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Study to assess the knowledge, attitude, and practice about acute respiratory infections among school going children and their parents in rural Maharashtra.


More than 12 million children die every year due to acute respiratory illness in developing countries die before they reach their fifth birthday, many during the 1st year of life. [1] Among all illnesses of childhood, acute respiratory tract infections, malnutrition, and diarrheal diseases are the principal causes of morbidity and mortality in the developing countries. [2]

Acute respiratory diseases are reported to be the 3rd leading cause of child morbidity and mortality. [3] Acute respiratory diseases continue to affect the developing world causing in more than 3 million deaths, accounting for 15.5% of total childhood deaths, i.e., under 5 years. [4] India ranks 2st for three-quarter of death due to acute respiratory illness in under five population in the developing regions of the world (2004). [5,6]

A significant determinant of child health is the attitude and knowledge of the child's mother toward these diseases. Mother is the main caregiver for the child in almost all societies. Hence, the knowledge, attitude, and health practices of the mothers directly implies on the health status and survival of the child. Most of the morbidity due to acute respiratory diseases is such that, they can adequately managed at home. A comprehensive health education on the etiology or causation, its prevention and management has the potential to establish appropriate contact between the health services provided and the society. This will increase the capability of the families to identify the danger signs of acute respiratory diseases in children and to encourage appropriate and early care seeking behaviors. National family health survey - 3 study found that before 2 weeks of survey around 6% of under five children had on amor the other symptoms of an acute respiratory infection (ARI) which included cough, short and rapid breathing. Among these children, just 69% reported to a health facility or health provider for treatment. [7] Health education is an important and a primary aspect of health care. It is reported that the incidence of acute respiratory diseases in rural India is 11.3% and in urban India is 8.5%. [8] Hence, the purpose of this study is to identify the knowledge, attitude, and practice (KAP) regarding acute respiratory diseases among school going children and their mothers.


The objective of the study was to find out the KAP toward acute respiratory diseases among school going children and their parents.


A descriptive study was conducted among the secondary high school children (9th standard) Azad high school, Kasegaon, to find out the level of KAP of children and their parents about the acute respiratory illness. The mother was specifically selected for the study because she is the primary caretaker of her children and her family. She is the one who spends maximum time with children and plays an important role in inculcating health KAP in them. If the child had single parent, i.e., father, then the father would have been considered for the study, but in the current study, no such child was found without a mother.

A pre-structured and pretested questionnaire was used to get the information regarding definition, causes, signs, symptoms, treatment, prevention of respiratory illness, etc. Total 12 questions were asked to assess KAP of ARI of which 4 for knowledge, 4 for attitude, and 4 for practice for children. Scoring system was developed to assess both pre- and post-test performance of study and control group. Correct answer was given score 1 and wrong answer and uncertain answer 0. The grading of KAP was done as 0-1 = Poor, 2 = Average, and 3-4 = Good. The grading for overall KAP was done as 0-3 = Poor, 4-7 = Average, and 8-12 = Good. This was done in consultation with a statistician and with the help of reference studies number 52.

Data were collected related to knowledge, attitude, and practice on respiratory diseases among 9th students and mothers in predesigned and pretested questionnaire. The mothers were interviewed personally. Institutional Ethical Committee clearance and permission from school was taken before the start of the study.


Following Figures 1 and 2 show that a maximum number of children in both was having an age of groups 15 and 14 years whereas male gender (boys) which was found in maximum number compared to female (girls).

According to Table 1, the majority of parents had school education (mothers 71.6% and father 59.5%) whereas illiterate mothers were less than one third (20.3%). More than one-fourth mothers of were engaged in one or the other form of work. Majority of them were engaged in farm work (52.7%) followed by labor work (23%). Similarly, 66.2% of fathers were engaged in farming and 23% in labor work. It was observed that two-third of students (71.6%) belonged to middle class followed by lower (24.3%) and upper class.

Tables 2 and 3 summarize the responses given by school children's and their mothers to the questions regarding KAP of ARI. Table 2 summarized that the proportion of children given correct answers to the questions was from 1.4% to 64.9%. Mothers were asked about 12 questions 4 each in knowledge, attitude, and practice in section, and the correct responses were from 2.7% to 52.7%.

Tables 4 and 5 summarizes scoring of marks allotted to answers given by children and their mother separately. More than half of children had average knowledge, but attitude and practice regarding respiratory diseases were found very poor. Overall, KAP score was also between poor and average. Whereas more than 2/3rd mothers were having very poor KAP about ARI.


