DEBRE BERHAN UNIVERSITY

ASRAT WOLDEYES HEALTH SCIENCE CAMPUS

SCHOOL OF MEDICINE
DEPARTMENT OF BIOMEDICAL SCIENCE

MODULE: HEALTH EDUCATION AND PROMOTION

Individual Assignment On Planning, Implementation, Monitoring and Evaluation of Health Education

Programs On Pneumonia Under 5 Children Using Precede Proceed model

SUBMITTED BY

NAME: ERMIYAS BELETEW

ID: 0504/12

SUBMITTED TO

ADDISALEM M. (MPH)

Submitted on 17th march 2023

Table of Contents
Introduction ............................................................................................................................................ 1
PHASE 1: Social assessment........................................................................................................ 1

PHASE 2; Epidemiological assessment ................................................................................... 3

PHASE 3: Behavioural and environmental assessment ................................................. 4

PHASE 4: Educational assessment ........................................................................................... 4

1. Predisposing factors: ....................................................................................................................... 4
2. Reinforcing factors .......................................................................................................................... 4
3. Enabling factors: ............................................................................................................................. 5

PHASE 5: Administrative and policy assessment. ............................................................. 5

PHASE 6: Implementation .............................................................................................................. 6

Setting Goals, Objectives and Indicator ............................................................................. 7

Evaluation ........................................................................................................................................ 9

PHASE 7: Process evaluation ..................................................................................................... 9

PHASE 9; Outcome evaluation ................................................................................................ 9

Reference .............................................................................................................................................. 11
Pneumonia in under 5 children

Introduction

Pneumonia is an acute respiratory infection of the lungs. It doesn’t have one single cause – it can
develop from bacteria, viruses or fungi in the air. When a child is infected, their lungs are filled with
fluid and it becomes difficult to breathe. Children whose immune systems are immature (i.e. new-
borns) or weakened – such as by undernourishment, or diseases like HIV – are more vulnerable to
pneumonia.

Pneumonia is contagious and can be spread through airborne particles (a cough or sneeze). It can
also be spread through other fluids, like blood during childbirth, or from contaminated surfaces.

Bacteria are the most common cause of community-acquired pneumonia (CAP), with Streptococcus
pneumonia isolated in nearly 50% of cases. The clinical picture of pneumonia differs depending on
the microorganism causing the disease and the age of a child. The presence of cough and fast
breathing and or difficulty of breathing for specific age clenches the classification of suspected
pneumonia in children older than 2 months and yet less than 60 months of age.

Pneumonia can be prevented in the first place by increasing protective measures, such as adequate
nutrition, and by reducing risk factors like air pollution (which makes the lungs more vulnerable to
infection) and using good hygiene practices. Studies have shown that improved hand washing with
soap reduces the risk of pneumonia by up to 50 per cent by lowering exposure to bacteria.

Pneumonia caused by bacteria is easily preventable with vaccines. However, more than 50 per cent
of children around the world are not fully protected with the primary vaccine to prevent pneumonia
– the Pneumococcal (PCV) vaccine. A new vaccine for one of the main viral causes of pneumonia is
under development.

If pneumonia is diagnosed and treated early and appropriately, morbidity and mortality in under-five
children can be reduced significantly.

PHASE 1: Social assessment

1. Availability, preparation, feeding practice, breast feeding practice and Nutritional status of
the mother and child
2. Immunization status (check the immunization card)
3. Ventilation of the house
4. Culture and beliefs of the family related to pneumonia
5. Educational status of the family, Income of the family
6. The traditional treatment and supportive health practices for pneumonia

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 7. Attitude about early diagnosis and curability

Sign and symptoms

Children with pneumonia manifest the following sign and symptoms during social diagnosis:-
1. Sick-child- Assess for danger signs
 Convulsions
 Unconscious
 Lethargic
 Unable to drink/breastfeed
 Repeated vomiting
2. Assess for cough/difficult breathing
 Fast breathing
 Lower chest indrawing
 Stridor (a rattling noise heard when breathing)
 Grunting when breathing out
3. Check for fever
 Measure the child’s temperature
 Try to feel the fever of the child by using your hands if thermometer is not
available

