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A STUDY TO ASSESS THE EFFECT OF BALLOON BLOWING EXERCISE ON AIRWAY PATENCY AMONG PRESCHOOL

CHILDREN WITH ACUTE RESPIRATORY ILLNESS IN SELECTED SCHOOLS AT KANYAKUMARI DISTRICT

A DISSERTATION SUBMITTED TO THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY CHENNAI, IN

PARTIAL FULFILMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING

OCTOBER - 2020

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A STUDY TO ASSESS THE EFFECT OF BALLOON BLOWING EXERCISE ON AIRWAY PATENCY AMONG PRESCHOOL

CHILDREN WITH ACUTE RESPIRATORY ILLNESS IN SELECTED SCHOOLS AT KANYAKUMARI DISTRICT

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Internal Examiner External Examiner

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A STUDY TO ASSESS THE EFFECT OF BALLOON BLOWING EXERCISE ON AIRWAY PATENCY AMONG PRESCHOOL

CHILDREN WITH ACUTE RESPIRATORY ILLNESS IN SELECTED SCHOOLS AT KANYAKUMARI DISTRICT

APPROVED BY DISSERTATION COMMITTEE ON ………

PROFESSOR IN NURSING RESEARCH:

Prof. Santhi Letha, M.Sc(N), M.A, Ph.D(N) Principal

Sree Mookambika College of Nursing,

Kulasekharam……….

RESEARCH GUIDE:

Mrs. Daly Christabel H, M.Sc(N), Ph.D(N)

Head of the Department, Department of Child Health Nursing, Sree Mookambika College of Nursing,

Kulasekharam……….………..

MEDICAL GUIDE:

Dr. Sanjay Masaraddi, MD,

Associate Professor, Department of Pediatrics, Sree Mookambika Institute of Medical Sciences,

Kulasekharam………...

A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI, IN

PARTIAL FULFILMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING

OCTOBER - 2020

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BONAFIDE CERTIFICATE

This is to certify that the dissertation entitled “A STUDY TO ASSESS THE EFFECT OF BALLOON BLOWING EXERCISE ON AIRWAY PATENCY AMONG PRESCHOOL CHILDREN WITH ACUTE RESPIRATORY ILLNESS IN SELECTED SCHOOLS AT KANYAKUMARI DISTRICT” is a bonafide research work done by Mrs. Abisha Olive O.G., II year M.Sc (N), Sree

Mookambika College of Nursing, Kulasekharam under the guidance of Mrs. Daly Christabel H, M.Sc(N), Ph.D(N)., Head of the Department, Department

of Child Health Nursing in partial fulfillment of the requirements for the Degree of Master of Science in Nursing under Tamil Nadu, Dr. M.G.R Medical University.

Place: Kulasekharam Prof. Santhi Letha, M.Sc(N), M.A, Ph.D(N),

Date: Principal, Sree Mookambika college of Nursing,

Kulasekharam.

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CERTIFICATE

This is to certify that the dissertation entitled “A STUDY TO ASSESS THE EFFECT OF BALLOON BLOWING EXERCISE ON AIRWAY PATENCY AMONG PRESCHOOL CHILDREN WITH ACUTE RESPIRATORY ILLNESS IN SELECTED SCHOOLS AT KANYAKUMARI DISTRICT” is a

bonafide research work done by Mrs. Abisha Olive O.G, II year M.Sc (N),

Sree Mookambika College of Nursing under the Guidance of Mrs. Daly Christabel H, M.Sc(N), Ph.D(N)., Head of the Department, Department

of Child Health Nursing in partial fulfillment of the requirements for the Degree of Master of Science in Nursing under Tamil Nadu Dr. M.G.R Medical University.

Place: Kulasekharam Mrs. Daly Christabel H, M.Sc(N), Ph.D(N).,

Date: HOD, Department of Child Health Nursing, Sree Mookambika College of Nursing,

Kulasekharam.

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DECLARATION

I hereby declare that the present dissertation titled “A STUDY TO ASSESS THE EFFECT OF BALLOON BLOWING EXERCISE ON AIRWAY PATENCY AMONG PRESCHOOL CHILDREN WITH ACUTE RESPIRATORY ILLNESS IN SELECTED SCHOOLS AT KANYAKUMARI DISTRICT” the outcome of the original research undertaken and carried out by me under the guidance of Mrs. Daly Christabel H, M.Sc(N), Ph.D(N)., Head of the Department, Department of Child Health Nursing in Sree Mookambika College of Nursing, Kulasekharam. I also declare that the material of this has not formed in anyway, the basis for the award of any degree or diploma in this university or any universities.

Place: Kulasekharam Mrs. Abisha Olive O.G., Date: II year M.Sc (N),

Sree Mookambika College of Nursing, Kulasekharam.

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ACKNOWLEDGEMENT

“Man’s efforts are always crowned by God’s grace and blessing”

I thank my Lord Almighty for His enriched blessing and abundant grace and mercy, which encircled me throughout this research. His presence has enabled me in my attempt to convert to this work into a reality and without His kindness; this attempt would have been a failure.

Motivation and guidance of many people helped me in completing the research project successfully. It is my greatest privilege to acknowledge all those resource persons. I offer my sincere thanks to each and every one who have contributed to the successful completion of this study.

I submit my sincere thanks and respectful regards to Dr. Velayudhan Nair, MS, chairman and Dr. Rema V. Nair, MD, DGO., Director, Sree Mookambika Institute of Medical Sciences, for providing facilities and encouragement for the study.

I wish to place my sincere thanks to our Trustees Dr. R. V. Mookambika, MD., Department of Nephrology and Dr. R. Vinu Gopinath, MD., Department of Urology, Sree Mookambika Institute of Medical sciences, for providing facilities and encouragement.

I wish to place my sincere thanks to Mrs. Santhi Letha M.Sc.(N), MA, Ph.D.(N)., Principal Sree Mookambika College of Nursing, Kulasekharam for her excellent guidance, encouragement, valuable advice and constructive criticism from the initial to final level enabled me to develop an understanding of the subject as well as to carry out the study, on time.

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I sincerely express my thanks to Mrs. Ajitha Retnam, M.Sc., MBA, Ph.D.(N)., Vice principal and ethical committee member, Sree Mookambika College of Nursing for their guidance, support, encouragement, valuable advices and constructive criticism for complete this study.

I owe my deepest sense of gratitude to Dr. T. C. Suguna, M.Sc. (N), MA(Socio), Ph.D., Sree Mookambika College of Nursing for consistent help, academic support, direction and guidance to complete the study.

