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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 50-61

Effect of instructional guidelines on mothers of children with conjunctivitis


1 Lecturer of Pediatric Nursing, El-Fayoum Faculty of Nursing
2 Assistant Professor of Community Health Nursing, Helwan Faculty of Nursing
3 Lecturer of Community Health Nursing, Helwan Faculty of Nursing

Date of Submission25-Sep-2017
Date of Acceptance30-Jan-2018
Date of Web Publication3-Sep-2018

Correspondence Address:
Azza El-Sayed Ali Hegazy
Lecturer of Pediatric Nursing, El-Fayoum Faculty of Nursing

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_36_17

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  Abstract 


Background Conjunctivitis is a common infection especially among children younger than 5 years. Although conjunctivitis rarely results in permanent visual loss or structural damage, it causes discomfort and is highly contagious. This study aimed to assess, plan, implement, and evaluate the effect of instructional guidelines on knowledge and reported practices of mothers regarding care of their children with conjunctivitis.
Patients and methods A pretest/post-test quasi-experimental research design was used. This study was conducted at the outpatient clinics of El-Fayoum Ophthalmic Hospital. The study participants included a random sample of 50 mothers having children with conjunctivitis attending the previously mentioned setting with their children at the time of this study. Tools used for data collection include: Mothers’ knowledge assessment sheet was used, which consisted of four parts: the first part included demographic characteristics of the children such as age, sex, birth order, residence, and crowding level; the second part included demographic characteristics of mothers such as age, educational level, working status, and health history of mothers; the third part included history of conjunctivitis in the studied children such as onset, source of infection, medical history, previous infection of the family members, and recurrent infection and its manifestation; and the fourth part included mothers’ knowledge about conjunctivitis throughout the guidelines phases such as definition, causes, clinical picture, mode of transmission, complications, prevention, and treatment. It also includes reported practices related to conjunctivitis throughout instructional guideline phases, such as practices related to use of personal protective measures to prevent spread of infection and alleviate symptoms.
Results The main results revealed that there were highly statistically significant differences between before and after guidelines implementation.
Conclusion The present study findings revealed that mothers had poor knowledge and unsatisfactory reported practices related to conjunctivitis and its management. Subsequently, they did not follow the correct instructions related to treatment. There was a positive effect of guidelines on improving knowledge and practices of the studied mothers.
Recommendations Mothers’ classes and educational programs about management and prevention of conjunctivitis and its infection should be held at El-Fayoum Ophthalmic Hospital.

Keywords: children, conjunctivitis, instructional guidelines, mothers, nursing


How to cite this article:
Hegazy AE, Abd El-Maksoud MM, Sabea MT. Effect of instructional guidelines on mothers of children with conjunctivitis. Egypt Nurs J 2018;15:50-61

How to cite this URL:
Hegazy AE, Abd El-Maksoud MM, Sabea MT. Effect of instructional guidelines on mothers of children with conjunctivitis. Egypt Nurs J [serial online] 2018 [cited 2018 Nov 13];15:50-61. Available from: http://www.enj.eg.net/text.asp?2018/15/1/50/240354




  Introduction Top


Conjunctivitis is described as any inflammatory process that involves the conjunctiva and is also called pink or sticky eyes. Conjunctiva is a mucous membrane that covers the white of the eye and inner surface of the eyelids (LaMattinaa and Thompson, 2014).

The eyeball is an elongated sphere, ∼2.5 cm in diameter. It has three layers: the sclera, the choroid, and the retina. The outer layer, the sclera, is a white part and is fibrous, except for the cornea, which is made up of transparent collagen fibers. Therefore, the cornea is known as the window of the eye. The choroid is the thin middle layer and it has an extensive blood supply in the front part of the eye. The retina contains the sensory receptors of the eye (Michael et al., 2014).

When bacteria or viruses come in contact with the conjunctiva, they are recognized as foreign antigens, and an antigen-antibody immune reaction occurs, resulting in inflammation. Allergic conjunctivitis (AC) occurs through a different mechanism. Contact with the allergen results in an allergic response (overreaction of the immune response) or the mast cell and histamine mediators are activated, resulting in inflammation (Ricci and Kyle, 2015).

