EFFECTIVENESS OF CHILD TO CHILD PROGRAMME ON LEVEL OF KNOWLEDGE OF SCHOOL GOING CHILDREN REGARDING
PREVENTION OF WORM INFESTATION AT A SELECTED SCHOOL, SALEM
By
Ms. MALARVIZHI. P Reg.No:30099413
A DISSERTATION SUBMITTED TO
THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE
DEGREE OF MASTER OF SCIENCE IN NURSING
(CHILD HEALTH NURSING)
APRIL – 2011
CERTIFICATE
Certified that this is the bonafied work of Ms. MALARVIZHI. P, Final year M.Sc(Nursing) Student of Sri Gokulam College of Nursing, Salem, submitted in partial fulfillment of the requirement for the Degree of Master of Science in Nursing to The TamilNadu Dr.M.G.R.Medical University, Chennai under the Registration No. 30099413.
Colle ge Seal:
Signature: ………..
PROF. A. JAYASUDHA, M.Sc (N)., Ph.D., PRINCIPAL,
SRI GOKULAM COLLEGE OF NURSING,
3/836, PERIYAKALAM,
NEIKKARAPATTI,
SALEM – 10.
EFFECTIVENESS OF CHILD TO CHILD PROGRAMME ON LEVEL OF KNOWLEDGE OF SCHOOL GOING CHILDREN REGARDING
PREVENTION OF WORM INFESTATION AT A SELECTED SCHOOL, SALEM
Approved by the Dissertation Committee on: 20.12.2010
Signature of the Clinical Speciality Guide ……….………...………...
Mrs. A. LATHA, M.Sc (N), Associate.Professor,
Department of Child Health Nursing, Sri Gokulam College of Nursing, Salem.
Signature of the Medical Expert ……….
Dr. R . RAMALINGAM, M.D., DCH., F.A.A.P., Consultant pediatrician,
Sri Gokulam Hospital, Salem.
______________________________ _______________________________
Signature of the Internal Examiner Signature of the External Examiner
with Date with Date
ACKNOWLEDGEMENT
“Gratitude makes of our past, brings peace for today, And creates a vision for tomorrow”
-John Fitzgerald Kennedy
With deep sense of gratitude I thank GOD Almighty, for his blessings in successful completion of the study.
I take this opportunity to thank Dr. K. Arthanari, M.S., Managing Trustee, Sri Gokulam College of Nursing, for all his blessings, encouragement and for giving me a chance to upgrade my education.
It is a great privilege for me to thank Prof. A. Jayasudha, M.Sc (N)., Ph.D., Principal, Sri Gokulam College of Nursing, for her fondle care, patience, encouragement, abiding guidance and constant support given during the entire study.
I express my sincere thanks to Dr. K.Tamizharasi, Ph, D., V ice Principal, Sri Gokulam College of Nursing, for her valuable suggestions and guida nce for my study.
I express my heartfelt thanks to Dr. R. Ramalingam, M.D., DCH, F.A.A.P., Consultant pediatrician, Sri Gokulam Hospital, Salem and Dr. Singaravelan, MBBS, DCH, District Medical Officer, Ullupagudi for their guidance and contribution to the study.
“Wake at dawn with a winged heart and give thanks for another day of loving”. I express my heartfelt thanks to Mrs. A.Latha, M.Sc(N)., Associate Professor, HOD of Child Health Nursing department for her guidance, encouragement, support and valuable suggestion throughout the study.
I glad to express my special thanks to Mrs.S.Kalaiselvi, M.Sc(N), Mrs.K.Kala, M.Sc(N), Mrs.R.Sagunthala, M.Sc (N)., Lecturers, Department of Child Health Nursing for their innovative, constructive and diligent effort to ensure
best quality of the study and their inspiring words will never be forgotten, which helped me to do my study in fruitful manner.
My sincere thanks to our class co-coordinator Prof. P.Lalitha, M.Sc(N)., HOD, Department of Mental Health Nursing, Sri Gokulam College of Nursing, Salem, for her guidance and support and the words of appreciation which made my study successful.
A special note of thanks to All the Faculties of Sri Gokulam College of Nursing who gave timely help and support to complete the study.
I am thankful to Mr.L.Baskar., MILS, Librarian of Sri Gokulam College of Nursing and also special thanks to Librarians of the Tamil Nadu Dr. M.G.R. Medical University for their cooperation to collect literature for this study.
I glad to thank to Dr. Dharmalingam Ph.D., Statistician for his commendable work, support and guidance in statistical analysis and interpretation of the data.
I wish to expr ess my sincere thanks to Mrs. Sakila Banu, M.Com, M.Phil., Wing’s English Academy for editing the dissertation.
I express my special thanks to V. Murugesan, Shri Krishna Computers, and Mr. P.Periyasamy, Golden Computers, Salem for their untiring, innovative, diligent effort for carefully printing my dissertation.
I am very much grateful to Mr.Gunasekar, Headmaster and other teaching
staffs of Panchayat Union Elementary School, Varagambadi, Salem for their co-operation and support.
I would like to express my deepest thanks to all the school going children , Panchayat union elementary school, Varagambadi, Salem, who had participated in the study without them it would have been impossible to complete this study.
I express my heartiest gratitude to my lovable Parents Mr.K.Periyasamy, Mrs.C.Suganthi Jeya Rani, and my sisters Ms.P.Suganya, Ms.P.Saranya for their strong support and encouragement throughout my career.
Last but not least I wish to heart fully acknowledge all My Friends, Collegues and My Classmates Pyrates for their continuous strong support and help throughout this research project who have always been so tolerant and understanding.
TABLE OF CONTENTS
CHAPTER CONTENT PAGE NO
I INTRODUCTION 1-10
? Need for the s tudy 3
? Statement of the problem 5
? Objectives 5
? Operational definitions 5
? Assumptions 6
? Hypotheses 6
? Delimitations 6
? Projected Outcome 7
? Conceptual framework 7
REVIEW OF LITERATURE 11 -23
? Incidence and prevalence of worm infestation 11
? Risk factors of worm infestation 14
? Consequences of worm infestation 15
? Prevention of worm infestation 16 II
? Child to child programme 21
III METHODOLOGY 24 -31
? Research approach 24
? Research design 24
? Population 26
? Description of setting 26
? Sampling 26
? Variables 27
? Description of the tools 27
? Validity and reliability 28
? Pilot study 29
? Method of data collection 30
? Plan for data analysis 31
IV DATA ANALYSIS AND INTERPRETATION 32 -49
V DISCUSSION 50 -53
VI SUMMARY, CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS
54 -58
BIBILOGRAPHY 59 -63
ANNEXURES i-xli
LIST OF TABLES
TABLE NO
TITLE PAGE
NO 3.1 Scoring procedure for level of knowledge 28 4.1 Percentage distribution of samples according to the pretest
level of knowledge of school going children regarding prevention of worm infestation
44
4.2 Comparison of Mean, standard deviation and mean difference of level of knowledge of school going children regarding prevention of worm infestation.