I acknowledge with immense sincerity to Dr. Daly Christabel H, M.Sc., Ph.D.(N)., my research guide and HOD of Child Health Nursing, Sree Mookambika College of Nursing, Kulasekharam for her meticulous guidance, valuable opinions, timeless suggestions and limitless support which laid a strong foundation in moulding this research study successfully.

I acknowledge my professional gratitude to Dr. Elizabeth KE, MD., DCH, Ph.D., Department of Paediatrics, Sree Mookambika Institute of Medical Sciences for her valuable suggestions and guidance.

I sincerely express my gratitude to Dr. Sanjay Masaraddi, MD., Associate Professor, Department of Paediatrics in Sree Mookambika Institute of Medical Sciences for his guidance.

I express my gratitude to Mrs. Suja Renjini, M.Sc(N)., Associate Professor, Mrs. P. Shanthi M.Sc(N)., Associate Professor, Mrs. Agin Navis Mary, M.Sc(N)., Assistant Professor and Mrs. Ajitha M.Sc(N)., Assistant Professor the department of child health nursing for their valuable guidance and support.

I am grateful to Prof. Arumugam Pitchai, biostatistician, Rtd Professor for

guiding me to complete the statistical analysis carefully.

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My heartfelt thanks to Mrs. Angeline Beula, M.A, M.Phil., Ph.D for her support by editing the content of research.

I sincerely thanks all the participants who form to core and basis of this study and for their whole hearted co-operation.

My special thanks to the school authorities and all the teachers of the government school children and their ape rents who were participated in the study and for their valuable time and sincere co-operation, without which the study would have been impossible.

I express my sincere thanks to the experts who contributed their valuable time and effort toward validating the tool for the study.

I am indebted to my beloved classmates, friends and seniors for their direct and indirect support, concern and help to make this attempt an interesting one.

My heartful thanks to the library staff of Sree Mookambika College of Nursing for their support.

I am very thankful to Mr. Sumen and all the staff of Leos Data Makers, Kulasekharam who helped me to bring this project in printed form.

Above all I express my heartfelt and explainable thanks to my better half Mr. N.D. Christopher, B.Sc., B. Pharm., loveable son Mast. Efren C.A. Chris, my

mother, father, mother-in-law and my all family members who are the source of strength, inspiration, constant help, support and encouragement to overcome the tides of heavy schedules and problems in the path of progress in this study and my life.

Finally, the investigator thanks to all those who inspired to undertake their topic confidently and full fill this dissertation in time.

Investigator

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TABLE OF CONTENTS

Chapters Content Page no.

I INTRODUCTION

 Back ground of the study

 Need for the study

 Statement of the problem

 Objectives

 Hypotheses

 Operational definitions

 Assumptions

 Delimitations

 Ethical consideration

 Conceptual framework

1 6 12 12 12 13 14 14 15 15

II REVIEW OF LITERATURE

 Studies related to prevalence and risk factors of acute respiratory illness among children.

 Studies related to Balloon blowing exercise among children with acute respiratory illness.

 Studies related to Balloon blowing exercise on other conditions.

 Studies related to other intervention on respiratory illness.

19 25 30

34 III RESEARCH METHODOLOGY

 Research approach

 Research design

 Variables

 Settings of the study

 Population

 Sample

 Sample size

40 40 42 42 42 42 43

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 Sampling technique

 Criteria for sample selection

 Description of the tool

 Validity

 Reliability

 Pilot study

 Procedure for data collection

 Plan for data analysis

43 43 44 45 45 45 45 46

IV DATA ANALYSIS AND INTERPRETATION 48-80

V RESULTS AND DISCUSSION 81-86

VI SUMMARY, CONCLUSION, IMPLICATION, LIMITATION AND RECOMMENDATIONS

87-94

BIBLIOGRAPHY 95-100

ANNEXURES i-xxi

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LIST OF TABLES

Table Title Page No

4.1 Frequency and percentage distribution of demographic variables of preschool children with acute respiratory

illness in experimental group and control group 49 4.2 Frequency and percentage distribution of clinical variables

of preschool children with acute respiratory illness in

experimental group and control group 63

4.3 Frequency and percentage distribution of preschool children with acute respiratory illness according to the

level of respiratory parameters in experimental group 69 4.4 Frequency and percentage distribution of preschool

children with acute respiratory illness according to the

level of respiratory parameters in control group 71 4.5 Mean, Standard deviation and paired ‘t’ value on pre and

posttest level of respiratory parameters among preschool children with acute respiratory illness in experimental group and control group

73

4.6 Mean, Standard deviation and Unpaired ‘t’ value on pre and posttest level of respiratory parameters among preschool children with acute respiratory illness in experimental group and control group after intervention

74

4.7 Chi-square test on the pretest level of respiratory parameters among preschool children with acute respiratory illness with their selected demographic and clinical variables in experimental group

75

4.8 Chi-square test on the pretest level of respiratory parameters among preschool children with acute respiratory illness with their selected demographic and clinical variables in control group

78

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LIST OF FIGURES

Figure Title Page No.

1.1 Conceptual Framework 18

3.1 Schematic representation of Methodology 41 4.1 Percentage distribution of Pre School children

according to age 53

4.2 Percentage distribution of Pre School children

according to gender 54

4.3 Percentage distribution of Pre School children

according to educational status 55

4.4 Percentage distribution of Pre School children

according to type of family 56

4.5 Percentage distribution of Pre School children

according to order of birth 57

4.6 Percentage distribution of Pre School children

according to religion 58

4.7 Percentage distribution of Pre School children

according to residence 59

4.8 Percentage distribution of Pre School children

according to family monthly income 60

4.9 Percentage distribution of Pre School children

according to father occupation 61

4.10 Percentage distribution of Pre School children

according to mother occupation 62

4.11 Percentage distribution of Pre School children

according to RTI/Month 65

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Figure Title Page No.

4.12 Percentage distribution of Pre School children

according to food habit consumption 66

4.13 Percentage distribution of Pre School children

according to allergens 67

4.14 Percentage distribution of Pre School children

according to family history 68

4.15 Percentage distribution of preschool children according to the level of respiratory parameters in experimental group

70

4.16 Percentage distribution of preschool children according to the level of respiratory parameters in control group

72

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LIST OF ANNEXURES

Annexures Title Page No.

