INTRODUCTION:

Gastrointestinal infections are the leading cause of morbidity and mortality throughout the world. Children and young adults are the most commonly affected group. Worldwide, 17% under-five mortality has been attributed to diarrhea. In India, diarrhea is the cause of hospital admissions in one third paediatric patients and a cause of death in 17% of all indoor paediatric patients, however, the data in general population is sparse.¹ Gastrointestinal (GIT) illnesses contribute significantly to the burden of illness from infectious diseases worldwide.

Diarrhoea is the second leading cause of preventable illness in children under age five.Despite the strong association between gastrointestinal illnesses and factors such as poor sanitation, inadequate access to safe drinking water and other risk factors, both resource-rich and less developed countries alike are impacted by gastrointestinal illness. The risk factors however appear to be distributed differently between developed and developing countries and as a result, the incidence of specific pathogens may differ between each setting. Several studies have described the pathogens, associated risk factors and the costs and burden of illness on health care.²

Gastrointestinal illnesses can be either acute self-limiting infections or chronic idiopathies.Both acute and chronic infections can be caused by pathogenic bacteria, viruses and parasites. Diarrhoea can also be caused by idiopathic diseases arising from internal dysfunctions of gastrointestinal tract include diseases such as Idiopathic bowel disease, Crohn’s disease and ulcerative colitis. The majority of gastrointestinal illnesses are self-limited, however, certain risk factors such as malnutrition, immunosuppression, and young age predisposes the development of persistent diarrhea. Patients with immune deficiencies (congenital, iatrogenic or acquired) are unusually more susceptible to infections and are at an increased risk for malignancy.²

Infectious gastrointestinal illnesses are transmitted through a variety of routes including contaminated food or water borne, the faecal oral route, and person-to-person. A significant proportion, about 36%, of gastrointestinal illnesses is attributable to food borne transmission.²

Health care associated infections are drawing increasing attention from patients, insurers, governments and regulatory bodies. This is not only because of the magnitude of the problem in terms of the associated morbidity, mortality and cost of treatment, but also due to the growing recognition that most of these are preventable³. The prevalence of gastrointestinal diseases markedly differs between developed and developing countries because of the poor sanitation, hygiene, impure water and food ingestion, widespread illiteracy and poverty in the developing world. The incidence of gastrointestinal diseases such as diarrhoea, cholera, typhoid, dysentery, viral hepatitis (A and E virus) can be substantially reduced by providing clean water and food to the population. Restricting consumption of tobacco and nonsteroidal anti-inflammatory drugs will reduce diseases and/or complications of the upper gastrointestinal tract. Diminishing alcohol intake and overuse of blood transfusion and improving blood banks would prevent many acute and chronic liver diseases. Costly passive and active immunoprophylaxis will become unnecessary if these measures are undertaken.⁴ The best ways to prevent gastrointestinal infection include:

· Proper hand-washing

· Disinfecting of contaminated surfaces with bleach

· Washing of soiled articles of clothing

· Identifying infected patients as soon as possible to implement extended infection control

· There are no vaccines for most gastrointestinal infections. Exceptions:

· Rotavirus

· Adenovirus (limited availability)

· For C. difficile: avoid prescribing antibiotics unnecessarily⁵

United Nations Children’s Fund Water, Sanitation, Hygiene Annual Report, (2009) illustrated that the increased burden of communicable diseases among school children are due to poor personal hygienic practices and inadequate sanitary conditions that remains a concern on the public health agenda in developing countries. Hand washing with warm water and soap can greatly reduce the chances of spreading or getting germs when done correctly. The mechanical action of scrubbing loosens up the dirt and microbes on hands and the soap picks up and bindsto the microbes so that the water can wash away. Thus hand washing is the best way to prevent communicable disease.⁶

STATEMENT OF THE PROBLEM:

A study to assess the prevalence of gastro-intestinal diseases among primary school children in a selected school of Jhajjar” Haryana

OBJECTIVES:

To assess the prevalence of gastro intestinal disease (GID)among primary school children (6-12 yrs) in Jhajjar, Haryana

OPERATIONAL DEFINITIONS:

1. Gastro –intestinal disease:

In the present study Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.

2. Prevalence: In the present study the term prevalence refer to the number of primary school children of (6-12) yrs age found positive for Gastrointestinal diseases during the time of study.

3. Assess: In the present study assess reflects the method of estimating the prevalence of gastro-intestinal diseases among the primary School Children in Selected school of jhajjar, Haryana.

4. Primary School Children: In the present study Primary school children refer to the individuals who are studying 5^th standard and in the age group of (6-12 years).

Description of Tools:

Methodology:

For the present study, a survey research approach and design was considered appropriate to gather the data related to the gastrointestinal diseases.

