PROFORMA FOR REGISTRATION

OF
SUBJECTS FOR DISSERTATION

GREESHMA VARGHESE
1ST YEAR M.Sc NURSING
CHILD HEALTH NURSING
2011-2013

SEA COLLEGE OF NURSING

K.R PURAM, BANGALORE-49

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE MS. GREESHMA VARGHESE

AND ADDRESS 1ST YEAR MSC ( N )
SEA COLLEGE OF NURSING
BANGALORE-49

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 2 NAME OF THE INSTITUTION SEA COLLEGE OF NURSING

3 COURSE OF STUDY AND MSc NURSING

SUBJECT CHILD HEALTH NURSING

4 DATE OF ADMISSION TO THE 09 – 05- 2011

COURSE
5 TITLE OF THE TOPIC
“A STUDY TO IDENTIFY THE
PREVALENCE OF HEALTH
PROBLEMS AMONG ORPHAN
CHILDREN IN SELECTED
ORPHANGES, BANGALORE, WITH
VIEW TO DEVELOP AN
INFORMATION BOOKLET FOR
CAREGIVERS REGARDING
PREVENTION AND MANAGEMNT
OF HEALTH PROBLEMS OF
CHILDREN”

6.0 BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

“Behold, children are a gift of the LORD, The fruit of the womb is a reward.”

Psalms 127:3

Children are the ones who are very vital for deciding how the world is going

to be after some years. So if one can do some good in the life of a child then there can

be change, atleast a slightest change, in the world to come 1. Children are gift by GOD;

unfortunately not all children are brought up by their parents .Most of these orphans is

placed in orphanages2.

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 An orphan is a child permanently bereaved of or abandoned by his or her

parents3. Many of these children suffer from physical neglect, poor hygiene and a lack

of nurturing is all too common even in today’s modern orphanages which results in

various health problems among children4.

The number of orphans is increasing daily. The basic human rights of these

children are violated severely threatened. The future might look bleak for these

children as long as they do not receive social support. The community needs to

nurture its own children since ‘nurturing is an important component of any child’s

growth and thus it is important to meet the psycho-social needs of children’. Children,

particularly orphans are among the most vulnerable groups in each society. The reason

being that “there are few support systems outside the family for them.”Orphans are

usually emotionally deprived, financially challenged and desperate5.

According to recent UNICEF Report, it is estimated there are between 143

million to 210 million orphans in world wide. Everyday 5,760 more children become

orphans. Every 2.2 seconds a child loses a parent somewhere in the world. 2,102,400

more children become orphans every year in Africa alone6. By 2015, It is projected

that there will be 400 million orphaned children worldwide 7. A survey conducted by

the Ministry Of Civil Affairs in 2005 showed that China has about 573,000 orphans

below 18 years old. In Russia 650,000 children are orphans3.

Orphanages are part of every societal culture 8. It provide an alternative to

foster care or adoption by giving orphans a community based setting in which they

live and learn9. Orphanage is the name to describe a residential institution devoted to

the care and education of orphans-children who parents are deceased or otherwise
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unable to care for them10. The purpose of an orphanage is to care for children who

have no one to care for them. These orphanages often provide high quality care in

terms of material needs such as food, clothing, but they have limited capacity11.

According to UNICEF report, In India, 31 million children living as orphans.

Indian Health Ministry and UNICEF estimated that 46% of children under age 3 are

suffering from malnutrition12. It is estimated that India has the largest number of

AIDS orphans. Out of the 55,764 identified AIDS cases in India 2,112 are children.

And this number is expected to double in the five year13.

Care givers are the persons who provide care or meet the necessary need of

orphan children at orphanages. They are the one who takes primary responsibility for

the physical mental and emotional needs and well being of a child. They will support

the children’s social and emotional development through their daily routines14.

A study was conducted in an orphanage in Dhaka, to find out the outbreak of

scabies and socio-economic profile, water sanitation facilities, personal hygiene and

living condition of the orphan children. The study included 492 children and they

received clinical check up. The result highlights that 98%children had scabies, and

71% has been infected15.

A study conducted by the Smith Research Institute found that orphans health

had been affected by their bereavement. The study shows that 65% of the orphans are

having serious behavioral and learning problems16.

A comparative study was conducted to identify the orphan mental health in

South Africa. The study sample consisted of 1200 children of comparing orphan and

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non orphan children. The study shows that orphans had significantly more

psychological problems than non-orphaned children17.