TABLE1.IDENTIFIED PROBLEMS AND PREDEFINED CRITERIAS

Identified problems Immediate No.of Severity Communities equity Cost Resource Local
necessity people of the capacity sustain available leadership
benefited problem ability available
for the task

Unimmunized 3 3 3 2 2 2 2 2 2
child(low
immunization
coverage)
Inadequate breast 2 2 1 2 2 2 3 2 1
feeding and not
breast feeding
Overcrowding and 2 2 1 2 1 2 2 2 2
poor ventilation
Indoor air pollution 2 2 2 2 2 2 2 2 2
Late detection of 3 3 3 2 1 2 2 2 2
pneumonia
symptoms and late
reporting to the
health center
Malnutrition PEM, 3 2 3 2 2 2 2 2 1

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HYPOVITANOSIS
A,…

Sum of scores of the above criteria’s with their respective identified problems are 21, 17,
16,18,20,19 respectively.

TABLE 2.PREDEFINED CRITERIAS WITH THEIR RESPECTIVE SCORES

Criteria’s 1 2 3
Immediate necessity low moderate high
No. people benefited few moderate many
severity less moderate high
Community capacity minimum moderate maximum
equity Less fair Moderately fair fair
sustainability low moderate high
cost expensive moderate cheap
Resource available few moderate high
Local leadership Few present Moderately Highly present
present

Prioritized problems based on the sum of scores

1. Unimmunized child(low immunization coverage)

2. Late detection of pneumonia symptoms and late reporting to the health center
3. Malnutrition PEM, hypovitanosis A,…
4. Indoor air pollution
5. Inadequate breast feeding and not breast feeding
6. Overcrowding and poor ventilation

PHASE 2; Epidemiological assessment

Globally, According to different reports, in developing countries, a child dies every seven seconds
from Acute Respiratory infections (ARI) usually pneumonia.

In Ethiopia ARI were reported to be among the leading causes of under-five mortality accounting for
40% of hospital admissions and a third of the deaths in children. The Case Fatality Rate (CFR) in Addis
Ababa was 14.7%, which is slightly greater than the highest rate reported in other developing
countries. Based on the report of the MOH, pneumonia was the 4th leading cause of morbidity in
infants (1).

In Ethiopia, pneumonia is a leading single disease killing under-five children. It is estimated that in
Ethiopia, 3,370,000 children encounter pneumonia annually which contributes to 18 percent of all
causes of death killing over 40,000 under-five children every year (2).

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These deaths are easily preventable by cost-effective interventions like immunization, good
nutrition, exclusive breastfeeding, appropriate complementary feeding hand washing (3).

According to a study conducted at Wondo Genet district, Sidama zone, Ethiopia, the prevalence of
pneumonia among under-five children who visit health centers was 33.5% (4).

According to a study conducted at Angolela Tera district, North Shoa, Ethiopia, The prevalence of
pneumonia in children under five was 5.8% (95% CI 3.6–8.2%)(5) .

According to a study conducted Gamo Zone, southern Ethiopia, The prevalence of pneumonia in the
study area was 30%. Among the factors assessed, place of food cooking—inside the living room
[adjusted odd ratio (AOR) = 5.79, 95% confidence interval (CI): 2.47–13.58],nonexclusive
breastfeeding (AOR = 3.26, 95% CI: 1.42–7.52), vitamin A Supplementation status (AOR = 5.62, 95%
CI: 2.65–11.94), and vaccination status (AOR = 3.59, 95% CI: 1.49–8.66) were significantly associated
with the occurrence of pneumonia in under-five children(6).

PHASE 3: Behavioural and environmental assessment

 Delivering at home
 Inadequate breast-feeding and not breast-feeding
 Indoor - air pollution, such as from use of bio-mass fuel (fire wood, charcoal) and cigarette
smoking
 Overcrowding and poor ventilation
 carrying baby during cooking
 poor hand washing practice

PHASE 4: Educational assessment

1. Predisposing factors:
 Lack of knowledge by care givers about sign and symptoms.
 Lack of awareness about early diagnosis and early treatment.
 Lack of awareness about Vitamin A supplementation.
 Inappropriate weaning practice after 4 to 6 months of age by mothers.
 Misguided understanding about immunization.
 Lack of awareness about proper ventilation of house, keeping away child from different
kinds of smoking and separation of living room from kitchen.

