Health is an asset and is more valuable than wealth. But, man’s triumph in controlling a single disease is always associated with the emergence of a new disease. Acute upper respiratory infection is the major cause of morbidity and mortality in children throughout the world, particularly in developing countries. In developing countries, a children under 5 years of age dies every 7 seconds due to acute respiratory infection. In both the developed and developing countries 20-30 episodes of ARI occurs during the first 5 years of life in a child. About 4 ½ million children die due to ARI which accounts for about 30% of all deaths in children (Behara D, 1995).
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Lahiri and Nadkarni (2001) say that ARI accounts for 20 – 25% of deaths among under five and 15-30% of total deaths. In a sample survey, pneumonia ranked first in all ages. In India, 10 -15 children per 10,000 die whereas in united states one child per 10,000 die of acute upper respiratory infection. Thus, 25% of the deaths are preventable through proper immunization.
Acute upper respiratory infection is the leading cause of child mortality (30%) followed by diarrhea (20%) in India. One in every 100 children in India between the age group of 0 – 14 years suffers from AURI (ALL INDIA SURVEY 2002).
In a general hospital acute upper respiratory infection accounts for 20 – 40% of outpatient and 12 – 35% of Inpatient attendance. The vast majority of acute upper respiratory infections are caused by viruses. Most children have 3 to 8 episodes of common cold in a year. Rhinovirus accounts for up to 60% of infections. Cough occurs in 60 to 80% of children with cold. A streptococcal infection accounts for approximately 15% of bacterial pharyngitis.
Acute upper respiratory infections (ARI) are one among the important causes of death in all age groups especially in children below 1 year of age. It has been estimated that 2.2 million deaths are due to Acute upper respiratory infections (ARI) throughout the world. ARI accounts for 13 -20% mortality during first year of life and in child hood in India (Registrar general’s published figures). It is estimated 630,000 deaths occurred due to acute upper respiratory infection annually among pre-school age group. The magnitude of ARI morbidity and its impact on health services can be measured by the proportion of outpatient attendance due to ARI. As high as 20 – 40% of children brought to outpatient department and 12 -35% of children admitted to hospital have ARI.
There is a need to undertake periodic surveys in various parts of the country to determine the incidence of ARI associated morbidity and mortality in children in order to plan organize and evaluate the health services. The government of India in its policy document of health for all by 2000 A.D recommends the ARI control program me to reduce infant and pre-school child mortality.
(Tambe MP, Shivaram.C, Chandrashekhar.Y. Acute upper respiratory infection in children a survey I the rural community, 1999).
The symptoms of acute upper respiratory tract infection include rhinitis, pharngitis/ tonsillitis often referred to as a common cold and their complications sinusitis, ear infection, laryngitis and sometimes bronchitis. Symptoms of upper respiratory tract infection are cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure and sneezing. Onset of the symptoms usually begins 1 – 3 days after the exposure to a microbial pathogen. The duration of illness lasts for 7 -10 days.
(WIKipedia, the free encyclopedia 2000).
Acute respiratory infections (ARIs) also includes pneumonia, influenza, and respiratory syncytial virus (RSV), causes 4.25 million deaths every year. ARIs accounts for third largest causes of mortality in the world and the top killer in low and middle-income countries.
Acute upper respiratory infection causes at least 6 percentages of the world’s disability and death. These deaths occur mainly in the world’s poorest countries, where the drives of acute upper respiratory infection, includes malnutrition, pollution, overcrowding, and tobacco use.
The death due to pneumonia is 215 times higher in low-income countries
3 million to 5 million people suffer from flu every year
The most common source of respiratory illness in children is Respiratory Syncitial Virus.
Acute upper respiratory infection affects people infected with HIV.
The main cause for 20 percent to 40 percent of all hospitalizations in childhood is due to Acute Respiratory Infection.
Pneumonia causes 20 percent of all pediatric deaths around the world -1.6 million in 2008, and, 732,000 children die from malaria and 200,000 from HIV/ AIDS every year.