46
4.3 Effectiveness of child to child programme on level of knowledge of school going children regarding prevention of worm infestation.
47
4.4 Association between level of knowledge of school going children regarding prevention of worm infestation and their selected demographic variables.
48
LIST OF FIGURES
FIGURE
NO TITLE PAGE
NO 1.1 Conceptual Frame Work based on J.W.Kenny’s Open
System Model for Child to Child Programme on Level of Knowledge of School Going Children regarding Prevention of Worm Infestation
9
3.1 Schematic Representation of Research Methodology 25 4.1 Distribution of samples according to their age 33 4.2 Distribution of samples according to their sex 34 4.3 Distribution of samples according to their height. 35 4.4 Distribution of samples according to their weight 36 4.5 Distribution of samples according to the educational status of
the father
37
4.6 Distribution of samples according to the occupational status of the father
38
4.7 Distribution of samples according to the educational status of the mother
39
4.8 Distribution of samples according to the occupational status of the mother
40
4.9 Distribution of samples according to sanitary facilities 41 4.10 Distribution of samples according to source of water supply 42 4.11 Distribution of samples according to previous knowledge of
worm infestation
43
4.12 Percentage distribution of samples according to their Pre and post-test level of knowledge of school going children regarding prevention of worm infestation
45
LIST OF ANNEXURE S
ANNEXURE. TITLE PAGE
NO.
A. Letter seeking permission to conduct a research
study i
B. Tool for data collection ii
C. Letter requesting opinion and suggestion of experts
for content validity of the research tool xxxi
D Certificate of validation xxxii
E. List of Experts xxxiii
F. Certificate of editing xxxiv
G. Flash cards xxxv
H. Photos xl
ABSTRACT
A Quantitative evaluative research approach with pre-experimental(one group pre test post test) design study was conducted to evaluate the effectiveness of child to child programme on level of knowledge regarding prevention of worm infestation among 40 school going children selected by simple random sampling technique from Panchayat Union Elementary School, Varagambadi, Salem. The interview schedule was used to assess the level of knowledge analyzed by using descriptive and inferential statistics.
The findings reveals that, majority of the samples 20(50%) were 9 years old, most of the samples 22 (55%) samples were male, all(100%) of the samples were practicing open field defecation and all (100%) of them were not having previous knowledge of worm infestation. In pretest majority of the samples 35(87.5%) of had inadequate knowledge and 5 samples (12.5%) of had moderately adequate knowledge.
The calculated‘t’ value was 26.72 which is highly significant at p < 0.001 level which shows that, the child to child programme was effective. Hence the research hypothesis H1 was retained. There is a significant association between the level of knowledge of school going children and their selected demographic variables such as occupational status of the father and educational status of the mother. Hence the research hypothesis H2 is retained, except age in years, sex, height, weight, educational status of father, occupational status of mother, sanitary facilities, source of water supply and previous knowledge regarding worm infestation where there is no association found.
The study implies that the child to child programme on level of knowledge of school going children regarding prevention of worm infestation is an effective intervention to increase the knowledge.
CHAPTER I INTRODUCTION
“Babies were invented to help adults grow up”
-Robert M A child is individual he or she is not a miniature adult, not a little man or woman. The childhood period is important because of socialization process by the transmission of attitude, customs, and behavior, through the influence of the family and community. Family’s cultural and religious belief, educationa l level and ways of living influence the promotion and maintenance of child health. (Dutta Parul, 2009 )
Children are the major consumers of the health care. In India, about 40 % of total population is school going children. Health status of the children of a nation is a highly reliable index of the health of its population. In the developing country like India the child health care givers are facing a large number of problems. The major health problems include infestations and infections, diarrhea, typhoid, measles, malaria, tuberculosis, whooping cough, respiratory infections and pneumonia.
(Patil. A.V., et.al, 2002)
Worm infestation is an important public health problem. There are different types of worms in the environment like tape worm, round worm, pin worm, and hook worm. The more common infestations are hook worm and round worm in the children. They are estimated that between 576-740 million are infected with hook worm today; about 80 millions are severely affected with hook worm. (Unknown author, Wikipedia, 2010)
Worm infestation is mainly due to ineffective disposal of human excreta, ingestion of contaminated food, fruits, fluids and vegetables, and also improper cooked meat of infected pork or beef, contaminated clothing, open field defecation,
and the social factors like illiteracy, ignorance, poor socio economic condition and low standard of living. It is one of the major causes of childhood malnutrition. It potent iates problems like anemia, stunted physical and mental growth, and psycho- social problems, repeated gastro intestinal and upper respiratory tract infection which causes high morbidity in children and remains a major cause of high infant and childhood mortality rate in our country. (Tambulwadkar, 2005 )
Health education is an important component of the health programmes for school children’s and it promotes physical, intellectual and social development. The Government of India has undertaken several programmes aimed at preventing the worm infestation among school going children. Previously the programmes are related to mother and child which concern the MCH services are directed towards educating and motivating the mothers only. The mother finds difficulty to devote sufficient time towards these educational programmes because of her ever increasing involvement in the activities at home and outside. Recently, the school based programmes (like mobile crèche programme and child to child approach) are necessary to prevent the childhood illnesses such as anemia, diarrhea, dental caries and malnutrition. (The Consultative Group on ECCD, 1999)
David Morley (1978) developed the concept of child to child programme in the Institute of child health, London. Child to child programme is a powerful idea. It rests on the belief that children can have the skill and the motivation to educate and assist to each other and can be trusted and encouraged to do so. This is a radically new view of the potential for education. Such helping and caring activities are called child to child activities. So this programme will change one’s views of the educational processes and systems we have. It helps the child to make learning a relevant meaningful and enjoyable experience for the children. It helps the children to enable
the children to make qualitative improvements in life of their siblings, their parents, and their neighbors. Schools must make fundamental changes in the way children learn. (David Morley, 2009)
Need for the Study
Worm infestation is a significant problem in developing countries. The source of parasitic infestation could be either water or food. The risk factors responsible for worm infestation are poor food hygiene, poor habits, and poor personal hygienic measures. (Park. K, 2007)
Worldwide there are 800-1,000 million cases of ascariasis, 700-900 million cases of trichiuriasis, 200 million cases of giardiasis and 500 million cases of amoebiasis. Among these intestinal parasitic infections, helminthic infestations are the most common in the Indian sub-continent. (WHO, 2008)
In South India majorit y 50% of school children in tribal’s were infected with Ascaris lumbricoides, Trichuris trichuria and hook worm. In western part of Nepal, preschool children were affected with single geohelminthic infestations about 86.7%
and 13.3% of them had mixed infections. (WHO, 2008)
Totally 198 million and 149 million infected individuals in sub-Saharan Africa and East Asia/the Pacific Islands with each region respectively. In South Asia 50 million were affected, and in Latin America and the Caribbean 50 million were affected, in South Asia (59 million), Middle East/North Africa (10 million) were affected. The majority of these infected individuals live in poverty-stricken areas with poor sanitation. (WHO, 2007)
The worm infestation is the second leading cause of mortality among school going children in TamilNadu. The prevalence rate of worm infestation in the whole Tamil Nadu is 6.96%. (Vozhvozhi Tittam, 2000)
Prevention is the key word, but early intervention can improve the outcomes.
