Rajiv Gandhi University of Health Science, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME REGARDING PREVENTION OF CHILDHOOD ORAL
CANDIDIASIS ON KNOWLEDGE OF MOTHERS RESIDING AT
UTTRAHALLI AREA, BANGALORE CITY.”

SUBMITTED BY
REMYA MARIAM THOMAS,
I YEAR M.SC., NURSING,
BHAGATH COLLEGE OF
NURSING,
NO.60, UTTARAHALLI MAIN
ROAD,
UTTARAHALLI,
BANGALORE – 61

1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 Name of the Candidate and Address Remya Mariam Thomas.

1year M.Sc., Nursing,
Bhagath College of Nursing,
No.60, Uttarahalli Main Road,
Uttarahalli,
Bangalore – 560 061.
2 Name of the Institution Bhagath College of Nursing,
Bangalore.
3 Course of Study and Subject I year M.Sc., Nursing
Child Health Nursing
4 Date of Admission to Course 1.10.2011
5 Title of the Topic:
“A Study to assess the effectiveness of planned teaching programme regarding
prevention of childhood oral candidiasis on knowledge of mothers residing at
Uttrahalli area, Bangalore city.”
6 Brief Resume of the Intended Work
6.1. Need for the Study Enclosed
6.2. Review of Literature Enclosed
6.3. Objectives of the Study Enclosed
6.4. Operational Definitions Enclosed
6.5. Hypothesis of the Study Enclosed
6.6. Assumptions Enclosed
6.7. Delimitations of the Study Enclosed
6.8. Pilot Study Enclosed
6.9. Variables Enclosed
7 Material and Methods:
7.1. Source of Data: Data will be collected from the mothers residing at
Uttrahalli area, Bangalore city.
7.2. Method of Collection of Data: Structured Knowledge Questionnaire
7.3. Does the study require any investigations or interventions to be conducted
on clients or other human or animals? Yes.
7.4. Has ethical clearance been obtained from your institution? Yes, Ethical
committee’s report is here with enclosed

8 List of References Enclosed

2
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 Name of the Candidate and Address REMYA MARIAM THOMAS,

1year M.Sc., Nursing,
Bhagath College of Nursing,
No.60,Uttarahalli Main Road,
Uttarahalli,
Bangalore – 560 061.

2 Name of the Institution Bhagath College of Nursing,

Bangalore

3 Course of Study and Subject I year M.Sc., Nursing

Child Health Nursing

4 Date of Admission to Course 1.10.2011

5 Title of the Topic:

“A Study to assess the effectiveness of planned teaching programme regarding
prevention of childhood oral candidiasis on knowledge of mothers residing at
Uttrahalli area, Bangalore city.”

6. BRIEF RESUME OF THE INTENDED WORK

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INTRODUCTION

“A well-informed mind is the best security against the contagion of folly and of vice.
The vacant mind is ever on the watch for relief, and ready to plunge into error, to
escape from the languor of idleness”.

----- Ann Radcliffe

Oral candidiasis, also known as "thrush", is an infection of yeast fungi of the

genus Candida on the mucous membranes of the mouth. It is frequently caused by
Candida albicans, or less commonly by Candida glabrata or Candida tropicalis. Oral
thrush may refer to candidiasis in the mouths of babies, while if occurring in the mouth
or throat of adults it may also be termed candidosis or moniliasis.

Oral candidiasis is a common infection that affects many newborns and younger
children. It is caused by the Candida albicans yeast or fungus, which can also cause
vaginal infections and diaper rashes. When it infects a child's mouth, it is called
oropharyngeal Candidiasis, or more simply - oral thrush.

