EFFECTIVENESS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE ON FEBRILE SEIZURE AMONG THE MOTHERS OF CHILDREN ATTENDING PRIMARY HEALTH CENTRE, PODANUR.
Mrs. A.S.ARUN SUBINI
Reg. No: 301818401
A Dissertation Submitted to
The Tamil Nadu Dr. M.G.R. Medical University, Chennai - 32.
In Partial Fulfillment of the Requirement for the Award of the Degree of
MASTER OF SCIENCE IN NURSING BRANCH-II
PAEDIATRIC NURSING
2020
EFFECTIVENESS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE ON FEBRILE SEIZURE AMONG THE MOTHERS OF CHILDREN ATTENDING PRIMARY HEALTH CENTRE, PODANUR.
Mrs. A.S.ARUN SUBINI
Reg. No: 301818401
A Dissertation Submitted to
The Tamil Nadu Dr. M.G.R. Medical University, Chennai – 32.
In Partial Fulfillment of the Requirement for the Award of the Degree of
MASTER OF SCIENCE IN NURSING BRANCH-II
PAEDIATRIC NURSING
2020
EFFECTIVENESS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE ON FEBRILE SEIZURE AMONG THE MOTHERS OF CHILDREN ATTENDING PRIMARY HEALTH CENTRE, PODANUR.
BY
Mrs. A.S.ARUN SUBINI Reg. No : 301818401
A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE
DEGREE OF
MASTER OF SCIENCE IN NURSING BRANCH-II
PAEDIATRIC NURSING 2020
INTERNAL EXAMINER EXTERNAL EXAMINER
EFFECTIVENESS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE ON FEBRILE SEIZURE AMONG THE MOTHERS OF CHILDREN ATTENDING PRIMARY HEALTH CENTRE, PODANUR.
APPROVED BY THE DISSERTATION COMMITTEE
1. RESEARCH GUIDE : ……….
Prof. Dr.D.CHARMINI JEBAPRIYA, M.Sc(N)., M.Phil, Ph.D., Principal,
Texcity College of Nursing, Coimbatore - 23.
2. CLINICAL GUIDE : ……….
Prof.Mrs.THEMOZHI.P, M.Sc (N), M.Sc (Psy), MA Sociology, Professor cum Vice Principal,
Texcity College of Nursing, Coimbatore – 23.
3. MEDICAL GUIDE : ………
Dr. MALLIKAI SELVARAJ, MBBS..DCH. Pgd. DN Developmental paediatrician,
Royal Care Super Speciality Hospital, Coimbatore – 18.
CERTIFICATE
Certified that this is the bonafide work of Mrs.A.S.ARUN SUBINI, Texcity College of Nursing, Coimbatore, submitted as a partial fulfillment of requirement for the Degree of Master of Science in Nursing to The Tamilnadu Dr.M.G.R.Medical University, Chennai under Registration No: 301818401
College Seal
Prof. Dr. D. CHARMINI JEBAPRIYA, M.Sc (N)., M.Phil, Ph.D, Principal,
Texcity College of Nursing, Coimbatore – 23,
TEXCITY COLLEGE OF NURSING Podanur Main Road
Coimbatore-23.
2020
DECLARATION
DECLARATION
I hereby declare that the dissertation entitled “A study to evaluate the effectiveness of educational intervention on knowledge on febrile seizure among the mothers of children attending Primary Health Centre, Podanur”.
Submitted to the Tamilnadu Dr.M.G.R Medical University, Chennai, in partial fulfillment of the requirements for the award of the degree of Master of Science in Nursing is a record of original research done by myself.
This is the study under the supervision and guidance of Prof. Mrs. THENMOZHI.P M.Sc (N) Paed. Nsg M.Sc (Psy), MA(Socio), Vice Principal, Texcity College of Nursing, Coimbatore and dissertation has not found the basis for the award of any degree / diploma / associated degree / fellowship or similar title to any candidate of any university.
SIGNATURE OF THE PRINCIPAL SIGNATURE OF THE GUIDE
CANDIDATE
Mrs. A.S.ARUN SUBINI
DEDICATION
THIS DISSERTATION IS DEDICATED TO
ALMIGHTY GOD
OUR EVER LOVING TEACHERS, PARENTS, HUSBAND AND FRIENDS
FOR THEIR
“VALUABLE SUPPORT AND ENCOURAGEMENT”
THROUGHOUT THE STUDY.
ACKNOWLEDGEMENT
ACKNOWLEDGEMENT
The perfection of work and efforts molded by various persons to complete it successfully. It will not be a fruitful one unless I extend my heartfelt thanks and gratitude to all who guided me to the treasure of knowledge.
First of all, I would like to convey my sincere gratitude to ALMIGHTY GOD for His grace, strength and wisdom throughout the completion of the study.
I would like to extend my sincere thanks to Haji.Janab.A.M.M.Khaleel, Chairman, Texcity Medical and Educational Trust, Coimbatore, for his support and providing
me an opportunity to utilize all the facilities in this esteemed institution for successful completion of the study.
I express my sincere thanks to Major H.M. Mubarak, Manager, Texcity College of Nursing, for supporting me to complete this study, as greater achievements comes from experience and success.
With profound delight, I have immense pleasure to respect and heartfelt gratitude to my beloved Prof. Dr. Charmini JebaPriya, M.sc (N)., M.Phil., Ph.D The Principal, Texcity college of nursing, Coimbatore, for her appreciation, support and excellent, guidance encouragement which enabled me to reach my objective.
With profound pleasure I express my deep sense and sincere heart full gratitude to my research guide Prof. Mrs. P.Thenmozhi, M.Sc (N),[Paed], MSc (Psy), MA (Socio), Vice Principal, Department of Child Health Nursing, Texcity college of Nursing, Coimbatore for all the support rendered to during the endeavor. Her hard work, sincerity, inspiration, suggestion, illuminating comments and support helped me to mould this study in a successful way. This study could not have been presented in the manner it has been made and would have never taken up the shape.
I extend my sincere and deep sense of thanks to Asst Prof. A.Vedha Darly, M.Sc (N), [MHN], class Co-ordinator Texcity College of Nursing, Coimbatore for her extended suggestions, constant support, timely help and guidance till the completion of this study.