The global strategy health for all more towards primary health care which can be possible only by encouraging the community participation and mobilizing the community resources and using appropriate technology for reducing the morbidity and mortality among children. Worm infestation can be prevented by maintenance of personal hygiene, careful hand washing with soap and water after defecation and before meals, consumption of meat with proper cooking and adequate sewage treatment. Health education also plays an important role in passing the health messages. (Nagalakshmi .E, 2008)
Various national health programmes are currently in operation for the improvement of child health and prevention of childhood diseases. Some of the programmes are Reproductive Child Health Program, Integrated Child Development Services Scheme, School Health Programme, Nutritional Program (Mid Day Meal Program, Special Nutrition Program), MCH Services and Child to Child Approach.
(Dutta Parul , 2009)
Child to child programme is one of the approaches in health education. The concept of this programme that children in schools and family members need to be considered as partners in spreading health messages as well as benefiting them.
Imparting health information during childhood remains longer in their life offspring.
For communicating health information, one has to adopt an appropriate strategy.
(Chitra.R, 2009)
In the light of above facts and from the experience of the investigator during the community posting, the investigator decided that, it is essential to assess the knowledge of school going children regarding prevention of worm infestation and to improve their knowledge and practices through child to child programme.
Statement of the Problem
“ A Study to Evaluate the Effectiveness of Child to Child Programme on Level of Knowledge of School Going Children Regarding Prevention of Worm Infestation at a Selected School, Salem ”.
Objectives of the Study
1. To assess the existing level of knowledge of school going children regarding prevention of worm infestation.
2. To evaluate the effectiveness of child to child programme on level of knowledge of school going children regarding prevention of worm infestation.
3. To associate the level of knowledge of school going children regarding prevention of worm infestation with their selected demographic variables.
Operational Definitions 1. Effectiveness
Gain in the level of knowledge of school going children regarding prevention of worm infestation as determined by significant difference in pre test and post test knowledge scores.
2. Child to child programme
The planned set of activities, implemented in a sequence by change agents (5th standard students) to spread the knowledge regarding the prevention of worm infestation to the recipients (3rd and 4th standard students).
3. Knowledge
The correct responses given by the school going children to the knowledge items regarding prevention of worm infestation.
4. Prevention of worm infestation
The measures to prevent the occurrence of worm infestation or invasion of worms in the body.
5. School going children
In this study school going children are the children between the age of 8-10 years.
Assumptions
? Child to child programme may provide valuable information regarding prevention of worm infestation.
? Child to child programme may increase the interpersonal relationship and play way learning.
? Level of knowledge will vary from individual to individual.
Hypotheses
H1: There will be a significant difference in the level of knowledge of school going children regarding prevention of worm infestation after child to child programme at p < 0. 05 level.
H2: There will be a significant association between the level of knowledge of school going children regarding prevention of worm infestation and their selected demographic variables at p < 0.05 level.
Delimitations
1. The study was limited only to school going children (8-10years) 2. The sample size was limited only to 40 samples.
3. The study period was limited only to 4 weeks.
Projected Outcome
This study was conducted to evaluate the effectiveness of child to child programme on level of knowledge of school going children regarding prevention of worm infestation. Findings of the study will help to improve the knowledge of children and improve their practices through child to child programme.
Conce ptual Framework
Conceptual framework is a type of intermediate theory that has the potential to connect all aspects of enquiry. They take different forms depending upon the research question of problem.
The present study is based on the concept of J.W. Kenny’s open system model. According to J.W. Kenny all living system are open. They are in continuous exchange of matter, energy and information, which results in varying degree of interaction with the environment from which the system receives input and gives output in the form of matter, energy and information.
Input:
Input can be matter, energy and information from the environment. In the present study the environment refers to school setup and input refers to the collection of demographic data from samples and assessing the level of knowledge on prevention of worm infestation by using structured interview schedule.
Throughput
The matter, energy and information are continuously processed through the system which is also called complex transformation, known as throughput process is used of input (i.e.) energy and information for the maintenance of homeostasis of system. It refers to the different operational products in the overall programme implementation and includes factors that facilitate/ block implementa tion at various
stages. In the present study the throughput refers to pre test, education to the change agents , child to child programme to the recipients and post test.
Output
After processing the input and throughput, the system returns to the output matter, energy and information to the environment in an altered state. Change is a feature of the process that is observable and measurable as output which should be different from that which is entered into the system. In the present study gain in level of knowledge regarding prevention of worm infestation is considered as output.
Feedback
Feedback gives information of environmental responses to the system; output is utilized by the system in adjustment, correction and accommodation to the interaction with the environment. In the present study, effectiveness of child to child programme is considered as difference in mean percentage and testing hypotheses.
