Rajiv Gandhi University of Health Sciences



A STUDY TO ASSESS THE KNOWLEDGE OF MOTHERS REGARDING PICA AMONG THEIR TODDLER CHILDREN IN SELECTED RURAL AREAS AT GULBARGA

PERFORMA FOR REGISTRATION OF STUDENTS FOR DISSERTATION

DEEPENDRA SINGH SHEKHAWAT

M.SC NURSING 1ST YEAR

PAEDIATRIC NURSING

YEAR 2010-2011(MID-STREAM)

AL-KAREEM COLLEGE OF NURSING BAREY HILLS NEAR ADARSH NAGAR GULBARGA-585105

RAJIV GHANDI UNIVERSITY OF HEALTH SCIENCES BANGLORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTION

| | |DEEPENDRA SINGHSHEKHAWAT |

|01 |NAME OF THE CANDIDATE & |1ST YEAR M.SC PAEDIATRIC NURSING AL-KAREEM COLLEGE GULBARGA |

| |ADDRESS | |

| | |AL-KAREEM COLLEGE OF NURSING, GULBARGA |

|02 |NAME OF THE INSTITUTION | |

| | | |

|03 |COURSE OF STUDY |M.SC NURSING PAEDIATRIC |

| |DATE OF ADMISSION TO THE COURSE | 29-11-2010 |

|04 |Batch 2010-2011 |2010-11(MID-STREAM) |

|05 | |

| |TITLE OF THE TOPIC: |

| |A STUDY TO ASSESS THE KNOWLEDGE OF MOTHERS REGARDING PICA AMONG THEIR TODDLER CHILDREN IN SELECTED RURAL AREAS AT GULBARGA |

6.0.BRIEF RESUME OF THE INTENDED WORK:

6.1.INTRODUCTION

The word pica comes from the Latin word for magpie, a bird known for its large and indiscriminate appetite. Pica is most common in people with developmental disabilities, including autism and mental retardation, and in children between the ages of 2 and 3. Pica also may surface in children who've had a brain injury affecting their development. It can also be a problem for some pregnant women, as well as people with epilepsy.People with pica frequently crave and consume nonfood items such as: Dirt, Clay, paint chips, plaster, chal, cornstarch ,laundry starch, baking soda, coffee grounds, cigarette ashes, burnt match heads, cigarette butts, feces, ice, glue, hair, buttons, paper, sand,toothpaste, soap + Although consumption of some items may be harmless, pica is considered to be a serious eating disorder that can sometimes result in serious health problems such as lead poisoning and iron-deficiency anemia. 1.

•

•

• About Pica

• Signs of Pica

• Why Do Some People Eat Nonfood Items?

• When to Call the Doctor

• What Will the Doctor Do?

Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g., metal, clay, coal, sand, dirt, soil, feces, chalk, pens and pencils, paper, batteries, spoons, toothbrushes, soap, mucus, ash, gum, etc) or an abnormal appetite for food ingredients (e.g. flour, raw potato, raw rice, starch, ice cubes, salt) For these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for magpie, a bird that is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women, small children, and those with developmental disabilities. Pica is more common in women and children. Pica in children (usually only in young children or children with autism or another mental or developmental disorder) may be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phase out of tetra-ethyl lead in gasoline (in some countries) or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach.2.

This is also true in animals. Another risk of dirt-eating is the possible ingestion of animal feces and accompanying parasites. Pica can also be found in animals, and is most commonly found in dogs. The scant research that has been done on the causes of pica suggests that the disorder is a specific appetite caused by mineral deficiency in many cases, such as iron deficiency, which some time is a result of celiac disease Some of the traumatic events common in individuals with pica include maternal deprivation, parental separation or neglect, child abuse, disorganized family structure and, pica can also be a cultural practice not associated with a deficiency or disorder. Ingestion of kaolin (white dirt) among African-American women in the U.S. state of Georgia shows the practice there to be a DSM-IV "culture-bound syndrome" and "not selectively associated with other psychopathology". Similar kaolin ingestion is also widespread in parts of Africa. Such practices might stem from health benefits such as clay's ability to absorb plant toxins and protect against toxic alkaloids and tannic acids. poor parent-child interaction 3.