I express my sincere and deep sense of gratitude to Mrs.Valarmathy, M.Sc(N), [CHN], who encouraged and guided me to carry out the thesis in a successful manner in a given period.
I would like to extend my thanks to Mrs.Litterishia Balin, M.S.c (N), [MSN]., and Mrs.Saranya M.Sc (N), [MHN]; Mrs.Akila, M.Sc (N) [OBG], Texcity College of Nursing, Coimbatore, for their expert guidance, support and valuable suggestion given to me throughout the study.
I express my sincere thanks to Ms.Delpa Alex, M.Sc (Statistics), Coimbatore for her necessary guidance in statistical analysis.
I would like to thank all the experts who have done the content validity and contributed their valuable suggestion in modification of tool even in their busy schedule.
I extend my cordial thanks to my medical guide, Dr. MALLIKAI SELVARAJ, MBBS., DCH. Pgd. DN, Developmental pediatrician. Royal Care Super Speciality Hospital, Coimbatore for permitting me to do the data collection.
I would like to extend my thanks to Mrs.D.Muthumalni Alice, M.A(English)., B.Ed Professor. Texcity College of Nursing, Coimbatore, for editing and for helping me to achieve english language appropriateness in my dissertation.
I honestly express my sincere thanks and gratefulness to the mothers of under five children who participated in my study for their co operation.
I express my heartful thanks to Mrs.Famy Carmel.F, M.Li.Sc, Librarian and Ms.SUMAYA.A M.Sc (CS) computer staff for her kind cooperation in providing the necessary materials.
Final and not the least my special thanks goes to my parents Mr.S.Arul peter, N.Suseela and my husband Mr.M.John Manoj, for sparing their time and providing financial support for my study.
I would like to extend my thanks to Star Color Park, Gandhipuram, for his full cooperation and help in bringing in a printed form.
Above all, I express my deep sense of gratitude and indebtedness to our ever loving parents and family members and friends for rendering emotional support during the hard working period for preparation of this project.
ABSTRACT
ABSTRACT
The main aim of the present study was “To evaluate the effectiveness of educational intervention on febrile seizure among the mothers of under five children at Primary Health Center, Podanur”.
OBJECTIVES
To assess the existing level of knowledge and practice on febrile seizure among the mothers of under five children.
To evaluate the effectiveness of educational intervention on febrile seizure among mothers of under five children.
To associate the pretest knowledge and practice score with selected demographic variables.
To identify the Correlation between post test knowledge and practice on febrile seizure among the mothers of under five children.
HYPOTHESIS
H1- There will be a significant difference between pretest and post test knowledge score on febrile seizures.
H2- The mean post test practice score will be significantly higher than mean pretest practice score.
H3- There will be a significant association between pretest scores of knowledge and selected demographic variables.
H4- There will be a significant association between pretest practice score and selected demographic variables.
H5- There will be significant relation between the post test knowledge and practice score.
METHODOLOGY
Pre-experimental one group pretest and post test design was used, 40 samples were selected using non- probability convenient sampling method. A self administered questionnaire and observational checklist was used to evaluate the knowledge and practice of mothers. Descriptive and inferential statistics were used to analyze the data.
RESULTS
The study findings revealed that the educational intervention was effective on knowledge and practice of mothers in prevention and care of children with febrile seizures.
The findings shows that among 40 mothers of under five children, 36(90%) had moderate knowledge, 4(10%) had adequate knowledge in the pretest. The level of knowledge was improved after intervention and in the post test 1(2.5%) had moderate knowledge and 39(97.5%) had adequate knowledge.
The findings shows that among the 40 mothers of under five children, 2 (5%) had inadequate practice, 28 (70%) had moderate practice, 10 (25%) had adequate practice in pre test. The level of practice improved after the intervention and in the post test 3 (7.5%) had moderate practice and 37 (92.5%) had adequate practice.
The findings revealed that, the pretest knowledge score mean was 10.6 and post test mean was 16.3, So mean difference 5.75 was a true difference. The standard deviation of pretest was 2.340 and post test was 1.388. The calculated paired ‘t’ value was 24.01 was highly significant than the table value (2.05) at 0.05 level. Hence the stated hypothesis was accepted.
The findings revealed that, the pretest practice score mean was 9.10 and post test mean was 12.77, So mean difference 3.67 was a true difference. The standard deviation of pretest was 2.08 and posttest was 1.44. The calculated paired ‘t’ value 18.933 was highly significant than the table value (2.05) at 0.05 level. Hence the stated hypothesis was accepted.
The findings done by chi square test to find out the association between the pretest knowledge score with the selected demographic variables, revealed that the pretest
knowledge score is associated with the reason of visit to primary health centre and χ2value was 8.393 which is significant at level of p<0.05.
The findings revealed by, chi square analyzes to find out the association between the pretest practice score with the selected demographic variables. The findings revealed that there was no association between the pretest practice score with the selected demographic variables.
The findings revealed that there is a positive correlation between the post test knowledge and post test practice score.
CONTENTs
TABLE OF CONTENTS
CHAPTER CONTENT PAGE NO
I
II
III
INTRODUCTION
1.1 Background of the study 1.2 Significance and Need for the study
1.3 Statement of the problem 1.4 Objectives of the study 1.5 Hypothesis
1.6 Operational definition 1.7 Assumptions
1.8 Delimitations 1.9 Projected outcome 1.10 Conceptual frame work
REVIEW OF LITERATURE
2.1 Studies and literature related to febrile seizure in children.
2.2 Studies and literature related to educational intervention on febrile seizure.
METHODOLOGY
3.1 Research approach 3.2 Research design 3.3 Research variables 3.4 Setting of the study 3.5 Population
3.6 Samples 3.7 Sample size
1 4 11 16 16 16 17 17 18 18 18
21 22 26
35 36 36 36 37 37 37
IV V VI
VII
3.8 Criteria for selection of samples 3.9 Sampling technique
3.10 Description of the tool 3.11 Scoring procedure 3.12 Validity and reliability
3.13 Pilot study 3.14 Data collection procedure
3.15 Plan for data analysis 3.16 Ethical considerations
DATA ANALYSIS AND INTERPRETATIONS FINDINGS AND DISCUSSION
SUMMARY AND CONCLUSION
6.1 Summary 6.2 Objectives 6.3 Major findings 6.4 Conclusion 6.5 Implication
REFERENCES APPENDICES
37 38 38 38 39 40 40 41 41
43 66
68 68 69 71 71
73
76
LIST OF TABLES
TABLE
NO TITLE PAGE NO
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
Frequency and percentage distribution of samples with demographic variables
Distribution of the samples according to their level of knowledge in pretest and post test
D
istribution of the samples according to their level of practice in pretest and post testMean, Mean difference, Standard deviation and ‘t’ value of pretest and post test level of knowledge among samples.