DEMOGRAPHIC VARIABLES
? Age
? Sex
? Height
? weight
? Educational status of the father
? Occupational status of the father
? Educational status of the mother
? Occupational status of the mother
? Sanitary facilities
? Source of water supply,
? Previous knowledge regarding worm infestation
? Flash cards on prevention of worm infestation
? Definition
? Causes
? Mode of transmission
? Types
? Signs and symptoms
? Treatment
? prevention
? Structured interview schedule
? Pre test
? Teaching the recipients
? Child to child programme
? Post test
Feed back
? Difference in mean percentage (Y-X=E)
? Testing hypotheses
FIGURE- 1.1: CONCEPTUAL FRAMEWORK BASED ON J.W.KENNY’S OPEN SYSTEM MODEL FOR CHILD TO CHILD PROGRAMME ON LEVEL OF KNOWLEDGE OF SCHOOL GOING CHILDREN REGARDING PREVENTION OF WORM INFESTATION
Post test Knowledge score
Adequate
Moderately adequate
Inadequate
INPUT THROUGHPUT OUTPUT
Y: Post-test; X: Pre-test; E: Effectiveness
Summary
This chapter dealt with introduction, need for the study, statement of the problem, objectives, operational definitions, assumptions, delimitations, projected outcome and conceptual framework.
CHAPTER II
REVIEW OF LITERATURE
This chapter presents review of related literature relevant to the present study.
Review of literature is an important step in the development of the research project, and in broadening and understanding and developing an insight into the problem area.
It further helps in the problem fits, methodology instruction of tool, development of evaluative approach and analysis of data.
Related literature were reviewed and organized under the following headings.
Literature related to,
? Incidence and prevalence of worm infestation
? Risk factors of worm infestation
? Consequences of worm infestation
? Prevention of worm infestation
? Child to child programme
Literature related to Incidence and Prevalence of Worm Infestation
Albonico., et.al., (2008) conducted a study on controlling soil transmitted helminthiasis in preschool children through preventive chemotherapy in Italy, detected preschool age children accounts for 10-20% of parasitic infestation. The study recommended that pre-school children should be included in regular deworming programme.
Hopkins D R., et al. (2008) conducted a study and reported that the status of the global dranculiasis eradication programme as of early 2008. By the end of 2007, dranculiasis guinea worm disease transmission had been eliminated from 15 of the 20 countries. There were 9,585 cases reported globally and there was 2,016 villages still
had indigenous cases of the disease. Nigeria and Niger reported more than 100 cases are affected with worm infestation in 2007. Though they have implementing programme , there will be increasing incidence of parasitic infestation was presented.
Knopps et.al., (2007) conducted study among school going children in Unguja Island, Zanzibai. 3 serial stool samples from each of 342 school children were examined using the kato- katz (K-K), koga agar plate (KAP) and baurmann (BM) techniques. It was estimated that the prevalence of T.Trichiura, hook worm, A.Lumbricoides and S.Stercoralis were 47.9%, 22.5% , 16.5% and 10.8% respectively.
Luong TV., (2007) consultant of water environment and sanitation, UNICEF East Asia and Pacific Regional Office, Bangkok, Thailand conducted a study on incidence rate among the children. They reported that globally over 3.5 billion people are infected with intestinal worms of which 1.47 billion are with round worm, 1.3 billion people with hook worm and 1.05 billion are pin worm. Children below 5 years of age suffer the highest infection rate and worm burden that attributes to poor sanitation and hygiene. About 400 million children are infected with round worm, whipworm and hook worm worldwide a large population of who are found in the East Asia region.
Ram. R, et.al., (2007) conducted a cross-sectional study carried out among 370 school-going children of the Nepali community, aged 5-10 years, in the Siliguri subdivision of Darjeeling district revealed the prevalence of parasitic infestation to be 51.4 per cent of which 28.2% and 23.2% had single and multiple parasitism respectively, A. lumbricoides was the commonest infestation (31.73%) in single parasitism and both A. lumbricoides and T. Trichiura was found to be the most prevalent (36.05%) in multiple parasitism. There was a significant association found
in the decreasing of worm infestation rate among children with the increasing mothers educational status.
Warunee N., et.al., (2007) conducted a study on intestinal parasitic infections among 1920 school children in Thailand. The purpose of the study was to determine the prevalence of intestinal parasites in children. Stool samples were collected and examined for intestinal parasites by using formalin -ethyl acetate concentration technique. Of these subjects 12.6% were infected with one or more of 10 intestinal parasitic species. Among these infected subjects, 11.1% of them had single infections whereas (1.5%) of them had mixed infections. The commonest parasite was Blastocystis hominis (6.2%). Some of Other parasites were Giardia lamblia (1.7%), Entamoeba coli (1.5%), Hookworm (0.3%), Trichuris trichiura (< 0.1%), Taenia spp.
(< 0.1%), Strongyloides stercolaris (< 0.1%), and liver fluke or small intestinal fluke (Opisthorchis eggs) (< 0.1%). They suggested that the preventive programme and control programme for intestinal parasitic infestation to be discussed for long term use in this area.
Bora D., et.al., (2003) conducted a study to compare and correlate findings of a soil transmitted helminthiasis survey carried out using two sampling methodology for mothers of under five children and community survey by random sampling. 642 stool samples of under five age group of children were examined.
Overall soil transmitted helminthiasis prevalence in the under five children was found to be 32.4%.
Chandrasekar MR., (2003) investigated a study of fecal samples from 1000 children below 6 years of age, among them 680 were detected to have intestinal helminthic infestation. The incidence of helminthiasis in urban group of children was 56.8% and in rural group of children was 79.2%. Both in rural and urban population
Ascaris Lumbricoides were predominant. All cultures of samples were positive for hook worm infestation.
Literature related to Risk Factors of Worm Infestation
Curtale, F., et.al., (2005) conducted an operational research in Egypt.
Qualitative and quantitative techniques were used to question the mothers about their knowledge and perception of intestinal helminthiasis their hygienic habits and health seeking behaviors. Almost all respondents considered worms harmful and were aware of the need for treatment. There was an adequate knowledge was present about the ways to prevent infection.
Vinod Kumar. C.S., Sunitha. V., (2003) carried out studies in various part of India and reported a prevalence of intestinal parasitism up to 30-50% among school children. They stated factors responsible for increased prevalence in developing countries which include unhygienic conditions and habits, improper disposal of excreta and poor quality of drinking water. They also emphasized that incidence and prevalence of worm infestation can be prevented by modifying the factors through awareness.