I Ethical Committee Certificate i

II Letter from school study conduction ii III Letter seeking experts opinion for tool validity iv

IV Certificate for Editing v

V List of experts for tool validation vi

VI Data Collection tool viii

VII Content Validation Certificate xiv

VIII Evaluation tool Checklist xv

IX Intervention Guide xviii

X Photographs xx

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ABSTRACT

Introduction

Children are the blessings from the Lord. They are like clay in the potter’s hand. Health plays a major role in the future of the children to withstand and meet personal, psychological and social needs and fulfils the challengers in life. In India about 35% of total population are children below 15 years of age. They are not only large in number but vulnerable to various health problems and considered as special risk group. Acute respiratory infections (ARIs) are a major cause of morbidity and mortality worldwide among children. The World Health Organization (WHO) estimates that respiratory infections account for 6% of the total global burden of disease.

Statement of The Study

“A study to assess the effect of Balloon Blowing Exercise on Airway Patency among Preschool Children with Acute Respiratory Illness in selected schools at Kanyakumari District”.

Objectives

1. To assess the pre-test and post-test score of respiratory parameters among preschool children in experimental group and control group.

2. To compare the mean pre-test and post-test score between experimental group and control group.

3. To find the association between the pre-test score of respiratory parameters and selected demographic variables among preschool children in experimental group and control group.

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Hypotheses

H1: There is a significant difference between the pre-test and post-test score of respiratory parameters among preschool children with respiratory tract infection in experimental group than in control group.

H2: There is a significant association between the pre-test score of respiratory parameters and selected demographic variables among preschool children in experimental group and control group.

Methodology

The study was quasi experimental study with quantitative research approach.

The study was conducted in 2 government primary schools (Marankonam and Mundavilai). The samples were preschool children between the age group of 4-6 years with acute respiratory illness. The data collection period was one month. Purposive sampling technique was used to select the sample, sample size was 40. The tools used for data collection was Respiratory Parameter’s Observation Checklist.

The data gathered was analysed by descriptive and inferential statistics and interpretations were made based on the objectives of the study.

 During pre-test in experimental group, majority 19(95%) were having moderate level of Acute respiratory illness and 1(5%) were having mild level of Acute respiratory illness. In posttest, majority 19(95%) of them were having mild level of Acute respiratory illness and 1(5%) were having moderate level of Acute respiratory illness.

 The mean score level of respiratory parameters among preschool children with acute respiratory illness in experimental group, mean value was 24 in pretest and 16.5 in posttest respectively. The Paired ‘t’ value is 19.034* which is significant at p<0.001.

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 In experimental group the mean score of respiratory parameters among preschool children with acute respiratory illness in post-test was 16.5 and in control group 19.4 respectively. The estimated Unpaired ‘t’ values were 3.908 * which is significant at p<0.001 level.

Conclusion

The study was done to assess the effect of balloon blowing exercise on airway patency among preschool children with acute respiratory illness in selected schools at Kanyakumari district. Based on statistical findings, in experimental group the mean score of respiratory parameters among preschool children with acute respiratory illness were 16.5 and 24 respectively. The Paired ‘t’ value is 19.034*

which is significant at p<0.001. It shows that balloon blowing exercise was effective in reducing the level of respiratory parameters among preschool children. Hence the research hypothesis (H1) is accepted. The study proves thatBalloon blowing exercise was cost effective, easily available, it is applicable to be used even by low socio- economic group people and also enjoyable to children as a recreational game and children were easily attracted towards it.

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CHAPTER I

INTRODUCTION

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1 CHAPTER - I

INTRODUCTION

If you know the art of breathing,

You have the strength, wisdom, and courage of ten tigers.

- Chinese Adage Background of The Study

Children are the blessings from the Lord. They are like clay in the potter’s hand.

Blend them with godly love and care, they become a vessel that stays strong and perfect, purge them with toil and dust they may break and crumble. They build the nation sound and strong, because today’s children are responsible citizens of tomorrow.

Health plays a major role in the future of the children to withstand and meet personal, psychological and social needs and fulfils the challenges in life. Children are the future of a nation. In India about 35 % of total population are children below 15 years of age. India is the second most populous nation in the world. India with a population of 131.1 billion, has 16.45 billion children in the age group 0-6 years and 37.24 billion in the age group 0-14 years which constitute 13.59% and 30.76% of the total population respectively.74% of the children (0-6 years) live in rural areas where as the rural population constitute 69% of the total population of India. They are not only large in number but vulnerable to various health problems and considered as special risk group.

Acute respiratory infections (ARIs) are a major cause of morbidity and mortality worldwide. Each year, about 1.3 million children under 5 years die from

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2 acute respiratory infections worldwide. ARIs constitute one third of the deaths among under five in low income countries. The World Health Organization (WHO) estimates that respiratory infections account for 6% of the total global burden of disease; this is a higher percentage compared with the burden of diarrheal disease, cancer, human immunodeficiency virus (HIV) infection, ischemic heart disease or malaria . Each year ARIs account for over 12 million hospital admissions in children less than 5 years. The study was conducted the causes and circumstances of death among northern Cameroon, Out of 67% of all deaths in children, majority 24% (167) deaths were caused by ARIs, followed by malaria 21% (152) and diarrheal diseases 19%

(133). ARIs is one of the leading public health problems in under-fives in Cameroon.

Globally, Respiratory infection causes morbidity and mortality in young children. Majority of under five children were affected with 3 to 8 respiratory illnesses in a year, Globally 3.9 million deaths occur every year. Children develop five to eight attacks of respiratory illness such as bronchiolitis, asthma and pneumonia which causes 30 - 40% of hospitalization. Lower respiratory tract infection is more fatal than upper respiratory infection. Moreover in 2013, 6.9% of death due to respiratory illness which is the leading cause when compare to other diseases. Lower respiratory tract infection manifests symptoms like runny nose, dry cough, fever, sore throat, head ache, difficulty breathing, blue tint to the skin and chest pain.

Indian Academy of Paediatrics (2013) estimated that approximately, 150 million episodes of childhood pneumonia are reported every year from the world , Out of which 95% are from developing countries.15 countries account for nearly 75% and 6 countries including India account for 50%. Out of the 7.6 million under-5 childhood mortality world over 16%, i.e. 12 million deaths are due to pneumonia. More than

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3 90% of deaths, due to pneumonia occur in 68 poor nations, mostly in Africa and Asia.

In India, the disease burden is huge.45million episodes are estimated annually with 6.6 million hospitalizations, which contribute to 24% national disease burden and 0.37 million deaths annually.

Although respiratory tract infections are common in infants and young children, it is difficult to identify them as separate clinical entities. The reason is the tissues of the respiratory tract are continuous from the nose, pharynx, epiglottis and larynx to the trachea, bronchi, bronchioles, lungs, the Para nasal sinuses and the middle ear.

Often an infection beginning in the upper respiratory tract will proceed downward to the lower tract. These infections may be mild to severe or even fatal illnesses.