Mean, Mean difference, Standard deviation and ‘t’ value of pretest and post test level of practice among samples.
Frequency, percentage and chi square distribution of pretest level of knowledge score among mothers of under five children with the selected demographic variables.
Frequency, percentage and chi square distribution of pretest level of practice score among mothers of under five children with the selected demographic variables.
Correlation between post test knowledge and post test practice of mothers regarding febrile seizure.
45
55
57
59
60
61
63
65
LIST OF FIQURES
FIQURE NO
TITLE PAGE NO
1.1
1.2 1.3 1.4
1.5 1.6
1.8 3.1 4.1 4.2 4.3 4.4 4.5 4.6 4.7
Prevalence and cumulative prevalence rates for febrile seizures at different ages.
Prevalence of febrile seizures in children.
Depicting the causes of febrile seizure.
Recurrence rates of febrile seizures versus sex and the duration after the first seizure.
Incidence rate of febrile seizures for different ages.
Frequency of consequative episodes of febrile seizure.
Conceptual frame work based on pender’s health promotion model (1996)
Schematic representation of research methodology
The percentage distribution of sample in terms of age of the mothers.
The percentage distribution of sample in terms of their educational status.
The percentage distribution of samples in terms of their occupation.
The percentage distribution of sample in terms of family history of febrile seizure.
The percentage distribution of the sample in terms of previous history of febrile seizure.
The percentage distribution of the sample in terms of reason of visit to primary health center.
The percentage distribution of the sample in terms of having thermometer at home.
2 3 4 9 14 14 20 42 48 49 50 51 52 53 54
4.8
4.9
The percentage distribution of sample in terms of their pretest and post test level of knowledge score.
The percentage distribution of sample in terms of their pretest and post test level of practice score.
56
58
LIST OF APPENDICS
APPENDIX TITLE
I Plagirism certificate.
II
Letter seeking and granting permission to conduct the study.
III Letter requesting expert’s opinion for content validity.
IV List of experts given opinion for content validity.
V
Evaluation criteria check list for content validity Tool-I demographic data
VI
Evaluation criteria check list for content validity
Tool-II self administered questionnaire and observational checklist.
VII
Evaluation criteria check list for content validity.[ Educational Intervention]
VIII Letter seeking consent for participation in this study.
IX Certificate for English Editing.
X Research Tools.
XI Health teaching plan and module
XII AV Aids.
CHAPTER - I
INTRODUCTION
1
CHAPTER – I INTRODUCTION
It‟s health that is real wealth and not pieces of gold and silver
-Mahatma Gandhi
A febrile seizure is a convulsion in a child caused by a spike in body temperature, often from an infection. They occur in young children with normal development without a history of neurologic symptoms. Children aged 3 months to 5 or 6 years may have seizures when they have a high fever.
Febrile seizures are convulsions that can happen when a young child has a fever above 100.4°F (38°C). (Febrile means "feverish.")Febrile seizures (seizures caused by fever) occur in 3 or 4 out of every 100 children between six months and five years of age, but most often around twelve to eighteen months old.
Children younger than one year at the time of their first simple febrile seizure have approximate 50 percent chance of having another episode, while children over one year of age when they have their first seizure have about a 30 percent chance of having a second one.
Nevertheless, only a very small number of children who have febrile seizures will go on to develop epilepsy.
Alexander KC (2018) stated that febrile seizures are generally defined as seizures occurring in children typically 6 months to 5 years of age in association with a fever greater than 38°C (100.4°F), who do not have evidence of an intracranial cause (e.g. infection, head trauma, and epilepsy).
Medscape (2018) updated pediatric essentials; Pediatric febrile seizures, which represent the most common childhood seizure disorder, exist only in association with an elevated temperature.
Evidence suggests, however, that they have little connection with cognitive function, so the prognosis for normal neurologic function is excellent in children with febrile seizures.
2
Diana K. Wells (2018) written that, febrile seizures usually occur in young children who are between the ages of 3 months to 3 years. They‘re convulsions a child can have during a very high fever that‘s usually over 102.2 to 104°F (39 to 40°C) or higher. This fever will happen rapidly. The rapid change in temperature is more of a factor than how high the fever gets for triggering a seizure. They usually happen when your child has an illness. Febrile seizures are most common between the ages of 12 and 18 months of age. There are two types of febrile seizures: simple and complex. Complex febrile seizures last longer. Simple febrile seizures are more common.
John J Millichap (2019) revealed that febrile seizures are convulsions that occur in a child who is between six months and five years of age and has a temperature greater than 100.4ºF (38ºC). The majority of febrile seizures occur in children between 12 and 18 months of age.
Febrile seizures occur in 2 to 4 percent of children younger than five years old. They can be frightening to watch, but do not cause brain damage or affect intelligence. Having a febrile seizure does not mean that a child has epilepsy; epilepsy is defined as having two or more seizures without fever present.
Fig:1.1 Prevalence and cumulative prevalence rates (reported as percentages) for febrile seizures at different ages. The prevalence peaked (at 27.5%) among those aged 2 years (age range 18-30 months).
3
National institute of health (2020) modified, febrile seizures are seizures or convulsions that occur in young children and are triggered by fever. Young children between the ages of about 6 months and 5 years old are the most likely to experience febrile seizures; this risk peaks during the second year of life. The fever may accompany common childhood illnesses such as a cold, the flu, or an ear infection. In some cases, a child may not have a fever at the time of the seizure but will develop one a few hours later.
The vast majority of febrile seizures are convulsions. Most often during a febrile seizure, a child will lose consciousness and both arms and legs will shake uncontrollably. Less common symptoms include eye rolling, rigid (stiff) limbs, or twitching on only one side or a portion of the body, such as an arm or a leg. Sometimes during a febrile seizure, a child may lose consciousness but will not noticeably shake or move.