Charanjit Singh, et.al., (2002 -2003) conducted a prospective study to identify the factors associated with intestinal parasitosis in 274 school children in Kashmir. The result shows that 214(46.7%) students had stool tests positive for parasitosis and also there was higher prevalence of parasit osis among rural orphanage compared to urban orphanage children 76% and 48% at p < 0.05 respectively. The factors like poor environmental sanitation, personal hygiene, type of toilet and water have association for recurrent intestinal infestation. Regular deworming programmes are needed to be adopted at the school level especially in 8-11 years old children. To check the intestinal parasites and their subsequent morbidities.
Albright. JW., Hidayate. WR., Basaria Keys J., (2002) conducted a study to identif y physical, hygienic and behavioral characteristics of the children that increase the likelihood of becoming infected in Indonesia. The results of this study suggest that systematic and sustained effects to teach children to avoid infections and practice personal hygiene are the best approaches and significant and ensuring reduction of the courage of intestinal parasitism.
Farook M U., et.al., (2002) conducted a study on environmental factors in relation to helminthic infestation among tribal population of Kottor concluded that the place of hand wash alone was found statistically significant, showing that habit of proper hand wash considerably reduces the risk of helminthic infestation.
Literature related to Consequences o f Worm Infestation
Sousa-Figueire do JC., et.al., (2008) conducted a study on a parasitological survey, in rural Zanzibar, among 152 pre-school children and 113 of their mothers were assessed for urinary schistosomiasis, soil-transmitted helminthiases and malaria, with observations on incidence of anemia. Urinary schistosomiasis was rare among pre-school children because they have no contact with environmental water. In contrast, the prevalence of infection with at least one type of soil-transmitted helminthes and of anemia were high among those pre-school children, at 50.0% and 73.4% respectively; the corresponding values in the mothers of the children were 35.2% and 25.9%. In the rural study area, household aggregations of STH were common.
Chakma T, Rao PV, Tiwary RS., (2000) conducted a study to assess the Prevalence of anemia and worm infestation among 6-14 years of school going children in Madhya Pradesh. A total of 776 school going children were taken for the
study of which blood samples of all and stool samples of 409 were collected. Their hemoglobin was measured and stool samples were examined under microscope for ova and cysts. The results revealed that 30.3% of the children had severe anemia (Hb < 7g/dl) and 50% children had intestinal para sites. The most common parasitic infesta tion was hookworm (16.3%) and A. lumbricoides (18.5%) respectively.
Though hookworm ova loads indicated mild to moderate infestation in most of the children, the continued presence of worms in marginally nourished children could contribute significantly to blood loss in the intestine with resultant anemia .
Literate related to Prevention of Worm Infestation
Hazarika.P., and Pandry B.K. (2010) conducted a study on traditional phyto- remedies for worm infestation of two important tribal communities of Assam, India. This study was carried out in 4 village’s inhabitated by 2 tribal groups, to acquire the knowledge of the local use of plant resources to prevent and cure intestinal worm infestation. The result shows that, they are using 43 medicinal plant species in their locality that are traditionally used for the prevention and cure of worm infestation. The method they used for the preparation and doses of those medicines administered were given as per the prescription by the Traditional Medicine Practitioners (TMP) of the 2 communities.
Massa K., (2009) conducted a study to evaluate the combined effect of the lymphatic filariasis elimination programme and the schistosomiasis and soil- transmitted helminthiasis control programme among 228 primary schoolchildren in Tanzania. Mass Drug Administration (MDA) with Ivermectin and Albendazole were given. The results shows that, the prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm had decreased from 0.9 to 0.7% (P=0.84), from 4.8 to 0.7%
(P=0.004) and from 45.6 to 11.9% (P<0.001), respectively. Overall, 81.2% of the school children were treated by Lymphatic Filariasis Elimination Programme.
Stothard JR., et.al., (2009) conducted a study on the epidemiology and control of urinary schistosomiasis and soil-transmitted helminthiasis in140, 000 schoolchildren on Unguja Island, Zanzibar. The purpose of the study was to provide information on the impact of this intervention. They were treated annually with a combination of praziquantel and albendazole. Overall, prevalence of urinary schistosomiasis fell by 52%, intensity by 55%. There was a significant reductions were documented in the prevalence of both Trichuris trichiura and hookworm.
Kabatereine N.B., et.al, (2007) conducted a study on impact of a national helminth control programme on infection and morbidity in Uganda . The purpose of the study was aimed to assess the health impact of a national control programme targeting schistosomiasis and intestinal nematodes, which have provided population, based anthelminthic chemotherapy. A total of 1871 schoolchildren were taken for the study. The chemotherapy was given before and after one year and two years of annual mass chemotherapy. The effect of intervention on S. mansoni prevalence and intensity was equal to that predicted by mathematical models of the impact of chemotherapy on human schistosomiasis. Improvements in hemoglobin concentration were greatest among children who were anemic or harboring heavy S. mansoni infection at baseline. As a part of a national helminthes control programme anthelminthic treatment were provided to decrease infection and morbidity among schoolchildren and improve their hemoglobin concentration.
Phommasack B., et.al, (2007) conducted a study on coverage and costs of a school deworming programme in targeting all primary schools in Lao PDR. The school deworming campaign in Lao PDR reached school children in a national
coverage rate of 95% at a cost of US$0.124/head for two rounds of deworming per year. The programme was taken under by the umbrella of the national school health programme. After 1 year (two rounds of deworming) the intervention reduced the prevalence of Ascaris lumbricoides from 60% to 20% and of Trichuris trichiura from 42% to 31%. Although infection was not eliminated by the deworming interventions, over 90% of those children who remain infected had a 'light' infection. The absence of high and moderate intensity of infection demonstrates the effectiveness of periodical deworming in reducing morbidity due to STHs and also they had suggested that additional rounds of deworming will reduce the STH prevalence in Lao PDR.