Oral candidiasis can affect anyone, although it's most common in infants younger
than 6 months and in older adults. A baby with oral thrush might develop cracked skin in
the corners of the mouth or whitish patches on the lips, tongue, or inside the cheeks, on
the roof of his mouth, and gums that look a little like cottage cheese but can't be wiped
away. Scraping the white patches off can cause some bleeding. Many babies don't feel
anything at all, but some may be uncomfortable when sucking. Some babies may not
feed well because their mouth feels sore. These white patches, unlike breastmilk or
formula, cannot easily be wiped away. However, if tried to wipe them away, the area may
bleed and leave behind a painful ulcer.1

Although oral thrush is a common infection in infancy, it can be prevented by

educating the mothers or caregivers of children. If the baby is on formula-feeding or
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using a pacifier, it's important to thoroughly clean the nipples and pacifiers in hot water
or dishwasher after each use. That way, if there's yeast on the bottle nipple or pacifier,
your baby doesn't continue to get re-infected. Storing milk and prepared bottles in the
refrigerator prevents yeast from growing. If breastfeeding mothers have nipples which
are red and sore, there's a chance mother have a yeast infection on her nipples, and that
you and the baby are passing it back and forth.2

Factors commonly listed as contributory to oral thrush, such as debility,

prematurity, and so forth, were not found to be operative in the series of cases studied.
Preceding antibiotic therapy did not raise the incidence of neonatal oral thrush. The lack
of resistance of the newborn infant to Candida albicans infection of the mucous
membranes appears to be due to intrinsic defects in immunity which are not as yet
understood. Maternal vaginal candidiasis appears to be the primary source of neonatal
candidiasis. The latter is most effectively prevented by adequate mycologic screening
and therapy of the expectant mother. Infants infected at birth harbor Candida albicans for
several days before they develop clinical evidence of oral or cutaneous candidiasis. In
view of these findings a reevaluation of public health measures for the prevention and
spread of oral thrush in nurseries appears desirable.3

Thrush in infants may be painful, but it is rarely serious. Because of discomfort, it

can interfere with eating. For thrush in infants, treatment is often NOT needed. It usually
gets better on its own within 2 weeks. If an infant with thrush is breastfeeding, to prevent
future infections, use antifungal medication. Sterilize or throw out any pacifiers. For
bottle-fed babies with thrush, throw out the nipples and buy new ones as the baby's
mouth begins to clear.4

6.1 NEED FOR THE STUDY

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 “An ounce of prevention is worth a pound of care”
-Benchemin Franklin

Oral thrush is a very common infection in infants that causes irritation in and
around a baby's mouth. It is caused by the overgrowth of the yeast (a type of fungus)
called Candida albicans. Candida overgrowth can lead to vaginal (yeast) infections,
diaper rashes, or oral thrush. Most people (including infants) naturally have Candida in
their mouths and digestive tracts, which is considered normal growth. The amount is
controlled by a healthy immune system and some "good" bacteria. If the immune system
is weakened (due to an illness or medicines like chemotherapy), or if the immune system
is not fully developed as is the case in infants, the Candida in the digestive tract can
overgrow and lead to an infection. Sometimes Candida overgrowth occurs after a baby
has received antibiotics for a bacterial infection, because antibiotics can kill off the
"good" bacteria that keep the Candida from growing. Similarly, infection can occur with
the steroid use.5

Candida infections in infancy can manifest themselves as skin, mucosal or

systemic candidiasis. Eighty to nintey percent of all candida infections in this age group
are caused by Candida albicans. Whereas in neonates, infections mostly occur sub partu,
in older children predisposing underlying diseases get an increasing etiological
importance. The diagnosis is based on microscopic and cultural detection of yeast as well
as on the course of the titers of Candida antigen and antibodies. For topical antifungal
treatment of skin and mucosa infections, different preparations of the polyenes nystatin
and amphotericin B have been proven to be most effective. In systemic candidiasis the
combination of amphotericin B and 5-flucytosin is the treatment of choice. In view of the
potential severe side effects of this combination therapy, fluconazol as a sole treatment
represents an effective alternative. Prophylaxis against Candida infections comprises
sticking to hygienic regimes, mycological surveillance of risk groups and oral
application of antimycotics.6