Oxygen is very much important for the human body. Oxygen plays a vital role in breathing processes and in the metabolism of the living organism. The respiratory system is an anatomical system. The primary purpose of respiratory system is gas exchange which involves the transfer of oxygen and carbon dioxide between the atmosphere and blood. Molecules of oxygen and carbon dioxide are passively exchanged by diffusion between the gaseous external environment and the blood. The exchange process occurs in the alveolar region of the lungs. The respiratory system enables us to produce energy by supply the body with a continuous supply of oxygen.

It is also responsible for eliminating carbon dioxide, a by-product of cell metabolism, whereas oxygen is necessary for human respiration.

Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs) and lower respiratory tract infections (LRIs). The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear. This commonly includes: tonsillitis,

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4 pharyngitis, laryngitis, sinusitis, otitis media, and the common cold .The lower respiratory tract covers the continuation of the airways from the trachea and bronchi to the bronchioles and the alveoli. ARIs are not confined to the respiratory tract and have systemic effects because of possible extension of infection or microbial toxins, inflammation, and reduced lung function.

Upper respiratory tract infection is usually caused by 150 serologically different viruses, the major share of the rhino viruses all of which belong to picrona virus family of small RNA viruses. Other than viruses certain bacterias also causes upper respiratory tract infection, this includes group A.Sreptococci, Corynebacterium diphtheria, N.Meningitidis M.Pneumonia, N. gonorrhea, H. influenza, pneumococcus, and staphylococcus aureus.

Upper respiratory tract infection is a communicable disease and is transmitted via respiratory droplets or by virus-contaminated hands. Coughing and sneezing facilitates the spread of infection.

Children with lower respiratory tract infections can be treated with gravity assisted bronchial drainage and both manual and mechanical percussion and vibration.

Both treatment produced improvement in expiratory flow rate, indicating improved airway status. Jan Stephen Tecklin., (2009).

In India, Acute respiratory disease control programme is the standard case management of acute respiratory infection (ARI) and prevention of deaths due to pneumonia is now an integral part of RCH programme. Peripheral health workers are being trained to recognise and treat pneumonia. Cotrimoxazole is being supplied to the health workers through the child survival and safe motherhood programme drug kit.

Park K, (2009)

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5 Children with respiratory infections might find that specific breathing exercises and physical exercise can help their condition. Some hospitals run rehabilitation courses for children with lung infections. Specific breathing exercises and a little physical activity can help children to facilitate health by alleviating symptoms. George Krucik., (2010).

Breath is the key to health and wellness, a function can learn to regulate and develop in order to improve our physical, mental and spiritual wellbeing. Breathing is one of the most important functions to our body. A person can only live from 5 to 10 seconds without taking another breath. The main function of breathing is to deliver oxygen to our lungs and to remove carbon-di-oxide when necessary which is done by respiratory system. Respiratory disease is a significant chronic health problem in our society. Chronic respiratory disease is found to be one of the most distressful conditions, badly affecting human life. Acute respiratory infections (ARI), particularly lower respiratory tract infections (LRTI), are the leading cause of death among children and are estimated to be responsible for between 1.9 million and 2.2 million childhood deaths globally (Klugman.et al.,2012).

Breathing techniques are helpful for reducing breathing difficulty. The ultimate goal is for children to be able to relax quickly when faced with stressful situations. Breathing exercise as an integral part plays a notable role in airway clearance and parenchyma expansion by enhance the efficiency of respiratory muscles. Modified breathing exercise is mandatory in children because they might not co-operate like adults. The principle is to mesmerize the children and not to create boredom. It can be accompanied by musical tone that would evince interest in a child.

Various modified forms of breathing exercises like group exercises, running, balloon

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6 blowing, abduction, adduction and forward movement of upper limbs, blowing air into the water with a straw, blowing a trumpet, candle blowing, flute and mouth organ playing are found effective in children.

The aims of breathing training are to “prevailing” breathing patterns, usually by adopting a slower respiratory rate with longer expiration and reduction in overall ventilation. Use of abdominal rather than the upper-chest and accessory muscles of ventilation in resting breathing and nasal rather than mouth breathing are also frequently stressed. The rationale for this training is based on the assumption that people with lower respiratory tract disorders have unusual or debilitated breathing pattern.

When performing abdominal breathing, child able to breathe more deeply in lungs. Exhale via mouth, and then tighten abdominal muscles. This helps to squeeze remaining air from the lungs, helping to breathe more fully thereby initiating mobilization of the secretions in the airways. American Medical student’s Associations (2006).

Breathing exercises enlarges the trachea bronchial tree enabling air to circulate around and through secretions that are not affected by usual tidal volume.

Incorporation of play helps to extend the expiratory time and increase expiratory pressure. Play which include blowing a pinwheel toys, moving small items by blowing through straw, blowing cotton ball or a ping pong ball on a table, preventing tissue from falling, blowing balloons, sing loudly, blowing soap bubbles.

Need For The Study

In worldwide, Lower respiratory tract infections among children place a considerable strain and serious on the health budget. In 2008 lower respiratory tract

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7 infections was the leading cause of deaths among all infectious diseases, and they accounted for 3.9 million deaths. Egore R., (2008)

The estimated median incidence of lower respiratory tract infection in developing countries are 44 episodes per 100 child/year, equal to approximately 150.7 million new cases each year, 7 to 13 percent of which were severe enough to warrant hospitalization

In worldwide, the incidence of clinical pneumonia in children aged less than 10 years in developing countries is close to 0.29 episodes per child/year. This equates to 151.8 million new cases every year, 13.1 million or 8.7% which are severe enough to require hospitalization. (WHO 2014)

The prevalence of cough in Chinese children is about 6.4 percent. In the United States, it accounts for 3 percent of medical consultations. Girls seem to have a lower cough threshold but the reason for this gender difference is unclear. While much of acute cough is due to viral infection of the upper respiratory tract (Cherry, 2006).

In Southeast Asia, it was estimated that acute respiratory infections caused 4 million child deaths each year - 2.6 million in infants (0-1 years) and 1.4 million in children aged 1–4years.There are 450 million cases of pneumonia each year and that it causes 3.9 million deaths. In the sub-Saharan region of Africa, 1 022 000 die and 702 000 die in south Asia.

In India 57,000 deaths were attributed to Asthma that estimated in 2004 (WHO 2004) and it was seen as one of the leading cause of morbidity and mortality in rural India (Smith 2000). Though effective screening, evaluation, and management strategies for Asthma are well established in high-income countries, these strategies

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8 have not been fully implemented in India as evidence had previously suggested that Asthma is not to be treated independently but fitted into the general spectrum of respiratory diseases. Furthermore, even though medicines that treat asthma effectively are available at affordable costs, they rarely reach more than one per cent of those who would benefit from it. In India, every 7 seconds one child under 8 years of age dies because of lower respiratory tract infection (usually pneumonia). Each year about

four and half million children dies of this, ie; 30% of all deaths in childhood.

