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Year : 2021  |  Volume : 14  |  Issue : 6  |  Page : 646-651  

Effectiveness of structured teaching versus child-to-child teaching program on knowledge regarding worm infestation to middle school children in Puducherry

Department of Child Health Nursing, Kasturba Gandhi Nursing College, Puducherry, India

Date of Submission17-Jun-2020
Date of Decision08-Sep-2020
Date of Acceptance15-Sep-2020
Date of Web Publication24-Jun-2021

Correspondence Address:
P Sumathy
Department of Child Health Nursing, Kasturba Gandhi Nursing College, Puducherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_279_20

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Background: Worm infestations are one of the most widely prevalent neglected tropical diseases (NTDs) which are inextricably linked to poor sanitation and hygiene. Aims: This study aims to assess the effectiveness of structured teaching plan and child-to-child teaching in raising awareness about helminthiasis. Methods: Thirty-seven standard children each from two government secondary schools in Puducherry were selected by simple random sampling. Data on knowledge regarding worm infestation and selected demographic variables were collected using a structured questionnaire. Two groups with 30 subjects each were created, where Group 1 was taught according to a structured teaching plan, and a child-to-child teaching approach was adopted for Group 2. The effectiveness of interventions was adjudged using a paired t-test. The association between the level of knowledge and select demographic variables was examined using a Chi-square test. Results: A vast majority of subjects in Group 1 and Group 2 had inadequate and moderately adequate knowledge of helminthiasis, respectively, prior to intervention. However, the mean test scores of Group 1 increased by 20.6 following intervention with a structured teaching plan. An incremental mean difference of 19.16 was witnessed in Group 2. The child-to-child teaching program was found to be equally effective as a structured teaching plan. A statistically significant association was found between the level of knowledge and demographic variables such as age and place of defecation (P < 0.05). Conclusion: Peer learning was found to be a novel and reliable method of expanding the knowledge of middle school children on prevention of hookworm infestation, thereby encouraging healthy behaviors.

Keywords: Child-to-child teaching program, helminthiasis, structured teaching plan

How to cite this article:
Jemima S, Sumathy P. Effectiveness of structured teaching versus child-to-child teaching program on knowledge regarding worm infestation to middle school children in Puducherry. Med J DY Patil Vidyapeeth 2021;14:646-51

How to cite this URL:
Jemima S, Sumathy P. Effectiveness of structured teaching versus child-to-child teaching program on knowledge regarding worm infestation to middle school children in Puducherry. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Dec 6];14:646-51. Available from: https://www.mjdrdypv.org/text.asp?2021/14/6/646/319173

  Introduction Top

Soil-transmitted helminths (STH) are a major cause of concern, especially in children, as out of 1.5 billion people infected, over 568 million school-age children are at risk of morbidity.[1] Worm infestations are more frequently seen among children aged 5–14 years, living in poor sanitary conditions, practicing open defecation, and unaware of good hygiene habits.[2],[3] Helminth transmission occurs mainly through the soil, from where eggs present in human feces find their way into vegetables and water sources, which may be consumed by other individuals. Eggs are often ingested by young children through the fecal-oral route while playing in contaminated soils.[1] Hookworm larvae possess the additional ability to penetrate the skin and hence can infect barefooted individuals walking on contaminated soil as well. The prevalence of STH is over 50% in six Indian states, with India alone accounting for 25% of total STH cases worldwide.[4]

Worm infestation is primarily caused by helminths species such as roundworm (Ascaris lumbricoides), hookworms (Necator americanus and Ancylostoma duodenale), and whipworms (Trichuris trichiura).[1] STH has been known to hinder growth and development in multiple spheres of a child's life, by causing nutritional disorders such as malnutrition, anemia, dysentery along with stunted intellectual growth and psychosocial issues.[1],[3] These factors along with repeated gastrointestinal and upper respiratory tract infection remain a major cause of high infant and child mortality in India.[5] Despite the availability of medicines such as albendazole and mebendazole which are short-term measures, chances of transmission, and reinfection are high in susceptible areas. This parasitic cycle can be only be stopped when children and their parents are made equally aware of the simple preventive measures to be taken in their daily lives, along with proper disposal of waste, improved sanitation, and use of pit latrines instead of open defecation.[5]

Few pioneer studies have shown the effect of a structured teaching program and child-to-child approach; however, their comparative efficacy has not been extrapolated adequately. This study aims to evaluate the effectiveness of a structured teaching plan versus that of a child-to-child teaching program, by identifying levels of knowledge on worm infestation among middle school children before and after each intervention. An additional objective of this study is to find an association between the level of knowledge regarding worm infestation and selected a set of demographic variables.