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 Candidiasis is common in children with cancer, particularly during periods of
severe immunosuppression and neutropenia. The aim was to study the microbiological
changes in the oral cavity of children with newly diagnosed cancer. The study group
consisted of 30 consecutive children and adolescents, 16 with acute lymphoblastic
leukemia and 14 with solid tumors. There was no association between the underlying
malignancy and the occurrence of the positive cultures. Of the 30 patients, all 23 (76.7%)
who have developed moderate-to-severe neutropenia, developed oral fungal colonization
or clinically obvious fungal infection at least on one occasion during the study.
Neutropenic episodes of children with cancer are associated with an increased risk of
developing oral and even systemic infections with C. albicans that can be replaced by
azole-resistant nonalbicans strains in prolonged neutropenia of patients.7

Oral candidiasis is one of the most common clinical features of HIV infection in
children and adults. The lesion occurs in three predominant forms, and the two intraoral
examples, pseudomembranous and erythematous, are equally predictive of the
development of AIDS, independent of CD4 counts. The predominant species is C.
albicans, although other species are occasionally found. Some studies claim correlation
of salivary Candida counts with CD4 numbers or clinical stage of HIV-related disease,
but this approach has not been used widely in HIV staging. Therapy with a variety of
antifungal agents, including both topical and systemic drugs, is effective. New slow-
release oral topical drug delivery systems may prove to be useful.8

From the above discussions, it is seen that, Candidiasis is a common infection of

infancy and early childhood, though it can occur in adult as well. Oral candidiasis or
thrush can be easily prevented and treated in the children, if we educate the mothers
regarding its preventive measures. If the parents get adequate information, they would be
able to identify the root causes of oral candidiasis in their children. They will also be able
to handle and prevent such problems of their children in future. The investigator had also
seen several cases of oral candidiasis in her clinical duty as well as in the community
area and felt an urge to conduct this study. In view of the above mentioned facts and
interest regarding the topic, the investigator felt a strong need to carry out this study.

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6.2. REVIEW OF LITERATURE

“Literature review to the activities involved in identifying and searching for

information or a topic and developing a comprehensive picture of the state of knowledge
on the topic.” Here reviews are categorized into following categories

6.2.1. Studies related to the information regarding prevalence, causes and risk factors of
childhood oral candidiasis.

6.2.2. Studies related to prevention and management of childhood oral candidiasis.

6.2.1. Studies related to the information regarding prevalence, causes and risk
factors of childhood oral candidiasis.

Oral candidiasis is a common opportunistic infection of the oral cavity caused by

an overgrowth of Candida species, the commonest being Candida albicans. The
incidence varies depending on age and certain predisposing factors. There are three
broad groupings consisting of acute candidiasis, chronic candidiasis, and angular
cheilitis. Risk factors include impaired salivary gland function, drugs, dentures, high
carbohydrate diet, and extremes of life, smoking, diabetes mellitus, Cushing's syndrome,
malignancies, and immunosuppressive conditions. Management involves taking a
history, an examination, and appropriate antifungal treatment with a few requiring
samples to be taken for laboratory analysis. In certain high risk groups antifungal
prophylaxis reduces the incidence and severity of infections. The prognosis is good in the
great majority of cases.9

Candida albicans infection of the nipples and breast ducts is a cause of sore
nipples and "shooting" breast pain during lactation. A questionnaire which sought to
identify predisposing factors was given to 51 women with candidiasis of the lactating
breast, 18 women with other breastfeeding difficulties, and 29 women breastfeeding
without any difficulties. Nipple damage in early lactation, mastitis, recent use of

8
antibiotics postpartum, long-term use prior to pregnancy, and history of vaginal thrush
were positively associated with candidiasis of the lactating breast. Thrush, especially oral
thrush, was more common in babies of mothers in the candida group. However, some
mothers with symptomatic candida infection reported none of these predisposing
factors.10

A prospective study investigated the major epidemiological characteristics of

Candida species colonizing oral and rectal sites of Jordanian infants. Infants aged one
year or less who were examined at the pediatrics outpatient clinic or hospitalized at the
Jordan University Hospital, Amman, Jordan, were included in this study. Culture swabs
were collected from oral and rectal sites and inoculated on Sabouraud dextrose agar. A
total of 61/492 (12.4%) infants were colonized with Candida species by either their
oral/rectal sites or both. Rectal colonization was significantly more detected than oral
colonization (64.6% verses 35.4%), particularly among hospitalized infants aged more
than one month. The pattern and rates of colonization were as follows: C. albicans was
the commonest species isolated from both sites and accounted for 67.1% of all isolates,
followed by C.kefyr (11.4%), each C. tropicalis and C. glabrata (8.9%) and C.11