Fig:1.2 Prevalence of febrile seizures in children younger than 5 years in Korea during 2009-2013.
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Fig 1.3: Depicting the causes of febrile seizure
Most febrile seizures last only a few minutes and are accompanied by a fever above 101°F (38.3°C). Although they can be frightening for parents, brief febrile seizures (less than 15 minutes) do not cause any long-term health problems. Having a febrile seizure does not mean a child has epilepsy, since that disorder is characterized by reoccurring seizures that are not triggered by fever. Even prolonged seizures (lasting more 15 minutes) generally have a good outcome but carry an increased risk of developing epilepsy.
1.1 BACK GROUND OF THE STUDY
Children comprise one third of our population and all of our future and their health is our foundation. The childhood period is also a vital period because many of the health problems will arise from this period and most of the studies reveal that many children are suffering from one or the other disease. Our responsibility is to maintain certain specific biological and psychological
40%
8%
24%
28%
0 5 10 15 20 25 30 35 40 45
RESP.TRACT.INF CNS Inf UTI Others
PERCENTAGE
causes of febrile seizure
RESP.TRACT.INF CNS Inf
UTI Others
5
needs to ensure the survival and healthy development of the child, future adult and also to maintain optimum health of the children to enjoy their childhood. But unfortunately children are at risk of diseases, the reason may be many. One of such disease is febrile seizure which threatens life of the child.
Hackett R (2011) conducted a study one thousand four hundred and three children
participated in a home-based survey of psychiatric disorders in 8- to 12-year-old children in Calicut District, Kerala, India. One thousand one hundred and ninety-two consecutive children underwent neurological and psychometric assessments. The projected number of children with a history of febrile seizures was 120 giving a lifetime incidence of 10.1%. Recurrent febrille seizures predominated and these were strongly associated with a history of perinatal adversity.
Febrile seizures were independently association with indices of infective illness and mothers' education. Epilepsy developed in 2.7% of children with febrile seizures, but no evidence was found that febrile seizures had adverse intellectual or behavioural sequelae.
Srinivas.M (2011) found out that febrile seizures are defined as ―an event in neurologically healthy infants and children between 6 months and 5 years of age, associated with fever >38ºC rectal temperature but without evidence of intracranial infection as a defined cause and with no history of prior afebrile seizures. Febrile seizures are to be distinguished from epilepsy which is characterized by recurrent non febrile seizures. All seizures with fever are not febrile seizures.
Generally, febrile seizures occur during early phase of rising temperature and are uncommon after 24 hours of onset of fever.
National Survey (2011) found out the Prevalence of febrile seizure in the countries are, India it is 360/100,000,in Japan it is 89/1000 in children younger than 13 years, in Peru it is 2016/100,000 in children younger than 15 years and 10.1% is estimated to be life time prevalence of febrile convulsion in India. Iranian journal of public health says that in a study the life time prevalence of febrile convulsion was 32/1000 population, approximately 60% of case reported febrile convulsion as the presumptive cause.
Manikam K (2011) conducted a cross sectional study in Andhra Pradesh showed that the prevalence rate of epilepsy as 6.2/1000 population, where as in Kerala it is 4.9/1000population.School age children are most affected with a slight male preponderance. In
6
America 300,000 people have a first convulsion each year and 120,000 of them are under the age of eighteen.
Child Welfare Report (2011) elated that discrimination against persons suffering from febrile seizure is common. This is often due to sudden falls and convulsive episodes at unexpected times in public places 6resulting in rejection. Sometimes, the social discrimination against these persons with epilepsy may be more devastating than the disease itself. Children with epilepsy may be rejected from their classes because of frequent seizures which makes their teachers and fellow students uncomfortable with their presence in class. Also, some children are not allowed in schools once the school authority become aware that the child has epilepsy.
World Health Organization (2012) stated that febrile seizures (FS) are common, with a life time prevalence of 2-6%. The definition of FS is controversial. The International League against Epilepsy (ILAE) defines FS as ―an epileptic seizure occurring in childhood associated with fever, but without evidence of intracranial infection or defined cause. Seizures with fever in children who have experienced a previous non-febrile seizure are excluded (ILAE, 1993). British Pediatric Association suggested "an epileptic seizure occurring in a child aged from six months to five years, precipitated by fever arising from infection outside the nervous system in a child who is otherwise neurologically normal‖ (Joint Working Group of the Research Unit of the Royal College of Physicians and British Pediatric Association, 1991). Although it is important to distinguish "seizures with fever" and "febrile seizures" in terms of management and prognosis, this is often not possible in many primary health facilities in resource poor countries (Joint Working Group of the Research Unit of the Royal College of Physicians and British Pediatric Association, 1991). Seizures with fever include any seizure in a child of any age with fever of any cause.
World Health Organization (2012) revealed that febrile Seizure is a common neurological problem in children. Many seizures disorders have their origin in childhood. Nearly two-third of febrile seizure disorder can be treated easily by them without the need for the specialist. In ancient times convulsions are considered as curse of evils. Today also people with seizure disorders are facing superstitions to this disease, this attitude can be changed once the scientific cause of this condition is defined and the public is aware through education.
7
Fernandocendes (2012) pointed that febrile seizure promotes temporal lobe epilepsy through the retrospective study: The sequence of febrile seizures followed by intractable temporal lobe epilepsy is rarely seen from a population perspective. There is a significant relationship between a history of prolonged febrile seizures in early childhood and mesial temporal sclerosis. This association results from complex interactions among several genetic and environmental factors. Early febrile seizure damages the hippocampus, and therefore the child has a prolonged febrile seizure because the hippocampus was previously damaged. A retrospective study of a series of 167 consecutive patients with lesional epilepsy supports the concept of prolonged febrile seizure leading to mesial temporal sclerosis in a predisposed hippocampus. In the study, febrile seizures were recurrent in five patients: three had simple and two had complex febrile seizures. There is a strong correlation between mesial temporal sclerosis and the severity of the epilepsy. Although there is a high incidence of complex febrile seizures among patients with mesial temporal sclerosis, it is still not clear whether complex febrile seizures are an epiphenomenon or a causative factor.