Ulukanligil M., (2007) conducted a study on School-based deworming programme in Sanliurfa, Turkey, changing from externally funding phase to self- sufficient phase. A total of 200,000 doses of mebendazole were distributed to school children, and examined them using the Kato-Katz technique. The results showed that 85.2% of them had benefited from the extended anthelminthic coverage. A total of 67.4% of them received the drugs from schools and 10.9% received from health centres. The prevalence of helminthic infection had declined from 77 to 35% in Shanty town school children and from 53 to 6.4% in apartment schoolchildren. The prevalence of Ascaris lumbricoides and Trichuris trichiura decreased from 63.2 to 17% and from 16.8 to 1.1%, respectively, in schoolchildren. The results also indicated that 53.5% of the schoolchildren changed over to clean habits and began to use soap after using the toilet. The cost of treatment was $0.05 for each child. $11 000 was sufficient to implement the total broad-range programme includes education of children regarding cleanliness and treatment of infection to improve their health.
Poudyal A.K., et.al, (2006) conducted a study on targeting newly enrolled low-age school children for the control of the intestinal helminthic infestation in rural
Nepal. Totally 1677 stool samples of school-age children from 25 schools were examined. The results revealed that the newly enrolled under-6-year-old children at the schools were more widely infected with at least one of the three major helminthes than those in the communities and also detected a significant difference in the prevalence of A. lumbricoides (1.70), hookworm (2.57) and T.trichiura (3.23) between under-6-year-old children at the schools and those at the communities. The study results suggeste d that an appropriate deworming programme is needed for the newly enrolled under-6-year-old children in the primary schools in Nepal.
Suzuki C., et.al., (2005) conducted a study on effects of a school based education programme for schistomiasis control. The purpose of the study was to investigate the effect, particularly a school education programme for schistomiasis control with 299 primary school children. The results indicated a considerable effect of the programme in all aspects except for practice.
Magnussen., et.al ., (2003) conducted a school based approach to the control of intestinal helminthic infestations by Chemotherapy based control programme among 12,000 children in Kenya. More than 80% of the school children were infected with one or more intestinal helminthes at ba seline. The result shows that mass chemotherapy reduced prevalence of ascaris infection from 18% to 3%. In the second year of programme albendazole 600mg was administered to the children once every 6 months. This results shows that there was decreasing infection rate from 52% to 23%
respectively after 2 years.
Nithikathkul.C., et.al., (2003) conducted a study on impact of health educational programmes on the prevalence of enterobiasis in 777 school children in Thailand. Medical treatments were applied for 5 of 11 school children, followed by a programme of educating the children in the prevention of infection. Further six sc hool
children were received medical treatment only. The study results show that there was decreasing infections among children who had received supplementary education.
This decrease shows a significant in comparison to the decrease shown among children who received medical treatment only. They concluded that, educating high risk individuals plays a key role in the prevention of enterobiasis.
Taylor.M., Coovadia.H.M., Kvalvig J.D., Jinabhai C.C., (2003) conducted a study regarding helminthic control as an entry point for health promotion among people of Kwazulu. Natal predisposing factors are found as the unawareness of respondents, they were unfamiliar with symptoms, but did not know cause or mode of transmission of helminthic infection. Many respondents perceived food to be the cause of helminthic infection and swimming in the river to be the cause of infection.
Parents and pupils unanimously supported health education and 655 (89.8%) questionnaire respondents say that they wished to learn how to avoid helminthic infection.
Aswathi.S and Pande.V.K., (2001) conducted a study to assess the effectiveness of six monthly de worming in infants for improving the height and weight in urban slums of Lucknow. Control children received 2 ml of Vitamin A every 6 months, whereas those in the ABZ areas received in addition 400 mg of Albendazole suspension every 6 months. The results showed that there was an improvement in weight and height (95% ).
Jarallah J S., et.al., (2001) conducted a control programme for intestinal helminthes in Saudi Arabia was started. A training programme was extended to personnel in primary health care centers. The results of this programme shows significant reduction of intestinal helminthic infection from 13.2 % to 0.17 % .
Literature related to Child to Child Programme
Anantaphruti. MT., et.al., (2008) conducted a study on school based health education for the control of soil- transmitted helminthiases, Thailand among 4 primary schools. This health education programme was given to various grades of children. The result shows that the health education had a greater impact on the children in the higher grades than on the younger children. The younger children were getting education from their higher grades children.
Mishra.G., (2006) stated that Child to child programme is based on the concept that the children in schools and family members need to be considered as a partners in spreading the health information as well as benefits.
Aarons. A and Haves, (2005) stated that the older children learn how to help and care for the younger children. Such helping and caring activities are called as child to child activities. The objectives were,
? To improve the levels of health, nutrition and development of children through child to child activities
? To make learning a relevant, meaningful and enjoyable experience for children.
? To enable the children to make qualitative improvements in life of their younger sisters, brothers.
? To improve the school and neighborhood environment through organized activities.
? To help the children feel a sense of being in control of their lives.
Naghma Igbal., (2004) conducted a study on helping the families using child to child approach and reported that common problems such as poor dental hygiene
and dental caries as well as unsafe home environment were minimized by child to child programme.
Divya Lata., (2003) stated about two main goals includes, to help children become knowledgeable and competent concerning health and hygiene, through the activity based learning and that can be applied to their day today activities and to help the children become agents in the local environment (e.g. Through sanitation of tree planting programme), with other children (e.g. by using the positive health practices in their sibling care), with their families and in their communities (eg. Through the role plays, active participation in immunization campaigns etc.,)
Freeman R., Buting G., (2003) conducted a study to assess effectiveness of child to child approach to promote healthier snacking in 482 primary school children in Northern Ireland. The older children were given the snacks facts programme and become teachers in the child to child intervention. It was concluded that the child to child approach provided an avenue by which children improved their dental health knowledge and modified their snacking habits during break time at schools.
Lang down R., Led ward A., Mall, et.al, (2002) conducted a study of achieving behavior change through health education about helminthic infestation in 232 primary school children in Tanzania. When randomly selected group of children were compared with a comparison group there was an evidence of changes in both knowledge and health seeking behavior. The result shows that the passing of message from children to the communities was very effective.
Deepti Agarwal., (2001) conducted a study to create better schools for extraordinary students in which she noted that, peer group plays an important role in child socialization. Acceptance by peers can help a child to become well adjusted to
the school environment. Classmates usually help each other to resolve big and small problems.
Patrica Pridome , (2000) noted that the child to child work based on the belief that children, a large proportion of the world’s citizens can play a positive role in raising the health of the others and in so doing, improve their own knowledge and self belief and develop attitudes of caring responsibility for others.
Summary
This chapter dealt with review of literature related to Incidence and prevalence of worm infestation, risk factors of worm infestation, consequences of worm infestation, prevention of worm infestation and child to child programme.