Stephen B., (2007).

In India, upper respiratory tract infection is one of the major reasons for which children are brought to the hospitals and health facilities. About 13 percent of inpatient death in pediatric wards is due to upper respiratory tract infection. The proportion of death due to upper respiratory tract infection in the community is much higher as many children die at home. Most children have three to five attacks of upper respiratory tract infection in a year. The incidence is highest in young children especially below five years of age and decreases with the increasing age (Parul Data, 2009).

In Andhra Pradesh, It was found that 19% of children under age 8, suffered from lower respiratory tract infections. Point prevalence of lower respiratory tract infections in AP was lower compared to Kerala, Madhya Pradesh and Orissa. Other states like Tamil Nadu, Karnataka and Maharashtra had lower point prevalence of lower respiratory tract infections. Samatha R., (2003)

In Tamil Nadu the incidence of the common cold varies by age. Rates are highest in children younger than five years. Children who attend school or day care are a large reservoir for URIs, and they transfer infection to those who care for them.

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9 In Tamil Nadu, lower respiratory tract infection prevalence among school children aged 6-13 years were studied. Over all prevalence of LRTI was found to be 2.3 percent. Boys had a higher prevalence (3.1%) than girls (1.4%). Behl R.K., (2010).

According to WHO “Health is a complete state of physical, mental, social and spiritual well-being not merely the absence of any disease or illness”. Healthy children are the future citizen of nation so protection and promotion of the child is of prime importance for building a healthy and sound nation.

In India, as per Centre for Disease Control (CDC) 30-50% of people were visited for pursuing medical facility and 20-40% having hospital admissions. In India, more than 4 lakh deaths every year are due to pneumonia accounting for 13%-16% of all deaths in the pediatric hospital admissions. In 2001 to 2009 there is 50% increase in cases of acute respiratory infection and approximately 3,404 deaths occur in 2010.

In urban areas, acute respiratory infection consist over two-thirds of child diseases.

A study to evaluate the effectiveness of breathing exercises as play method on cardiopulmonary parameters among children with acute respiratory tract infections.

True experimental pre-test and post-test design was used. A total of 67 children aged 3–12 years having acute respiratory tract infections were randomly divided into experimental 34 and control group 33. Pre-test data were collected in both the groups.

Balloon blowing breathing exercises were administered to the experimental group. Post interventional cardiopulmonary parameters were assessed after 1 week in both the groups. The mean post-test heart rate 96.47, respiration rate 25.47, and SpO2 95.2 of the experimental group was significantly near to normal as compared to control group. The mean post-test cough score 1.62, breath sound score 2.18, chest expansion score 2.16, and dyspnoea score 3.74 of experimental group was significantly lower than the control

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10 group. There was significant association between cardiopulmonary parameters and selected demographic variables. Breathing exercises have advantageous effects on cardiopulmonary parameters among children with acute respiratory infections.

Kripa A (2017) conducted a study to evaluate the effectiveness of balloon therapy on level of dyspnoea among patients with lower respiratory tract disorders during post-test. On conducting post-test to the selected 20 12(60%) was found to be non-dyspnoea, 8(40%) were dyspnoea. There was no association with most of the demographic variables like educational status, occupational status area of work, type of workers, co-morbid illness, tobacco chewing, alternative therapies, medication intake and life style practices with respiratory status which includes dyspnoea scale.

Whereas there was an association with age, gender, smoking habit and duration of illness with the level of dyspnoea.

Shakila D (2016) conducted a study to carried out in the asthmatic children to evaluate the effectiveness of balloon blowing exercise among children with bronchial Asthma. Asthma is considered an important problem in children and influences on their everyday functioning. Pathologically there is mucosal inflammation, production of inflammatory mediators, bronchio constriction with oedema and excess mucus production, airway obstruction and air trapping which lead to ventilation perfusion alteration can cause increased work of breathing, hypercapnia and hypoxemia. Presently it is difficult to control all the triggers in a single patients. But it is always possible to improve the respiratory pattern by therapeutic interventions. In the present study the analyzing the effect of balloon blowing exercise on the respiratory patterns among children with bronchial asthma. The result revealed that in pre intervention mean values was 27.0 with standard deviation 4.61 and in post-test I the mean value was 22.2 with

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11 standard deviation 5.78 and in post-test II the mean value was 16.2 with standard deviation is about 0.752. The calculated t value is 6.467 in post-test I and 10.09 in post- test II, is more than the critical t value, which is 2.042 at p<0.05 level. This indicates that, the differences between the scores obtained from the pre and post-test value intervention are highly significant. So we accept the research hypothesis H1. So there was significant improvement of respiratory pattern among children with bronchial asthma by using balloon blowing exercise. Hence, the post-test II score is more comparable rate than post-test I score. Breathing exercise in the present study were based on the expiratory phase of respiration.

Rudan et al., (2011) Upper respiratory tract infections are the most frequent infectious disease in humans with the average adult contracting two to four infections a year and the average child contracting between six to twelve infections in a year.

For children less than five years of age the reported incidence of upper respiratory infections are 24 percent.

Subramanian RK (2008), Investigated the effects of breathing exercise as recreation on respiratory parameters and oxygen saturation among children with respiratory infections (bronchitis, pneumonia) in Cochin, Kerala. Hospitalized children with respiratory infections (6-15 years, both genders) were randomized into the intervention group (n=18), which performed daily breathing exercise for 7 days, and a control group (n=18) which did not perform any breathing exercise. Comparison of the absolute changes of the parameters between the intervention and control group showed a significant difference in the peak flow rate [intervention group -2.50 (-4.00, -1.00), control group 0.00 (-1.00, 1.00), litres/min, P<0.001].

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12 During the clinical experience, the investigator noticed that the children admitted with acute respiratory illness were treated with antibiotics and other flu medications. Thus the researcher was interested to do a study on balloon blowing exercises on respiratory parameters among children with acute respiratory illness which is cheap and easily available.

Statement of the Problem:

“A Study to assess the effect of Balloon Blowing Exercise on airway patency among Preschool Children with Acute Respiratory Illness in selected schools at Kanyakumari district”.

Objectives:

 To assess the pre-test and post-test score of respiratory parameters among preschool children in experimental group and control group.

 To compare the mean pre-test and post-test score between experimental group and control group.

