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

1

RAJIV GHANDI UNIVERSITY OF HEALTH SCIENCES

BANGLORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTION

01

NAME OF THE CANDIDATE &

ADDRESS

DEEPENDRA SINGHSHEKHAWAT

1ST YEAR M.SC PAEDIATRIC NURSING AL-KAREEM COLLEGE GULBARGA

02 NAME OF THE INSTITUTIONAL-KAREEM COLLEGE OF

NURSING, GULBARGA

03 COURSE OF STUDY M.SC NURSING PAEDIATRIC

04

DATE OF ADMISSION TO THE COURSE

Batch 2010-2011

29-11-2010

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

2

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.

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

3

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.

4

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

5

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

6

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

7

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

8

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),

9

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

10

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

11

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

12

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.

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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.

14

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:

15

7.2.7 Sampling criteria:

Inclusion criteria:

1. Mother’s who are willing to participate in this study2. Mother’s who have toddler children3. Mother ‘s residing at selected rural areas of Nandur at Gulbarga4. Mother’s who available data collection are

Exclusion criteria:

1. Mother’s who are not willing to participate in the study2. 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.

16

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

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8.0 BIBLIOGRAPHY:

1.Auhor: Cynthia REllis, Et.al eating disorder, Pica follow up Medscap, ABOUT PICA. WWW.GOOGLE.COM: Available from Wikipedia

2. Jeannine Stein. "Treating people who intentionally swallow foreign objects can be costly, a study finds."Los Angeles Times. November 03, 2010.

3. Karl, Peter. "Comfort food: The woman who suffers from a rare disorder that means she Cannot stop herself from eating. sofas". Daily Mail Online. http://www.dailymail.co.uk/news/article-1375586/Comfort-food-The-woman-stop-eating- sofas.html. Retrieved April 21, 2011.

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

5. Auhor: MD chief Editor Et. Al Eating Disorder, pica Clinical Presentation. Medscap Reference

6 . WWW.GOOGLE.COM: ‘’ Pica cause and symptoms and diagnosis treatment’’. Available from Wikipedia.

7 . Available from http:/www. Google. com: “ sign pica and pica description WHEN to call the Doctor: sign pica

8. Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD “ Epidemiology Eating Disorder, pica “ http:/www. Google. com Available from.

9 . Author: Chief Editor:  “ Eating Disorder, pica work up” http:/www Google.com Available from.

10. Author: Caroly Pataki,MD : “sign of pica why do some people eat nonfood items.’’ http:/www Google.comAvailable from.

11 . WWW.GOOGLE.COM:” when to call the doctor and what 4will the doctor do”. Available from Wikipedia.Reviewed by: Mary L. Gavin, MDDate r eviewed: January 2011

12 . Mengh H, LangA, ‘’ PICA in germany- amylophagia as the etiology of iron deficiency anemia’ Klinikum Remscheid GmbH,Medizinische Klinik it. Z Gastroenterol, 1998 Aug, 36(8):635-40.

13. Rose EA, Porcerelli JH, ‘’pica: common but commonly missed’’Department of family Medcine, Wayne state university, Detroit,USA. J Am Board fam pract 2000 sep-oct:13 (5):353-8.

14. Ivascu NS, Samaik S, Et.’’ Characterization of pica prevalence among patient with Sickle cell disease,’’ Al Sickle cell centre, children’s Hospital of Michigan,3901 Beaubien, Detroit, Arch Pediatr Adolesc Med 2001 Nov, 155(11):1243-7.

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15. Kettaneh A, Sontag C, Et. Al ‘’Perception of pica and its relationship with iron.deficiency by Hospital physicians in the paris area.’’ Service de Medecine inteme, Hospital Jean Verdier, avenue du 14 Juillet,F93143 Bondy. Presse Med,2001 Feb 3:30(4):155-8.

16 . Newton RW, Stack T, Et. Al ‘’ Pets,pica, pathogens and pre-school children,’’JR Coll Gen Pract 1981 Dec:31(233):740-2.

17. Federman DG, Kirsner RS, Et. Al “ pica: are you hungry for the facts “ Yale university school of Medicine, West Haven, USA.Conn Med,1997 APR;61(4);207-9.

18 . Lacey EP.Broadening the perspective of pica: literature review.. department of behavioral and social science, Southem Illinois university,Carbondale.Public Health Rep. 1990 Jan- Feb;105(1):29-35.

19 . Knecht T. ‘’PICA- AQUALITATIVE APPETITE DISORDER’’ klinik, Munsterlingen. Schweiz Med Wochenschr 1999sep. 11;129(36);1287-92.

20. Winton AS, Singh NN. ‘’SUPPRESSION OF PICA USING brief-duration physical restraint,’’ 1983 Jun,27(pt2);93-103.

21. Singh NN, BaKKer LW. ‘’Suppression of pica by overcorrection and physical restraint: a Comparative analysis’’ JAutism Dev Disord. 1984 Sep;14(3);331-41.

22 . Author; Cynthia R Ellis, MD; Chief Editor, ‘’ pathophy siology Eating Disorder, pica,’’ Available from;/www. Google.com 2007

23 . Author; Chief Editor; caroly Pataki, MD ‘’Causes of eating disorder, pica clinical presentation’’WWW.GOOGLE.COM; available from WIKIPEDIA.

24 . Viguria Padilla F, Mijan de la Torre A. ‘’PICA THE PORTRAIT OF A LITTLE KNOWN CLINICAL ENTITY,’’ Centro Atencion inusvalidos psiqucos(CAMP) Fuentes Blancas. Nutr. Hosp; 2006 Sep- oct;21(5);557-66. 25. Grigsby RK, Thyer BA, Et. al ‘’chilk eating in middle Georgia; a culture-bound syndrome of pica’’ Department psychiatry and Health Behavior, Medical college of Georgia, Augusta309912, USA. South Med J. 1999 Feb;92(2);190-2.

26 . Obialo CI, Crowell AK Et. al ‘’ Clay pica has no hematologic or metabolic correlate in Chronic hemodialysis patients’’ Department of Medicine , Morehouse school of Medicine, Atianta, USA. J Ren NUTR, 2001 Jan,11(1)32-6.

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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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