In general, the mother is the primary caretaker of the family and is thus charged with teaching her children proper health and hygiene practices. An illiterate or uneducated mother even though she takes care of her family, she may be less knowledgeable about teaching her children proper hygienic practices, subsequently leading to increased rates of infection and disease among her children. Most common age was 13 years with boys being the majority. Most of the mothers had school education and were farmers. The KAP was poor among both students as well their mothers.

According to age group and gender, the mean age of 9th standard students was 13 years (range: 12-14). Majority of them were boys constituting 74.7% in the study group and 70.7% in control group whereas only about 1/4th girl's population was constituted in study and control group (25.3% and 29.3%, respectively). In a study of Danielle Ferreira de Magalhaes et al. [9] students from the 5th and 8th grades were participants of the study. Mean age was 10 years (range: 9-14) in the 5th grade and 14 years (range: 13-17) in the 8th grade. Moreover, 46.8% were boys and 53.2% girls. Nearly 20% mothers were illiterate and 71% had school education and 8% had school education. In a study of Savitha et al. [10] reported illiteracy among mothers of 63.46% of study subjects and very less proportion of mothers with school and college education among study subjects. Similarly, Haroun et al. [11] observed less of maternal illiteracy (13.2%) among study subjects and Broor et al. [12] made the observation of more proportion of maternal illiteracy (42.6%). In this study, 1/4th mothers were illiterates among 9th standard (20.3% in study and 29.3% in control group) students. With respect to maternal occupation among 9th standard students, most of the mothers were laborers and farmers as most of them had their own lands and with very less proportion being housewives and professionals in both studies. A study by Lloyd [13] showed 11% of mothers of children doing agriculture work, 3.36% daily based labor, 1.68% domestic work for others families, and 85.71% being housewife. The KAP was found to be poor among both children and their mothers, i.e. 38% and 58%, respectively. The above findings are almost similar to the studies of Tragler [14] and Fawole et al. [15] in which significant increase in KAP after the experiment (health education) was observed. The proportion of correct answers reported among mothers is similar to study conducted by Danielle Ferreira de Magalhaes et al. [9] which observed the less proportion of correct answers by family members.

The strength of the study is as it was one of its kinds in the part of western Maharashtra where it tried to identify the KAP regarding ARIs among children and their mothers.


A major determinant of child health is the health and knowledge of the child's mother. It has been seen that the mother is the main caregiver for the child in almost all societies. Hence, the knowledge, attitude, and health practices of the mothers directly reflect on the health and vitality of the child. In light of these observations, future school-based health and hygiene education programs should include strategies to involve family members, particularly mothers and siblings.

DOI: 10.5455/ijmsph.2017.0721414092017


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[2.] WHO. Serious childhood problem in countries with limited resources, background book on management of the child with serious infection or malnutrition. Geneva: WHO; 2004.

[3.] Bhattacharya R, Kaur P. Epidemiological correlates of Diarrhoea in a rural area of Varanasi. Indian J Community Med. 1989;12(2):79-82.

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[5.] WHO. Health Situation in the South East Asia Region, Regional Office for SEAR. New Delhi: WHO; 1999.

[6.] Bhanderi D, Chowdhary SK. An epidemiological study of health and nutrition status of under five children in semiurban community of Gujarat: Estimating child mortality due to Diarrhoea in developing countries. Indian J Public Health. 2006;50(4):213-9.

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[9.] O'Reilly, Freeman, Ravani M, Migele J, Mwaki A, Ayalo M, et al. The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya. Epidemiol Infect. 2008;136(1):80-91.

[10.] Vasanthamala A, Arokiasamy JT. Knowledge, attitude and practice factors in childhood acute respiratory infections in a peninsular Malaysia health district. Asia Pac J Public Health. 1989;3(3):219-23.

[11.] Datta V, John R, Singh VP, Chaturvedi P. Maternal knowledge, attitude and practices towards diarrhea and oral rehydration therapy in rural Maharashtra. Indian J Pediatr. 2001;68(11):1035-7.

[12.] Savitha MR, Nandeeshwara SB, Pradeep Kumar MJ, Ul-Haque F, Raju CK. Modifiable risk factors for acute lower respiratory tract infections. Indian J Pediatr. 2007;74(5):477-82.

