and Research. 2020; 10(4):413-418.

DOI: 10.5958/2349-2996.2020.00088.9