Pica is defined as the persistent ingestion of nonnutritive substances for a period of at least 1 month at an age at which Individuals who present with pica have been reported to mouth and/or ingest a wide variety of nonfood substances, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches. pica is observed most frequently in children, it is the most common eating disorder in individuals with developmental disabilities. In some societies, pica is a culturally sanctioned practice and is not considered to be pathologic. Pica may be benign, or it may have life-threatening consequences 4.

Development of the treatment plan must take into account the symptoms of pica and contributory factors, as well as the management of possible complications of the disorder. Toxic ingestions: Lead toxicity is the most common poisoning associated with pica. Physical manifestations are nonspecific and subtle, and most children with lead poisoning are asymptomatic. Physical manifestations of lead poisoning. Infections and parasitic infestations: Toxocariasis (visceral larva migrans, ocular larva migrans) and ascariasis are the most common soil-borne parasitic infections associated with pica. Symptoms of toxocariasis are diverse and appear to be related to the number of larvae ingested and the organs to which the larvae migrate. Physical findings associated with visceral larva migrans may include fever, hepatomegaly, malaise, coughing, myocarditis, and encephalitis. Ocular larva migrans can result in retinal lesions and loss of vision.GI tract symptoms may be evident secondary to mechanical bowel problems, constipation, ulcerations, perforations. 5.

The hallmark feature of pica, consistently consuming nonfood substances, often does not present publicly. People may be embarrassed to admit to these unusual eating habits individual may not report the pica to a simply because of alack of knowledge of pica's potential medical significance. Because the eating behaviors of pica are not usually detected orreported, pica. Geophagiaha spotential side effects that most commonly affect the intestine and bowel. Complications caninclude constipation, cramping, pain, obstruction caused by formation of an indigestible mass, perforation from sharp objects likerocks orgravel, and contamination and infection from soil-dwelling parasites. Amylophagia usually involvesthe consumption of cornstarch and, less frequently, laundry starch. The high caloric content of starch can cause excessive weight gain, Compulsive consumption of even a seemingly harmless substance like ice (pagophagia) can have negative sideeffects, including decreased absorption of nutrients by the gut .Amylophagia - The compulsive eating of purified starch, typically cornstarch or laundry starch .Geophagia - The compulsive eating of earthy substances, including sand, soil, and clay.Pagophagia - The compulsive eating of ice 6.

Pica is the persistent craving and compulsive eating of nonfood substances. classifie it as a feeding and eating disorder of childhood. Evidence suggests that there may be several causes of pica. One widely held theory points to iron deficiency as a major cause of pica. Several reports have described pica in individuals with documented iron deficiency, there has been uncertainty as to whether their on deficiency was a cause of pica or a result of it. Because some substances, such as clay it was thought that low blood levels of iron could be the direct result of pica. Evidence suggests that there may be several causes of pica. One widely held theory points to iron deficiency as a major cause of pica there has been uncertainty as to whether the iron deficiency was a cause of pica or a result of it. Because some substances, suchas clay, it was the Warning signs that a child may have pica include: repetitive consumption of non food items ,despite efforts to restrict it, for a period of at least 1 month or longer the behavior is considered inappropriate for your child's developmental stage (older than 18 to 24 months)the behavior is not part of a cultural, ethnic, or religious prels .The specific causes of pica are unknown 7.

6.2.NEED FOR THE STUDY:

Pica occurs throughout the world. Geophagia is the most common form of pica in people who live in poverty and people who live in the tropics and in tribe-oriented societies. Pica is a widespread practice in western Kenya, southern Africa, and India. Pica has been reported in Australia, Canada, Israel, Iran, Uganda, Wales, Turkey, and Jamaica. In some countries, Uganda for example, soil is available for purchase for the purpose of ingestion. Morbidity and mortality are related to the following types of ingestions: Ingestion of poisons: Lead toxicity is the most common type of poisoning associated with pica. Lead has neurologic, hematologic, endocrine, cardiovascular, and renal effects. Lead encephalopathy is a potentially fatal complication of severe lead poisoning, presenting with headache, vomiting, seizures, coma, and respiratory arrest. Ingestion of high doses of lead can cause significant intellectual impairment and behavioral and learning problems. Studies also have demonstrated that neuropsychologic dysfunction and deficits in neurologic development can result from very low lead levels, even levels once believed to be..Exposure to infectious agents: Various infections and parasitic infestations, ranging from mildtosevere, are associated with the ingestion of infectious agents via contaminated substances, such as feces or dirt.