6.2.2. Studies related to prevention and management of childhood oral candidiasis.

A study evaluated the effect of chlorhexidine (CHX) 0.12% rinses on the clinical
and microbiologic manifestations of oralcandidiasis in HIV-infected children. This was a
cross-sectional, clinical intervention study of 38 HIV-positive children. Of 18 culture-
positive subjects, 12 were included in the CFU analyses. After 3 months of CHX oral
rinse therapy, Candida was undetectable in 3 children; another 8 showed an average 2-
fold reduction in CFU. In 1 child the number of CFU increased modestly. Overall, the
average pre- and posttreatment mean CFU was 6.18 ± 2.19 and 2.73 ± 3.15, respectively
(P = .009). Five patients with clinical oralcandidiasis at baseline, including all 3 who had
pseudomembranous candidiasis, were free of signs of disease at the end of the study.
This study suggests that the topical disinfectant CHX may be a promising agent for
treating and preventing oralcandidiasis in HIV-infected children.12

9
 This case report illustrates the difficulties inherent in treating candidal mastitis in
lactating women and concurrent thrush in the breastfeeding baby. This mother's
candidiasis vacillated from topical to ductal, depending on which medications were
being used over the course of several months. Her baby's oral thrush was unique in that
there were never any white plaques visible on his oral mucosa. Ultimately, both mother
and child were treated simultaneously with oral fluconazole, with a relief of symptoms in
both individuals.13

A study conducted to determine the effects of any intervention in preventing or

treating Oral Candidiasis in children and adults with HIV infection. Oral candidiasis
(thrush) associated with human immunodeficiency virus (HIV) infection occurs
commonly and recurs frequently, often presenting as an initial manifestation of the
disease. Interventions aimed at preventing and treating HIV‐associated oral thrush form
an integral component of maintaining the quality of life for affected individuals. This
review evaluated the effects of interventions in preventing or treating oral thrush in
children and adults with HIV infection. Compared to placebo and no treatment,
fluconazole was effective in preventing clinical episodes from occurring. Continuous
fluconazole was better than intermittent treatment. Insufficient evidence was found to
come to any conclusion about the effectiveness of clotrimazole, nystatin, amphotericin B,
itraconazole, ketoconazole or chlorhexidine with regard to OC prophylaxis.14

The aim of this study was to investigate the effects of A-type cranberry
proanthocyanidins (AC-PACs) on pathogenic properties of C. albicans as well as on the
inflammatory response of oral epithelial cells induced by this oral pathogen. Although
AC-PACs did not affect growth of C. albicans, it prevented biofilm formation and
reduced adherence of C. albicans to oral epithelial cells and saliva-coated acrylic resin
discs. In addition, AC-PACs significantly decreased the secretion of IL-8 and IL-6 by
oral epithelial cells stimulated with C. albicans. This anti-inflammatory effect was
associated with reduced activation of NF-κB p65 and phosphorylation of specific signal
intracellular kinases. AC-PACs by affecting the adherence properties of C. albicans and
attenuating the inflammatory response induced by this pathogen represent potential novel
therapeutic agents for the prevention/treatment of oral candidiasis.15
10
 Fungal infections have become an increasing cause of morbidity in patients with
acute leukemia undergoing chemotherapy. Oral candidiasis is prone to develop in these
patients, and there is also a risk of the development of esophageal Candida infection.
Clotrimazole troches have been previously reported to be effective in the treatment of
documented oral Candida infection. This report documents a double-blind controlled
study in 30 patients with acute leukemia in which the effectiveness of clotrimazole
troches in preventing oropharyngeal candidiasis was assessed. Patients were randomly
assigned to receive 10 mg troches of clotrimazole or a placebo three times per day.
Mucosal scrapings were obtained weekly and examined directly by smear and culture.
There were 28 evaluable patients. Of 12 patients with oral Candida infection, 11 were
taking placebo and one received clotrimazole (p = 0.0002). Clotrimazole is effective in
preventing oropharyngeal candidiasis.16

