CHAPTER 1

INTRODUCTION
“Water is life and clean water means health”

- Audrey Hepburn

“Practice good personal hygiene. Wash your hands before you eat. Be aware of good

clean sources”

-James Wright

Food and water are the two essential basic necessities of life. Without food and
water, life is impossible. Food provides essential nutrients substance that supports
growth, maintenance of body tissues and for the regulation of vitals. Nutrients are
converted to energy that our body uses to function. Also all the living beings have a
fundamental need for water. Man’s health and well-being depends on adequate water
supply to fulfill his bodily needs and to make hygiene . [28]

Food and waterborne disease are illnesses caused by consuming contaminated food
or water, which can contains pathogens, toxins, or other harmful substances. [30]

Food and waterborne disease are growing public health problem worldwide. The
most virulent pathogen causing food and waterborne disease are E coli, salmonella,
shigella’campylobacter, norovirus, retrovirus, cyclosporine, aspergillus,
[31]
staphylococca enterotoxin.

The sources of contamination is from poor hygiene, cross contamination, inadequate

cooking, contaminated wells, river, municipal water supplies, and environmental
factors such as flooding, poor sanitation, inadequate waste management etc. [31]

According to center for disease control, when two or more people develop the same
disease from a shared food source, it’s considered a foodborne outbreak. The
symptoms include stomach ache, vomiting, abdominal cramps diarrhea, dehydration
and fever. [29]

According to WHO every year, millions of people worldwide fall ill, and thousands
lose their lives due to contaminated food and water. The common health risk
associated with drinking water and its contamination either directly or indirectly by
human or animal excreta. [2]

1
Various form of waterborne diarrheal disease is a significant public health concern in
developing countries, particularly among children under the age of five. According to
the world health organization, these diseases contribute to a significant global health
burden, causing around 1.8 million deaths annually. [2]

In Kerala, the WBD include Acute Diarrheal Disease, dysentery and hepatitis,
affected Kerala’s population, 72 episodes of waterborne disease (WBDs) with
incidence rate of 49/1000 population per year and proportional morbidity due to
WBDs was 11.9%.. [23]

In our country children constitute a large segment of population and 6,000 children
die daily from water-related diseases. Young children are particularly vulnerable to
waterborne and sanitation- related illnesses, such as diarrhea and malaria, which can
have severe consequences. Practicing proper hand washing and drinking safe water
can reduce the risk of waterborne disease. School programmers should be conducted
on safe water and sanitation it is important for children in school going age to
understand about water borne diseases and preventive method. [3]

The estimated of 37.7 million Indians affected by waterborne diseases annually

seems to be related to diarrheal disease. Approximately 1.5 million children are
dying from diarrheal disease globally each year and 73 millions of working days are
lost per year due to waterborne disease. The impact of water-borne diseases is
affecting not only individual health but also a nation’s economic growth. Waterborne
disease tend to peak during the summer and rainy season due to inadequate
management of water supply and sanitation system. [1]

The world health organization estimates that 88% of the cause of this disease is due
to unsafe water supply, hygiene and sanitation. Microorganism causing disease
waterborne disease are include protozoa and bacteria many of which are intestinal
parasites, or invade the tissue of or circulatory system through walls of the digestive
tract.[5]

Food and waterborne diseases are significant public health concerns, causing
morbidity and mortality worldwide understanding the causes, symptoms, and
prevention strategies can help reduce the risk of these disease

2
NEED AND SIGNIFICANCE OF THE PROBLEM

Kerala faces high mortality- morbidity rates from food and waterborne disease. For
the timely management, understanding trends, pattern and seasonality of disease was
important to preventing outbreaks and reducing disease burden. Food and waterborne
disease are known as food poisoning. It occurs eating or drinking food or beverages
contaminated by bacteria, parasites or viruses. The aim was to find out the
knowledge regarding food and water born disease among upper primary school
children and identify the gaps in their knowledge. Food and waterborne disease are
significant public health concerns globally, particularly among vulnerable population
like children ages between 10- 14 are at increased risk due to various factors such as
poor hygienic factors such as inadequate hand washing, improper food handling,
limited health literacy such as lack of knowledge about safe food and water practices,
school aged children are more chance to get food and water illness due to their
weakened immune system. According to world health organization about 1.7 billion
peoples are suffer from food and waterborne disease each year. 220 million school
days are lost annually due to food and waterborne disease and 1.4 million deaths
annually. According to the Directorate of health services (DHS), Kerala the state
reported, 1,435 cases of food poisoning in 2020, with a case fatality rate of 0.07%,
234 outbreak of waterborne disease between 2018 and 2020, affecting over 10,000
people. Understand the prevalence, risk factors, and knowledge gaps related to food
and waterborne disease among upper primary school children in Kerala. [19]