Study Setting: The study was conducted at Govt. Sr. Sec. School, Baharana (Jhajjar) Haryana.

Data collection tool and techniques

Tools	Purpose	Techniques
Demographic data	To collect personal information of hand washing techniques among primary school children (6-12year)	Paper and pen
Dichotomous knowledge questionnaire	To assess the prevalence of gastro intestinal disease (GID)among primary school children	Self

CRITERIA FOR SELECTION OF SAMPLE:

The sample was selected with the following predetermined selection criteria:

Inclusive Criteria:

The study includes primary school children (6-12 yrs)

1. Who under this age group.

2. Who are studied in selected school

3. Who are present at time of study

4. Who are willing to participate

Exclusive criteria:

The study excludes children in primary school children (6-12 year).

1. Sick at the time of data collection.

2. Not able to cooperate during the time of data collection.

Sampling technique:

A purposive sampling is adopted to select the subjects from the population of primary school children.

Sample size:

The sample size for this present study was 100 children among primary school children (6-12 yrs).

METHOD OF DATA COLLECTION:

The data collection procedure included the following steps through the study.

· Collection of Socio Demographic variables by self administered questionnaire.

· Collection of prevalence by standardized questionnaire.

RESULTS:

SECTION: I

Table 1: Frequency and percentage distribution of demographic variables N= 100

S No	DEMOGRAPHIC VARIABLES	Frequency	Percentage
1.	DEMOGRAPHIC VARIABLES	Total	%
1.	Age in year
a)	6-7 Year	18	18%
b)	8-9 year	37	37%
c)	10-11 year	35	35%
d)	12 year	20	20%
2.	Religion
a)	Hindu	42	42%
b)	Muslim	29	29%
c)	Sikh	0	0%
d)	Christian	2	2%
3.	Father’s Education
a)	Illiterate	45	45%
b)	Primary school	10	10%
c)	Middle school	26	26%
d)	Graduate and Above	19	19%
4.	Father’s Occupation
a)	Labour	36	36%
b)	Government servant	23	23%
c)	Business man	30	30%
d)	Personnel work	11	11%
5.	Mother’s Education
a)	Illiterate	41	41%
b)	Primary school	18	18%
c)	Middle school	30	30%
d)	Graduate work	11	11%
6.	Mother’s occupation
a)	Labour	20	20%
b)	Private work	30	30%
c)	Government job	45	45%
d)	Self business	5	5%

Data presented in the Table 2 revealed that majority 37% of the children were in age group 8-9-year age group. Most of the study participants (76) %, were Hindu by religion. Majority of children’s Fathers (70%) were Illiterate and had no formal education. Majority of the children’s Father’s (60%) were Businessman.

SECTION- II

Table 2: Percentage of Gastrointestinal Diseases among primary school children (6-12 year) Types of Diseases Prevalent among children N= 100

S. No	Diseases	Frequency	Percentage (%)
1.	Diarrhea	26	26%
2.	Vomiting	24	24%
3.	Abdominal pain	23	23%
4.	Fever	27	27%

Data presented in the Table 1 revealed that 26% children had Diarrhoea, (24%) children were having vomiting, (23%) children had abdominal pain , (27%) children had fever and 35% children were healthy with no symptoms of any gastrointestinal disturbances. It is depicted from the above mentioned table that majority of study participant identified with fever and diarrhoea as a symptoms of gastrointestinal disease.

DISCUSSION:

Present study discusses the prevalence of gastro-intestinal diseases among the children of the age group 6-12 years in a government school of Haryana. Present study shows that diarrhoea and fever were among the most prevalent symptoms of gastrointestinal diseases. Present study also shows that children who fell ill and started showing the symptoms of gastrointestinal diseases majorly belongs to the age group of 8-9 years, were hindu and belongs to the low socioeconomic status. Babakhani. M. et, al( 2016) also conducted a cross-sectional study on 200 school children who selected randomly among 390 attending health care centers in Gashki, West Iran in 2016. The study we used validated questionnaire and stool tests togather epidemiological and disease data. The samples were examined to the presence of the parasites by direct wet mount, Lugol's iodine solution and modified formaline-ethyl acetate sedimentation methods.The Chi- square and binary logistic regression procedure was applied to test the association between the variables. The p-value of <0.05 was considered significant. The mean and standard deviation of children ages were 10.7±2.29 years old. The overall prevalence of the IPIs was estimated at 66 (33.0). The highest prevalence of the IPIs was related to Blastocystis 35 (17.5%), and Giardia lamblia 22 (11.0%), respectively. 18 (9.0%) out of 66 infected children had double infection. Male gender (Adjusted odds ratio (AOR): 2.20 95% Confidence Interval (CI): 1.19-4.09) was only factor significantly associated with the prevalence of the IPIs in this population.⁷