The aim of this study was to evaluate the effects of photodynamic therapy (PDT)
using rose bengal or erythrosine with light emitting diode (LED) on Candida albicans
planktonic cultures and biofilms. Seven C. albicans clinical strains and one standard
strain (ATCC 18804) were used. The biofilms were analysed using scanning electron
microscopy (SEM). The results revealed a significant reduction of planktonic cultures
(3.45 log(10) and 1.97 log(10) ) and of biofilms (<1 log(10) ) for cultures that were
subjected to PDT mediated using either erythrosine or rose bengal, respectively. The
SEM data revealed that the PDT was effective in reducing and destroying of C. albicans
blastoconidia and hyphae. The results show that erythrosine- and rose bengal-mediated
PDT with LED irradiation is effective in treating C. albicans.17

Oral candidiasis is presently a common problem affecting children in third world

countries. This is probably due to the increasing prevalence of human immunodeficiency
virus infections, poverty and malnutrition, which predisposes to candida infections. A
study was conducted to determine the efficacy of Jatropha multifida in the management
of oral candidiasis and compare its efficacy with that of oral Nystatin. All the clinically
detected cases of children with oral candidiasis at the children's outpatient department of
the State Hospital, Osogbo and children's welfare clinic of the Wesley Guild Hospital,

11
Ilesa were randomized into either Jatropha multifadum Juice extract therapy or the
Nystatin group. Oral Nystatin was administered 4 times a day, for 7 consecutive days to
the children randomized to the Nystatin group. The result shows that Jatropha multifada
is efficacious in the management of oral candidiasis. Compared to oral Nystatin
suspension, it has the advantages of acting faster and being efficacious as a single dose.
Its use in the management of oral candidiasis is recommended in third world countries
where it is easily cultivated and accessible.18

Parents should prepare a solution made from equal parts water and vinegar to
rinse pacifiers or toys used to chew or suck. This solution should be used for rinsing
bottle nipples and detachable breast pump parts exposed to breast milk. Breastfeeding
moms should eat unsweetened yogurt containing acidophilus or take acidophilus
supplements to aid in the fight against oral thrush. While these items will not destroy
yeast, they can help restore "good bacteria" to the body that helps keep yeast growth in
check. There are over-the-counter infant versions of acidophilus capsules designed for
babies, parents should check with a doctor before beginning any supplement regimen.
Parents can use one-third the contents of an adult strength acidophilus capsule spread on
a wet finger for the baby to suck.19

Mothers can keep from passing thrush back and forth to their infant. Allow nipples to
air dry between feedings, while using disposable breastfeeding pads to prevent the
fungus from spreading to your clothes. Mothers who use washable nursing pads should
be sure to wash in hot water with bleach. Doctors often prescribe the antifungal medicine
Nystatin to kill the fungus that causes thrush. This is particularly true when a baby is
showing signs of discomfort when feeding. Parents should squirt Nystatin into their
baby's mouth after feedings, and treat larger patches with a cotton swab dipped in
Nystatin.20

During an outbreak of oral thrush, practice good oral hygiene. Brush at least twice a
day and floss at least once daily. Replace toothbrush frequently until your infection

12
clears up. Avoid mouthwash or sprays — they can alter the normal flora in your mouth.
Don't share toothbrushes. Risk of candida infection can be reduced by the following
measures: Rinse your mouth, if on corticosteroid inhaler, or brush teeth after taking your
medication. Try using fresh-culture yogurt containing Lactobacillus acidophilus or
bifidobacterium or take acidophilus capsules while taking antibiotics. Treat any vaginal
yeast infections that develop during pregnancy as soon as possible. See your dentist
regularly — especially if you have diabetes or wear dentures. Brush and floss your teeth
regularly. Clean dentures every night. Limit intake of sugar- and yeast-containing
foods.21