STATEMENT OF THE PROBLEM

A study to assess the knowledge regarding food and waterborne disease among upper
primary school children in selected schools of Thiruvananthapuram district.

RESEARCH QUESTION

What is the level of knowledge regarding food and water borne disease among upper
primary school children in Kerala?

3
AIMS

The aim of the study was to find knowledge regarding food and water borne diseases
among upper primary school children

OBJECTIVES

1. To assess the level of knowledge regarding food and waterborne disease among
upper primary children

2. To determine significant association between levels of knowledge regarding Food

and waterborne disease among upper primary school children and selected socio
demographic variables

OPERATIONAL DEFINITION

Asses: in this study, assess refers to statistical measurement of knowledge level of

upper primary children about food and waterborne disease

Upper primary: it refers to age group 10-13 years. [27]

Food borne disease: In my study food borne disease refers to illness caused by
contaminated with bacteria, virus, parasites, fungi, or toxin substance. [26]

Waterborne disease: In my study waterborne disease refers to illnesses caused by

microorganisms in untreated or contaminated water. [24]

HYPOTHESIS

1. H1 : there will be good knowledge regarding food and waterborne disease

2. H2 : there will be significant association between level of knowledge

regarding food and water borne disease among upper primary school children
with their selected demographic variables

4
 CONCEPTUAL FRAMEWORK
Conceptual framework provides a foundation for formulating relationship among
variables. Conceptual framework of this study designed on the concept of health
promotion model of Becker expanded by Nola J Pender's in 1987 which focus on
health promotion behavior.

The Health Promotion Model is a widely used conceptual framework in nursing

and health education. Health-promoting behaviors should result in improved health,
enhanced functional ability, and better quality of life at all development stages.
Pender's Health Promotion Model theory was published in 1982 and later
improved in 1996 and 2002. It has been used for nursing research, education, and
practice. Applying this nursing theory and the body of knowledge that has been
collected through observation and research, nurses are in the top profession to enable
day people to improve their well-being with self-care and positive health behaviors.
The Model was designed to be a complementary counterpart to models of health
protection. It develops for improving health and applies across the life span. Its
purpose is to help nurses know and understand the major determinants of health
behaviors as a foundation for behavioral counseling to promote well-being and
healthy lifestyles.
Pender's model defines health as "a positive dynamic state not merely the absence
of disease." It focuses on helping individuals achieve higher levels of well- being and
is based on the understanding that people will naturally seek to control their own
behavior and make choices that benefits their health
It focuses on the following three areas:

 Individual characteristics and experience

 Behavior - specific cognitions and affect

 Behavioral outcomes.

Major Concepts of the Health Promotion Model

Health promotion is defined as behavior motivated by the desire to increase well-
being and actualize human health potential. It is an approach to wellness.

Individual characteristics and experiences:

prior related behavior and personal factors.
Behavior-specific cognitions and affect: (perceived benefits of action).

Perceived barriers to action, perceived self-efficacy, activity-related affect,

interpersonal influences, and situational influences.

5
Behavioral outcomes:
Commitment to a plan of action, immediate competing demands and preferences, and
health-promoting behavior.

Sub concepts of the Health Promotion Model

Personal Factors:

Personal factors are categorized as biological, psychological, and socio-cultural.

These factors are predictive of a given behavior and shaped by the target behavior's
nature being considered.

Personal biological factor:

Include variables such as age, gender, body mass index, pubertal status, aerobic
capacity, strength, agility, or balance.

Personal psychological factors:

Include variables such as self-esteem, self- motivation, personal competence,
perceived health status, and definition of health.