A similar study was done by Pradhan P. et al, (2014) to determine the prevalence of intestinal parasitic infection and types of intestinal parasites in rural public school children of Nepal. It included students from Nursery to Class X of a rural public school located in the northeast part of the Kathmandu Valley, Nepal. Among the 194 participating children, prevalence of intestinal parasitic infection was found as 23.7%; (28.2% for boys; 20.2% for girls). Result concluded, the infected children, single and mixed parasitic infection was detected in 43 (93.5%) and 3 (6.5%) children respectively. Among protozoan parasites, Giardia lamblia was the most common (58.6%) whereas Hymenolepis nana was the most common (21.7%) among the helminths. Statistically different prevalence of intestinal parasitic infection was observed among children aged above 10 years and children aged below 6 years as well as 6 to 10 years. Gender-wise, there was no statistical difference in prevalence of intestinal parasitic infection. This study findings suggests that the need of health education program in schools along with regular screening of intestinal parasites and treatment for effective management of the intestinal parasites among school children in Nepal.⁸

Abate A, Kibret B, Bekalu E, Abera S, Teklu T, Yalew A et al:(2013 Aug) Conducted a cross-sectional study on the Prevalence of Intestinal Parasites and Associated Risk Factors in Teda Health Centre, Northwest Ethiopia. A cross-sectional study was conducted in Teda Health Centre from February to April, 2011. Stool samples were collected from 410 study participants and analysed by direct wet mount and formal ether concentration techniques. Furthermore, sociodemographic data were collected by using standardized questionnaire. The overall prevalence of intestinal parasitic infection in this study was 62.3%. Ascaris lumbricoides was the most predominant parasite (23.2%) followed by Giardia intestinalis (12.4%), Entamoeba histolytica/dispar (4.6%), Schistosoma mansoni (8.9%), hookworm (6.6%), Hymenolepis nana (1.5%), Enterobius vermicularis (0.4%), and Strongyloides stercoralis (0.2%). Absence of toilet and hand washing after toilet was shown to be associated with intestinal parasitic infection (P < 0.05 for both). Furthermore, swimming and less shoe wearing habits showed a significant prevalence of S. mansoni and hookworm infections, respectively.⁹

RECOMMENDATIONS:

1. A comparative study may be conducted to compare the prevalence of Gastrointestinal Diseases among primary school.

2. A comparative study may be conducted to compare the prevalence of Gastrointestinal Diseases living in urban and rural areas.

CONFLICT OF INTEREST:

Nil.

CONCLUSION:

In the present study findings revealed that Gastro-intestinal diseases was prevalent among the children age group between 6-12 years with variety of symptoms including vomiting, diarrhea, fever and abdominal pain. Socio-demographic variables of the study participants revealed that the prevalence was more in low socio economic status.

REFERENCES:

1. Beena Uppal, Naz Perween, Prabhav Aggarwal, and Shyam Kishor Kumar. A Comparative Study of Bacterial and Parasitic Intestinal Infections in India https://www.ncbi.nlm.nih.gov /pmc/articles/PMC4413063/

2. Stephanie M. Fletcher, Mary-Louise McLaws, and John T. Ellis Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis 2013 Apr 28; 2(1): 42–53.https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4140330/

3. Mathur P. (2011). Hand hygiene: back to the basics of infection control. The Indian journal of medical research, 134(5), 611–620. doi:10.4103/0971-5916.90985. Available from URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/

4. Dhawan PS, Desai HG. Prevention of gastrointestinal diseases.https://www.ncbi.nlm.nih.gov/pubmed/8857042

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7. Maryam Babakhani; Roya Safari; FatemehRajati; Syrus Salimi; Ali Omidiandoost Prevalence and Risk Factors Associated with Intestinal Parasitic Infections among School Children in Gashky, West of Iran Article 6, Volume 5, Issue 7 - Serial Number 43, July 2017, Page 5263-5273

8. Pradhan P, Bhandary S, Shakya PR, Acharya T, Shrestha A. Prevalence of intestinal parasitic infections among public school children in a rural village of Kathmandu Valley. Nepal Med Coll J. 2014 Sep;16(1):50-3.

9. Abate A, Kibret B, Bekalu E, Abera S, Teklu T, Yalew A, Endris M et al; Cross-Sectional Study on the Prevalence of Intestinal Parasites and Associated Risk Factors in Teda Health Centre, Northwest Ethiopia. 2013 Aug

Received on 24.02.2020 Modified on 14.03.2020

Int. J. of Advances in Nur. Management. 2020; 8(2):145-148.

DOI: 10.5958/2454-2652.2020.00034.7