The practice is reported to be more common among certain cultural and geographic populations. For example, geophagia is accepted culturally among some families of African lineage and is reported to be problematic in 70% of the provinces in Turkey. geophagia has been associated with soil-borne parasitic infections, such as toxocariasis , toxoplasmosis, and trichuriasis. GI tract effects: GI tract complications associated with pica range from mild (eg, constipation) to life threatening (eg, hemorrhages secondary to perforations or ulcerations) Sequelae in the GI tract may include mechanical bowel problems, onstipatiul cerations, perforations, and intestinal obstructions caused by bezoar formation and the presence of undigestible materials in the intestinal tract. Direct nutritional effects: Theories regarding the direct nutritional effects of pica are related to characteristics of specific ingested materials that either displace normal dietary intake or interfere with the absorption of necessary nutritional substances. Examples of nutritional effects that have been linked to severe cases of pica include iron and zinc deficiency syndromes; however, the data are only suggestive, and no firm empirical data support these theories. Dental effects: Pica has been reported to result in severe tooth abrasion, abfraction, and surface tooth loss.

Pica typically occurs in equal numbers of boys and girls; however, it is rare in adolescent and adult males of average intelligence who live in developed countries Pica is observed more commonly during the second and third years of life and is considered developmentally inappropriate in children older than 18-24 months. Research suggests that pica occurs in 25%-33% of young children and 20% of children seen in mental health clinics. Infants and children commonly ingest paint, plaster, string, hair, and cloth. Older children tend to ingest animal droppings, sand, insects, leaves, pebbles, and cigarette butts. Adolescents and adults most often ingest clay or soil.8.

Although pica in children often remits spontaneously, a multidisciplinary approach involving psychologists, social workers, and physicians is recommended for effective treatment Universal screening of blood lead concentrations in all children aged 1-2 years is recommended in localities where at least 27% of houses were built before 1950. Screening is also recommended in places where the prevalence of elevated blood levels in children aged 1-2 years is 12%. Targeted screening for high-risk 1- and 2-year-old children is otherwise recommended. No specific laboratory studies are indicated in the evaluation of pica. However, certain laboratory studies may be indicated to assess the consequences of pica, depending on the characteristics and nature of the ingested materials and the resultant medical sequelae.9.

Eating earth substances such as clay or dirt is a form of pica known as geophagia, which can cause iron deficiency. One theory to explain pica is that in some cultures, eating clay or dirt may help relieve nausea (and therefore, morning sickness), control diarrhea, increase salivation, remove toxins, and alter odor or taste perception. nutritional deficiencies, such as iron or zinc, that may trigger specific cravings (however, the nonfood items craved usually don't supply the minerals lacking in the person's body) dieting — people who diet may attempt to ease hunger by eating nonfood substances to get a feeling of fullness malnutrition, especially in underdeveloped countries, where people with pica most commonly eat soil or clay cultural factors — in families, religions, or groups in which eating nonfood substances is a learned practice parental neglect, lack of supervision, or food deprivation — often seen in children living in poverty.10.

A child who continues to consume nonfood items may be at risk for serious health problems, including: lead poisoning (from eating paint chips in older buildings with lead-based paint)bowel problems (from consuming indigestible substances like hair, cloth, etc.)intestinal obstruction or perforation (from eating objects that could get lodged in the intestines)dental injury (from eating hard substances that could harm the teeth)parasitic infections (from eating dirt or feces)Your doctor will play an important role in helping you manage and prevent pica-related behaviors, educating you on teaching your child about acceptable and unacceptable food substances. The doctor will also work with you on ways to restrict the nonfood items your child craves Depending on a child's age and developmental stage, doctors will work with kids to teach them ways to eat more appropriately. Medication may also be prescribed if pica is associated with significant behavioral problems not responding to behavioral treatments.

A child who has ingested a potentially harmful substance, such as lead, will be screened for lead and other toxic substances and might undergo stool testing for parasites. In some cases, X-rays or other imaging may be helpful to identify what was eaten or to look for bowel problems, such as an obstruction Following treatment, if your child's pica behavior continues beyond several weeks despite attempts to intervene, contact your doctor again for additional treatment. Remember that patience is key in treating pica because it can take time for some kids to stop wanting to eat nonfood items. 11.