2. Reinforcing factors
 Child care responsibility to be fulfilled solely by a mother, but a responsibility that is to
be equally shared by both the parents.
 No government support for Expenses for transportation and foods and no free service at
health centre.

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3. Enabling factors:
 Low socio-economic status of the family
 Shortage of health extension worker
 Inadequate accessibility of nearby health centres
 Inadequate transportation

PHASE 5: Administrative and policy assessment.

The WHO and UNICEF integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) aims to
accelerate pneumonia control with a combination of interventions to protect, prevent and treat
pneumonia in children with actions to:

 protect children from pneumonia, including promoting exclusive breastfeeding and

adequate complementary feeding;

 prevent pneumonia with vaccinations, hand washing with soap, reducing household air
pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed
children;

 treat pneumonia focusing on making sure that every sick child has access to the right kind of
care – either from a community-based health worker, or in a health facility if the disease is
severe – and can get the antibiotics and oxygen they need to get well.

Recommendations

 The evidence from the above epidemiological assessment calls for government of Ethiopia
to play a role in reducing childhood mortality and morbidity imposed by pneumonia through
controlling indoor and outdoor air pollutions, ensuring adequate ventilation, applying
mechanisms in vector control, and improving environmental cleanliness and safety which
are also endorsed by the global policies for pneumonia control.
 The government should take steps to achieve Global Immunization Vision and Strategy
(GIVS) targets for measles and pertussis containing vaccines; countries that have not yet
done so should add Hib and conjugate pneumococcal vaccines to their national
immunization programmes, especially if they have high child mortality.
 Policy makers should adopt plans to expand adequate case management of pneumonia
following IMCI at hospital, health facility and community levels to achieve 90% coverage
within a predetermined time frame.
 Promotion of exclusive breastfeeding and appropriate complementary feeding are an
important element of pneumonia prevention. Strategies to reduce rates of low birth weight
and malnutrition will prevent pneumonia and should be encouraged.

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  the government and the federal and wereda health office need to enhance awareness and
resource mobilization for health care providers toward ANC follow-up, diarrhea prevention,
educating mothers, and exclusive breastfeeding.

PHASE 6: Implementation

Using the information or the problems diagnosed at the PRECEDE phase, the following action plan
prepared and will be implemented at debreberhan town based on the time frame in the action plan.

Ser. problems Clear List of activities Speci Time frame Clear Specific
No. objectives fic indicators resource to
priori be utilized
ty and
tasks methods
1 Unimmunized child(low - To Convince - Disseminate ‘’ ‘’ March 03- 10 Percentage - Speaker
immunization coverage) people that information of -radio
immunization about immunized
reduces the immunization in children
risk of public meetings,
acquiring home visits
pneumonia - Mobilize the
through HE community for
and provision immunization
of schedules
immunization
services
2 Late detection of pneumonia -To promote -HE about the March 13-22 Percentage -radio
symptoms and late reporting early diagnosis treatment, of early -television
to the health centre and treatment danger signs & reporting -poster
and sign when to and -speaker
recognition bring the child if diagnosis -leaflets
condition gets for
worse pneumonia
-HE about need ‘’ ‘’
for early
recognition of
symptoms and
visit to health
institutions or a
CHW

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3 Indoor air pollution -To reduce - Advice on the ‘’ ‘’ March 25- Home visit -television
indoor air construction of April 03 by taking -radio
pollution stove, kitchen sample of -HID
and windows houses -group
-HE not to ‘’ ‘’ discussion
expose children
to smoke from
cooking areas or
from cigarettes
4 Malnutrition PEM, To create - Demonstration ‘’ ‘’ March 10-21 Weight and -Radios,
HYPOVITANOSIS A… awareness of Preparation mental, -televisions
about Proper of balanced diet emotional -other social
nutrition for weaning and Medias
foods physical
-vitamin A wellbeing
suplementation