There are a host of food prescriptions along with natural remedies that have been
known to have a beneficial in the management of oral thrush. Yogurt supplies healthy
bacteria to the body, which can capable of fighting yeast infection. Allowing the baby to
consume some bit of yogurt or applying yogurt locally at the site of the infection can be
highly beneficial. Grapefruit extract mixed with honey can also be beneficial in
management of oral thrush. Garlic oil has potent antiseptic properties and can manage
some stubborn forms of oral thrush quickly. Maintaining utmost oral hygiene in infants
and babies is very crucial. While weaning the child, sugary foods or packed baby foods
that contain refined sugar should be avoided. Baby’s bottle, pacifier, comforters, etc are
should be cleaned and washed. Administration of steroids, especially up to the age of
nine months should be avoided.22

STATEMENT OF PROBLEM:

“A Study to assess the effectiveness of planned teaching programme regarding

prevention of childhood oral candidiasis on knowledge of mothers residing at Uttrahalli
area, Bangalore city.”

6.3. OBJECTIVES OF THE STUDY

6.3.1 To assess the existing knowledge of mothers regarding prevention of childhood oral
candidiasis.
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6.3.2 To find out the effectiveness of planned teaching programme regarding prevention
of childhood oral candidiasis.
6.3.3 To evaluate the effectiveness of planned teaching programme regarding prevention
of childhood oral candidiasis.
6.3.4 To find out the association between knowledge scores of mothers regarding
prevention of childhood oral candidiasis with selected demographic variables.

6.4. OPERATIONAL DEFINITIONS

Assess: Assess refers to the critical analysis and evaluation or judgment of knowledge
regarding prevention of childhood oral candidiasis.

Effectiveness: It refers to the extent to which the planned teaching programme regarding
prevention of childhood oral candidiasis achieves desired effect in improving the
knowledge of mothers as evident from the gain in their knowledge scores.

Planned teaching programme: It refers to the systematically developed instructional

method and teaching aids designed for mothers to provide information regarding
prevention of childhood oral candidiasis.

Prevention: It refers to measures taken to stay away from oral candidiasis infection.

Childhood: It is a period in a person’s life below 12 years of age.

Oral candidiasis: It is caused by the Candida albicans yeast or fungus, characterized by

cracked skin in the corners of the mouth or whitish patches on the lips, tongue, or inside
the cheeks, on the roof of his mouth, and gums which cannot be wiped off.

Knowledge: In this study, it refers to the correct response from the mothers regarding
prevention of childhood oral candidiasis as elicited through structured knowledge
questionnaire.

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Mother: In this study, it refers to woman who has children below 5 years, residing at
Uttrahalli area, Bangalore city.

6.5. HYPOTEHESIS OF THE STUDY

H1: There will be statistically significant difference between the pre and post test
knowledge scores of mothers regarding prevention of childhood oral candidiasis in
experimental group.
H2: There will be a statistically significant association between the knowledge scores of
mothers with selected demographic variables.

6.6. ASSUMPTIONS

6.6.1 Mothers may have some knowledge regarding prevention of childhood oral
candidiasis.
6.6.2 Mothers may have interest to learn more regarding prevention of childhood oral
candidiasis.

6.7. DELIMITATIONS OF THE STUDY

6.7.1 The study is delimited to

 The mothers having children below 5 years, residing at Uttrahalli area, Bangalore
city.
 Those who are willing to participate in the study.
6.7.2 Assessment of knowledge is based on response to objective type test items used in
questionnaire.

6.8. PILOT STUDY

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The pilot study will be conducted with 12 samples among which 6 in experimental and 6
in control group. The purpose of the pilot study is to find out the feasibility for
conducting the study and design on plan on statistical analysis.

6.9 VARIABLES
A concept which can take on different quantitative values is called a variable.
Dependent variables:
Knowledge of mothers regarding prevention of childhood oral candidiasis.
Independent variable:
Planned teaching programme regarding prevention of childhood oral candidiasis.
Extraneous Variable: Age, education, occupation, religion, Per capita monthly income
of the family, number of children, previous knowledge, sources of information, etc.
7. MATERIALS AND METHODS

7.1.1 SOURCES OF DATA

The data will be collected from the mothers having children below 5 years
residing at Uttrahalli area, Bangalore city.