6.3.REVIEW OF LITERATURE

Review of literature is the key step in research process. The review of the literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audio visual materials and personal communication.

Emphasis has been placed on pharmacologic procedural sedation and analgesics, but environmental and non pharmacologic therapis contribute greatly to distress reduction.

Review of literature is organized under the following sections:

SECTION- І REVIEWS RELATED TO DEMOGRAPHIC VARIABLES & PICA.

SECTION-П REVIEWS RELATED TO MOTHER KNOWLEDGE ON PICA.

SECTION-Ш REVIEWS RELATED TO PICA.

Section- І

REVIEWS RELATED TO DEMOGRAPHIC VARIABLES IN PICA

A study was conducted on Pica (pica = magpie) is an eating disorder that is manifested by a craving for oral ingestion of a given substance that is unusual in kind (nonfood items) or quantity (food items). PICA has been described as a worldwide phenomenon, there are more frequent occurrences of selected substances among selected groups--especially young children. In Central Europe and Germany this syndrome has not been described in the modern literature. For this reason, we report a case of pica for starch associated with severe iron deficiency anemia in Germany. Iron deficiency anemia and--less often-potassium and zinc deficiency are the main complications of an excessive starch or clay ingestion, lead poisoning (in dried paint pica) have been described. 12.

A study was conducted on Pica is the compulsive eating of nonnutritive substances and can have serious medical implications. there has been no single agreed-upon explanation of the cause of such behavior .were searched from 1964 to the present to find relevant sources of information using the key words "pica," "obsessive-compulsive disorder," "iron-deficiency anemia," and "nutrition."Pica is observed most commonly in areas of low socioeconomic status in children. To our knowledge, the prevalence of pica is not known. Numerous complications of the disorder have been described, including iron-deficiency anemia, lead poisoning, and helminthic infestations. Pica is probably a behavior pattern driven by multiple factors. Many different treatment regimens have been described, with variable responses.13

A study was conducted to determine the prevalence of pica and its characteristics among children with sickle cell disease.The acute illness, or age younger than 3 years.Sex, age, weight, height, Tanner stage, complete blood cell count, sickle cell genotype, pica history, and levels of iron, zinc, lead, and fetal hemoglobin (Hb).Of 395 study patients, 134 (33.9%) reported pica. Ingested items included paper, foam, and powders. There was a significantly higher prevalence of pica among patients homozygous for Hb S (Hb SS, sickle cell anemia) compared with the combined group of double heterozygous patients the mean age of patients with pica was significantly lower; however, the prevalence was 23.3% (27/116) among those aged 10.0 to 14.9 years and 14.8% (8/54) among those aged 15.0 to 19.0 years. Within age groups, patients with pica weighed significantly less Pica appeared to have an unusually high prevalence in patients with sickle cell disease and a correlation with lower Hb levels. It is unclear whether pica is a specific marker of disease severity,the association between picaica and low body weight suggests a nutritional effect on its prevalence.14.

A study was conducted To ascertain the attitude of hospital physicians in the Paris area concerning pica and its relation to iron deficiency and to compare findings with data in the literature. An anonymous questionnaire was sentto 174 department heads of specialty units caring for iron deficiency patients: internal medicine (n = 56), hepatogastroenterology (n = 39), hematology (n = 13), gynecology and obstetrics (n = 34), pediatrics (n = 32).The overall response rate was 40.2%. Ninety-seven percent of all the physicians found pica in less than 10% of patients with iron deficiency, and 95.6% considered geophagia as the most frequent pica. For 58.5% of the adult medicine practitioners, pica was regarded only as a cause of iron deficiency, but for 64.7% of the pediatricians. In the majority of the cases, the attitude of hospital physicians concerning pica is in disagreement with published data, suggesting either epidemiolo1 PICA 15.

A study was conducted on The incidence of pica in pre-school children was investigated by studying 192 children. The incidence of pica was twice as common in those who kept pets in both study groups. Half of the pet-keeping children with pica had eaten their pet's food. Imitative behaviour is suggested as a probable cause. Pet-keeping compounds a child's risk of infestation not only by providing close contact with a reservoir of enteropathogens but also by encouraging pica. 16.