Peter Camfield (2012) conducted a study on Antecedents and Risk Factors for Febrile Seizures; One child in 28 will have a febrile seizure. It would be an enormous clinical boon to be able to predict accurately which child would develop febrile seizures so that parents could be counseled and potentially preventive treatment could be offered. There are a significant number of independent risk factors, such as day-care attendance, parental education, prenatal maternal smoking, maternal alcohol intake, late neonatal discharge, slow development, degree of fever, gastroenteritis, and family history of febrile seizures. In a study described in the chapter, an interview with 13,135 parents who gave birth to children in the same week revealed that 303 children were known to have had at least one febrile seizure. The effect of low birth weight seemed to be the result of a brain injury from complications of prematurity or premature birth in children with existing brain abnormalities. The strongest association with febrile seizures is a history of febrile seizures in the mother. Risk factors provide an insight into the pathophysiology of febrile seizures, which will eventually yield all the secrets of this common and frightening disorder.
Carl E.Stafstrom (2012) said that nearly every article or text written about febrile seizures contains a statement about febrile seizures being the most common type of seizure in childhood,
8
occurring in 2–5% of children. The prognosis of febrile seizures in the early literature was fairly pessimistic because of the inclusion of symptomatic causes of seizure other than fever and patient selection bias. The consensus that febrile seizures do not constitute a form of epilepsy is an important conceptual advance with relevance to the consideration of febrile seizure incidence and prevalence. A disproportionate number of patients with temporal lobe epilepsy have febrile seizures as young children. According to the International League, febrile seizures are an acute, symptomatic type—that is, a ―special,‖ situation-related—seizure. Febrile seizures are not associated with a structural or developmental anomaly of brain, though the existence of such pathology may enhance the susceptibility to febrile seizures. The majority of febrile seizures occurs between 6 months and 3 years of age, with the peak incidence at about 18 months. The data obtained from epidemiological studies can help in the understanding of the genetics and prognosis of febrile seizures.
Wongs (2013) pointed out another treatment option for seizure is surgical removal of the brain tissue where the seizures originate (i.e., temporal lobectomy) but this technique is not often used in children. Another possible preventive measure for epilepsy in children is avoidance of triggers for seizures. Many children with epilepsy have triggers for seizures such as foods, scents, or other environmental factors. If these triggers can be identified, seizures may be more easily controlled. When used in some combination, all of these treatment methods have shown effectiveness, however, there are few treatments that keep individuals entirely seizure free.
Ali Delpisheh (2014) said febrile seizures are the most common neurological disorder observed in the pediatric age group. The present study provides information about epidemiological and clinical characteristics as well as risk factors associated with FS among Iranian children. On the computerized literature valid databases, the FS prevalence and 95%
confidence intervals were calculated using a random effects model. A meta regression analysis was introduced to explore heterogeneity between studies. The important viral or bacterial infection causes of FSs were; recent upper respiratory infection 42.3% (95% CI: 37.2%–47.4%), gastroenteritis21.5% (95% CI: 13.6%–29.4%), and otitis media infections15.2% (95% CI: 9.8%- 20.7%) respectively. The pooled prevalence rate of FS among other childhood convulsions was 47.9% (95% CI: 38.8–59.9%). The meta–regression analysis showed that the sample size does not significantly affect heterogeneity for the factor ‗prevalence FS‘.
9
Fig:1.4 Recurrence rates of febrile seizures versus sex and the duration after the first seizure. The recurrence rate was more than halved in patients with no recurrence for 6 months after the first seizure.
Hocken Berry and Wilson (2015) stated that Febrile seizure management techniques include the use of deep brain stimulators and vagus nerve stimulators. Deep brain stimulators are implanted within the brain and send impulses to the cerebellum to increase seizure control by stimulating deep brain structures, while vagus nerve stimulators are implanted near the clavicle and send an electrical impulse to stimulate the vagus nerve in the neck.
Subramaniyam (2016) revealed that there is a dramatic global disparity in the care of febrile seizure between high and low income countries and in rural and urban setting. The burden of epilepsy in developing countries has become obvious as nearly 75% of people with epilepsy were residing in these countries, where the diagnostic and therapeutic facilities are poor. A large proportion of patients with epilepsy do not get treatment because medical facilities are not available or approachable to them. In many of the cases it was found that the people are unaware regarding the care of febrile seizure.
10
Dr. Bhattia (2017) conducted two community based studies in India (both rural and urban) showed that the prevalence rate of febrile seizure stands around 5/1000 population (at this rate present estimate of total epileptics in this country is about 5 million) and incidence rate varies from 38 to 49.3 per 100,000 population per year. Treatment gap, which is a measure of per cent of patient populations not receiving the treatment, was estimated to be up to 73.7% to 78% in India. In 2/3 of cases etiology was unknown. Hot water epilepsy is unique in South India and single solitary ring enhancing lesion in brain imaging is a common feature in Indian subcontinent.
Dutta (2018) stated that febrile Seizures are caused by malfunctions of the brain‘s electrical system that results from cortical neuronal discharge. The manifestations of seizures are determined by the site of origin and may include altered consciousness, involuntary 2 movements, changes in perception, behaviours, sensation and posture. A diagnosis of epilepsy is made when a person has three or more seizures. A seizure is behaviorally characterized by an abrupt unconscious change in behaviour, movement, autonomic function, or sensation.
Henry (2018) stated that febrile seizures are the most common pediatric neurologic disorder.
Four per cent to ten per cent of children suffer at least one febrile seizure in the first 3 years of life. The incidence is highest in children less than 6 years of age, with a decreasing frequency in older children.
Febrile Seizures associated with fever occur in one in every 30-50 children, and those unassociated with fever occur in about 1/200 children. About 5% of children experience one or more seizures before they reach adulthood. Febrile Seizures activity often involves the diagnosis of potential for injury, both physical& psychosocial. A potential for injury can be minimized with first aid measures. Thus school teachers should possess skills in observational assessment and first aid.
World Health Organization report suggested that even though the febrile seizure are managed with the help of technology in present era people who are staying at rural and remote areas of developing countries are not accessible or approachable to them. People in the developing countries like India, Pakistan and Bangladesh believe that febrile seizure is one of the diseases caused due to mistakes done in the past life. It is also concluded from various studies
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that, false belief have major implication regarding epilepsy in illiterate as well as in the minds of the people from these countries.