7.1.2 RESEARCH DESIGN

The research design adopted for this study is Pre experimental in nature(one
group pre test and post test design).

7.1.3 RESEARCH APPROACH

Evaluative research approach.

7.1.4. SETTING OF THE STUDY

The study will be conducted at Uttrahalli area, Bangalore city.

7.1.5. POPULATION
Mothers having children below 5 years residing at Uttrahalli area, Bangalore.

16
7.2. METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING
PROCEDURE)

The data collection procedure will be carried out for a period of one month. This
study will be conducted after obtaining permission from the concerned authorities. The
investigator will collect data from the mothers by using a structured knowledge
questionnaire. Data collection instrument consists of following sections:
Section A: Demographic data
Section B: Questions to assess the level of knowledge of mothers regarding prevention
of childhood oral candidiasis.

7.2.1 SAMPLING TECHNIQUE

Sampling technique adopted for selection of sample is non- probability
convenience sampling.

7.2.2. SAMPLE SIZE

Sample consists of 60 mothers having children below 5 years residing at
Uttrahalli area, Bangalore city.

SAMPLING CRITERIA

7.2.3 INCLUSION CRITERIA

1. Mothers who are willing to participate in the study.
2. Mothers who are available during the period of data collection.
3. Mothers who are residing at Uttrahalli area, Bangalore.
4. Mothers who have children below 5 years.

7.2.4. EXCLUSION CRITERIA

1. Mothers who are selected for the pilot study.
2. Mothers who do not know to read and write English or Kannada.

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7.2.5. TOOL FOR DATA COLLECTION

Structured knowledge questionnaire will be used to collect the data.

* Structured knowledge questionnaire is divided into 2 parts—
Part-1: Items on demographic variables like age, educational qualification, religion,
socio-economic status, type of family and number of children, prior knowledge, source
of information, etc.
Part-2: Knowledge items regarding prevention of childhood oral candidiasis.

7.2.6. DATA ANALYSIS METHOD

The data collected will be organized, tabulated and analyzed by using descriptive
and inferential statistics.

Descriptive statistics—
* Frequency, mean, mean percentage and standard deviation will be used to
describe the demographic variables and knowledge scores.
* Correlation coefficient will be used to find out the relation between the
knowledge scores.

Inferential statistics—
* Paired ‘t’ test will be used to compare the pre and post test scores.
* Chi-square test will be used to find out the association between selected
demographic variables with knowledge scores.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIETNS OR OTHER HUMAN
OR ANIMALS ?

Yes, since the study is Pre-experimental in nature, so interventions are required.

18
7.4. ETHICAL CLEARANCE

Yes, ethical committee’s clearance has been obtained from the institution. The
purpose and details of the study will be explained to the study subjects and assurance
will be given regarding the confidentiality of the data collected.

8. LIST OF REFERENCES: (VANCOUVER’S STYLE FOLLOWED)

1. Wong L Donna. Essentials of Paediatric Nursing. 5th ed. Missouri: Mosby; 1993.

2. Fox LA. The oral cavity. In Behrman RE, Klieman RM and Jenson HB, eds. Nelson
textbook of Paediatrics. Pennsylvania: Saunders (Publisher), 2000.

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3. Kozinn Philip J, Taschdjian Claire L, Wiener Harry. Incidence and pathogenesis of
neonatal candidiasis: American journal of paediatrics. 2009 Sep-Oct;9(5):300-6.
Available from: http://www.pubmed.com

4. Edwards JE Jr. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia:
Elsevier Churchill Livingstone; 2009.

5. Kauffman CA. Cecil Textbook of Medicine. 23rd ed. Philadelphia: Saunders; 2007.

6. Schwarze R, Seebacher C, Blaschke-Hellmessen R. Candida infections in infancy and

early childhood: Journal of the International Association for the study of infectious
disease. 1998 Apr;92(3):163-8. Available from: http://www.ehow.com.html.