  Methods Top

Study design

A true experimental design was applied to this study, wherein 7th grade middle school children from two government higher secondary schools in Kirumamapakkam and Thananpalayam, Puducherry were selected as subjects. Schools were selected on the basis of availability of adequate samples and the co-operation extended by the school management. Ethical clearance was obtained from the Institutional Ethics Committee (Dissertation Protocol meeting- February 17, 2012). Informed consent from the parents and assent from the children was obtained along with permission from the principals of both schools. The purpose and process of the study were also clearly conveyed to study subjects. Children of both sexes, studying in 7th standard of either of the two selected government higher secondary schools, with command over Tamil language and present at the time of data collection were included in this study. Exclusion criteria comprised of children with visual, speech, and hearing impairment. Sample selection in each school was done through a simple random sampling technique called lottery method. As per this method, each student was assigned a number on a chit, followed by a blind draw of random numbers called out by the researcher. Thus, a sample size of 60 middle school children was calculated based on a preliminary survey done using health records of local schools. The following formula was used for estimating sample size;

where P is the probability of events in Group 1, Zα/2 is the standard normal variate for level of significance, Zβ standard normal variate for power (80%), δ0 is the acceptable margin of error (0.84).[6] Extraneous variables were ruled out by adhering to the following tenets; random sampling technique, standardization of intervention time span and content, maintaining sample size equivalence and consistency through 100% attendance of the study participants, mapping out association with socio-demographic variables as well as providing prior instruction to parents and students to avoid preparation for the interventional sessions and corresponding tests.

Two groups each containing 30 children were created. Group 1 was constituted by students from Kirumampakkam and was taught according to a structured teaching plan, whereas Group 2 comprised of students from Thananpalayam who were given the child-to-child teaching intervention.

Data collection and intervention

A structured questionnaire consisting of two parts that efficiently record the demographic characteristics and knowledge about worm infestation respectively was developed based on the inputs from experts in the field of pediatrics. The tool was estimated to have a reliability score of 0.84 using the Karl Pearson reliability formula. The first section of the questionnaire collated demographic data such as age, gender, religion, area of residence, monthly income of child's family, type of family, father's occupation, mother' occupation, educational qualification of mother, dietary habit, place of defecation, health problems, medical history of worm infestation, and source of information. The second section contained 25 multiple choice questions pertaining to worm infestation, each worth 2 marks for right answers and 1 mark for wrong answers. Out of 25 questions, 4 were framed on the definition of worm infestation, 3 on causes and mode of transmission, 4 on symptoms and complications, 11 on prevention, and 3 on its management. Adequate knowledge is represented by a score above 75%, while scores between 50% and 75% and below 50% reflect moderate and inadequate knowledge, respectively. On completion of the pre-test, the randomly assigned intervention of 45 min was provided to study participants on the same day, who were then asked to return after a week for a posttest.

A comprehensive 45-min teaching plan covering the definition, causes, mode of transmission, the life cycle of roundworm and hookworm, clinical manifestations, health problems, prevention, and management of worm infestation was developed and presented with the help of audio-visual aids to subjects in Tamil.

As part of the child-to-child teaching program, 3 students were selected as change agents responsible for teaching their peers and the intervention was carried out in 1:10 ratio among each group for 45 min. Purposive sampling was utilized to select change agents based on their academic performance. The top 3 scorers of 7th grade were shown demonstrations and verbally explained concept of preventive and managing worm infestation, following which students were allowed to clear their doubts. These change agents were instructed to not add any additional information of their own while teaching their peers enrolled as participants for this study. Audio-visual aids were also employed by change agents to enhance interest and comprehension of study subjects. Topics covered during this intervention were identical to those covered by the teaching plan.

Statistical analysis

Statistical analysis of data collected was done on R software. Descriptive statistics such as frequency and percentage distribution were used to analyze the vast demographic data. The relation between the interventions and the pre-test and post-test scores of the subjects was evaluated with the help of a paired t-test. A Chi-square test was employed to analyze the association between the level of knowledge on worm infestation and selected demographic variables.

  Results Top

Prior to intervention with a structured teaching plan in Group 1, out of 30 subjects, a large majority of 24 (80%) had inadequate knowledge, followed by 4 (13.3%) subjects with moderately adequate knowledge, while only 2 (6.7%) had adequate knowledge. However, in Group 2, most subjects, i.e., 20 (66.7%) possessed moderately adequate knowledge on worm infestation prior to intervention with a child-to-child teaching program, while 6 (20%) and 4 subjects (13.3%) possessed inadequate and adequate knowledge, respectively. Post-test scores in both the groups reflect that majority of the subjects gained adequate knowledge following intervention.