Inadequate housing results in overcrowding, poor sanitation, and thus greater exposure to communicable diseases. Environmental risk factors such as unsafe water, including poor sanitation and hygiene, and indoor air pollution owing to solid fuel used for cooking increase the risk of eye disease, and worldwide, children younger than 5 years are the main victims (Centers for Disease Control and Prevention, 2014).

Moreover, low socioeconomic status has the greatest adverse effect on heath owing to escalating healthcare costs and unaffordable health insurance premiums (McKenzie et al., 2015). The reasons for eating unbalanced meals and insufficient food are related to lack of funds or lack of understanding of the benefits of certain foods on health. In addition, some bad habits such as household animals and some cultures and beliefs, interpersonal relationship, and communications pattern also have an adverse effect health (Stanhope and Lancaster, 2016).

It has been found that a healthy toddler or preschool children probably spends a lot of time on the floor, in the dirt outdoor, or exploring the of the rubbish bin or dog feces in the park. Preschool children are usually a little more discriminatory about what they explore, but they still get very dirty through playing, running, climbing, and jumping, which are the mainstays of activity; beside that, they may learn to ride tricycle and may eat fruits without washing (Glasper et al., 2016).

A similar study by Huband et al. (2012) reported that some of the children who are toilet trained are unlikely to be able to wipe themselves clean after defecation, and they are unable to protect themselves against causes of contamination, such as flies, infected fingers, and infected towels.

As mentioned in World Health Organization (2015), eye problems can be improved by appropriate resources, improved environmental conditions, and timely intervention. In addition, improved face washing and reduced flies count along with proper antibiotic treatment can treat eye problems.

According to World Health Organization (2015), vision problems affect between 10 and 20% of all children in the first year of life and ∼50% from 0–2 years. Moreover, 20–48% have greater risk of recurrent eye infection. Approximately 5.5 million are at risk in Egypt along with 15 million children worldwide, most of them in the age of 0–6 years.

Conjunctivitis has been mentioned to be a common disease in pediatric age group and is one of the most common nontraumatic eye complaints resulting in presentation to the emergency department. Conjunctivitis is responsible for ∼30% of all eye problems. Furthermore, eye infection, especially conjunctivitis, is estimated to cause total blindness in 5–15% of cases. Moreover, it leads to inability to be a part of playing and performing various activities, in addition. Studying and doing school work, which results in delayed in attendance and school performance (American Academy of Ophthalmology, 2013).

Conjunctivitis infection often occurs when dirty fingers, towels, handkerchiefs, or facecloths touch the eyes. Symptoms appear 2–10 days (usually 3–4 days) after catching conjunctivitis. As with any mucous membrane, infectious agents may adhere to the conjunctiva, thus overwhelming a normal defense mechanism and producing clinical symptoms of redness, discharge, irritation, and sometimes photophobia. It is normal for some amount of eye discharge to deposit in the corners of eyes while sleeping at night, resulting in some morning crusting. Cellular infiltration and exudation characterize conjunctivitis on a cellular level (Akpalaba and Aluge, 2012).

Classifications of conjunctivitis are usually based on the cause, including viral, bacterial, fungal, parasitic, toxic, chlamydial, chemical, and allergic agents. In newborns, the cause may be incompletely opened tear-drainage ducts (Cash and Glass, 2011). Newborn babies can catch a form of conjunctivitis from the mother’s birth canal. This condition, known as ophthalmia neonatorum, can be serious and needs prompt treatment with antibiotics. Infants often develop ‘sticky eyes’ as their tear ducts are tiny and can easily get blocked. When this happens, a clear or white sticky fluid collects in the eye. As long as the eye is not red or inflamed, it does not usually need treatment (Alwan, 2016).