[13.] Lloyd A. Maternal Knowledge, Attitudes and Practices and Health Outcomes of Their Preschool-Age Children in Urban and Rural Karnataka, India, Graduate School Theses and Dissertations, Paper 2066; 2009.

[14.] Vaughan C, Gack J, Solorazano H, Ray R. The effect of environmental education on schoolchildren, their parents, and community members: A study of intergenerational and intercommunity learning. J Environ Educ. 2003;34(3):12-21

[15.] Tingen MS, Waller JL, Smith TM, Baker RR, Reyes J, Treiber FA. Tobacco prevention in children and cessation in family members. J Am Acad Nurse Pract. 2006;18(4):169-79.

Source of Support: Nil, Conflict of Interest: None declared.

Anirudha Vijay Mutalik (1), Vaishali V Raje (2)

(1) Department of Community Medicine, KMCT Medical College, Manassery, Calicut, Kerala, India, (2) Department of Community Medicine, Krishna Institute of Medical Sciences Deemed University Karad, Maharashtra, India

Correspondence to: Anirudha Vijay Mutalik, E-mail:

Received: July 29, 2017; Accepted: September 14, 2017
Table 1: Distribution according to parents education,
occupation, and socioeconomic status

Particulars               Study
                        n=74 (%)

Mother education
  Illiterate            15 (20.3)
  School education      53 (71.6)
  College education      6 (8.1)

Mother occupation
  Housewife             10 (13.5)
  Farmer                39 (52.7)
  Labor                  17 (23)
  Professional          8 (10.8)

Father education
  Illiterate            14 (18.9)
  School education      44 (59.5)
  College education     16 (21.6)

Father occupation
  Farmer                49 (66.2)
  Labor                  17 (23)
  Professional          8 (10.8)

Socioeconomic status
  Upper class            3 (4.1)
  Middle class          53 (71.6)
  Lower class           18 (24.3)

Table 2: Proportion of correct answers by children to
questions about KAP of ARI

Variables    Questions numbers   Correct answers
                                    n=75 (%)

Knowledge       Question 1          51 (68.9)
                Question 2          31 (41.9)
                Question 3          22 (29.7)
                Question 4          9 (12.2)
Attitude        Question 5          13 (17.6)
                Question 6          27 (36.5)
                Question 7          19 (25.7)
                Question 8           1 (1.4)
Practice        Question 9           20 (27)
                Question 10         13 (17.6)
                Question 11         27 (36.5)
                Question 12         11 (14.9)

KAP: Knowledge, attitude, and practice, ARI:
Acute respiratory infection

Table 3: Proportion of correct answers by the mothers of
children's for questions about KAP of ARI

Variables    Question numbers   Correct answers
                                   n=75 (%)

Knowledge           Q1             39 (52.7)
                    Q2             23 (31.1)
                    Q3             18 (24.3)
                    Q4             9 (12.2)
Attitude            Q5             19 (25.6)
                    Q6              20 (27)
                    Q7             13 (17.6)
                    Q8             13 (17.6)
Practice            Q9             25 (35.8)
                   Q10             27 (36.5)
                   Q11              2 (2.7)
                   Q12             9 (12.2)

KAP: Knowledge, attitude, and practice,
ARI: Acute respiratory infection

Table 4: Distribution of children's according to KAP

                           n=74 (%)

Variables        Poor       Average     Good

Knowledge      39 (51.4)   29 (39.1)   7 (9.5)
Attitude        57 (77)    16 (21.6)   1 (1.4)
Practice       59 (79.7)   13 (17.6)   2 (2.7)
Overall KAP    38 (51.4)   36 (48.6)    0 (0)

KAP: Knowledge, attitude, and practice

Table 5: Distribution of mother according to grades of

                           n=74 (%)

Variable         Poor       Average      Good

Knowledge      51 (68.9)    5 (6.8)    18 (24.3)
Attitude       55 (74.3)   8 (10.8)    11 (14.9)
Practice       51 (68.9)   19 (25.7)    5 (6.8)
Overall KAP    53 (71.6)   15 (20.3)    6 (8.1)

KAP: Knowledge, attitude, and practice

Figure 1: Distribution of study group according to age group in 9th

13yrs    0%
14yrs   11%
15yrs   89%

Note: Table made from bar graph.

Figure 2: Distribution of study group according to gender in 9th

Male     76%
Female   54%

Note: Table made from pie chart.
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Title Annotation:Research Article
Author:Mutalik, Anirudha Vijay; Raje, Vaishali V.
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Nov 1, 2017
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