Respiratory Syncitial Virus kills at least 66,000 children every year.
(Acute respiratory infections Atlas 2010).
Researchers from the universita delgi reported that bacteria in the mouth offer probiotic potential against upper respiratory tract infections. There is only a minimal understanding of internal communication between human hosts and their microbes is available,it is of an idea that probiotics are live microorganism which promote health within their host. The benefits of probiotics are predominantly explored so far in the intestinal tract; but,few studies suggest probiotics also promote wellness in the stomach, vaginal tract, skin and mouth.
The leading cause of visits to the pediatrician is due to upper respiratory infection in children between the ages of 5 and 12. The main cause for upper respiratory infection is Streptococcus pyogenes and the only treatment available at present is antibiotics, where it prescription rates are running up to 90 percent.
Bacteria from the mouths of healthy volunteers were isolated and identified two potential probiotic bacterial strains named Streptococcus salivarius RS1 an ST3. The recently developed oral probiotic prototype and these two strains bound to human pharyngeal cells and responsibe for antagonizing of S. Pyogenes adhesion and growth. Additionally, all these strains were sensitive to antibiotics which are used routinely for treating upper respiratory tract infection.
Only about 1 percent of development funding was spent on research on Acute Respiratory Infection in 2007, than the amount spent on HIV – related research.
Some of the low-cost strategies are available which can be implemented immediately whereas,others require longer – term efforts. The strategies mentioned are:
Effective distribution of nutritional supplements,
Dissemination of knowledge by public awareness campaigns,
Tobacco use to be reduced.
Identifying efficient ways to produce vaccines and the distribution need to be strengthened.
(Acute respiratory infections Atlas 2010).
The supportive therapy of sore throat is gargling with lukewarm saline solution, steam in inhalation, not forcing the child to eat and giving frequent small amount of warm liquid. Tulsi or the loly basil is one of the most common herbs used in cough related remedies. It maintains the health of the throat chest and lungs. In fact, it helps to protect the entire respiratory tract.
NEED FOR THE STUDY
Literature highlights are increasing incidence of ARI as a major health problem for under five children and health experts advocate alternative therapies like lukewarm saline solution, steam inhalation to treat ARI rather than medication alone.
A survey conducted in the rural community regarding respiratory tract infections says that the delay in receiving medical care is considered to learn important reason for the high mortality related to acute respiratory infections in the developing countries. Far distance of the hospital was the main reason for not receding treatment followed by ignorance, family problems etc. Those reasons may force the parents to seek treatment from other alternate resources.
The rural medical practitioners are often not institutionally qualified and hence are frequently not able to select and use appropriate antibiotics in adequate dosage for proper duration for the treatment of acute respiratory infections, making the outcome unfavorable in many children.
Sensitive use of antibiotics can decrease the adverse effects of it and also the costs spent towards it. Decreased antibiotic usage benefits the patient by reducing the rise of drug resistant bacteria, which is now concerned as a problem in the world nowadays. Health authorities are encouraging physicians to reduce the prescription of antibiotic to treat common Upper Respiratory Infection due to above reasons. (National Center for health statistics 2008)
Upper respiratory tract infections (URIs) accounts significant health burden among children.An average child suffers from six to eight attacks of colds each year, where, each attack lasts for seven to nine days. While children are frequently given drugs such as antihistamines, cough suppressants and decongestants, to reduce symptoms, there is no such effectiveness by these medications among children younger than 12 years.
The drugs which prescribed for respiratory tract infections are antibiotics, all these antibiotics are not providing much protection against respiratory infections which in turn becomes a sign of future asthma. This again becomes difficulty to attribute antibiotic use in case of asthma.
(Anita Kozyrskyj, PhD, University of Manitoba, Winnipeg, MB 2010″).
When young children affected with both respiratory and non respiratory infections, the antibiotic is the one which is being prescribed frequently.