Section-П

REVIEWS RELATED TO MOTHER KNOWLEDGE ON PICA.

A study was conducted on Pica, the persistent and compulsive ingestion of particular food items or nonnutritive substances, has been associated with iron deficiency, zinc deficiency, geophagia, mental deficiency, developmental delay, and a family history of pica. Nutritional, sensory physiologic, psychosocial, and cultural theories. the etiology of pica is poorly understood. Pica, secondary to iron deficiency, is relatively common and remits after iron therapy. Complications of pica include abdominal problems (sometimes necessitating surgery), lead poisoning, hypokalemia, hyperkalemia, mercury poisoning, phosphorus intoxication, and dental injury.17.

A study was conducted on Pica is an eating disorder that is manifested by a craving for oral ingestion of a given substance that is unusual in kind and or quantity. It is a long-standing practice that has far reaching implications for prevention and treatment--implications for public health as well as clinical personnel who work in settings where they have the potential for influencing health knowledge, attitudes. The body of literature on pica is so fragmented that it is difficult to find a precise summary of the knowns and unknowns about the condition. There is little consistency defining pica, classifying substances ingested, identifying key characteristics of practicers, there is a need for more comprehensive studies of prevalence and incidence and use of deductive as well as inductive research processes.18.

A study was conducted on Pica is the collective term for any form of qualitative disorder of eating behaviour. If a patient's deviant appetite is fixated on one special object, there are quite a number of corresponding terms available (e.g. geophagia for eating dirt). Pica, shows heightened prevalence in certain high-risk populations, i.e. infants. The author briefly summarizes the medical history of the pica concept and the present state of knowledge concerning aetiology and pathogenesis. The numerous possible complications and various therapeutic approaches are pointed out. 19.

A study was conducted to the present study supported the finding of Bucher et al. (1976) that physical restraint can control pica. unlike the earlier study which additionally used a verbal reprimand, physical restraint alone was shown to be effective. Further, this study showed that while all three durations of physical restraint suppressed pica. The procedure proved simple to use, took minimal staff training time, and required no equipment. During treatment some increase in pica was observed in settings where treatment had not yet been applied but later treatment in these settings quickly controlled the behavior . A precursor for pica, which showed variable changes, with reductions being the only large changes. 20.

A study was conducted to be effective in controlling certain classes of maladaptive behavior in mentally retarded persons. In the present study, an alternating treatments design was used to measure the differential effects of overcorrection and physical restraint procedures in the treatment of pica. Each occurrence of pica was followed by either an overcorrection procedure or a physical restraint procedure. the occurrence of pica and had a similar effect on the occurrence of collateral behaviors, physical restraint was clinically more effective in terms of immediate response reduction. 21.

Section-Ш

REVIEWS RELATED TO PICA.

A study was conducted on Pica is a serious behavioral problem because it can result in significant medical sequelae. The nature and amount of the ingested substance determine the medical sequelae. Pica has been shown to be a predisposing factor in accidental ingestion of poisons, particularly in lead poisoning. The ingestion of bizarre or unusual substances has also resulted in other potentially life-threatening toxicities, such as hyperkalemia following cautopyreiophagia (ingestion of burnt match heads). In particular, geophagia (soil or clay ingestion) has been associated with soil-borne parasitic infections, such as toxoplasmosis and toxocariasis. Gastrointestinal (GI) tract complications, including mechanical bowel problems. 22 .

A study was conducted to the etiology of pica is unknown, numerous hypotheses have been advanced to explain the phenomenon, ranging from psychosocial causes to causes of purely biochemical origin. Cultural, socioeconomic, organic, and psychodynamic factors have been implicated.0Although no firm empirical data support any of the nutritional deficiency etiologic hypotheses, deficiencies in iron, calcium, zinc, and other nutrients ( eg , thiamine, niacin, vitamins C and D) have been associated with pica. In particular, the ingestion of clay or soil and the ingestion of starch may be culturally based and is regarded as acceptable by various social groups. Clay eating and starch eating are seen in the United States in some southern, rural, African American communities, primarily among women and children. Starch eating, in particular, Underlying biochemical disorder: The association of pica, iron deficiency, and a number of pathophysiologic states with decreased activity of the dopamine system has raised the possibility of a correlation between diminished dopaminergic neurotransmission and the expression and maintenance of pica however, specific pathogenesis resulting from any underlying biochemical disorders has not been identified empirically. Other risk factors Parent/child Psychopathology Family disorganization Environmental deprivation Pregnancy Epilepsy Brain damage Mental retardation Developmental disorders 23

