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\begin{document}


\def\RunningAuthor{Shiny Chrism Queen Nesan G et al.}
\firstPage{16}
\articleType{Original Article}
\receivedDate{15 Nov 2019}
\acceptedDate{03 Mar 2020}
\revisedDate{19 Dec 2019}
\journalVolume{2020, 11(SPL)}
\journalIssue{2}
\journalDoi{ijrps.v11iSPL2.2054}
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\title{Knowledge, attitude and practices about acute respiratory infection among mothers of under 5 children in an urban area of Tamil Nadu}
\author{Jeya~Subha~C,  
            Shiny~Chrism~Queen~Nesan~G\textsuperscript{*},  
            Charumathi~B, 
            Timsi~Jain~\\[5pt]{Department of Community Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai 602 105, Tamil Nadu, India}}

\begin{abstract}
Acute respiratory infection (ARI) is one of the major public health problems in developing countries and in India, ARI is considered as one of the major killer diseases and leading cause for morbidity and mortality in children below five years. Knowledge, attitude and practice of mothers play a major role in the decrease of morbidity in under 5 children. The objective is to evaluate the health-seeking behaviour of mothers and to assess knowledge, attitude and practices of mothers regarding ARI. Using pretested semi-structured proforma, a descriptive study on 204 mothers was done and information on knowledge of ARI, attitude and practice regarding consulting physician, antibiotic use were collected and results were analysed using SPSS 22. Questionnaire regarding knowledge preferred that 61.8\% of mothers preferred private set up as a place of choice of treatment and the commonest aggravating factor was infection (36.8\%), most common complication was Pneumonia (32.4\%), and most mothers opted for the medical practitioner (86.3\%) for treatment. Self-medication was seen to be practiced by (52.5\%). The younger age, a short period of time since marriage, and higher educational level were found to be significantly correlated with the good knowledge, attitude and practice and this could be due to that younger women with a lower duration of marriage have more time as well as being aware of new media and internet. They would gain knowledge easily compared to older women.  
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}ARI,\newline Attitude,\newline Knowledge,\newline Mothers,\newline Practice,\newline Under 5
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Shiny~Chrism~Queen~Nesan~G~\\ Phone:\ 9500101858~\\  Email:\ shinynesan75@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
Acute respiratory infection is defined as "inflammation of the respiratory tract anywhere from nose to alveoli with a wide range of combinations of signs and symptoms". It may interfere with the normal breathing of the individual and is-communicable in nature \unskip~\citep{701100:16602086}. ARI is a major public health problem in our country and one of the leading causes of morbidity and mortality in children below 5 years of age. Every year ARIs account for over 12 million hospital admissions among children below five years of age \unskip~\citep{701100:16602082,701100:16602084}. India ranks 2\ensuremath{^{nd}} for three-quarters of death due to ARI in under 5 population in developing regions of the world \unskip~\citep{701100:16602083}. Socio-economic conditions influences human health and measure to assess the health status is education, especially of a female as a mother is the main caregiver for the child. ARI there is a lack of basic health service availability, lack of awareness and other factors associated like over-crowding, environmental factors, defects in immune system, over use and mis