(Mark J.Rosen, MD, FCCP, President, American college of chest Physicians 2010).These physicians came with the conclusion that better decisions for treatment option for respiratory infection can be made only if physicians understand clearly the relationship between asthma and antibiotic use.
Tulsi has an important role to play in treating the symptoms of respiratory tract diseases. It acts regularly on phlegm hence it works as a good expectorant giving relief from wet cough. It helps to fight the cause of allergy by which our respiratory tract gets inflamed and then resolves the causative agent. It is anti-inflammatory. It promotes optimum respiratory support. It is an excellent remedy for sore throat and fever.
The investigator during her clinical exposure in the community observed that 50% of the under five population is suffering from acute upper respiratory infections. The investigator observed that mothers with under five (child affected with AURI) seeking medical treatment only in case when AURI becomes severe. Mothers in this community ignoring treatment when their children affected with mild AURI and also they are unaware about home remedy for treating the symptoms of AURI. The investigator also identified that reason for seeking treatment only in the severe AURI by the mothers with under five is due to far distance of the health care facilities and also due to poor transportation facilities. And even if mothers seek medical treatment, antibiotics are being prescribed and it is not advisable as per study conducted by (National centre for health statistics 2008).
So, the investigator found it is useful to a conduct a research in this community to find the effectiveness to Tulsi on upper respiratory tract infection among under five
with upper respiratory infection, where this herb is commonly available and is of no cost.
STATEMENT OF THE STUDY
A study to assess the effectiveness of steam inhalation with Tulsi leaves on signs and symptoms and behavioral responses of children aged 6 months to 2 years with acute upper respiratory infection at home in a rural community, Coimbatore.
AIM OF THE STUDY
The aim of the study was to assess whether there was a reduction in the signs and symptoms of acute upper respiratory infection and changes in behavioral responses of the children who received steam inhalation compared to children who did not receive steam inhalation.
To assess and compare the degree of acute upper respiratory infection in experimental and control group after intervention.
To assess and compare the behavioral responses of children with acute upper respiratory infection in experimental and control group after intervention.
To find out the mother’s views about steam inhalation with Tulsi leaves.
To find out the association between the degree of acute upper respiratory infection demographic variables (Age, sex, immunization status, education of mother, total income of the family).
H1 – There will be a significant difference in the degree of acute upper respiratory infection between the experimental and control group after intervention.
H2 – there will be a significant difference in the behavioral responses between experimental and control group after intervention.
Producing the desired or intended result which is the reduction of symptoms of mild and moderate acute upper respiratory infection and duration of the infection.
Steam inhalation with Tulsi
1 liter of water is boiled in a wide mounted receptacle and Tulsi leaves are added to it. The steam coming out of it is breathed by the child while mother is sitting in front of the steam holding the child with head covered.
Changes which are observed by the researcher with naked eyes.
Changes that are noticed by the mother and reported on asking
The reaction of the child in terms of activities such as smiling, walking, running, eating and playing.
Acute upper respiratory tract infection (AURI)
It is inflammation of the upper respiratory tract involving nose, pharynx and tonsils and manifesting signs and symptoms like runny nose, sneezing, tearing eyes, itching of the nose, pink and shiny nasal mucosa, red and swollen throat, cough, fever and fatigue.
Based on the signs and symptoms, AURI is classified as mild moderate and severe AURI.
In mild AURI. The symptoms are runny nose, sneezing, tearing eyes, itching of the nose, pink and shiny nasal mucosa, and presence of crusts on the nose and fever.
In moderate ARUI, the symptoms are red swollen throat, cough along with the symptoms of mild AURI.
In severe AURI, the symptoms are inflamed and enlarged tonsils, pus within the fold of the tonsils, pain during swallowing and pain in the symptoms of mild and moderate AURI.
Acute upper respiratory infections are very common among under five children in urban and rural community.