A study was conducted to the eating behavior in childhood. It is defined as the persistent intake of non-nutritional substances for at least one month, in an inappropriate way from an evolutionary perspective. including primates, have this behavior. Documented from antiquity, in most cases it has been considered a symptom of another related disorder rather than as independent condition. Its prevalence is unknown. It is mainly described in mentally disabled people, pregnant women, autism, mentally ill patients, children, and others. The ingestion of earth, ice, starch, ropes, wood, and other products has been observed, although some authors also include the obsessive and reiterate consumption of eatable substances. Geophagia is considered a cultural phenomenon. The etiology of pica is unknown and it has no markers. Sensitive, digestive, nutritional, psychological, and psychiatric factors have been implicated in its origin and maintenance. Although the morbimortality is unknown and difficult to study. the global management of this entity requires a coordinated intervention of different health care professionals.24.

A study was conducted on geophagia (earth eating) has been observed and documented in many areas of the world, the specific preference for consuming kaolin is less well known. The ingestion of kaolin, also known as white dirt, chalk, or white clay, is a relatively common type of pica found in the central Georgia Piedmont area.We reviewed the literature, and arranged semistructured interviews with 21 individuals with of chalk eating; we gathered both quantitative and qualitative information.kaolin ingestion appears to be a culturally-transmitted form of pica, ingestion appears to meet the DSM-IV criteria for a "culture-bound syndrome.25.

A study was conducted on Clay pica is a form of compulsive ingestion of non-nutritive substances frequently practiced by dialysis patients. Its consequences are unknown. In this study, we evaluated the effect of regular consumption of clay on hematologic and metabolic profiles in hemodialysis patients.A prospective, case-control study with use of structured questionnaire.One hundred thirty-eight patients on hemodialysis for at least 12 months were interviewed. Thirteen of 138 (9.4%) confessed to clay pica. Estimation of the daily consumption of Al, Fe, and Si from clay and their relationship to the laboratory profiles.Iron was significantly higher in pica patients (13.0 +/- 7.9 micromol/L v 7.5 +/- 2.5 micromol/L, P =.04), but potassium was higher among control than pica cases (4.9 +/- 0.7 mmol/L v 4.4 +/- 0.6 mmol/L, P =.07). Estimated metal exposure from daily clay consumption per patient were: Al (1-2 mg), Fe (11-23.5 mg), and Si (2-4.5 gClay pica does not appear to be detrimental to the hematologic and metabolic milieu of hemodialysis patients.26.

6.4 STATEMENT OF PROBLEM

A STUDY TO ASSESS THE KNOWLEDGE OF MOTHERS REGARDING PICA AMONG THEIR TODDLER CHILDREN IN SELECTED RURAL AREAS AT GULBARGA

6.5 OBJECTIVE OF THE STUDY:

1. To assess the knowledge of mother’s regarding PICA among their toddlers.

2. To associate the knowledge of mother with selected demographic variables.

3. To develop health education handouts regarding consequence of PICA on health of the child.

6.6 OPERATIONAL DEFINATION:

1. Assess: TO measure the quality of knowledge related to PICA among their mother

2. Knowledge: It refers to the understanding or awareness of mother’s regarding PICA the

disorder of eating unwanted and Unnutritive substances

3. Mother’s: In this Study mothers refers to women who have children from age group 1 to 3

years at selected rural areas of Gulbarga.

4. Pica: In this study, it refers to eating of unusual things. Like sand, soil, clay, lead, starch &

corn starch

5. Toddler children: A young child who is learning or learned to walk from the age group 1 to 3

years.

6. Selected rural areas: In this study it refers to selected villages which come under Gulbarga

district.

6.7. ASSUMPTION

1 Mothers may have knowledge regarding PICA among their toddler children.

2 Socioeconomic factors may have effect on PICA among their toddler children.

3 Health eduction pumplet may improve the knowledge of mother in imparting knowledge on

the PICA and its imparting daily.