Several studies demonstrate that acute conjunctivitis occurs with almost equal frequency between bacterial and viral causes (American Academy of Pediatrics, 2013). James and Ashwill (2016) noted that viral conjunctivitis occurs more frequently in the summer and bacterial conjunctivitis occurs more often in the winter and spring. Viral etiologies are more common than bacterial. Most cases of conjunctivitis are benign, with a self-limited process; however, depending on the immune status of the child and the etiology, conjunctivitis can progress to increasingly severe and sight-threatening infections (Michael et al., 2014).

In viral conjunctivitis, there is contact history with recent eye or upper respiratory tract infection, especially in children, there is a burning sensation and watery discharge that differs from purulent exudates in bacterial infection, begins in one eye with rapid spread to the other and often preauricular lymphadenopathy. The eye appears red and watery with swollen conjunctiva particularly in the eye lid and may coincide with other symptoms like a sore throat (Centers for Disease Control and Prevention, 2014).

Transmission may occur through accidental inoculation of viral particles from the patient’s hands or by contact with infected upper respiratory droplets and fomites, or through contaminated swimming pools. Viral conjunctivitis can spread very rapidly through a community or an institution such as a nursery or school. This is a highly infectious disease and needs to be controlled by enforcement of strict hygiene standards. The infection usually resolves spontaneously within 2–4 weeks (Canadian Pharmacists Association, 2014).

Viral conjunctivitis is highly contagious, usually for 10–12 days from the onset as long as the eyes are red. Preventing transmission of viral conjunctivitis is important and relies primarily on a good personal hygiene. However, ophthalmia neonatorum can be prevented by use of povidone iodine drops, tetracycline eye ointment, or other antiseptics or antibiotics at birth (Ezegwui and Onwasigwe, 2015).

The management is aimed at comfort. Swelling resolves on its own, and resolutions may take weeks. Cold compresses, regular lubricants (without preservative), and antibiotic drops if indicated are helpful (Isenberg et al., 2002). Those who wear contact lenses should be instructed to discontinue lens wearing until signs and symptoms have resolved (Alwan, 2016).

Bacterial infection usually occurs in both eyes and produces more discharge than viral. In bacterial conjunctivitis, there are red sticky eyes, usually bilaterally with purulent discharge. No corneal or anterior chamber is involvement. The child is systemically well and can be effectively managed by regular hygiene and topical antibiotics for 5 days with no bandage (Glasper et al., 2016).

Regarding AC, the eyes are red, sore, bloodshot, and more itchy, and there may be a clear discharge that makes it feel sticky but without any yellow discharge. It is caused by an allergy to pollen, cosmetics, or other substances (Everitt et al., 2016). If it is worse in the pollen season, it is a form of hay fever. The eyelid shows swelling and has papillae (tiny elevation on the palpebral conjunctiva). If you pull down your lower eyelid you will clearly see redness in the lower eyelid lining and history of atopy, for example, asthma and eczema (Abelson and Granet, 2016).

Treatment of conjunctivitis in general starts by keeping the child’s eyes clean, and washing them gently several times a day with cotton wool soaked in tepid water. Moreover, the doctor should be seen for appropriate treatment; the doctor might prescribe antibiotic eye drops or ointment for several days or topical antihistamines if the child has AC (American Academy of Pediatrics, 2015).

Nursing management of the various types of conjunctivitis focuses on alleviating symptoms and preventing spread of infectious causes. To alleviate symptoms, the parents should be taught on how to apply eye drops or ointment, and warm compresses may be used to help loosen the crust that accumulates on the eyelids overnight. Educate families to encourage the child not to rub or touch the eyes (Isenberg et al., 2002). Prevention of infectious spread should be considered because conjunctivitis is extremely contagious, and the parents must wash their hands diligently after caring for the child. Parents and children should be taught about appropriate hand washing after applying drops or compresses to the infected children, touching eyes, sneezing, or coughing, and they should be discouraged from sharing towels, washcloth, and eye drops (get a separate bottle for each infected family member) (Ricci and Kyle, 2015).

Children can return to school or daycare when the infection has cleared completely. Teaching families regarding good hygiene is vital to prevent conjunctivitis from recurring. Parents should be instructed to do the following: keep hands away from the eyes, wash hands frequently, change pillowcases frequently, and do not share towels or clothes. A productive and energetic population cannot grow from unhealthy children who are chronically affected by repeated conjunctivitis (Navachetan, 2017).