 To find the association between the pre-test score of respiratory parameters and selected demographic variables among preschool children in experimental group and control group.

Hypotheses

H1 : There is a significant difference between the pre-test and post-test score of respiratory parameters among preschool children with respiratory tract infection in experimental group than in control group.

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13 H2 : There is a significant association between the pre-test score of respiratory parameters and selected demographic variables among preschool children in experimental group and control group.

Operational Definitions Assess

It refers to systematically measuring the level of respiratory parameters among Pre-school children before and after balloon blowing exercise by using Respiratory Parameter’s Observation Check List.

Effect

It refers to the desired level of reduction in respiratory illness among preschool children after balloon blowing exercise, it was measured by using Respiratory Parameter Observation Check List.

Balloon Blowing Exercise

It refers to simple exercise that creates that lung capacity by blowing up balloons each day, the child motivated to puffed up new balloon with the size of 1 inch diameter blown to the diameter of 7 inches with the interval of one minute pause and for 10 times with new 10 balloons, the same thing continued for 25 - 30 minutes duration per day for 3 days.

Respiratory Parameters

In this study upper respiratory parameters, helps to identify the upper respiratory tract infection. The respiratory parameters consist of 10 items i.e.

Respiratory rate (28->40 breaths/min), heart rate (90 to >122 beats/min), temperature (98.6°F to 101°F), breath sounds (absent, crackle, wheeze, stridor), running nose

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14 (absent, morning only, with sneeze, continuous), mucous secretion (absent, cloudy, yellowish green, rusty colour), sore throat (absent, scratchy, irritation while swallowing, pain and tender), fatigue(absent, less active, generalized weakness, extreme weakness) and sneezing(absent, with cough, intermittent, continuous).

Acute Respiratory Illness

It refers to infection that may interfere with normal breathing it may cause elevation in temperature, respiratory rate, heart rate, altered breath sounds, running nose, excess mucous secretion, sore throat, fatigue and sneezing. It can be measured by using Respiratory Parameter’s Observation Check List.

Preschool Children

In this study preschool children refers to those who between the age of 4- 6 years of both sexes and studying LKG, UKG and 1st STD.

Assumptions

 Acute respiratory illness is more prevalent among preschool children.

 Balloon Blowing Exercise may have an effect on the Respiratory parameters among preschool children (4-6 years) with acute respiratory illness.

 Balloon Blowing Exercise are easy to perform and cost effective.

Delimitations

 Balloon blowing exercise intervention was delimited to 4 weeks.

 The study will be delimited to the preschool children within the age group of 4 to 6 years.

 The study is delimited to sample size of 40.

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15 Ethical Consideration

The proposed study was conducted after the approval of the dissertation committee of Sree Mookambika College of Nursing, Kulasekharam. Permission was obtained from the Headmistress of Government primary school, Marankonam and Headmistress of Government primary school, Mundanvilai. Written consent from the headmaster from the selected schools. The oral consent was obtained from the Parents, Class teacher before starting the data collection. Assurance was given to the study subjects that anonymity of each individual would be maintained. This was done for maintaining the moral, ethical as well as the legal safety of the investigator.

Conceptual Frame Work

Conceptual frame work is a group of related ideas, statements or concepts which deals with concepts that are assembled by the virtue of their relevance to a common theme. A conceptual model broadly presents an understanding of the phenomenon of interest and reflects the assumption and philosophic views of the models designer.

The conceptual framework of the study was based on Ludwing Von Bertanlaffy’s general system theory. In 1968 Bertanlaffy’s introduce this theory as universal theory that could be applied to many field of study.

According to Bertanlaffy’s general system theory provides a way of examining interrelationship and deriving principles. Theorist described human begin as an open system. For proper functioning of human begin depends on the quality of its input and feedback. Being an open system, the client is capable of receiving information and gain knowledge from his environment. Utilizing this capacity of

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16 client, investigation examines whether the information is processed or not with the help of feedback.

Bertanlaffy’s model includes the following components System

System is connected; interdependent, interacting elements [E.g.; components, people] that are hierarchically organized into a single entity for purpose of achieving a common goal. In the field of nursing system can be individual, a family or a community. These systems are always complex and often studied as systems.

In the present study, School considered as a system.

Input

It consists of information, material or energy that enters the system.

In this study input is the Balloon Blowing Exercise after pre-assessment of airway patency among Pre-schoolers (4-6 years) with acute respiratory illness by using Respiratory Parameter’s Observation Check List.

Throughput

The system uses, organizes and transforms the information in between input, throughput or process and output.

In this study throughput is the process taking place within the subjects during Balloon Blowing Exercise.

Output

Output in the transformed form of information, energy and matter that are given out by individual after processing. It is the evaluation phase.

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17 In this present study output is considered as the evaluation of Balloon Blowing Exercise on respiratory illness among Pre-schoolers by using Respiratory Parameter’s Observation Check List. After the post test, there will be significant reduction level of respiratory illness among Pre-schoolers.

Feedback

According to this system theory feedback refers to the output that is returned to the system and it allow it is monitor itself over time to a steady state known as equilibrium.

In this present study feedback refers to re-evaluate the effectiveness of negative outcome in Balloon Blowing Exercise on reduction level of respiratory illness by using respiratory parameter observation check list among Pre-schoolers with their selected demographic variables such as age, gender, type of family, birth order, residence, education, occupation and income of parents. Information related to acute respiratory illness such as Type of Allergens, family history of allergy, food habits (consumption) and source of information.

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18 CONCEPTUAL FRAME WORK

FIGURE: 1.1- VON LUDWIG BERTANLAFFYS (1968) GENERAL SYSTEM MODEL

THROUGHPUT

INPUT OUTPUT

Reduction in the level of respiratory illness DEMOGRAPHIC

VARIABLES

Age

Gender

Educational status

Type of family

Birth order

Religion

Residence,

Education

Occupation

Income of parents

Type of Allergens

Family history of allergy

Food habits (consumption)

Source of information.

No reduction in level of respiratory

illness Balloon

Blowing Exercise PRE-TEST

Pre- assessment level of respiratory illness among Pre-schoolers

by using Respiratory Parameter’s Observation Check List.

Feed back

POST- TEST Post assessment level of respiratory illness among preschool children by using Respiratory Parameter’s Observation Checklist.

The process

taking place within the

subjects during Balloon Blowing Exercise.

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CHAPTER II

REVIEW OF LITERATURE

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19 CHAPTER – II

REVIEW OF LITERATURE

The review of literature is a summary of previous research topic. Literature reviews can be either a part of larger report of a research project, a thesis or bibliographic essay that is published separately in a scholarly journal. The purpose of literature review is to the reader what knowledge and ideas have been established on a topic and what are the strength and weakness According to Polit and Hungler the task of reviewing research literature involves the Identification, Selection, Critical analysis and Written description of existing information related literature which one received is described under the following headings

Review of literature it contains four Sections:

 Studies related to prevalence and risk factors of acute respiratory illness among children.