Education and health have a considerable impact on individual well-being 18. In

this study the awareness regarding prevention and management of health problems

can be provided through an information booklet.

Based on the above studies and overviews, the researcher felt that identifying

the prevalence of health problems among orphan children are of great importance.

Hence, the present study is intended to identify the prevalence of health problems

among orphan children in selected orphanages, Bangalore with a view to develop an

information booklet for care givers regarding prevention and management of health

problems of orphan children, Karnataka.

6.2 REVIEW OF LITERATURE

The review of literature refers to the activities involved in indentifying and

searching for information on a topic and developing a comprehensive picture of the

state knowledge on the topic.

In the present research, the review of literature is presented under the following

headings.

1. Literature related to prevalence of health problems among orphan children.

2. Literature related to need and effectiveness of information booklet.

1. Literature related to prevalence of health problems among orphan

children.

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 A comparative study was conducted to compare the governmental orphanage

with private orphanage in Sana’s city. The study included 300 children between 6&18

years old. The study found that 25% of orphans were anemic. Governmental

orphanage had the highest percentage of anemia (14%) as compared with private

orphanage (8%).Poor hygienic conditions were also found to be as orphan’s current

status. The study recommended that dietician be hired to design balanced meals for

the children, hygienic conditions to be implemented19.

A study was conducted to determine the prevalence of iron deficiency and

anemia and to identify their non dietary determinants among orphans and vulnerable

children in Burkina-Faso. The sample size was 61 children, aged 1-6 years. The result

highlights that 60% of orphan children are having anemia. These findings suggest that

infection and protein energy malnutrition significantly contributed to iron deficiency

due to orphan status20.

A comparative study was conducted to investigate mental health outcomes for

urban children living in deprived settlements in Cape Town. The study included 30

orphan children and 30 matched controls. The study found that 73% orphans are

having concentration difficulties, frequent somatic symptoms and anger through loss

of temper. The findings suggested for conduct for large scale research for parentally

bereaved children21.

A cross sectional survey was conducted to assess the psychological well-being

and socio-economic hardship of orphan and non- orphan children in Conakry, Guinea.

The study included 133 orphan and 140 non-orphan children. Multiway analysis of

variance and multiple logistic regression models were used to measure the

association. The result shows that the psychological well-being score was
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significantly lower among orphan children than non- orphan children. The study

recommends for sustainable and holistic approaches to ensure the psychological and

socio- economic stability of orphans and other vulnerable children22.

A cross- sectional study was conducted to identify the prevalence of emotional

and behavioral problems in children and adolescents reared in orphanages. Study

sample consisted of 674 children and adolescents. Stratified and probability cluster

sampling was used to select the sample. The result highlights that the prevalence of

problem ranged between 18.3% and 47% among the children and adolescents. The

study recommended that an urgent need to develop alternative care models and

routine screening for mental health and training of professionals and development of

mental health services for children in institutional care should be a priority23.

An experimental study was conducted to assess the childhood adversity,

mental ill-health and aggressive behavior in an orphanage in Africa. The samples of

38 children were assessed at two time points. In the first study result shows that

violence experienced in the orphanage had a positive relationship with the aggressive

behavior of the children at time point. In the second study, with the help of the pre-

post assessment of the study, the implementation of a new instructional system and

psychotherapeutic treatment for trauma-related illness were evaluated. The results

indicate that the experience of violence in an orphanage also plays a crucial role in

aggressive behaviour of the orphans. The study suggests that mental health can be

improved by implementing a new instructional system and psychotherapeutic

treatment in an orphanage 24.

2. Literature related to need and effectiveness of information booklet

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 A cross –sectional prospective study was conducted to determine the oral

health needs of HIV-positive children residing in orphanage in Gauteng, South Africa.

Convenience sampling was used to select the sample. An oral examination was

performed on 87 children. The result highlights that training is needed among

caregivers regarding the oral health of children, and a role for health professionals in

preventing oral diseases and reducing suffering is necessary25.

A comparative study was conducted to compare the oral health related quality

of life and caries status between school children living with their parents and orphan

children in Udaipur city, India. Study sample consisted of 279 school children living

with their parents and 257 orphan children.The study shows that orphan children

presented poor scores for oral health related quality of life compared to those having

parents26.