Personal socio-cultural factors:

Include variables such as race, ethnicity, acculturation, education, and socioeconomic
status.

Perceived Benefits of Action:

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action:

Anticipated, imagined or real blocks and personal costs of understanding a given
behavior.

Perceived Self-Efficacy:
The judgment of personal capability to organize and execute a health-promoting
behavior.

Activity-Related Affect:
Subjective positive or negative feeling occurs before, during, and following behavior
based on the stimulus properties of the behavior itself. Activity-related affect
influences perceived self-efficacy, which means the more positive the subjective
feeling, the greater its efficacy.

Interpersonal Influences:
Cognition concerning behaviors, beliefs, or attitudes of others.

6
Situational Influences:
Personal perceptions and cognitions of any given situation or context can facilitate or
impede behavior.

Commitment to Plan of Action:

The concept of intention and identification of a planned strategy leads to the
implementation of health behavior.

Promoting Behavior:
A health-promoting behavior is an endpoint or action-outcome directed toward
attaining positive health outcomes such as optimal wellbeing, personal fulfillment,
and productive living.

7
Individual characteristics Behavioral specific cognition Behavioral

And experience and affect outcome

1
Perceived benefit of
action

Knowledge about
food and waterborne Immediate
Prior disease commending
related Perceived barrier to demands
behavior action
Children’s Child is having
previous Lack of knowledge, interest in
interest taking
knowledg
e appropriate
regarding Perceived self- health measures
efficacy while taking
food and
Children’s awareness food and water
waterborn
about hygienic and
e disease
safety consumption of
food and water

Activity related affect Commitment

to plan of
Hand washing Health
action
technique promotio
Children n
improved their behavior
Personal Interpersonal influence knowledge
factors of regarding food Hand
child Family, teacher, peer and washing
group waterborne technique
Age, sex,
family disease
income, Situational influences
education
Programs conducting in
schools

8
 REVIEW OF LITERATURE

Review of literature the most important steps in the research process. It is an account
of what is already known about a particular phenomenon. “The main purpose of
literature review is to convey to the readers about the work already done and the
knowledge and ideas that have been already established in a particular topic of
research.”

It is a compilation of resources that provides groundwork for further study. Any

researcher conducting research invariably needs to read a significant amount of
literature. It is not because writers need readers.

Research studies are usually undertaken within the context of an existing knowledge
base, because research cannot be conducted in an intellectual vacuum. Before
starting any research, a literature review of previous studies and experiences related
to the proposed investigation has to be done.

In facts motivation for conducting a piece of research work directly depends on to

the amount of reading done by a researcher. Reading also helps to click certain
questions to study. It prompts reader to conduct research where they find gaps.
Actually the purpose of research guides the primary purpose of review of literature.
That is why quantitative studies review of literature concentrate on what is already
known to provide a conceptual or theoretical framework and to gain insight to the
design, instrument and measurement

In this review of literature written under three headings

1. Study related to waterborne diseases

2. Study related to food borne diseases

3. Study related to food and water borne diseases

Study related to waterborne borne disease

A project study on the water quality and health conducted on 2022 in switzerland.
Unsafe water, together with inadequate sanitation and hygiene, is the overwhelming
contributor to the 4 billion illnesses and 1.8 million deaths caused by diarrhea every
year. 90% of this by children is under five years. The study showed that diarrheal
episode reduces calorie and nutrient uptake and sets back a child’s growth and
development. The result showed that 94% of diarrheal cases are preventable
thorough intervention to increase the availability of clean water. [21]

A quantitative study to assess the knowledge regarding prevention of waterborne

disease among school going children in selected community area at Meerut. And the
finding showed that the prevention of waterborne disease was 55% among school