 Studies related to Balloon blowing exercise among children with acute respiratory illness.

 Studies related to Balloon blowing exercise on other conditions.

 Studies related to other intervention on respiratory illness.

Section A: Studies related to prevalence and risk factors of acute respiratory illness among children

Savitha Gopalakrishnan (2018) conducted a study to evaluate the risk factors that contribute to occurrence of ARI among the under 5 children. The cross sectional study was carried out among 380 rural under five children in Kancheepuram district,

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20 by systematic random sampling method. A pretested structured questionnaire was used for data collection that was analysed using SPSS software version 16. Results shows that the prevalence of ARI among under five children was 41.6%.The prevalence of ARI was predominant among boys (50.6%) and those residing in semi pucca and kutcha type of house (50.3%) with poor ventilation (61.3%), history of parental smoking (57%), respiratory infection among family members (51.1%) children who did not cry immediately after birth because of any complication (60.9%), and malnourished children (66.4%). These factors contributed to increased prevalence of ARI with a statistically significant association with a P value < 0.05. The study concluded that high prevalence of ARI in this study was contributed by multiple factors. The primary care physician can play a vital role to create awareness on hazards because of exposure to the various contributing factors by lifestyle modifications, good nutrition, and healthy and safe environment.

Alexis A. Tazinya, Gregory E. Halle-Ekane (2018) done a research on risk factors for acute respiratory infections in children under five years attending the Bamenda Regional Hospital in Cameroon. A cross-sectional analytic study involving 512 children under 5 years and the Participants were enrolled by a consecutive convenient sampling method. A structured questionnaire was used to collect clinical, socio-demographic and environmental data. Diagnosis of ARI was based on the revised WHO guidelines for diagnosing and management of childhood pneumonia.

Results shows that the proportion of ARIs was 54.7% (280/512), while that of pneumonia was 22.3% (112/512). Risk factors associated with ARI were: HIV infection 2.76[1.05–7.25], poor maternal education (None or primary only) 2.80 [1.85–4.35], exposure to wood smoke 1.85 [1.22–2.78], passive smoking 3.58 [1.45–

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21 8.84] and contact with someone who has cough 3.37 [2.21–5.14]. Age, gender, immunization status, breastfeeding, nutritional status, fathers’ education, parents’ age, school attendance and overcrowding were not significantly associated with ARI.

A cross sectional study was conducted by Suguna E, Kumar S G., (2014) aimed to assess the prevalence and certain risk factors associated with ARI among school children. The study was conducted among 397 school children age 5-14 years from seven schools of rural Puducherry. Data was collected by interview method using pre-tested structured questionnaire and analyzed by univariate and multiple logistic regression analysis. Overall, 51.1% (203) of the subjects had at least one symptom of ARI in the preceding 2 weeks. The manifestations of ARI included allergic rhinitis (183) 46.1%, dry cough (75) 18.9%, throat pain and fever (54) 13.6%, wheezing (39) 9.8% and ear discharge (28) 7.1%. About half of the subjects with ARI (52.2%) belonged to 5-9 year age group and females (52.3%). Mother's education, family history of 60 allergic disorder and asthma, absence of smoke outlet in kitchen and windows in sleeping room were found to be significantly associated with ARI in univariate analysis (P < 0.05).

Przemko Kwinta, Grzegorz Lis., (2012) depicted a prospective community based study to assess the prevalence and risk factors of acute respiratory infections in an open cohort of 288 children aged 0–12 years in the town of Sisimiut, Greenland, Children were monitored weekly, and episodes of upper and lower respiratory tract infections were registered. Risk factor analyses were carried out using a multivariate Poisson regression model adjusted for age. Risk factors for upper respiratory tract infections included attending a child-care center (relative risk = 1.7) and sharing a bedroom with adults (relative risk = 2.5 for one adult). Risk factors for lower

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22 respiratory tract infections included being a boy (relative risk [RR] = 1.5), attending a child-care center (RR= 3.3), exposure to passive smoking (RR = 2.1), and sharing a bedroom with children aged 0–5 years (RR = 2.0 for two other children).

Breastfeeding tended to be protective for lower respiratory tract disorders.

A prospective case control study done by Pradeep MJ et al., (2011 to identify the risk factors of acute respiratory tract infection among 208 children aged 5 to 10 years in Cheluvambu government medical college hospital, Mysore. Pre designed profoma was used to assess the risk factors involved in the subjects. Chi square test was used for statistical analysis were p value <0.05 was taken as significant. Logistic regression method was used by SPSS package for data analysis. The study result shows that inappropriate immunization for age (21.2%vs 7.69%), families having more than two under five children at home (30.1 vs 11.4) and overcrowding (91.3 vs 20.19) are highly associated with respiratory tract infection. However there was no significant association between vitamin A deficiency, low birth weight and pneumonia.

Pradeep (2010) done a prospective case control study to identify the risk factors of acute respiratory tract infection among 208 children aged 5 to 10 years in Cheluvambu government medical college hospital, Mysore There were three episodes of mild, moderate, or severe ARI per child per year, including 1.3 pneumonia episodes per child per year. The peak of infection corresponded to the rainy season (July- November), and a smaller peak to the dry season (February-April). Pre designed profoma was used to assess the risk factors involved in the subjects. Chi square test was used for statistical analysis were p value <0.05 was taken as significant. Logistic regression method was used by SPSS package for data analysis. The study result shows that inappropriate immunization for age (21.2%vs 7.69%), families having

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23 more than two under five children at home (30.1 vs 11.4) and overcrowding (91.3 vs 20.19) are highly associated with respiratory tract infection.

A community based cross sectional study by Kuppusamy K., (2010) to determine the prevalence of ARI and its risk factors among children in urban and rural areas of Kancheepuram district, South India, during the period of October 2009-February 2010, covering a study population of 500 children. Descriptive statistics was done and chi-square was used as test of significance. Overall, prevalence of ARI was found to be 27%. ARI was noticed more among low social class (79.3%), illiterate mothers (37.8%), those living in kutcha houses (52.6%), overcrowded houses (63.7%), use of smoky fuel for cooking (67.4%), inadequate cross ventilation (70.4%), history of parental smoking (55.6%), low birth weight children (54.8%), and malnourished children (57.8%). Rural children (62.2%) were more affected than urban children.