Mothers follow certain home remedies like application of Vicks and Camphor over chest, over head and nose and administration of milk with turmeric and pepper and sugar.
Caring children with respiratory infection home in the community is influenced by personal and socio-cultural factors.
Children with acute upper respiratory infection mostly treated at home with home remedies which varies from one community to another
The study is delimited to children aged 6months to 2 years
The study is delimited to children suffering from mild to moderate acute upper respiratory infections.
SCOPE OF THE STUDY
The degree of AURI, duration of infection and behavioral response are assessed in AURI children before and after intervention. If there is a significant reduction in the degree, duration and changes in the behavioral responses of experimental group of sample, then it is the clear indication effectiveness of steam inhalation with Tulsi leaves. Teaching steam inhalation is very simple and it can be practiced very easily. If the mothers are able to administer the steam inhalation with Tulsi for their infected children without any difficulties, and if this intervention is acceptable it is clearly indicate the utility value of Tulsi leaves for acute upper respiratory tract infection children.
The findings will be beneficial to health practices to motivate mothers with AURI infected children and to promote health life.
A conceptual model can be defined as a set of concepts and those assumptions that integrate them into a meaningful configuration (Fewett, 1980).
The development of a concept model is a fundamental process required before conducting actual research. The frame work influence each state of research process. The conceptual framework in nursing research can help to provide a clear concise idea of knowledge in the area. Conceptual framework for this study nursing process model based on Dorothy E.Johnson’s Behavioral system theory (1980).
According to Johnson, nursing views the individual as a set of interconnected or inter-dependent parts functioning as a integrated whole. Johnson identified seven subsystems. The subsystems are affiliation, aggressive, dependency, eliminative, ingestive, restorative, and sexual. The subsystems carry out special function for the system as a whole. Disturbance in any of the subsystem usually affects the other. The steps of the nursing process in incorporated with the Dorothy Johnson’s Behavioral system model.
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Nursing process is a deliberate activity where the proactive of nursing is performed in a systematic order. Dorothy Johnson’s presents a three step nursing process, the steps are entitled nursing diagnosis which parallel the assessment and diagnosis phase, the second step nursing goal equal to the implementation and third step is evaluation. This study focused on children and the dependency system which is one among the subsystems which result in approval, attention, recognition, and physical assistance.
Assessment is the process of collecting data regarding each subsystem. In this study, the assessment was done in the dependency subsystem. Data on demographic profile (age, sex, immunization status, education of the mother, income of the family) was collected. The children were examined for signs and symptoms of acute upper respiratory infection and behavior responses of the children were collected by interviewing the children’s mother.
Through assessment from the subsystem problems are identified and diagnosis is made and it provides basis for nursing intervention. In this study the data collected through observation and interview using interview schedule and observation checklist was analyzed the diagnosis is made on acute upper respiratory infection and categorized into mild, moderate and no infection.
NURSING GOALS (PLANNING)
After diagnosis is made the goal is to maintain or restore the person’s behavioral system balance and stability through planning interventions. In this study, the goal was to reduce the degree acute upper respiratory infection and to restore the high level of activity (behavioral responses). In this study the planning occurs when the children and a nurse identify activities and bring about dependency system equilibrium.
Nursing activity as an external regulatory force assists the equilibrium.
Based on the diagnosis, nursing actions and intervention can be planned in terms of teaching, external control or providing responses needed by the client. In this study, the nursing activity was the administration of steam inhalation therapy with Tulsi leaves the children in the experimental group for a period of time brings about change in the degree of acute upper respiratory infection.
Evaluation refers to checking the subsystems identified as problematic for balance and overall system stability. In this study, the investigator compared the degree of acute upper respiratory infection of the experimental group children with the control group by using criteria and evaluated the effectiveness of the intervention by observing the signs and symptoms of infection and the report given by mothers of the children.
Figure – 1
Highlights the conceptual framework on modified nursing process based on Dorothy Johnson’s Behavioral system model.
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