7. Márta Alberth, et al. Significance of oral Candida infections in children with cancer:
Pathology and oncology research. 2006 Nov;12(1):237-241. Available from: http://
www.ncbi.nlm.nih.gov

8. Deborah Greenspan. Treatment of oralcandidiasis in HIV infection: Journal of Dental

research. 2005 Mar;63(3):156-163. Available from: http:// www.ncbi.nlm.nih.gov

9. Akpan A, Morgan R. Oral candidiasis: Postgraduate Medical Journal. 2002

Jun;78(1):455-459. Available from: http://www.ehow.com.html.

10. Amir Lisa Helen. Candida and the lactating breast: The Journal of the Royal Society
for the Promotion of health, 2004 Jan; 124 (1): 29 – 33. Available from: URL
www.pubmed.com.
11. Issa SY, Badran EF, Aqel KF, Shehabi AA. Epidemiological characteristics of
Candida species colonizing oral and rectal sites of Jordanian infants: International
journal of paediatrics, 2011 Sep; 9(11): 79. Available from: http:// www.ncbi.nlm.nih.gov

12. Barasch Andrei, Safford Monika M, Ingrida Dapkute-Marcus, Daniel H Fine.

Efficacy of chlorhexidine gluconate rinse for treatment and prevention of oralcandidiasis

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in HIV-infected children: Journal of medicine and dentistry, 2009 Oct; 7(2): 45-51.
Available from: URL www.pubmed.com.

13. Chetwynd Ellen M, Ives Timothy J, Payne Patricia M, Edens-Bartholomew Neva.

Fluconazole for Postpartum Candidal Mastitis and Infant Thrush: Postgrad Med J 2002
Jan; 78(922): 455-459. Available from: http://www.ehow.com.html.

14. Ramos-Gomez F. Interventions for the prevention and management of oral thrush
associated with HIV infection in adults and children: Dental considerations for the
Paediatric HIV/AIDS patients 2010 Nov; 1(2): 49-54. http://www.health med.com

15. Feldman Mark, Tanabe Shinichi, Howell Amy, Grenier Daniel. Cranberry
proanthocyanidins inhibit the adherence properties of Candida albicans and cytokine
secretion by oral epithelial cells: Journal of Oral Pathology 2004 Feb; 97(2): 204-207.
Available from: http://www.ehow.com.html

16. Cuttner Janet, Troy Kevin M, Funaro Laura, Brenden Rita, Bottone Edward J.
Clotrimazole treatment for prevention of oralcandidiasis in patients with acute leukemia
undergoing chemotherapy: Journal of paediatric oncology 2004 Jun; 109(6): 1028-35.
Available from: URL www.pubmed.com

17. Costa AC, Rasteiro VM, Pereira CA, Rossoni RD, Junqueira JC, Jorge AO. The
effects of rose bengal- and erythrosine-mediated photodynamic therapy on Candida
albicans: Journal of Dentistry 2012 Jan; 55(1): 56-63. http://www.health med.com

18. Adesola A. T, Adetunji O. The Efficacy Of Jatropha Multifida In The Management

Of Oral Candidiasis: The Internet Journal of Alternative Medicine 2007 Jul; 4(1): 1540-
2584. Available from: http.// pediatric.aapublications.org

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19. Levin Y, Sherer Y, Bibi H, Schlesinger M, Hay. Home remedies for oral thrush:
Journal of Emergency medicine 2000 May; 19(2): 173-5. http://www.health med.com

20. Amirali W, Moshiro C, Ramaiya K. Preventing and treatment of oral thrush in

newborn babies: East African Medical Journal 2004 Sep; 81(3): 226-9. Available from:
URL www.pubmed.com

21. Lumbreras C, et al. Oral thrush prophylaxis: Journal of Infectious Diseases 1996 Apr;
174(2): 583–8. Available from: http.// pediatric.aapublications.org

22. Shah Sweatha. Treating oral candidiasis in infants: Indian journal of paediatrics 2009
Nov; 22(1): 67-73. Available from: URL www.pubmed.com

9 Signature of the Candidate

10 Remarks of the Guide

11 Name and Designation of

11.1 Guide
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 11.2 Signature

11.3 Co-Guide

11.4 Signature

11.5 Head of Department

11.6 Signature

12 12.1 Remarks of the Chairmen and

Principle

12.2 Signature

23