Zaman K et al., (2009) explored a community based longitudinal study “to investigate acute respiratory infections among children”. Six hundred ninety six children under five years of age were selected randomly. Trained field workers visited the study children every fourth day for one year. Data on symptoms suggesting acute respiratory tract infection were collected by recall and to determine the type and severity of acute respiratory tract infection the field workers conducted physical examinations. The overall incidence of acute respiratory infection was 5.5 episodes per year, the prevalence was 35.4 per hundred days observed The incidence of upper respiratory infection was highest in 18 to 23 months old children, followed by infants six to eleven months old. About 46% of upper respiratory infection episodes lasted 15 days and more. The study documents acute respiratory infections to be a major cause of morbidity among rural children.

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24 McClure L., (2007) A descriptive study to assess the prevalence of lower respiratory tract infection of children, by use of peak flow meter in Central America.

12,245 urban children with persistent asthma were enrolled in a school-based study. Self- monitoring of symptoms or peak flow monitoring (PFM) is recommended for all asthma patients. The mean age of the children was 10.0 (SD 2.1) years; 57% were male and 91%

were African American. 98% (n = 11,974), confirming the peak flow meter readings reported by the children. The prevalence of reported asthma symptoms varied across PFM readings; the highest prevalence occurred in the setting of red zone readings, with intermediate prevalence in the setting of yellow zone readings, and lowest prevalence in the setting of green zone readings. There was no significant relationship between the symptoms with the hospital care.

Koopman LP et al., (2007) depicted a study “to investigate the association between contacts with other children and the development of respiratory infections in the first year of life in children with or without genetic predisposition at Sophia children’s hospital, Rotterdam, the Netherlands”. Four thousand one hundred and forty six children who participated in a prospective birth cohort study were investigated. Questionnaires were used to obtain information on doctor diagnosed upper and lower respiratory tract infections, child care attendance, having siblings, family history of allergic disease and various potential confounders. Child care attendance in the first year of life was associated with doctor diagnosed upper respiratory tract infection (adjusted odds ratio [AOR]: 2.7, 95 percent confidence interval [CI], 2.1-3.4 for large child care facility vs. no child care) and doctor diagnosed lower respiratory tract infection (AOR;5.6,95%CI,3.9- 7.9). Having siblings was associated with doctor diagnosed lower respiratory tract infection (AOR:

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25 2.6, 95% CI, 2.0-3.4). Based on the above results the author concludes that child care attendance or having sibling’s increases the risk of developing doctor diagnosed respiratory tract infections in the first year of life to a greater extent in allergy prone children than in children who are not allergy prone.

Section-B: Studies related to balloon blowing exercise among children with acute respiratory illness

Smita Majusha Das et al., (2018) the study was designed to evaluate the effect of balloon and bubble therapy on physiological parameters of lower respiratory tract infection among 3-12 years children. 60 children between 3-12 years of age with lower respiratory tract infection were randomized to receive either balloon therapy or bubble therapy. Pre-assessment of physiological parameters was done then both the groups were instructed to either blow balloon or bubble for 10 times in 1 session for 3 sessions in a day with 1 hour difference between sessions for 6 days. Finding of the study revealed that there was significant difference observed between pre and post- test mean score of physiological parameters both in bubble and balloon group at p

<0.0001. Study implies that both bubble and balloon blowing exercise are equally effective in improvement of physiological parameters of children with lower respiratory tract infection.

Kripa Angelin(2017) explored a study to assess the effectiveness of the effectiveness of ballooning exercise on level of dyspnoea among patients with lower respiratory tract disorder in medical wards of MGMC&RI, Puducherry. Quantitative research approach was used for this study. The pre-experimental study design was used for this study. Total 20samples were selected using purposive random sampling

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26 technique balloon therapy was given for a week. The data pertaining to level of dyspnoea was collected using structured self-administered questionnaire and respiratory assessment for dyspnea. Among 20 patients the level of dyspnea was measured using dyspnoea scale before the implementation of balloon therapy, 15(75%) patients had poor dyspnea score. Out of 20 samples, 12(60%) of patients had normal dyspnea scale. Regular practice of ballooning exercise can improve the respiratory status to a greater extent among patients with lower respiratory disorders.

Arunima(2016) A quasi experimental study to compare the effect of balloon therapy and incentive spirometry among children with ARI. Quasi experimental two group pre-test and post-test design was used. 40 children from the age group of 2- 6 years with ARI were the samples in this study. In both interventions the pulmonary function got improved along with routine treatment. The researchers found balloon therapy seems more effective in reducing respiratory symptoms in children with respiratory problems in comparison with spirometry. As the data supports balloon therapy is more effective than spirometry.

Sweetlin (2016) conducted a study to evaluate the effectiveness of Balloon blowing exercises on respiratory status among children with Lower respiratory tract infections. The research design used for this study was quasi experimental non equivalent control group pre-test and post-test design. Demographic variables were collected and Pre-test was done for both by using Modified Silverman Respiratory Assessment Index Scale. Then the intervention of Balloon blowing exercise was taught to child and to do exercises daily for 20 minutes in the morning, afternoon and evening for 7 days. Chi-square was calculated to find out the association between the respiratory status with their selected demographic variables. Significant association

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27 was found between respiratory signs in relation to family history of respiratory illness (2 =3.92) and pet animals’ in home (2 =4.28) and No significant association in respiratory signs were found when compared to age, sex, education, residence, type of allergy, and duration of illness.

Josmy George(2015) performed to evaluate the effectiveness of breathing exercises as a play way method on respiratory parameters among children with lower respiratory tract infections in selected hospitals, Coimbatore. The research design used was quasi experimental non-equivalent control group pre-test post-test design.

The convenient sampling technique was used to select the samples. In experimental group the intervention of breathing exercises as play way method was taught to the child and made them to do the exercises daily, 30 minutes for 5 consecutive days in the morning and evening. There is a significant difference in the paired ‘t’ test regarding respiratory parameters among children with lower respiratory tract infections such as peak flow rate (‘t’=8.54) and forced expiratory volume (‘t’=7.2) at p<0.05 level of significance. There was a significant association found between peak flow rates in relation to frequency of attacks in the last year (χ2 =11.71) at (P < 0.05) level of significance. The study findings revealed that there was significant improvement in respiratory parameters in experimental group. Hence breathing exercises as play way method were beneficial among children with lower respiratory tract infections.

Sree Devi(2015) done a study to evaluate the effectiveness of balloon blowing on respiratory parameters among children with lower respiratory tract infection in selected hospitals, Kanyakumari District. Quasi-experimental, Nonequivalent pre-test post-test control group design was adopted between the age group of 3 and 8 years.

References

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