The disease enrobed in superstition, discrimination, and stigma. There is a clear cut lack of information programmes in the developing world about febrile seizure and its management. The febrile seizure has an impact on many aspects of a child‘s development and functioning. As a result many of these children are at risk for unsuccessful school experiences, difficulties in social engagement with peers, inadequate social skills and poor self-esteem.
Many of the parents were not familiar with the initial procedures in attending a child during febrile seizure. The initial procedures adopted by some parents were inappropriate, like to pulling the tongue or to putting objects in the child's mouth. Some of these wrong procedures, which are potentially harmful, are mainly related to mythical concepts. As the parents are always in touch with febrile seizure children, public enlightenment program on health issues especially recognition and management of febrile seizure must be created in order to ensure that people have sufficient knowledge about this disease. This will helps to improve the quality of life of children with febrile seizure.
1.2 SIGNIFICANCE AND NEED FOR THE STUDY
Becker (2011) revealed that febrile seizure affects all age groups, but for children a variety of issues exists that can affect one‘s childhood. Some epilepsy ends after childhood, some forms of epilepsy are associated only with conditions of childhood that cease once a child grows up.
Approximately 70%of children who suffer epilepsy during their childhood eventually outgrow.
There are also some seizures, such as febrile seizures, that have one-time occurrence during childhood and do not result in permanent febrile seizure. The worldwide prevalence of active febrile seizure is between four and ten per thousand populations. Epidemiologic studies of febrile seizure have done much to define the frequency of seizures and seizure disorders in the population and to provide a far more accurate understanding of prognosis. Although the majority of individuals with febrile seizure do very well with respect to seizure control, they still face many challenges in everyday life. A recent meta-analysis of published and unpublished studies puts the overall prevalence rate of febrile seizure in India as 5.59 per 1,000 populations, with no statistically different rates between men and women or urban and rural residence. Based on the
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total projected population of India in 2001 the estimated number of people with epilepsy is 5.5 million.
Midhun Lal (2011) conducted a population based cohort study was conducted to examine the effect of pregnancy and neonatal factors on the subsequent development of childhood febrile seizure in Nova Scotia, Canada were followed up to December 2001. Data on pregnancy and neonatal events and on diagnosis of childhood febrile seizure were obtained through record linkage of 2 population based databases; the Nova Scotia Atlee Perinatal Database and the Canadian febrile seizure Database and Registry. Factors analysed included events during the prenatal, labor and delivery, and neonatal time periods. Cox proportional hazards regression models were used to estimate relative risks at 95 per cent confidence interval. There were 648 new cases of febrile seizure diagnosed among 124,207 live births, for an overall rate of 63 per 100,000 persons. Incidence rates were highest among children <1 year of age.
Bahadhoor (2011) done a home based survey was done on psychiatric disorders in 8 to12 year old children in Calicut District, Kerala, India. One thousand one hundred and ninety-two consecutive children underwent neurological and psychometric assessments. The projected number of children with a history of febrile seizures was 120 giving a lifetime incidence of (10.1%). Recurrent febrile seizures predominated and these were strongly associated with a history of perinatal adversity. Febrile seizures were 9 independently associated with indices of infective illness and mother‘s education. Epilepsy developed in (2.7%) of children with febrile seizures.
Journal of Pediatrics (2012) the article on advances in febrile seizure states that the prevalence rate of febrile seizure in countries of Asia was (4.4), Japan (1.7), Pakistan (4.7), Kashmir in India (2.4), Srilanka (9.0) and Guan (4.9) million. This prevalence rate indicates that prevalence of febrile seizure in Asian countries is comparatively higher than the prevalence in the world.
Daisy (2012) said that in India, there are 30 million people affected by febrile seizure in 2004.
About one in two hundred school children are affected with febrile seizure, about one person in twenty has a seizure of some type during life, and in the population at large about one in 200 has febrile seizure. Most of those who develop idiopathic febrile seizure do so before the age of 20
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years. The general systemic conditions in which seizures most commonly occur in children is due to hypoxia or high fever. As the understanding of its physical and social burden has increased, it has moved higher up in the world health agenda. 8 Seizure disorders are more common among children between 6 months of age and 15 years and in new-born period. It has been estimated that about 4 to 6% of all children will have fits during their lifetime and 90% of convulsive disorders have their onset in early life. One in 15 or 20 children admitted in hospitals give a history of convulsion.
Jung Hye Byeon (2018) published Febrile seizures are the most common type of seizure during childhood, reportedly occurring in 2–5% of children aged 6 months to 5 years. However, there are no national data on the prevalence of FS in Korea. This study determined the prevalence, incidence, and recurrence rates of FS in Korean children using national registry data.
Methods The data were collected from the Korea National Health Insurance Review and Assessment Service for 2009–2013. Patients with febrile convulsion as their main diagnosis were enrolled. The overall prevalence of FS in more than 2 million children younger than 5 years was estimated, and the incidence and recurrence rates of FS were determined for children born in 2009. Results The average prevalence of FS in children younger than 5 years based on hospital visit rates in Korea was 6.92% (7.67% for boys and 6.12% for girls). The prevalence peaked in the second to third years of life, at 27.51%. The incidence of FS in children younger than 5 years (mean 4.5 years) was 5.49% (5.89% for boys and 5.06% for girls). The risk of first FS was highest in the second year of life. The overall recurrence rate was 13.04% (13.81% for boys and 12.09% for girls), and a third episode of FS occurred in 3.35%. Conclusions Our study determined the overall prevalence of FS using data for the total population in Korea. The prevalence was comparable to that reported for other countries. Patients with three episodes of FS need to be monitored carefully.
Many parents still have a negative attitude about febrile seizure. Some of them feel it is contagious. Hence during the episodes of seizures the children are not given any assistance or care. The availability of antiepileptic drugs and the prolonged medical care needed by children with febrile seizure justify the careful planning of a social program.
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Fig:1.5 Incidence rate of febrile seizures for different ages. The cumulative incidence rate was 5.49% among those aged 4 years (age range 42-54 months).
Fig:1.6 Frequencies of first, second, and third episodes of FS. The recurrence rates of FS (second and third episodes of FS) were highest among those aged 3 years (age range 30-42 months). FS: febrile seizures.