\begin{table*}[!htbp]
\caption{\boldmath {Socio-demographic details of the Study participants } }
\label{tw-97407ba0eb01}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.512\linewidth-2\tabcolsep}p{\dimexpr.2468\linewidth-2\tabcolsep}p{\dimexpr.24119999999999997\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\textbf{Variables} & \textbf{Frequency (N)} & \textbf{Percentage (\%)}\\
\tblmidrule 
\textbf{Type of family} &
   &
  \\
Nuclear &
  168 &
  82.4\%\\
Joint &
  30 &
  14.7\%\\
Three generation &
  6 &
  2.9\%\\
\textbf{Income of family per month} &
   &
  \\
Less than 20000  &
  16 &
  7.8\%\\
20000-50000 &
  114  &
  55.9\%\\
Above 50000 &
  74 &
  36.3\%\\
\textbf{Educational status} &
   &
  \\
Primary &
  23 &
  11.3\%\\
Middle school &
  36 &
  17.6\%\\
High school &
  47 &
  23\%\\
Graduate &
  98 &
  48\%\\
\textbf{Occupation} &
   &
  \\
Unemployed &
  70 &
  34.3\%\\
Unskilled &
  21 &
  10.3\%\\
Skilled &
  32 &
  15.7\%\\
Semi profession &
  20 &
  9.8\%\\
Profession &
  61 &
  29.9\%\\
\textbf{Immunisation status of a child} &
   &
  \\
Partially immunised &
  19 &
  9.3\%\\
Immunised till date &
  185 &
  90.7\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Assessment of KAP on ARI among mothers based on their age} }
\label{tw-a513d65c2c50}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.49080000000000005\linewidth-2\tabcolsep}p{\dimexpr.1929\linewidth-2\tabcolsep}p{\dimexpr.17029999999999998\linewidth-2\tabcolsep}p{\dimexpr.14600000000000001\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\textbf{Variables} & \multicolumn{2}{p{\dimexpr(.3631999999999999\linewidth-2\tabcolsep)}}{\cAlignHack \textbf{Age (Years)}} & {\multirow{2}{*}{\textbf{P-value}}}\\
\rowcolor{kwdboxcolor} & \textbf{20-30} \mbox{}\protect\newline \textbf{N (\%)} & \textbf{{\textgreater}30} \mbox{}\protect\newline \textbf{N (\%)} & \\
\tblmidrule 
\textbf{Worsening of disease} &
   &
   &
  \\
Summer \mbox{}\protect\newline Winter \mbox{}\protect\newline Autumn \mbox{}\protect\newline Rain &
  2(1.0\%) \mbox{}\protect\newline 74(36.3\%) \mbox{}\protect\newline 16(7.8\%) \mbox{}\protect\newline 66(32.4\%) &
  4(2.0\%) \mbox{}\protect\newline 23(11.3\%) \mbox{}\protect\newline 2(1.0\%) \mbox{}\protect\newline 17(8.3\%) &
  0.040\\
\textbf{Infections cause ARI} &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  51(25.0\%) \mbox{}\protect\newline 21(10.3\%) \mbox{}\protect\newline 86(42.2\%) &
  24(11.8\%) \mbox{}\protect\newline 7(3.4\%) \mbox{}\protect\newline 15(7.4\%) &
  0.025\\
\textbf{Low birth weight causes ARI} &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  36(17.6\%) \mbox{}\protect\newline 32(15.7\%) \mbox{}\protect\newline 90(44.1\%) &
  19(9.3\%) \mbox{}\protect\newline 12(5.9\%) \mbox{}\protect\newline 15(7.4\%) &
  0.010\\
\textbf{Pneumonia complicates ARI} &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  42(20.6\%) \mbox{}\protect\newline 24(11.8\%) \mbox{}\protect\newline 92(45.1\%) &
  24(11.8\%) \mbox{}\protect\newline 4(2.0\%) \mbox{}\protect\newline 18(8.8\%) &
  0.005\\