The mean difference of 20.6 ± 4.9032 and 23.80 co-efficient of variance was observed between pre- and post-test scores of Group 1 were found to be significant at P < 0.05 level. A similar statistically significant improvement in test scores of Group 2 subjects was seen post-intervention with the child-to-child program, with a mean ± standard deviation of 19.16 ± 3.7239 and 19.42 co-efficient of variance (P < 0.05). However, an inter-group analysis by an independent t-test revealed no significant difference between outcomes of the two interventions (P > 0.05) See [Table 1]. Hence, it was inferred that both interventions were successful in significantly expanding the knowledge base of subjects on worm infestation.
Table 1: Mean, Standard Deviation and Co-Efficient of Variance to compare Structured Teaching Programme Vs. Child to child Teaching Programme on Worm Infestation

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There exists a linear association between certain demographic variables and level of knowledge on worm infestation among subjects as shown in [Table 2]. In Group 1, a significant association (P < 0.05) was observed between place of defecation and level of knowledge. Among Group 1 participants, only 1 student who had inadequate knowledge on worm infestation practiced open field defecation, while around 5 students using some type of toilet were found to be moderately or adequately informed. In Group 2, association with age group was found to be significant at P < 0.05. However, this may be due to a slightly higher proportion of Group 2 participants in the 9–11 years of age range, were adequately aware, with none having inadequate knowledge as ascertained by pre-test scores [Table 2].
Table 2: Frequency and percentage distribution of select demographic variables, along with its association to the level of knowledge on worm infestation

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Group 1 and Group 2 were predominantly rural (66.7% and 60%), practicing Hinduism (63.3% and 73.3%), consuming a nonvegetarian diet (66.7% and 53.3%), devoid of medical issues (46.7% and 40%), with a monthly household income above INR 1500 (43.3% and 53.3%) and living in a nuclear family (76.7% and 66.7%). Primary occupation of fathers was farmer (26.7%) and coolie (63.3%) in Group 1 and Group 2, respectively, whereas that of mothers was coolie (46.7% and 43.3%) among both the groups. Majority of fathers among both groups possessed secondary education qualification (40% and 43.3%), while most mothers had received only primary education (40% and 36.7%). Participants of Group 2 reported although having received general health information from multiple sources relied on parents (26.7%), while Group 1 participants relied on teachers (23.3%) for such information. Hence, indicating the potential of child-to-child teaching as an effective equalizer of information reception and dissemination. Majority of the students in both groups when mapped out across the sociodemographic factors were found to possess inadequate knowledge on prevention and management of worm infestation. The analysis between level of knowledge among subjects and demographic variables such as gender, religion, area of residence, monthly family income, type of family, father's occupation, mother's occupation, educational status of father, educational status of mother, dietary habit, health problems, and source of information was statistically insignificant (P > 0.05).

  Discussion Top

STH constitute 12% of the total disease burden in children and significantly depletes human capital in developing and least developed countries.[3] Despite consecutive worm infestation eradication targets set by the WHO, easy transmission and reinfection remain as hurdles. A primary reason behind progress in eradication being lack of awareness. Few studies have shown the effect of structured teaching plans and child-to-child approach on raising awareness, however, the comparative analysis of the two techniques has been carried out by very limited studies.[3],[6] The present study aimed to fill this lacuna by assessing the level of knowledge among middle school children and evaluating the efficacy of the two types of educational intervention on expanding knowledge regarding worm infestation. The association between knowledge of worm infestation and relevant demographic variables is probed in greater detail by this study.

A survey of 30 middle school children in Group 1 revealed that most subjects (80%) had inadequate knowledge of worm infestation, while only 2 (6.7%) had adequate knowledge. However, post-intervention with a structured teaching plan, mean post-test scores showed a statistically significant two-fold increase from the pre-test scores. A study by Panwanda reported a three-fold increase in post-test scores.[7] Similar findings were reported by Babitha et al., wherein a pre-test score of 12.46 increased to 25.48 following intervention with a structured teaching plan.[8]

Most Group 2 subjects displayed moderately adequate knowledge, while 4 (13.3%) possessed adequate knowledge during the pre-test. In Group 2, following intervention with a child-to-child approach, a two-fold increase was seen between pre-test and post-test scores, thereby indicating its effectiveness in imparting knowledge on worm infestation. These results are consistent with studies conducted by Priya and Abhirami who also reported a two-fold increase in mean pre-test scores from 13.78 to 29.56 after teaching with a child-to-child approach.[6]

On comparing the mean difference in test scores among the two cohorts, it was found that both interventions were successful in bringing about a two-fold increase in the average level of knowledge of subjects. However, a greater variation was observed among test scores subjects taught according to a structured teaching plan. Hence, the child-to-child approach is more consistent with the two techniques by this study. These results are discordant with the findings of Leena who deduced that child-to-child was more effective in increasing knowledge about the prevention of worm infestation than traditional teaching methods.[9] The difference in results may be due to corollary factors such as age group, background, prior knowledge due to worm infestation awareness drives in the region.