STATEMENT OF THE PROBLEM

“A study to identify the prevalence of health problems among orphan children

in selected orphanages, Bangalore, with view to develop an information booklet for

caregivers regarding prevention and management of health problems of orphan

children.”

6.3 OBJECTIVES OF THE STUDY

1. To identify the prevalence of health problems among orphan children.

2. To find out the association between the health problems of orphan children

and selected demographic variable.

3. To develop an information booklet on prevention and management of health

problems for care givers.

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6.4. HYPOTHESIS

H1-There will be a significant association between the health problems of orphan

children and selected demographic variables.

6.5. VARIABLES

1] Research variable

Research variable refers to health problems of orphan children.

2] Demographic variable

Demographic variable refers to age, sex, education, duration of stay.

6.6. OPERATIONAL DEFINITION

Prevalence: The total number of children who have a specific health problem that is

present in a defined population at one specific point in time. In this study it refers to

the total number of children suffering from each health problem during the time of

physical examination as measured by children physical assessment tool.

Health problems: In this study, it refers to all the health deviation which affects the

physical and developmental function of the children in the orphanages as measured by

physical examination.

Information Booklet: In this study it refers to a booklet which includes the

information related to prevention and management of prevalent health problems

among orphan children which is prepared for caregivers.

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Orphan children: In this study it refers to the children who lives in orphanage.

Orphanage: In this study it refers to a public institution for the care and protection of

orphan children.

Care givers: In this study it refers to persons who provide care or meet the necessary

needs of orphan children at orphanages.

7.0 MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from the orphan children residing in selected

orphanages.

7.2 METHOD OF COLLECTION OF DATA

7.2.1 Research design

Non- Experimental Survey design

7.2.2 Population

Orphan children who are residing in orphanages.

7.2.3 Sample size

80 orphan children

7.2.4 Sampling technique

Convenient Sampling

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7.2.5 Criteria for selection of sample

o Inclusion criteria :

Children who are residing in selected orphanages.

o Exclusion criteria :

Children who are mentally retarded.

7.2.6 Research setting

Study will be conducted at selected orphanages in Bangalore.

7.2.7 Tools for data collection

Part A: Baseline data

Part B: Standardized physical assessment tool.

7.2.8 Data collection procedure

Prior to the study, a written permission will be obtained from the concerned

authority .After obtaining content validity; a standardized physical assessment tool

will be used to identify the health problems among orphan children. An

information booklet will be prepared depends on the problems identified among

children regarding prevention and management of prevalent health problems.

7.2.9 Data analysis method

a] Descriptive statistics:

Mean, standard deviation and percentage will be used to assess the demographic

variables.

b] Inferential statistics:

Inferential statistics, Chi square test will be used to find the association between

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the health problems of orphan children and selected demographic variables.

7.3 DOES THE STUDY REQUIRE INVESTIGATION TO BE CONDUCTED

IN PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO PLEASE

DESCRIBE BRIEFLY.

No, only a physical assessment tool will be used to identify the health problems

among orphan children. No other invasive physical or laboratory test will be

conducted on samples.

7.4 HAS ETHICAL CLEARANCE HAS BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3?

Yes, A written permission from them institutional authority will be obtained.

Confidentiality and anonymity of the subject will be maintained.

8. LIST OF REFERENCES:

1. Mohammed S. Children-How important are they for the world. 2008; Available

from: URL: http://blog.sanaulla.info.

2. Child importance. 2002. Available from: URL: http://www.exampleessays.com.

3. Wikipedia. The free encyclopedia .Orphan. Available from: URL:

http://en.wikipedia.org/wik/orphan.

4. George R. Question on orphanages and development. Available from: URL:

http://www.adoptiondoctors.com.

5. Towanda N. Psychosocial support to orphans and vulnerable children. 2006.

Available from: URL: http://www.wordmart.com.

6. Orphan Statistics. Sky word journey 2009 Jun. Available from: URL:

http://skywordjourney.wordpress.com.

7. Orphan Statistics. Facts and Figures. SOS Children Villages. Available from

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 URL: http://www.sos-usa.org.

8. George R. Detrimental effects of institutions and orphanages. 1995. Available

from: URL:http://international adoption.com.

9. Orphanage. Grace full Gospel Assembly. 2011. Available from:

URL:http://gracefullgospelassembly.org.