\textbf{Home remedies resolve ARI} &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  52(25.5\%) \mbox{}\protect\newline 20(9.8\%) \mbox{}\protect\newline 86(42.2\%) &
  24(11.8\%) \mbox{}\protect\newline 8(3.9\%) \mbox{}\protect\newline 14(6.9\%) &
  0.016\\
\textbf{Vaccines prevent ARI} &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  42(20.6\%) \mbox{}\protect\newline 28(13.7\%) \mbox{}\protect\newline 88(43.1\%) &
  19(9.3\%) \mbox{}\protect\newline 8(3.9\%) \mbox{}\protect\newline 19(9.3\%) &
  0.136\\
\textbf{Preference of services} &
   &
   &
  \\
Government \mbox{}\protect\newline Private &
  69(33.8\%) \mbox{}\protect\newline 89(43.6\%) &
  9(4.4\%) \mbox{}\protect\newline 37(18.1\%) &
  0.003\\
\textbf{Hospital Approach} &
   &
   &
  \\
Immediately \mbox{}\protect\newline After2-3 days \mbox{}\protect\newline After it gets worse \mbox{}\protect\newline No illness during the study &
  42(20.6\%) \mbox{}\protect\newline 25(12.3\%) \mbox{}\protect\newline 0(0.0\%) \mbox{}\protect\newline 91(44.6\%) &
  16(7.8\%) \mbox{}\protect\newline 7(3.4\%) \mbox{}\protect\newline 2(1.0\%) \mbox{}\protect\newline 21(10.3\%) &
  0.034\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Assessment of KAP on ARI among mothers based on their Educational qualification} }
\label{tw-f207af274c2e}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.31710000000000008\linewidth-2\tabcolsep}p{\dimexpr.13449999999999998\linewidth-2\tabcolsep}p{\dimexpr.16009999999999998\linewidth-2\tabcolsep}p{\dimexpr.14259999999999998\linewidth-2\tabcolsep}p{\dimexpr.15200000000000003\linewidth-2\tabcolsep}p{\dimexpr.0937\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\textbf{Variables} & \multicolumn{4}{p{\dimexpr(.58919999999999995\linewidth-2\tabcolsep)}}{\cAlignHack \textbf{Educational status}} & \textbf{p-value}\\
\rowcolor{kwdboxcolor} & \textbf{Primary} & \textbf{Middle school} & \textbf{High school} & \textbf{Graduate} & \\
\tblmidrule 
 &
  N (\%) &
  N (\%) \mbox{}\protect\newline  &
  N (\%) \mbox{}\protect\newline  &
  N (\%) &
  \multicolumn{1}{p{\dimexpr(.0937\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{0.018}}\\
\textbf{Seizures complicates ARI} &
   &
   &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know \mbox{}\protect\newline  &
  10(4.9\%) \mbox{}\protect\newline 4(2.0\%) \mbox{}\protect\newline 9(4.4\%) &
  2(1.0\%) \mbox{}\protect\newline 8(3.9\%) \mbox{}\protect\newline 26(12.7\%) &
  16(7.8\%) \mbox{}\protect\newline 4(2.0\%) \mbox{}\protect\newline 27(13.2\%) &
  33(16.2\%) \mbox{}\protect\newline 13(6.4\%) \mbox{}\protect\newline 52(25.5\%) &
  \\
\multicolumn{2}{p{\dimexpr(.45160000000000004\linewidth-2\tabcolsep)}}{\textbf{Ear discharge complicates ARI}} &
   &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  7(3.4\%) \mbox{}\protect\newline 3(1.5\%) \mbox{}\protect\newline 13(6.4\%) &
  2(1.0\%) \mbox{}\protect\newline 10(4.9\%) \mbox{}\protect\newline 24(11.8\%) &
  17(8.3\%) \mbox{}\protect\newline 4(2.0\%) \mbox{}\protect\newline 26(12.7\%) &
  38(18.6\%) \mbox{}\protect\newline 10(4.9\%) \mbox{}\protect\newline 50(24.5\%) &
  0.006\\