9
going children. The mean scores were 11.49% of school going children on
preventive measures of waterborne disease. And the standard deviation is 4.11 and
the result was “there was a prevalence of waterborne disease increasing per year, and
school going children, age group between 6-12 and also find that there was less old
cases comes in both years 2018& 2019 comparison to new cases in community area
at Meerut. [14]
A quantitative study to assess the effectiveness of structured teaching programme on
knowledge regarding prevention of waterborne disease among school children in
selected schools at kamrup district, Assam. The result of the study revealed that pre-
test mean score was 10.89±4.83 and post-test mean score was 21.89±3.021 with
mean difference was 11.00. The findings of the study were “the knowledge of the
school children regarding prevention of waterborne disease was increased after
implementation of structured teaching program. [9]
A quantitative research approach regarding impact on structured teaching program
on knowledge regarding selected waterborne disease among secondary school
students of Muslim educational institute Pampore, Kashmir. 100 samples were
selected with the age group of 14- 16 years. The result was in pre-test, 77(77%) had
poor level of knowledge, 17(17%) had average level of knowledge, 6(6%) had good
level of knowledge, in post-test knowledge, 84(84%) have excellent knowledge,
15(15%) have good level of knowledge and 1(1%) had average knowledge. The
study concludes that impact of structured teaching program was effective in
enhancing knowledge of secondary students [7]

A experimental research design regarding the effectiveness of structured teaching

programme on selected water borne diseases and their prevention among upper
primary school children in selected schools of Indore city. 400 up school children,
studying in 6th , 7th and 8th class were selected by non-probability convenient sampling
technique for the study and the result was the pre-test knowledge score was 9.575
and post-test knowledge score was 20.845.Calculated t value was 45.16 (df=399)
found to be significant at 0.05 hence hypothesis is accepted. Thus they conclude that
after the structured teaching programme increase the knowledge level of the
students.[8]

A study on effectiveness of planned teaching program on prevention of water borne

diseases among school children in Sri Venkatramana Hr. Primary School, Kulai,
Mangalore. among 60 samples are taken by stratified random sampling technique
with one group pre-test post-test design. The study findings were showed that “prior
to the administration of intervention most 37 (61.66%) of the subjects had poor
knowledge, 17(28.34%) had average knowledge, 6 (10%) had good knowledge and
none had excellent knowledge whereas after the intervention most 40 (66.33%) of
the subjects had excellent knowledge, 16 (26.66%) had good knowledge, 4 (6.66%)
had average knowledge and none had poor knowledge.” The post-test mean

10
knowledge score (27.9±2.53) is greater than pre-test mean knowledge score
(18.72±3.74) which indicate the intervention was effective.[2]

A quantitative study to assess the knowledge regarding prevention of waterborne

disease among school going students in a school of Perinthalmanna. Samples of 100
school going students, showed that 0(0%) has poor knowledge, 22(22%) has average
knowledge, 70(70%) has good knowledge and 8(8%) has very good knowledge
regarding waterborne disease prevention. [3]

Study related to food borne disease

A cross sectional observational study on effect of food safety education on
knowledge, attitude, and practice of school children in southern Taiwan. Showed
that the 6 hour lecture – activity mixed food safety course improve the sixth graders
practice over the quartile significantly p<0.05 for those school children with low to
medium scores in the knowledge domain, the food safety course could significantly
improve the school children’s knowledge about food safety as well p<0.01 the school
children’s attitude towards food safety could also be significantly promoted p<0.05.
The result suggested that “the course could improve the sixth grader’s knowledge
about food poisoning, food preservation and food additives, change their attitude
towards food additives, promote the practice of personal hygiene, and pay more
attention to food labeling and packaging when buying food.” [17]

A cross sectional web based study on knowledge, attitude, and practice towards food
safety among students in Bangladesh. Finding showed that total of 777 samples in
the study, among these around 47% have adequate knowledge, 87% have favorable
attitude, and 52% had good practice towards food safety. The study reveals that large
proportions of Bangladeshi students have poor knowledge and practice regarding
food safety. [11]

A cohort retrospective study on Foodborne outbreak investigation in elementary

school, Gunungkidul district, Indonesia on January 2024. The aim was to find out
identify the sources, risk factors, assess its extent, and provide suggestion for
outbreak management. 102 individuals were interviewed, 12 were considered cases.
Most cases were in males (66.67%), aged 5 to 11, primarily third grade students
(50%) and a common symptom with nausea (100.00%). The investigation of 102
students revealed that12 students experienced one or more symptoms such as
dizziness, nausea, vomiting, abdominal pain, chills, and shortness of breath or sore
throat after consuming snacks that were sold around the elementary school on
January 25, 2024. The highest attack rate for the disease was observed in male
students, reaching 14.0%. in addition , the highest attack rate also occurred in
students aged 6-10 years( 11.9%), as well as grade 3students with an attack rate of
28.6%. [22]