6.8 Hypothesis:

There will be a significant association between the knowledge and selected demographic variables of mother’s

6.9 Variables:

Study variable: Knowledge of mother regarding pica Among their toddlers

Demographic variable: It consist base line characteristic age religion, education, occupation, income, type of family, family size, no of children, source of knowledge

6.10 Delimitation :

The study is limited to

1. Mother’s who have toddler children.

2. Mother’s who are available at the time of study.

3. Mother’s who are willing to participate in the study.

7.0 Material and methods

7.1 Source of data:

Mother’s of toddlers residing at selected rural areas of Gulbarga

7.2 Methods of data collection:

7.2.1 Research design:

Non experimental descriptive design

7.2.2 Setting of the study:

A study will be conducted in the rural areas of Nandoor at Gulbarga

7.2.3 Population:

Mother’s of toddlers (1-3 years) residing at selected rural areas of Nandoor at Gulbarga.

7.2.4 Sample:

Mother’s residing at selected rural areas who full fill the inclusion criteria and sample.

7.2.5 Sample size : Sample size consists of 60 mothers’ of toddler children at Gulbarga.

7.2.6 Sample techniques: Convenient sampling techniques:

7.2.7 Sampling criteria:

Inclusion criteria:

1. Mother’s who are willing to participate in this study

2. Mother’s who have toddler children

3. Mother ‘s residing at selected rural areas of Nandur at Gulbarga

4. Mother’s who available data collection are

Exclusion criteria:

1. Mother’s who are not willing to participate in the study

2. Mother’s who are not available data collection

3. Mother’s who don’t have toddlers children

7.2.8. TOOLS:

The tool for data collection consist the following section

A) Section1: Demographic data of mothers such as age, religion, education, occupation, income, type of family size, number of children, source of knowledge.

B) Section2-:Structured interview schedule to assess the level of knowledge regarding. PICA among

the toddler children.

7.2.9. METHODS OF DATA COLLECTION :

After optaining the official permission from concerned authorities and informed consent from the respondents, the researcher will conduct the interview schedule to assess the level of knowledge. Duration study of the 4-6 weeks.

7.3. DATA ANALYSIS AND INTERPRETION:

1) Data collected on knowledge regarding PICA will be analyzed throw following techiniqes.

2) Descriptive statistics and inferential statistics means standard deviation frequency will be used to assess the knowledge regarding PICA among their toddlers childrens. Chi-square test will be used to bring between knowledge with selected Demographic, Variables of mothers. The analysed data will be presented in the form of tables and graphs.

Projected outcome: After the study. The investigator will know the level of knowledge of mother regarding development of PICA and than base on the outcome the investigator will develop a health education pamphlet to distribute to all the participate.

7.4. DOES THE STUDY REQUIRE ANY INVESTIGATION TO THE CONDUCED ANIMALS?

NO

7.5. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM CONCERNED AUTHORITIES :

Yes permission will be obtained from concerned authorities

8.0 BIBLIOGRAPHY:

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WWW.: Available from Wikipedia

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4 . Auhor: Caroly Pataki, eating disorderpica, Background , Medscap reference

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Reference

6 . WWW.: ‘’ Pica cause and symptoms and diagnosis treatment’’.

Available from Wikipedia.

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the Doctor: sign pica

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from.

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http:/www Available from.

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Available from Wikipedia.Reviewed by: Mary L. Gavin, MDDate r eviewed: January 2011

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| |36(8):635-40. | |

| |

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| | | |

|9. |SIGNATURE OF THE CANDIDATE | |

| | | |

|10. |REMARKS OF THE GUIDE |THE SELECTED PROBLEM IS APPROPRIATE |

| | | |

|11. |NAME AND DESIGNATION OF | |

| | | |

| |11.1 GUIDE | |

| | | |

| |11.2 SIGNATURE | |

| | | |

| |11.3 CO-GUIDE | |

| | | |

| |11.4 SIGNATURE | |

| | | |

|12. |12.1 HEAD OF THE DEPARTMENT | |

| | | |

| |12.2 SIGNATURE | |

| | | |

|13. |13.1REMARKS OF THE CHAIRMAN & PRINCIPAL |THE SELECTED PROBLEM IS APPROPRIATE |

| | | |

| |13.2 SIGNATURE | |

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