\textbf{Measles complicates ARI} &
   &
   &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  7(3.4\%) \mbox{}\protect\newline 5(2.5\%) \mbox{}\protect\newline 11(5.4\%) &
  2(1.0\%) \mbox{}\protect\newline 10(4.9\%) \mbox{}\protect\newline 24(11.8\%) &
  13(6.4\%) \mbox{}\protect\newline 6(2.9\%) \mbox{}\protect\newline 28(13.7\%) &
  36(17.6\%) \mbox{}\protect\newline 12(5.9\%) \mbox{}\protect\newline 50(24.5\%) &
  0.018\\
\multicolumn{3}{p{\dimexpr(.6117\linewidth-2\tabcolsep)}}{\textbf{Child have excessive drowsiness during ARI}} &
   &
   &
  \\
Yes \mbox{}\protect\newline No \mbox{}\protect\newline Don't know &
  7(3.4\%) \mbox{}\protect\newline 3(1.5\%) \mbox{}\protect\newline 13(6.4\%) &
  4(2.0\%) \mbox{}\protect\newline 12(5.9\%) \mbox{}\protect\newline 20(9.8\%) &
  20(9.8\%) \mbox{}\protect\newline 9(4.4\%) \mbox{}\protect\newline 18(8.8\%) &
  42(20.6\%) \mbox{}\protect\newline 14(6.9\%) \mbox{}\protect\newline 42(20.6\%) &
  0.014\\
\textbf{Physician Consultation} &
   &
   &
   &
   &
  \\
Yes \mbox{}\protect\newline No &
  13(6.4\%) \mbox{}\protect\newline 10(4.9\%) &
  22(10.8\%) \mbox{}\protect\newline 14(6.9\%) &
  43(21.1\%) \mbox{}\protect\newline 4(2.0\%) &
  98(48.0\%) \mbox{}\protect\newline 0(0.0\%) &
  0.000\\
\multicolumn{3}{p{\dimexpr(.6117\linewidth-2\tabcolsep)}}{\textbf{Completion of a full course of treatment}} &
   &
   &
  \\
Yes \mbox{}\protect\newline No &
  21(10.3\%) \mbox{}\protect\newline 2(1.0\%) &
  20(9.8\%) \mbox{}\protect\newline 16(7.8\%) &
  43(21.1\%) \mbox{}\protect\newline 4(2.0\%) &
  98(48.0\%) \mbox{}\protect\newline 0(0.0\%) &
  0.000\\
\textbf{Preference} &
   &
   &
   &
   &
  \\
Home remedies \mbox{}\protect\newline Ayurvedic \mbox{}\protect\newline Homeopathy \mbox{}\protect\newline Allopathy &
  11(5.4\%) \mbox{}\protect\newline 2(1.0\%) \mbox{}\protect\newline 0(0.0\%) \mbox{}\protect\newline 10(4.9\%) &
  26(12.7\%) \mbox{}\protect\newline 2(1.0\%) \mbox{}\protect\newline 2(1.0\%) \mbox{}\protect\newline 6(2.9\%) &
  32(15.7\%) \mbox{}\protect\newline 2(1.0\%) \mbox{}\protect\newline 0(0.0\%) \mbox{}\protect\newline 13(6.4\%) &
  52(25.5\%) \mbox{}\protect\newline 0(0.0\%) \mbox{}\protect\newline 2(1.0\%) \mbox{}\protect\newline 44(21.6\%) &
  0.016\\
\textbf{Self-medication} &
   &
   &
   &
   &
  \\
Yes \mbox{}\protect\newline No &
  11(5.4\%) \mbox{}\protect\newline 12(5.9\%) &
  26(12.7\%) \mbox{}\protect\newline 10(4.9\%) &
  28(13.7\%) \mbox{}\protect\newline 19(9.3\%) &
  42(20.6\%) \mbox{}\protect\newline 56(27.5\%) &
  0.015\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
use of antibiotics, poverty, absence of ventilation and indoor air pollution however majority of associated factors are preventable \unskip~\citep{701100:16602087}. This study observes knowledge on home management practices of ARI, which is useful in the prevention and management of the disease. The need for this study is to assess the knowledge, attitude and practices of mothers on ARI in children under 5 years and to evaluate the association between KAP based on their education and age. 
    