A quantitative study on Knowledge regarding food safety among school going

children at selected schools of kurali (Punjab). The result showed that there was a
difference between the experimental group (8.94±3.71) and the controlled group

11
(9.10±3.80) in the mean score of the pre-test knowledge score about food safety
among school going children. After getting a health package, there was a big
difference between the experimental groups mean post-test score (18.37±4.62) and
the control group mean post test score (9.65±4.17). The test showed a difference in
mean knowledge scores that was statistically significant (p<0.5). The investigator
found that there was no notable correlation between pretest knowledge score and the
demographic characteristics they selected [12]
A quasi-experimental study using one group pre-test and post-test design was
conducted to assess the effectiveness of planned teaching program on knowledge
regarding food borne disease and food safety among students in selected school of
sangli, miraju, kupwad corporation area Maharashtra. 70 samples were selected of
age group of 11 to 15 years for this study. The finding was pre-test level of
knowledge regarding foodborne disease and food safety showed that overall pre-test
score was 11.21 and standard deviation was 4.5167 and the post-test mean score was
16.5 and standard deviation was 4.9512 and significant difference was found
between pre-test and post-test mean score of knowledge regarding food borne
diseases and food safety. This study also revealed that the planned teaching program
on knowledge regarding food borne disease and food safety was an effective to
increase the level of knowledge of school students [15]

A cross- sectional study on food safety knowledge and self-reported practices among
schoolchildren in the GA west municipality in Ghana. Showed out of the 1343
respondents the mean age of the student’s was13 years with their ages ranging from
7 to 21 years. The food safety knowledge level of the students was inadequate with a
mean score of 5.8 representing 64.08% of the maximum total food safety knowledge
score. 59.6% (801) of the students had adequate level of food safety knowledge. The
food safety among the respondents was generally appropriate with a mean score of
36.19 representing 80.4% of the maximum total food safety practice score. 90.2%
(1211) of the students reported to be engaging in appropriate food safety practice. No
statistical difference was observed in the level of food safety knowledge and practice
among the various demographic characteristic of the students. There was positive
correlation between food safety knowledge and practice. Even though the food safety
knowledge level of the students was inadequate, the food safety practice was
generally appropriate especially their hand washing practice.[16]

Study related to food and water borne disease

A pre experimental study on effectiveness of planned teaching program regarding

prevention of food and waterborne disease among upper primary school children in
selected schools of Mumbai. 200 samples are taken for the study using non-
probability convenient sampling. Most of the samples belong to age group of 11-12
years (161) 80.5% out of total samples (114)57% were boys and (86)43% were girls.
Majority of students parents (95)49.5% were graduates and majority (170)85% have
not fallen sick anytime due to food and water borne diseases. The mean knowledge

12
score of children were 11.15 in the pre-test and 16.20 in post-test. The computed SD
score was 2.67in the pre-test, 2.15 in the post-test and calculated "t" value (25.87)
was more than the table value (1.97) at 198 degree of freedom and significant at 0.05
level. Association of selected demographic variable and pre-test knowledge score
with age calculated "t" value (0.890) was less than the table value "t" (1.96).
Association of selected demographic variables and pretest gender calculated “t”
value (5.03) was more than table value of “t” (1.97). Hence it conclude that there is
an association between knowledge score and gender of the sample [6]

A descriptive study to assess the knowledge regarding food and waterborne disease
and their prevention among students of a selected school at Pilkuwa, district, Hapur
(UP). And the study revealed that 76.67% of the students had moderate knowledge
and 23.33% of the students had adequate knowledge regarding food and waterborne
disease and their prevention [13]