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It is also found that society‘s misconceptions have a major impact on peoples view towards febrile seizure and its management in rural areas in various parts of the country. Parental fear of convulsion is the major problem with serious negative consequences in their daily life. In early times people believed febrile seizure as a divine origin and were called the sacred disease because someone with epilepsy was thought to be ―seized‖. Majority of mothers have false belief about febrile seizure and they have different knowledge, attitude and practices especially in low socio-economic families. Global campaign against febrile seizure in Senegal, Zimbabwe and Argentina showed that the training and education programmes of parents of children suffering with febrile seizure effective and disseminating the knowledge regarding febrile seizure.
The parents should involve themselves in matters concerning their Childs febrile seizure.
It is important to involve the siblings of the febrile seizure, child helps to develop better understanding of condition as they may have all kinds of fears and misinformation about the disease. In many families, the mother tends to come closer to the situation. Often, she is the parent who visits the doctor, or meets the teacher or 10 talks to other parents at the local level.
As she learns more about the febrile seizure, it becomes much easier to adjust with the idea of having a child with febrile seizure.
Febrile seizure children express anxiety and embarrassment and see themselves as being different and inferior. A thorough evaluation of the patient‘s attitude and expectations concerning health maintenance is essential. The attitude and expectations of family members should also be evaluated since their understanding and support is crucial to the patient‘s ability to adjust to his condition. It is important for the nurse to be aware of potential prejudices which may be encountered by the client and his family.
During the clinical posting the investigator noticed that during the year of 2015 there were 184 admissions of children with seizure disorders, 253 cases of febrile seizures and 63 cases of convulsions of new-born. The mothers of children were anxious about the disease condition and also they had many doubts regarding the etiology, risk factors and both medical and home management of children with seizure disorder. It is very important to adhere with therapeutic regimen and the care giver should reinforce to avoid skipping of antiepileptic drugs.
It is also important to give attention to the emotional aspect of the child. So it is found that a
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structured Teaching Programme will be a guide for mothers regarding management of febrile seizure at home.
1.3 STATEMENT OF THE PROBLEM
―Evaluate the effectiveness of educational intervention on febrile seizure among the mothers of under five children at Primary Health Center Podanur.
1.4 OBJECTIVES
To assess the existing level of knowledge and practice on febrile seizure among the mothers of under five children.
To evaluate the effectiveness of educational intervention on febrile seizure among mothers of under five children.
To associate the pretest knowledge and practice score with selected demographic variables.
To identify the correlation between post test knowledge and practice on febrile seizure among the mothers of under five children.
1.5 HYPOTHESIS
H1- There will be a significant difference between pretest and post test knowledge score on febrile seizures.
H2- The mean post test practice score will be significantly higher than mean pretest practice score.
H3- There will be a significant association between pretest scores of knowledge and selected demographic variables.
H4- There will be a significant association between pretest practice score and selected demographic variables.
H5- There will be significant relation between the post test knowledge and practice score.
17 1.6 OPERATIONAL DEFINITIONS
• Evaluate: It means judgment of the value of that which is being assessed. In this study, it means judging the effectiveness of learning package regarding febrile seizure.
• Effectiveness: It refers to the extent of which the learning package on febrile seizure gives the desired effect in improving knowledge of mothers attending in Primary Health Center, Podanur.
• Educational Intervention: It is a teaching module developed by the researcher to impart knowledge on febrile seizure. In this study it is referred as organized content with relevant audio visual aids to provide information on febrile seizure among mothers of children.
• Knowledge: It refers to the response received from the mothers regarding febrile seizures in their children as measured by a structured knowledge questionnaire.
• Practice: It refers to the activities reported by mothers in relation to prevention, compliance with therapeutic regimen, and management of child with febrile seizure as measured by checklist.
• Mothers: It refers a mothers of under five children attending primary health center, podanur.
• Febrile Seizure: A febrile seizure is a convulsion in a child caused by a 100.4˚f in body temperature, often from an infection.
1.7 ASSUMPTIONS
This study assumes that, knowledge is the basis of practice
Parents of children may have inadequate knowledge regarding febrile seizure.
Educational intervention is interactive and effective way to gain knowledge regarding febrile seizure and related health problems.
18 1.8 DELIMITATIONS
The study is limited to
Mothers of children attending Primary Health Center, Podanur.
Sample size is 40.
Data collection period is limited to 4 weeks.
Educational intervention will be evaluated by self administered questionnaire.
1.9 PROJECTED OUTCOME
This study will help to evaluate the level of knowledge regarding febrile seizure.
This study will help the mothers of children to gain knowledge regarding febrile seizure.
The study will help to prevent complications of febrile seizure such as impaired growth and development.
1.10 CONCEPTUAL FRAME WORK Based on the Nola J. Pender (1996)
Health promotion model was designed to be a ―Complementary counterpart to models of health protection‖. The health promotion model describes the multi dimensional nature of persons as they interact with in their environment to pursue health.
It defines ―Health as a ―positive dynamic state not merely the absence of disease‖.
This model focuses on following three areas:
Individual characteristics and experiences.
Behavioral specific cognition and affect.
Behavioral out comes.
Individual characteristics and experience:- The health promotions model notes that each person has unique personal characteristics and experience that affect subsequent action. In this study we are focusing the factors influencing the mother and child on biological, psychological, and socio cultural.
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Behavioral specific cognition and affect:- The set of variables for specific knowledge and affect have important significance. In this we evaluate the specific cognition and affects related to febrile seizure.
Behavioral outcomes:- It is the end point. In this we are evaluating the mothers health promoted behaviours through post test questionnaires on prevention of febrile seizure.
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Figure 1.8 Conceptual frame work based on modified Pender‟s Health Promotion Model (1996 )
Individual characteristics and experience
Pre test
Prior related behavior Mothers may have inadequate knowledge and practice on prevention and care during febrile seizure.
Personal Factors
Biological factors; Age, Sex, type of family.
Psychological factors; knowledge, beliefs, Personal norms.
Socio-cultural factors Consists of occupational status, family income, educational status.
Behaviour specific cognitive and affect
Perceived benefits of action Mothers of children will be able to gain adequate knowledge on febrile seizure
Perceived barrier to action Inadequate exposure to health education related to prevention and care of children during febrile seizure
Perceived self efficacy Mothers of children are able to execute health promotion behavior related to febrile seizure
Teaching programme related affect By administering the educational intervention mothers of children will gain adequate knowledge regarding febrile seizure.