CHAPTER III METHODOLOGY
The methodology of research indicates the general pattern of organizing the procedure for the gathering valid and reliable data for the purpose of investigation.
(Polit, D.F, and Hungler, 2003)
The present study aims to evaluate the effectiveness of child to child programme on level of knowledge of school going children regarding prevention of worm infestation at a selected school, Salem.
Research Approach
Quantitative evaluative research approach was used in this study.
Research Design
Research design is a master plan specifying the methods and procedures for collecting and analyzing the needed information. (Ram Ahuja, 2001)
Pre experimental (one group pre test – post test) research design was adopted for this study.
E O1 X O2
E: Experimental group O1: Pre-test
X: Intervention (Child to Child programme) O2: Post test
Fig –3. 1 : Schematic Representation of Research Methodology
Population
School going Children (8 -10 years of age) in selected school
Sampling
Sampling technique - Simple random sampling technique Sample size - 40
Pre -test on level of knowledge regarding prevention of worm infestation by structured interview schedule
Intervention Child to child programme
Post test on level of knowledge regarding prevention of worm infestation by structured interview schedule
Analysis and interpretation Descriptive and inferential statistics
Setting
Panchayat Union Elementary School, Varagambadi, Salem.
Research approach
Quantitative evaluative research approach Research design
Pre experimental (one group pretest, post test) design
Population
Population is the entire aggregation of cases in which a researcher is interested. (Polit and Beck, 2004)
The population of this study was school going children aged 8-10 years. There were 62 children studying in 3rd and 4th standard.
Description of the Setting
Setting is the general location and condition in which data collection takes place for the study. (Polit, F.D, and Hungler. 2003)
The study was conducted in Panchayat Union Elementary School, Varagambadi, Salem. It is 20 km away from Sri Gokulam College of Nursing, Salem.
Sampling
Sampling is the process of selecting a portion of the population to represent the entire population. (Polit and Beck, 2004 )
Sample
The sample of the study was those who are studying in Panchayat Union Elementary School, Varagambadi, Salem.
Sample size
The sample size was 40 from Panchayat Union Elementary School, Varagambadi, Salem.
Sampling technique
Simple random sampling technique (Lottery method) was adopted for sele cting the samples for the study.
Criteria for Sample Selection
Inclusion criteria for change agents
? The children those who are 10 years of age.
? The children those who are studying in 5th standard.
? The children those who can understand Tamil.
Exclusion criteria for change agents
? The children those who are not present at the time of data collection.
? The children those who are not willing to participate in the study.
Inclusion criteria for recipients
? Samples those who are 8-9 years of age.
? Samples those who are studying in 3rd & 4th standard.
? Samples those who can understand Tamil.
Exclusion criteria for recipients
? Samples those who are not present at the time of data collection.
? Samples those who are not willing to participate in the study.
Variables
Independent variable: Child to child programme
Dependent variable : Knowledge of school going children regarding prevention of worm infestation.
Description of the tool
It consists of following sections.
Section-A
It consists of demographic variables such as age, sex, height, weight, educational status of the father, occupational status of the father, educational status of the mother,
occupational status of the mother, sanitary facilities, source of water supply and previous knowledge regarding worm infestation.
Section-B
It consists of knowledge items regarding prevention of worm infestation. It also had subsection such as,
? General information of worm infestation
? Prevention of worm infestation Scoring procedure for level of knowledge
Totally there were 21 items in which general information of worm infestation had 10 items and prevention of worm infestation had 11 items. Each items had four options of which one is the correct response. All the correct answers were given the score of one and the wrong answers were given the score of zero. The total score was 21. The total score for each sample was calculated, converted into percentages and interpreted as follows,
Table -3.1: Scoring Procedure of level of knowledge
Level of knowledge Score Percentage
Inadequate knowledge 1-7 < 50%
Moderately adequate knowledge 8-14 50-75%
Adequate knowledge 15-21 >75%
Validity and Reliability Validity
Validity refers to the degree to which an instrument measures what is supposed to be measured (Polit and Hungler, 1998).
The structured interview schedule constructed by the investigator was sent along with statement of the problem, objectives and hypothesis to 9 experts in the
field of Medicine and Nursing (2 pediatricians, 4 Child Health Nursing Specialists, 3 Community Health Nursing Specialists, 1 statistician, and 2 language experts) for validating the tool. Minor modifications were given regarding demographic variables to include self employee in occupa tiona l status of the father , and exclude family income. The tool was translated to Tamil with the help of language experts.
Retranslation of the tool was done to establish language validity.
Reliability
Reliability refers to the degree of consistency or de pendability with which an instrument measures an attribute. (Polit and Hungler, 1998).
Reliability of the tool was established by introducing the tool to 4 samples.
The reliability was established by tes t-retest method and was found r1=0.94, which showed t hat the tool was reliable.
Pilot Study
The pilot study was conducted over a period of one week from 07.06.2010 to 13.06.2010 in Panchayat Union Elementary School, Poolavari, Salem. Validity and reliability of the tool were tested during this time. The investigator selected 4 samples from 3rd and 4th standard students through simple random sampling technique. The data were collected through structured interview schedule. The tools were administered and checked for its feasibility, language and appropriateness. The sample chosen were similar in characteristic to those of the population under the study. The average time taken to conduct interview schedule was 20 minutes and it was found that the items were clear and understandable by the samples. The time taken for teaching was 25 minutes. Based on the pilot study necessary corrections made in the tool. The tool was found feasible, practicable. It also helped to select suitable statistical method.
Method of Data Collection Ethical consideration
The permission was obtained from Assistant Elementary Educational Officer, Ayothiyapattanam, Salem to conduct the study. The study was conducted in Panchayat Union Elementary School, Varagambadi, Salem. The investigator visited the school and got permission from Headmaster and selected the samples who are meeting the inclusion criteria. The oral consent was obtained from the samples to participate in this study.
Period of data collection
The data collection was done over a period of 4 weeks from 05.07.2010 to 31.07.2010.
Data collection procedure:
The investigator selected 40 samples from 3rd and 4th standard students through simple random sampling technique. Good rapport was maintained with the children. The pre test was conducted with the help of structured interview schedule to assess the level of knowledge of school going children regarding prevention of worm infestation which took about 15 minutes.
Then the change agents were selected from 5th standard students through simple random sampling technique. The education was given to the change agents by the investigator regarding prevention of worm infestation by using the flash cards.