A pre experimental approach with one-group pre-test – post-test design on

effectiveness of an information booklet on food and waterborne diseases and their
prevention to upper primary school students at Gwalior (M.P.). 120 school children
drawn using stratified random sampling technique. Results showed that there was
highly significant difference (t119 = 59.72, P<0.05) between the mean post-test (x2
= 36.633) and mean pre-test (x1 = 17.958) knowledge score. The area-wise mean
knowledge score of the pre-test was maximum (12.4417) in the area of ‘prevention
of food and waterborne diseases’ and minimum (0.3833) in the area of ‘causes of
food and waterborne diseases’ whereas the area-wise mean knowledge score of post-
test was maximum (19.3750) in the area of ‘prevention of food and waterborne
diseases’ and minimum(2.4333) in the area of ‘causes of food and waterborne
diseases. There was significant association between the gain in knowledge score and
selected variables like age P<0.05), class P<0.005) and number of family members
P<0.05). They conclude the information booklet on food and waterborne diseases
and their prevention has helped the students in attaining more information which was
evident in post-test [10]

A study conducted on effectiveness of structured teaching program on student’s

knowledge of food and waterborne illnesses and how to prevent them in a selected
group of upper primary schools in Chamarajanagar, Karnataka. The result showed as
the pretests mean score 9.63, whereas the post text mean score was 17.33. A
significant difference of calculated‘t’ value is 19.16. The study findings shows that
structured teaching approach helped pupils learn more about food borne and
waterborne disease. [18]

A Quasi-Experimental study on structured teaching program regarding food and

water borne diseases and its prevention among upper primary school children on
selected schools in Kochi, Kerala. 100 Students were selected from two schools with
50 samples each from experimental and control group by convenient sampling
technique with pre-test post-test control group design. The study revealed that the
mean post-test knowledge of 23.96±3.77 of the children in the experimental group

13
was significantly higher than pre-test knowledge score of 13.96±4.83. Similarly the
mean post-test knowledge of 23.96±3.77 of the children in the experimental group
was significantly higher than the mean post-test score of 11.66±4.89 of control
group. Significant association was found between knowledge level and sex of the
school children. The study revealed the importance of implementing structured
teaching program for school children on various topics as it would help to improve
knowledge and follow healthy practices through which the children can build up a
healthy generation. [1]

A descriptive cross sectional study designs on assess the prevalence of food and
waterborne disease school children in Ernakulum district, Kerala. A total of 500
upper primary school children were selected for the study using a systematic random
sampling technique. A structured questionnaire was used to collect data. The study
revealed that 70.2% of the study participants have good knowledge. However, only
50.8% of the study participants practiced proper hand washing before eating. The
study also found that 60.5%of the study participants had positive attitude towards
food and water safety. [20]

SUMMARY

The literature review enabled the investigator to have an in depth understanding and
deep insight in to the problem under study. It also enabled the researcher to establish
the need for the study, preparation of the tool designing conceptual framework and
research design collecting the data and plan for analysis and discussion

14
 CHAPTER 2

METHODOLOGY, RESULT, DISCUSSION

Research methodology is a structured and scientific approach used to collect,
analyze, and interpret quantitative or qualitative data to answer research question or
test hypothesis.it is a way to systematically solve the research problem

This chapter deals with the methodology adopted by the researcher includes research
approach, research design, variables, settings, population, sample, sample size,
sampling criteria, sampling technique, description of tool, content validity, pilot
study, reliability, method of data collection, plan for data analysis and protection of
human rights. In present study, “Assess the knowledge regarding food and water
born disease among upper primary school children in selected schools of
Thiruvananthapuram district.”

Research approach

Research approach is a plan and procedure that consist of the steps of broad
assumptions to detailed method of data collection, analysis and interpretation.
Research problem is the corner stone to decide which approach a researcher should
use in their research to study a topic

The research approach adopted for this study quantitative in nature. This study aims
at assessing the knowledge regarding food and water borne disease among upper
primary school children

Research design

Research design is a blueprint to conducting a study, which involves the description

of research approach, study setting, sampling size, sampling technique, tools and
methods of data collection and analysis to answer specific research question. It helps
to organize the research work and give an organized strategy to accomplish specific
objectives. It is the “overall plan an investigator uses to obtain valid answers to
research questions”

Research design selected for this study is descriptive research with the objectives of
assessing the knowledge regarding food and water born disease among upper
primary school children