Interpersonal Influences Encouragement and support from primary health care personnel, mothers and children
Situational influences Favorable family and Primary Health
Center environment
Commitment to a plan action
Implementation of educational intervention on prevention of febrile seizure group with the duration of 60 Minutes. Intervention
Behaviour outcome
Immediate competing demands and preference
Low control : environmental factors:- age, sex, religion, type of family, bread winner, food habits.
High control: education, monthly income
Post test
Health Promotion behaviour
Accomplishing of health promotion behavior on knowledge regarding prevention of febrile seizures
Prevent the febrile seizure for children and care of childhood febrile seizure.
Encourage the children to take healthy foods like milk, cereals, pulses eggs, fish, etc.. and prevent the infections.
Inadequate knowledge
Moderately adequate knowledge
Adequate knowledge FEED BACK
CHAPTER - II
REVIEW OF LITERATURE
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CHAPTER - II
REVIEW OF LITERATURE
“
Every moment is an experience” - Jake Roberts INTRODUCTIONReview of literature is a broad systematic and critical collection and evaluation of important scholarly published literature as well as unpublished materials. The review serves as an essential background for any research. The review of literature is essential to all steps of the research process. It is an account of what is already known about a particular phenomenon. The main purpose of literature review is to convey to the reader about the work already done and the knowledge and ideas that have been already established on a particular topic of research. From this prospective the review is based on broad, systemic and critical collection and evaluation of the important published scholarly literature and unpublished research findings, critically reading the literature is to develop a sound study that contribute to development of knowledge in the aspect of theory, research, evaluation and practice.
According to Polit and Hungler (2010) review of literature is a critical summary of research on a topic of interest generally prepared to put a research problem in context to identify gaps in prior studies to justify a new investigation.
According to Suresh.K.Sharma (2013) literature review is defined as a broad, comprehensive, in depth, systematic and critical review of scholarly publication, unpublished printed or audio visual materials and personal communication.
THE LITERATURE WAS REVIEWED AND PRESENTED UNDER THE FOLLOWING SECTIONS
Section-I: Studies and literature related to febrile seizure in children
Section-II: Studies and literature related to educational intervention on febrile seizure
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SECTION-I: STUDIES AND LITERATURE RELATED TO FEBRILE SEIZURE IN CHILDREN
European Journal of Pediatrics (2011) modified and published assessment of febrile seizure in children; Febrile seizures are the most common form of childhood seizures, affecting 2-5% of all children and usually appearing between 3 months and 5 years of age. Despite its predominantly benign nature, a febrile seizure (FS) is a terrifying experience for most parents.
The condition is perhaps one of the most prevalent causes of admittance to pediatric emergency wards worldwide. The risk of epilepsy following FS is 1-6%. The association, however small, between febrile seizure and epilepsy may demonstrate a genetic link between febrile seizure and epilepsy rather than a cause and effect relationship. The effectiveness of prophylactic treatment with medication remains controversial. There is no evidence of the effectiveness of antipyretics in preventing future febrile seizure. Prophylactic use of paracetamol, ibuprofen or a combination of both in febrile seizure, is thus a questionable practice. There is reason to believe that children who have experienced a simple febrile seizure are over-investigated and over-treated. This review aims to provide physicians with adequate knowledge to make rational assessments of children with febrile seizures.
Lalith. K (2011) conducted a prospective study which carried out in a tertiary hospital to evaluate the knowledge and attitudes of parents toward children with febrile seizure.
Questionnaires were administered to all the parents who attended the hospital with their children diagnosed of febrile seizure. Two hundred and eighty parents whose children suffered from febrile seizure participated in the study. The investigator concluded that more than 90% of parents and caregivers know about febrile seizures. There is a need to disseminate more information to the public about 22 its causes, clinical manifestation, approach to managing a convulsing child, and its outcome and periodic medical campaigns aimed at educating the public about febrile seizure through the media could go a long way in reducing the morbidity and mortality associated with this disorder.
Misle. K. et.al., (2012) anthropological study was conducted to analyse current parental perceptions of febrile seizures in order to improve the quality of management, care, and explanations provided to families at paediatric emergency unit. Investigators analysed
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interviews of 37 parents, whose child was admitted to the paediatric emergency unit due to a first seizure. The parental experience of the crisis was marked by upsetting memories of a "scary"- looking body and the perception of imminent death. The meaning attributed by parents to the word "seizure" and "epilepsy" usually referred to an exact clinical description of the phenomenon, but many admitted being unfamiliar with the term or at least its origin.
Understanding and integrating these parental interpretations seems essential to improving care for families who first experience this symptom.
Reese C. Graves (2012) published febrile seizures; risk, evaluation and prognosis for that Febrile seizures are common in the first five years of life, and many factors that increase seizure risk have been identified. Initial evaluation should determine whether features of a complex seizure are present and identify the source of fever. Routine blood tests, neuro imaging, and electroencephalography are not recommended, and lumbar puncture is no longer recommended in patients with uncomplicated febrile seizures. In the unusual case of febrile status epilepticus, intravenous lorazepam and buccal midazolam are first-line agents. After an initial febrile seizure, physicians should reassure parents about the low risk of long-term effects, including neurologic sequelae, epilepsy, and death. However, there is a 15 to 70 percent risk of recurrence in the first two years after an initial febrile seizure. This risk is increased in patients younger than 18 months and those with a lower fever, short duration of fever before seizure onset, or a family history of febrile seizures. Continuous or intermittent antiepileptic or antipyretic medication is not recommended for the prevention of recurrent febrile seizures.
Joshua R. Francis. (2016) conducted an observational study of febrile seizures: the importance of viral infection and immunization, Children aged 6 months to 5 years presenting to the Emergency Department of a tertiary children‘s hospital in Western Australia with febrile seizures were enrolled between March 2012 and October 2013. Demographic, clinical data and vaccination history were collected, and virological testing was performed on per-nasal and per- rectal samples. The result was one hundred fifty one patients (72 female; median age 1.7y; range 6 m-4y9m) were enrolled. Virological testing was completed for 143/151 (95%). At least one virus was detected in 102/143 patients (71%). The most commonly identified were rhinoviruses (31/143, 22%), adenovirus (30/151, 21%), entero viruses, (28/143, 20%), influenza (19/143, 13%) and HHV6 (17/143, 12%). More than one virus was found in 48/143 (34%). No significant