Ophthalmic nurses have an important role as teachers and advisors in educating service users and caregivers in providing health education in the society and in facilitating the development of other multidisciplinary team members’ knowledge and understanding of ocular health (Royal College of Nursing, 2014).

Significance

Acute conjunctivitis is the most common eye disorder in children, and most of these children are pupils. Children with conjunctivitis have poor school attendance and performance than other children owing to recurrent absence from school. They may also have other complications as inability to sharing in outdoor activities, playing, reading and social work. So this study was conducted to identify the management and prevention of conjunctivitis in children and review new insights, key therapies, and specific guidelines for more effective treatment strategies and educate mothers on how to prevent and treat childhood conjunctivitis. Mothers were taken as a sample of this study because children with conjunctivitis need home care more than hospital admission. Sufficient support for mothers may prevent or ameliorate these problems and indirectly achieve better outcomes for mothers and their children. Therefore, implementing the guidelines for mothers will be helpful in acquisition of knowledge and performance regarding the disease and may relieve mothers’ stressors and symptoms of their children. The flow rate of children with conjunctivitis in 2016 at El-Fayoum Ophthalmic Hospital is 360 cases, mostly preschool children.


  Aim Top


This study aimed to assess, plan, implement, and evaluate the effect of instructional guidelines on mothers’ knowledge and reported practices regarding care of their children with conjunctivitis.

Research hypothesis

Mothers of children with conjunctivitis, who will receive the guidelines, will have a high score of knowledge and reported practices immediately after more than before the guidelines implementation.


  Patients and methods Top


The patients and methods of this study were portrayed under four main designs as follows:
  1. Technical design.
  2. Operational design.
  3. Administrative design.
  4. Statistical design.


Technical design

The technical design included the following:

Research design

A before/after quasi-experimental research design was used.

Setting

The study was conducted at Outpatient Clinics of El-Fayoum Ophthalmic Hospital.

Participants

The study participants included a random sample of 50 mothers having children with conjunctivitis attending the previously mentioned setting with their children within a period of 6 months.

Inclusion criteria of sample selection

The study included children with conjunctivitis in the preschool age group and their mothers, regardless of their age and level of education.

Tools of data collections

Mothersknowledge assessment sheet: It was designed, validated, and utilized by the researcher to collect the necessary data. It consisted of four parts:

First Part: demographic characteristics of children such as age, sex, birth order, residence, and crowding level.

Second Part: demographic characteristics of mothers such as age, educational level, working status, and health history.

Third part: history of conjunctivitis in the studied children such as onset, source of infection, medical history, previous infection of the family members, and recurrent infection and its manifestation.

Fourth Part: mothers’ knowledge about conjunctivitis throughout guidelines phases such as definition, causes, clinical picture, mode of transmission, complications, prevention, and treatment. It also includes reported practices related to conjunctivitis throughout the guidelines phases such as practices related to use of personal protective measurements to prevent spread of infection and alleviating symptoms.

Scoring system

Knowledge Scoring System: The total nurses’ knowledge percentages were calculated for known and not known answers. Each correct answer was given 1 mark and 0 mark for wrong or not known one. For each area of knowledge, the scores of the items were summed up and the total divided by the number of the items, giving a mean score for the part. These scores were converted into a percentage score. The score 70% and more was considered good, 50–70% was considered as fair, and poor if less than 50%.

The numbers of knowledge questions were seven questions, and the total scores of them were 52 marks distributed as follows:
  1. Definition of conjunctivitis: 1 mark.
  2. Causes of conjunctivitis: 9 marks.
  3. Clinical pictures of conjunctivitis 8 marks.
  4. Mode of transmission: 3 marks.
  5. Complications of conjunctivitis: 6 marks.
  6. Preventions of conjunctivitis: 7 marks.
  7. Treatment of conjunctivitis: 18 marks.