5 Inadequate breast feeding -To give -HE about ‘’ ‘’ April 25 - Home visit -Counselling
and not breast feeding awareness importance of MAY 08 by taking -health talks
about breast breast feeding sample of
feeding - Encourage and houses
teach mothers
to
breast feed and
to start weaning
at
4 to 6 months
- Discourage
bottle feeding
6 Overcrowding and poor -To Improve - Give HE about ‘’ ‘’ MAY 15-17 Home visit -through
ventilation housing the benefit of by taking demonstrati
condition Ventilation at sample of ons
and community and houses
ventilation home level - by
- Reduce -HE and construct
overcrowding Convincing model
- Adequate communities houses
number of about
doors & the importance
windows for of ventilation
good air
circulation in
the house
Location Of
Windows

Setting Goals, Objectives and Indicator

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1. Goal

 To decrease morbidity and mortality of under 5 children associated with pneumonia by 15%.
 Increase the awareness of communities about pneumonia through health education by 50%.

2. Objectives

2.1. General Objectives

 To provide health education and knowledge about pneumonia for mothers (caregivers).
 To give visibility and raise awareness about pneumonia, a preventable infectious
disease.

2.2. Specific Objectives

1. To promote health education in the prevention and control of pneumonia.

2. Increase the communities’ awareness/knowledge and practice on Proper ventilation of
house
• Breast-feeding
• Immunization
• Vitamin A Supplementation
• Early detection of pneumonia symptoms and reporting to health institution

3. Participate and facilitate community mobilization on immunization and Vitamin

Supplementation

3. Development of Content and Messages

Health education about danger signs of severe pneumonia to mother and CHWs
Health education about proper housing, ventilation, environmental sanitation, child care,
etc.
Disseminate information about immunization
Identify and name the different preventive and control measures for pneumonia in under
five children
Encouragement mothers/caregivers on breast- feeding, weaning food, ORS, immunization,
etc.

Information about how they can immediately reporting of illness in their children

4. Selection of Methods and Medias

4.1. Method and Medias

- Posters & leaflets for Health Education

- Demonstration weaning food preparation, proper ventilation, etc.

-Health talks and discussions

-Role play, Mini lecture, Film shows, Videos, Charts, etc.

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-Radios, televisions and other social Medias

4.2. Target Group

o Mothers (caregivers).
o Community health worker
o Students at flag ceremony
o Peoples at idir,ekub,market places, streets,meeting etc

5. Identification of resources

External

Human: program planner (self), Health educators: Health advocates, etc.

Money: fund available from NGOs and donor agencies and IEC materials.

Transportation facilities

Internal

Human: local leaders, health staffs

Materials: Equipment, Furniture, Speaker, Projector, costumes, etc.

Infrastructure: Hall.

Evaluation

PHASE 7: Process evaluation

 The health education given in the time and person as planned.
 Check whether caregiver and family have understood what you have talked about or
demonstrated through observation,
 activities are going on based on action plan,
 Materials, media, Resource are all utilized for the planned activities,
PHASE 8: Impact evaluation
 Increased awareness on the importance of breast feeding & weaning of the child
and practicing it after the intervention.
 They began to opening the door and window of their house.
 Assessment of attitude about early diagnosis and curability.
 Assessment of ventilation of the house.
 Assessment of knowledge(through pre-test and post-test evaluation)

PHASE 9; Outcome evaluation

 Decreased morbidity and mortality of children by 8% due to pneumonia.
 Decreased in the prevalence children suffering from pneumonia.

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 Decreased percentage of unimmunized child .
 Increased percentage of visiting to health institutions or a CHW for early diagnosis
and treatment.

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Reference
1. MOH, 1994/95
2. Rudan et al. 2013; Rashid et al. 2017)
3. Chopra M, Mason E, Borrazzo J, Campbell H, Rudan I, Liu L et al (2013) Ending of
preventable deaths from pneumonia and diarrhea: an achievable goal.
4. Abuka T (2017) Prevalence of pneumonia and factors associated among children 2–
59 months old in Wondo Genet district, Sidama zone, SNNPR, Ethiopia.
5. Prevalence_of_pneumonia_and_associated_factors_among_children_aged_6-
59_months_in_Angolela_Tera_district_North_Shoa_Ethiopia_2021.
6. Prevalence of pneumonia and its determinant factors among under-five children in
GamoZone, southern Ethiopia, 2021
Pneumonia in Under-Five Children For the Ethiopian Health Center
Team,EPHTI

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