This study aimed to find an association between level of knowledge on worm infestation and select demographic variables, so that vulnerable groups if any can be better targeted with successful educational interventions. A significant association was observed between the place of defecation and the level of knowledge on worm infestation among the Group 1 cohort, whereas in Group 2, the age group and level of knowledge were found to be significantly associated. A study by Swarajyam reported a statistically significant association between the level of knowledge and age group of mothers.[10] Another study conducted by Aluko et al., reported that knowledge of caregivers and the age of under 5 children were significantly associated with the place of defecation practiced.[11],[12]

Some limitations of the current study include a small sample size of 60 and the restriction of the sample population to Kirumamapakkam and Thananpalayam in Puducherry. A follow-up assessing the impact of a structured teaching program and child-to-child approach on preventive measures and hygienic habits adopted by subjects protecting themselves from worm infestations, could have further strengthened the study. The results of this study encourage future research on the comparison between the effectiveness of an information campaign between parents to the child-to-child teaching approach pursued among school children on improving health outcomes among communities.

  Conclusion Top

Worm infestation must be prevented by imparting knowledge on simple yet vital sanitary practices and personal hygiene to children who then act as agents of change for their family and peers. Increased awareness among people translates into better health outcomes when the necessary basic amenities are provided. This study confirms the effectiveness of child to child teaching approach in increasing awareness about the definition, causes, and prevention of worm infestations. Structured teaching plans reinforced by peer teaching programs can be instrumental in evoking a behavioral change among communities. Future research can be done correlating the awareness of worm infestations with the usage of health facilities and health outcomes. An information dissemination campaign that brings the child-to-child approach to the forefront while enveloping parents, accredited social health activists workers, and health workers into its fold should be launched periodically.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

WHO. Soil Transmitted Helminths. Available from: https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections. [Last accessed on 2019 Mar 14].  Back to cited text no. 1
Awasthi S, Verma T, Kotecha PV, Venkatesh V, Joshi V, Roy S. Prevalence and risk factors associated with worm infestation in pre-school children (6-23 months) in selected blocks of Uttar Pradesh and Jharkhand, India. Indian J Med Sci 2008;62:484-91.  Back to cited text no. 2
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Nebhinani M. Effectiveness of structured teaching programme on prevention of worm infestation among school children. RRJHNS 2015;1:29-33.  Back to cited text no. 3
Salam N, Azam S. Prevalence and distribution of soil-transmitted helminth infections in India. BMC Public Health 2017;17:201.  Back to cited text no. 4
Guptha P. Essential Pediatric Nursing. 2nd ed. New Delhi: A. P Jain and Co.;2007:515-17.  Back to cited text no. 5
Sharma SK, Mudgal SK, Thakur K, Gaur R. How to calculate sample size for observational and experimental nursing research studies? Natl J Physiol Pharm Pharmacol 2020;10:1-8.  Back to cited text no. 6
Priya V, Abhirami P. Effectiveness of child to child approach on prevention and management of worm infestation among school children in Chengelpet. Int J Pharm Biol Sci 2016;6:23-8.  Back to cited text no. 7
Panwanda G. A quasi experimental study to assess the knowledge among school children at Alur Taluk, Karnataka. Nurs J India 2011;29:113-5.  Back to cited text no. 8
Babitha N, Abidfaheem TK, Beevi TM. Effect of structured teaching program on knowledge regarding prevention of worm infestation among high school students. IJRR 2018;5:400-5.  Back to cited text no. 9
Leena KC, D'Souza J. Effectiveness of child to child approach to health education on prevention of worm infestation among children of selected primary schools in Mangalore. NUJHS 2014;4:113-5.  Back to cited text no. 10
Swarajyam Y. A study to assess the knowledge and practices of mothers regarding worm infestation among school age children (6-12 years) in order to develop health education pamphlet in a selected rural community, Bangalore. Asian J Nur Edu Res 2011;1:28-30.  Back to cited text no. 11
Aluko OO, Afolabi OT, Olaoye EA, Adebayo AD, Oyetola SO, Abegunde OO. The management of the faeces passed by under five children: An exploratory, cross-sectional research in an urban community in Southwest Nigeria. BMC Public Health 2017;17:178.  Back to cited text no. 12


  [Table 1], [Table 2]


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