Reported practicesscoring system: The items reported to be done correctly were scored ‘1’ and the items not done or incorrectly done were scored ‘0’. For each area, the scores of the items were summed up, and the total divided by the number of the items, giving a mean score for the part. These scores were converted into a percentage score. Performance was considered satisfactory if the percentage score was 50% or more and unsatisfactory if less than 50%.

Instructional guidelines

The researcher designed and implemented the guidelines in Arabic language after reviewing the related literature based on assessment of the actual needs of the studied mothers. It covered the theoretical knowledge and practical procedures. Theoretical part includes their knowledge about definition, causes and clinical picture, mode of transmission, complications, prevention, and treatment of conjunctivitis. In contrast, the practical part included practices related to conjunctivitis such as use of personal protective measurements to prevent spread of infection and alleviating symptoms.

Operational design

This phase contains preparatory phase, pilot study, and content validity.

Preparatory phase

Review of the current and past available literature and theoretical knowledge will be done using books, articles, and magazines to develop the tool for data collection.

Development of the tool

The assessment sheet was developed after extensive review of literature. The tool was revised for content validity by five experts in the field of pediatric and community health nursing.

Pilot study

After development of the tool, a pilot study was conducted on 10% of the mothers of children with conjunctivitis before data collections. The purpose of the pilot study was to ascertain the feasibility of the tool and to detect any problems peculiars to the statement such as sequence and clarity. It also helped to estimate the time needed to complete the interview. After conducting the pilot study, it was found that the sentences of the tool were clear and relevant; however, few words had been modified. Following the pilot study, the tool was reconstructed and was ready for use.

Field work

  1. The actual field work was carried out over 6 months starting from September 2016 to February 2017.
  2. Each mother involved in the study was interviewed individually, and the researchers explained the purpose of the study, the component of the tool, and how to answer the questions, including data collection regarding pretest, implementation of the guidelines, and post-test.
  3. The researchers were available 2 days per week from 8 a.m. to 2 p.m. The researchers started by introducing themselves to mothers and their children and giving them a brief idea about the aim of the study, its components, and the expected outcomes.
  4. Before implementation of the guidelines, the researchers collected data related to demographic characteristics of children such as age, sex, birth order, residence, and crowding level; characteristics of the mothers such as age, educational level, working status, and health history; and mothers’ knowledge about conjunctivitis throughout the guideline phases such as, definition, causes, clinical pictures, mode of transmission, complications, prevention, and treatment. It also included reported practices related to conjunctivitis such as use of personal protective measurement to prevent spread of infection and alleviating symptoms throughout the guideline phases.
  5. The researchers assessed mothers’ knowledge and performance regarding care of their children with conjunctivitis before implementing the guidelines using pretest tools.
  6. The guidelines were discussed and distributed by the researchers to each mother after clarifying the purpose of the study, and the researchers explained to the mothers how to use the guidelines.
  7. After finishing the implementation of the guidelines, the researchers applied post-test to evaluate mothers’ knowledge and reported practices.


Administrative design

An official permission was obtained through an issued letter from the Dean of Faculty of Nursing, El-Fayoum University, to the director of El-Fayoum Ophthalmic Hospital to conduct the study.

Statistical design

Data entry and statistical analysis were done using statistical package for social sciences, statistical software package, version 20 (Lee A. Kirkpatrick, University of Denver, US). Data were presented using descriptive statistics in the form of frequencies and percentages for qualitative variables and mean and SDs for quantitative variables. Difference of two means test (t-test) was used. Statistical significance was considered at P-value less than 0.05.

Ethical considerations

The purpose of the study was explained to the mothers, and an oral consent to participate in the study was obtained. The agreement for participation of the subjects was taken after the aim of the study was explained to them, and they were given an opportunity to refuse to participate. Moreover, they were assured that the information would be confidential and used for research purpose only.