10. Elvira Salleras. Please take me home. 2011 Sep; 2 (3). Available from: URL:

http://www.ayakaonline.com.

11. Sarah B. What is an Orphanage and its function. Available from:

URL:http://www.ehow.com.

12. Kavitha PD. Orphan and Vulnerable Children in India. Available from:

URL:http://www.hopchest.org/india.

13. Anant K, Tani S. Orphan and Vulnerable children. Health Policy Interventions in

India. J Health Development. 2008; 4:1-4.Available from:

URL:http://hivaidsclearinghouse.unesco.org.

14. National Guidelines and standards of practice on orphans and vulnerable

children. Available from: URL:http://www.crin.org.

15. Essam EL, Nada AD. Epidemiological studies on children. Egyptian

Dermatology online J2006 Jun; Vol 2. Available from: URL: www.edoj.org.

16. Azoulay Y. Study reveals health problems among orphans. Open House

Wednesday. 2011 Dec 14. Available from: URL:http://www.haaretz.com.

17. Lucie C, Don O, Frances G. Mental health and orphan hood. J Child Psych

Psycho 2007. Available from: URL: http://young carers.netau.net/policy

brief.pdf.

18. Groot, Henriette M. What does education do to our health. Available from:

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 URL:http://www.oecd.org/dataoecd/15/17/37425763.

19. Thuria G. Orphans suffer from malnutrition infectious diseases. Sports health and

lifestyle 2007 Mar. Available from: URL: http://www.yobserver.com.

20. Sanou D, Turgeon H, Desrosiers T. Prevalence and nondietary predictors of

anemia and iron deficiency among preschool orphans and vulnerable children.

Nutrition Clinique et metabolism. 2008; 22 (1):10-9. Available from: URL:

http://www.mendeley.com/research/prevention

21. Lucie C, Frances G. The psychological wellbeing of children orphaned by AIDS.

Annals of General Psychiatry 2006 Jul; 19:5-8. Available from:

URL:http;//www.ncbi.nlm.nih.gov/pmc/articles/PMC1557503.

22. Delva W, Vercoutere A, Louca C, Lamah J, Vansteelandt S, De koker P, et al.

Psychological wellbeing and socio-economic hardship among orphans and other

vulnerable children 2009 Dec; l 21(12):1490-8.Available from:

URL:http://www.ncbi.nlm.nih gov/pub med/20024728.

23. Simsek Z, Erol N, Oztop D, Ozer O. Epidemiology of emotional and behavioral

problems in children and adolescents reared in orphanages. Turk pisikiyatri derg

2008 fall; 19(3):235-46. Available from:

URL:http://www.ncbi.mlm.nih.gov/pubmed/1879107.

24. Hermenau K, Hecker T, Ruf M, Schauer E, Elbert T, Schauer M. Child hood

adversity, mental ill health and aggressive behavior. Child Adolesc Psychiatry

Ment Health 2011 Sep; 25:5-29. Available from:

URL:http://www.ncbi.nlm.nih.gov/pubmed 21943214.

25. Biliqnaut E. Oral health needs of HIV/AIDS orphans. 2007 Apr; 19(4):532-6.

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 Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/17453594.

26. Kumar S, Goyal A, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S et al.

Oral health related quality of life among children with parents and those with no

parents. Community Dental Health 2011 Sep; 28(3):227-31. Available from:

URL: http://www.nchi.n/m.nih,gov/pubmed/21916359

9 SIGNATURE OF THE
CANDIDATE

10 REMARKS OF THE GUIDE THE TOPIC SELECTED FOR THE

STUDY IS RELEVANT AND BASED
ON ORPHANAGE CHILD NEEDS.
11 NAME AND DESIGNATION OF
11.1 GUIDE MRS.PROF.PRISCILLA NIRMAL,
HOD, CHILD HEALTH NURSING,
SEA COLLEGE OF NURSING.

11.2 SIGNATURE

11.3 CO-GUIDE MR. PRASANNA KUMAR D R,

LECTURER,
CHILD HEALTH NURSING,
SEA COLLEGE OF NURSING.

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11.4 SIGNATURE

12
12.1 REMARKS OF THE PRINCIPAL THE TOPIC SELECTED FOR THE
STUDY IS RELEVANT AND CAN
BE FORWARDED FOR NEEDFUL
ACTION

SIGNATURE
12.2

16