The time taken for teaching was 30 minutes. Then the change agents were asked to teach to the recipients by using flash cards with the supervision of the investigator.
Each day 5 child to child programme was conducted by the change agents to their assigned students. The time taken to conduct one child to child programme was 20 minutes. The post test was conducted on 7th day after pretest.
Plan for Data Analysis
Data will be collected, arranged and tabulated. Frequency and percentage distribution will be used for demographic variables. Paired‘t’ test will be used to evaluate the effectiveness of child to child programme. Chi-square test will be used to associate the level of knowledge of school going children and their selected demographic variables.
Summary
This chapter dealt with the methodology adopted for this study. It includes the research approach, research design, population, description of the setting, sampling (sample, sample size, sampling technique and criteria for sample selection), variables, description of tool, validity, reliability, pilot study, method of data collection, and plan for data analysis .
CHAPTER IV
DATA AN ALYSIS AND INTERPRETATION
Analysis is the process of organizing and synthesizing in such a way that question can be answered and hypothesis tested. (Polit & Hungler, 2003)
This chapter deals with analysis and interpretation of data collected to evaluate the effectiveness of child to child programme on level of knowledge of school going children regarding prevention of worm infestation, Salem.
The findings are presented under the following sections
Section-A: Distribution of samples according to their demographic variables.
Section-B: Level of knowledge of school going children regarding prevention of worm infestation.
Section-C: a) Comparison of pre and posttest on level of knowledge of school going children regarding prevention of worm infestation.
b) Comparison of mean, SD, mean difference on level of knowledge of school going children regarding prevention of worm infestation
Section-D: Hypotheses Testing
a) Effectiveness of child to child programme on level of knowledge of school going children regarding prevention of worm infestation.
b) Association between the level of knowledge of school going children regarding prevention of worm infestation and their selected demographic variables.
Section-A
Distribution of samples according to their demographic variables
45%
5%
50%
8 years 9 years 10 years
Fig-4.1 : Distribution of sample s according to their age
The above figure on distribution of samples according to their age shows that, majority of the samples 20(50%) were in the age group of 9 years, 2 samples (5%) were in the age group of 10 years and nearly half of samples 18 (45% ) were in the age group of 8 years.
55%
45%
Male Female
Fig-4.2. Distribution of samples according to their sex
The above figure on distribution of samples according to their sex depicts that, majority of the samples 22(55%) were males, when compared to females who were 45%.
60%
40%
100-120 cm 121-140 cm
Fig-4 .3 : Distribution of samples according to their height
The above figure on distribution of samples according to their height depicts that, majority of them 24(60%) had the height of 100-120cm and 16 samples (40%) had the height of 120-140 cm. This shows that the growth standard differs from each age group.
70%
30%
10-20 Kg 21-30 Kg
Fig-4.4: Distribution of samples according to their weight
The above figure on distribution of samples according to their weight depicts that, majority of them 28(70%) had 10-20 kg of body weight and 12 samples (30%) had 21-30 kg of weight.
15%
52.5%
25%
7.5%
0 10 20 30 40 50 60 70 80 90 100
Percentage
Illiterate Primary School Secondary School Higher Secondary EDUCATIONAL STATUS OF THE FATHER
Illiterate Primary School Secondary School Higher Secondary
The above figure on distribution of samples according to the educational status of the father shows that, 21 samples father (52.5%) had primary school education. 6 samples father (1.5% ) were illiterate. This may be due to literacy rate of rural community.
Fig-4.5 : Distribution of samples according to the educational status of the father
FATHER'S OCCUPATIONAL STATUS 82.5%
2.5%
10%
5%
0 10 20 30 40 50 60 70 80 90 100
Unemployed Coolie worker Private Employee Self Employee
Percentage
Unemployed Coolie worker Private Employee Self Employee
Fig: 4 .6. Distribution of sample s according to the occupational status of the father
The above figure on distribution of samples according to the occupational status of the father shows that, the majority of samples father 33(82.5%) were coolie workers, only few of samples father 1(2.5%) were private employee. The educational status of the father determines their occupation.
EDUCATIONAL STATUS OF THE MOTHER 37.5%
37.5%
20%
5%
0 10 20 30 40 50 60 70 80 90 100
Illiterate Primary school Secondary school Higher secondary
Percentage
Illiterate Primary school Secondary school Higher secondary
Fig: 4.7. Distributio n of sample s according to the educational status of the mother
The above figure on distribution of samples according to the educationa l status of the mother reveals that, 15 samples mother (37.5%) had primary and secondary school education.
20%
80%
House wifes Coolie workers
Fig: 4 .8. Distribution of sample s according to the occupational status of the mother
The above figure on distribution of samples according to the occupational status of the mother reveals that, majority of t he samples mother 32(80%) were coolie workers and 8 samples mother (20%) were housewives.
100%
Fig: 4.9. Distribution of sample s according to sanitary facilities
The above figure on distribution of samples according to sanitary facilities depicts that, all (100%) of them were practicing open field defecation.
32.5%
45%
22.5%
0 10 20 30 40 50 60 70 80 90 100
Percentage
Municipality Borewell Well
SOURCE OF WATER SUPPLY
Municipality Borewell Well
Fig : 4 . 10. Distribution of sample s according to source of water supply
The above figure on distribution of samples accor ding to source of water supply shows that, nearly fifty percentage of the samples 18(45%) were getting water from bore well, whereas 9 samples (22.25%) were getting water from well.
100%
Fig : 4 . 11. Distribution of sample s according to previous knowledge of worm infestation
The above figure on distribution of samples according to previous knowledge of worm infestation shows that, all (100%) of them have not received information regarding worm infestation.
Section-B
Level of knowledge of school going children regarding prevention of worm infestation.
Table -4.1:
Percentage distribution of samples according to the pretest level of knowledge of school going children regarding prevention of worm infestation
n=40 Pre test
Level of knowledge
Frequency (f) Percentage (%)
Inadequate knowledge - -
Moderately adequate knowledge 5 12.5
Inadequate knowledge 35 87.5
The above table shows that, distribution of samples according to the level of knowledge regarding preventio n of worm infestation, majority of samples 35(87.5% ) had inadequate knowledge and 9 samples (12.5%) had moderately adequate knowledge and none of them had adequate knowledge. This reveals that samples needs information regarding prevention of worm infestation.