  Results Top


[Table 1] presented characteristics of children with conjunctivitis. It was observed that two-fifths of children (40.0%) were aged 1 to less than 3 years, with a mean age of 2±1.5 years. Female patients represented 52.0% of the studied children with conjunctivitis. Regarding child’s birth order, more than one-quarter of them (28.0%) were the first child in the family. Most children (86%) were living in rural areas, and three-fifths of children (60.0%) were living in crowding level of more than two person per room.
Table 1 Characteristics of children with conjunctivitis (N=50)

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[Table 2] shows the characteristics of the studied mothers. It was observed that the highest percentage of mothers was in the age range of 20–30 years (60%), with a mean age of 27.5±6.1 years. It was found that slightly less than half of mothers (48.0%) had basic education, whereas only 6% were graduated from university, and most (94%) of the studied mothers were housewives.
Table 2 Characteristics of mothers (N=50)

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[Table 3] illustrates the disease characteristics of the studied children. It was observed that slightly more than two-fifths of them (44.0%) acquired the disease after 1 year and two-fifths (40.0%) acquired it immediately after birth. Regarding sources of infection, it was found that environmental sources and cross-infection from family members and nursery school were the main source of infection (40% and 30%, respectively). Moreover, slightly less than two-thirds of them (66.0%) had previous infection in the family members.
Table 3 Disease characteristics in the studied children and mothers’ health history (N=50)

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Regarding the previous affection with conjunctivitis, the highest percentage of children (74.0%) had conjunctivitis previously, and more than half of them (56.0%) had recurrent conjunctivitis. Concerning signs and symptoms of conjunctivitis, slightly more than half of them (54%) had red eyes. Moreover, slightly less than half of them (48.0%) had tears, purulent and watery discharge, and adhesive eyelids at morning.

Finally, regarding health history of mothers, more than half of them (56%) had vaginitis during pregnancy and childbirth; however, the vast majority of them (96%) did not have any chronic condition.

The effect of application of guidelines on mothers’ knowledge about conjunctivitis is demonstrated in [Table 4]. It was evident from that before the test, the vast majority of mothers did not have any knowledge about conjunctivitis. After implementation of the guidelines, statistically significant improvements were noticed in mothers’ knowledge in all tested areas (P<0.001).
Table 4 Mothers’ knowledge about conjunctivitis before and after the guidelines’ implementation

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[Table 5] portrays the effect of guidelines on mothers’ total level of knowledge about conjunctivitis. It showed that most mothers (90.0%) had poor level of knowledge at the pretest. After implementation of the guidelines, statistically significant improvements were noticed in mothers’ level of knowledge (P<0.001).
Table 5 Mothers’ knowledge level about conjunctivitis

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The effect of application of guidelines on mothers’ practices to alleviate symptoms of conjunctivitis is demonstrated in [Table 6]. It was evident that at the pretest, most mothers had poor practices’ scores, especially regarding using cold and hot compresses to alleviate symptoms of conjunctivitis. After implementation of the guidelines, statistically significant differences were noticed in mothers’ practices in all tested areas (P<0.001).
Table 6 Mothers’ practices scores to alleviate symptoms of conjunctivitis

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[Table 7] illustrates the effect of guidelines on mothers’ practices to prevent infection of conjunctivitis. It was revealed that at the pretest, most mothers had poor practices’ scores. After implementation of the guidelines, statistically significant improvements were noticed in mothers’ practices in all tested areas (P<0.001), except for wearing protective gloves when putting eye medications to their children.
Table 7 Mothers’ practices scores to prevent infection of conjunctivitis

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The effect of guidelines on mothers’ total scores of practices regarding conjunctivitis is presented in [Table 8]. It is observed that more than half of mothers (56.0%) had practices’ scores at the pretest. After implementation of the guidelines, statistically significant improvements were noticed in mothers’ total scores of practices (P<0.001).
Table 8 Total mothers practices’ scores regarding conjunctivitis

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[Table 9] presents the relation between total knowledge of the studied mothers about conjunctivitis and their personal data. It indicates a highly statistically significant difference between total knowledge of mothers about conjunctivitis and their education (P=0.001).
Table 9 Relation between total knowledge of studied mothers about conjunctivitis and their personal data (N=50)