\section{Materials and Methods}
A cross-sectional descriptive health survey conducted for 5 months in the 2018 at a semi-urban part of Chennai, Tamil Nadu using pretested, validated and a structured questionnaires to assess the demographic data and knowledge, attitude and practices among mothers of under 5 children. Based on a study done in Tamil Nadu, the prevalence of acute respiratory infection was found to be 59.1\% \unskip~\citep{701100:16602089}. Using the formula 4pq /L\ensuremath{^{2}} and considering 12\% of relative precision, the sample size was calculated as 192. The final sample of 204 was taken after considering a non-response rate of 5\%. The mothers who were willing to participate in the study were selected from four Anganwadis in the Thirumazhisai area in Chennai by a convenient sampling method. Informed and written consent was taken before interviewing the study subjects and after-explaining the purpose of the study. Data was entered and descriptive and inferential statistics was used for data analysis. Chi-square (\ensuremath{\chi }\ensuremath{^{2}}) test was applied to measure the association between the level of KAP and selected demographic variables done on SPSS version 22.
    
\section{Results and Discussion}
\textbf{Socio-demographic details}

It was observed that among 204 mothers, 77.5\% were between the age of 20 {\textendash} 30 years, 60\% of them had total family income between Rs. 20,000 to 50,000, 48\% of the mothers had an educational status of intermediate and above. It was observed that 20.6\% of the family members were suffering from a respiratory infection and 13.7\% had overcrowding in their homes during the time of the study. A high proportion of boys (59.3\%) were observed as compared to with-girls (40.7\%). 6.9\% of the mothers reported inadequate ventilation in their houses (Table~\ref{tw-97407ba0eb01}).

The KAP among mothers was observed based on their age, which revealed that the mothers between the age of 20-30 years reported that the infection is more common during the rainy season (40.7\%). 37.3\% use home remedies during the time of infection. Subjects prefer private hospitals (61.8\%) than Government hospitals (38. 2\%) (Table~\ref{tw-a513d65c2c50}).  86.3\% were consulting a physician during an acute respiratory infection. 91.3\% were following the medication prescribed by the doctor regularly.52.5\% was taking self-medication without doctors' consultation and 59.3\% were using home remedies (Table~\ref{tw-f207af274c2e}).

In our study, the proportion of boys (59.3\%) reported to have ARI more when compared to girls (40.7\%) and this finding was significant statistically and similar to various studies \unskip~\citep{701100:16602085,701100:16602087,701100:16602090}. The probable reason that there is predominance among male children could be because of the tendency of male children to play outside home gets them exposed to infected aerosols from the surrounding outdoor environment when compared to female children. Majority of the subjects belonged to the age group between 20-30years, 48\% were graduated and belongs to upper-middle-class socioeconomic status scale, 82.4\% belong to nuclear family and 34.3\% were home maker whereas study done by Meena et al. revealed mean age group between 25-30years, majority 94.5\% about 26.6\% were educated up to secondary level of education, 51\% belongs to nuclear family and about 49.2\% were of housewife \unskip~\citep{701100:16602088} which shows that mostly mothers are being educated among study subjects. 

An article observed \unskip~\citep{701100:16602091} that about 87.5\% reported that cold weather was the major reason for ARI wheras our study states that only 40.7\% who were exposed to cold weather had ARI. This may be due to the varying climatic changes observed in different places where the study was conducted. Only 32.4\% of mothers were aware of complications regarding ARI; among them, the most common complication is Pneumonia when compared to a study which showed about 83\% of mothers said the most common complication is pneumonia \unskip~\citep{701100:16602081}. 

A study reported that 29.9\% were only aware of vaccines available for the prevention of ARI \unskip~\citep{701100:16602091}, which also revealed about 60.2\% of mothers knew measles was preventable by immunisation. \unskip~\citep{701100:16602087} showed that 21.8\% used household remedies and another study \unskip~\citep{701100:16602081}, only 6\% of mothers used home remedies. Whereas in the present study, nearly 37.3\% used home remedies for ARI, 52.4\% gave antibiotics without doctor consultation. Whereas, a study observed by \unskip~\citep{701100:16602080} revealed that only 5\% of them gave antibiotics without consultation. These varying changes must be mostly due to the different levels of education and awareness observed between mothers from different study locations.
    
\section{Conclusion}
It was observed that younger the age of the mother and shorter the period of marriage, there was a significant association with good knowledge about ARI prevention and its management. It was observed that male children were affected more with ARI than female children, probably due to the male children play mostly outdoor. 
    

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