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[Table 10] shows the relation between mother’s personal data and their reported practices regarding conjunctivitis. It shows that there are no significant relations between mothers’ age and their reported practices regarding conjunctivitis. There were a significant relation between mothers’ education and their reported practices (P=0.001). It was found that the highest percentages of mothers with correct and complete practices regarding conjunctivitis (100%) were among those with university education, whereas the highest percentage of mothers with poor practices (75.0%) was among the read and write mothers.
Table 10 Relation between mother’s personal data and their reported practices regarding conjunctivitis

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  Discussion Top


Mothers of children with conjunctivitis play a central and essential role in providing home care, as they become nurses, pharmacists, and physician for their children. So, guidelines should be for mothers to supply them with the needed knowledge and true performance to help them decrease family stressors and achieve better outcome for children. Therefore, this study was conducted to evaluate the effectiveness of guidelines on mothers of children with conjunctivitis.

Ohnsman and Michael (2016) proved that conjunctivitis is a common infection especially among children younger than 5 years, and this was congruent with the result of the current study which revealed that most of the studied children aged from 1 to less than 3 years, with a mean age of 2±1.5 years. This may be related to decreased immune support in those children.

Most children were living in a rural area; however, three-fifths of them were living in a crowding level of more than two persons per room. This result goes in line with the result of Mohammed (2015) who studied assessment of mothers’ knowledge and practice about early childhood conjunctivitis at Assiut Ophthalmology Hospital and revealed that most of the studied children were living in rural area and having crowding level more than three persons per room. In agreement with the current study, the study by Azmy (2006) found that most of children’s families lived in rural area and had a large family size.

The result of the current study revealed that the highest percentage of mothers was in the age range 20–30 years, with a mean age of 27.5±6.1 years. Slightly less than half of them had basic education, whereas the minority graduated from university. Age is important in parenting and in the care of a child and understanding new experiences with care and treatment. In contrast to this result, the study done by Mohammed (2016) about assessment of mothers’ role in care of ophthalmological problems in their children reported that most of the studied mothers were in the age 20–30 years and had bachelor degree.

Regarding mothers’ job, the majority of the studied mothers were housewives, and this may explain the low level of mothers’ knowledge and poor performance.

The present study reported that the vast majority of the studied mothers did not have any chronic conditions, but more than half of them had vaginitis during pregnancy and childbirth. This was in contrast with the study done by Mohammed (2016), who found that more than two-thirds of the studied mothers had different diseases during pregnancy, especially preeclampsia and diabetes mellitus.

Regarding the disease characteristics, the current study illustrated that most children acquired the disease after 1 year or immediately after birth. This may be related to smaller age and decrease immunity in those children.

Regarding the sources of infection, the present study revealed that environmental sources and cross-infection from the family members and nursery school were the main sources of infection for most children. Moreover, more than two-thirds of them had previous infection of one member in the family. In contrast to that result, Mohammed (2016) reported that slightly less than one-third of the studied mothers reported bacterial infection as a cause of ophthalmological disease in their children; conjunctivitis is the most common one of them. The result of the current study may be related to increase crowding level in most families and in nursery school.

Regarding previous infection with conjunctivitis, the highest percentage of children had conjunctivitis previously and more than half of them had recurrent conjunctivitis. This may be related to the highly contagious level of conjunctivitis and increasing crowding and the low standard of living condition.

Concerning signs and symptoms of conjunctivitis, most children had red eyes. Moreover, redness in children’s eyes was mentioned by Mohammed (2016) as the most common symptoms of ophthalmological disease. This is likely owing to the dusty local environment (largely farming communities), the study season (which favors vernal catarrh), and the climate itself. Moreover, rural living is a risk factor for the development of chronic AC in children (Bekibele and Olusanya, 2016).

Concerning the effect of guidelines on mothers’ knowledge about conjunctivitis, it was evident that at the pretest most mothers did not have any knowledge about conjunctivitis. After implementation of the guidelines, statistically significant improvements were noticed in mothers’ knowledge in all tested areas (P<0.001). In agreement with this result, Mohammed (2015) found that most mothers did not have any knowledge about conjunctivitis.

Concerning the effect of guideline application on mothers’ practices to alleviate symptoms of conjunctivitis, the current study revealed that at the pretest most mothers had poor practices’ scores especially regarding using cold and hot compresses to alleviate symptoms of conjunctivitis. After implementation of the guidelines, statistically significant improvements were noticed in mothers’ practices in all tested areas (P<0.001). This result was congruent with the result of Mohammed (2015) who found in her assessment study that most mothers had poor practices’ scores regarding measures used to alleviate symptoms of conjunctivitis.

Regarding the effect of guidelines implementation on mothers’ practices to prevent infection of conjunctivitis, the present study revealed that at the pretest most mothers had poor performance scores. This may be related to ignorance of mothers about infection of the eye and its complications, in addition to low educational and socioeconomic level. After implementation of the guidelines, statistically significant improvements were noticed in mothers’ practices in all tested areas (P<0.001), except for wearing protective gloves when putting eye medication to the child. This may be related to unawareness of mothers about benefits of wearing gloves and also may be related to low income and ignorance.

Regarding the mothers’ total scores of knowledge and practices, the result of the current study revealed that most mothers had poor total knowledge scores and unsatisfactory performance at the pretest. This may be related to low educational and socioeconomic level as most mothers were housewives. Nearly the same results were reached by Yarnall et al. (2013). Moreover, Stevens and Shi (2012) found a significant relation between the level of knowledge and education, social class, and availability of good health services.

At last, poor levels of knowledge and inadequate practice regarding eye diseases should raise the attention of healthcare providers toward providing comprehensive health education programs together with proper health services for mothers having children with eye diseases; this may prevent blindness and complications of different childhood eye morbidities.

After implementation of the guidelines, statistically significant improvements were noticed in mothers’ total scores of knowledge and performance (P<0.001). This finding points to the success of the guidelines, which could be explained by the suitability of its practical components and by responding of the guidelines to mothers’ needs.

Regarding the relation between level of mothers’ knowledge about conjunctivitis and their personal data, the result of the current study indicated a highly statistically significant difference between level of mothers’ knowledge and their education; however, there is no significant relation between mothers’ age and their knowledge. This result goes in line with the result of El-Refai (2009) who studied maternal care patterns for children with common eye infections among children in rural and urban area and found that there is no significant difference between mothers’ knowledge and their age, but in relation to level of mothers’ education, there is a significant relation.

It is clear from the present study that there is no significant relation between mothers’ age and their reported practices regarding conjunctivitis. However, there were significant relations between mothers’ education and their reported practices. It was found that the highest percentages of mothers with correct and complete practices regarding conjunctivitis were among those with university education. In agreement with this result, El-Refai (2009) found that there is no significant differences between mothers’ reported practices and their educational level.


  Conclusion Top


The main results revealed that there were highly statistically significant differences between pretest and post-test of guidelines implementation; the present study findings revealed that mothers had poor knowledge and inadequate practices related to conjunctivitis and its management. Subsequently, they did not follow the correct instructions related to treatment. There was a positive effect of guidelines on improving knowledge and performance of the studied mothers.

Recommendations

The following recommendations are suggested based on the findings of the present study:
  1. Classes and educational programs for mothers about management and prevention of conjunctivitis and its infection should be held at El-Fayoum Ophthalmic Hospital.
  2. In-service educational program toward childhood conjunctivitis should be established for community and pediatric health nurses at rural health units and ophthalmic hospital.
  3. A well-planned health education programs about early childhood conjunctivitis should be introduced into the curriculum at preparatory, secondary school, and university levels.
  4. A written pamphlet, brochure, or booklet containing information about pediatric conjunctivitis such as symptoms, causes, mode of transmission and how to prevent it, treatment, and how to care of infected child should be printed, and its copies should be kept in clinics and department of ophthalmic and given to educated mothers to use it when necessary.
  5. Community awareness and improving the educational level of mothers to help in reducing conjunctivitis and how to provide appropriate treatment in its occurrence.
  6. Pregnant women should be screened for infection by N-Gonorrhea and C-Trachomatis during pregnancy, and their identified infections should be treated during pregnancy.
[31]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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