VARIABLES

Independent variable: knowledge level of upper primary school children

Dependent variable: socio-demographic variable such as age, sex, education,

monthly income

15
 TARGET POPULATION-

Upper primary school children

ACCESSIBLE POPULATION-

School children who are available at the time of study

SAMPLING TECHNIQUE –

Convenience sampling technique

SAMPLE-

Upper primary school children in selected schools of Thiruvananthapuram

district

SAMPLE SIZE-

171

DATA COLLECTION TOOL –

Semi structured questionnaire

ANALYSIS AND INTERPRETATION

FINDINGS

SCHEMATIC REPRESENTATION OF RESEARCH DESIGN

16
Setting of the study

The setting of a research study refers to the location, time period and specific
environment where research is conducted. This includes the location, time period,
population and environmental factors. Based on the feasibility and familiarity the
investigator selected Government VHSS Poovar 18 Km from Karakonam and
selected 5th and 6th standard student approximately 60 students and Government HSS
Balaramapuram 17 Km from Karakonam and selected 5th 6th 7th standard
approximately 115 students for the setting of the study

Population

The entire set of individuals or objects having common set of characteristics selected
for a research study. The population under the present study involves upper primary
school children in selected schools of Thiruvananthapuram district

Inclusion criteria

 school going students studying in 5-7th standard

 students present in the class during data collection
 students who are able to read and write Malayalam and English
Exclusion criteria

 students who are not willing to participate

Sample

 A part or subset of population selected to participate in research study. One

hundred seventy five children are selected for the study. The sample size was
calculated by following formula

4𝑝𝑞
n = 𝑑^2

4∗70∗36
= P =70% [proportion of people with good
10^2
knowledge]
= 171 q =36% (100-p)
= 175 samples d = 10% of p

Sampling technique

 The process of selecting sample from the target population to represent the
entire population. Convenient sampling technique was selected for the study

17
Tools / instrument

 Section A: Demographic data of the family

 Section B: semi structured questionnaire to assess the knowledge regarding
food and water born disease
Development/ selection of tool

A research instrument is a device used to measure the concept of interest in a

research project that a researcher used to collect data. A semi structured
questionnaire that assesses the knowledge regarding food and water born disease was
developed based on search of review of literature, discussion with the guide, internet,
journals and personal experience. Multiple choice questions were used

Scoring and interpretation

For section B, 1 mark for each correct answer and 0 mark for each wrong answer

Scoring system

 <50% -poor knowledge

 50%- 75% -moderate knowledge
 >75% - good knowledge
Content validity of the tool

It is concerned with scope of coverage of the content area to be measured. The

prepared tool is submitted to 5 experts for content validity. They gave their opinion
and suggestions and it was modified and deleted some questions

Reliability of tool

Reliability of an instrument is the degree of consistency with which it measures the

attribute it is supposed to be measuring. The reliability of the entire tool was tested
using test Cronbach’s Alpha method and found r=0.82. The reliability of the tool
indicated that the semi structured questionnaire was reliable

Pilot study

A pilot study was conducted to assess the feasibility of the study and also to
determine the plan of statistical analysis. Permission was obtained from Headmaster
of Government VHSS Poovar, and selected 7th standard students data were selected
by using convenience sampling technique. The pilot study findings reveal that the
study was feasible and practical

18
Data collection process

Data collection is the process of gathering data needed for the study. The study was
conducted after obtaining permission from scientific committee and human ethical
committee of Dr. SMCSI Medical College and Hospital Karakonam. And got
permission from Government VHSS, Poovar and Government HSS, Balaramapuram.
The data collection period was from 22/01/2025 to19/02/2025. Upper primary school
children were selected on the basis of inclusion and exclusion criteria. For the main
study Researcher avoids 7th standard students of Government VHSS Poovar because
the Researcher select 7th standard students for pilot study. On the first visit consent
form is given to the students. And on second visit informed consent form, assent
form and data are collected.

Plan for data analysis

Data analysis is the systemic organization and synthesis of data. The obtained data
were analyzed using descriptive and inferential statistics on the basis of objectives of
the study

Objective 1: descriptive statistics quartiles were used to assess the knowledge

regarding food and waterborne disease among upper primary school children

Objective 2: chi square is used to find the association between levels of knowledge
regarding Food and waterborne disease among upper primary school children and
selected socio demographic variables

19
SECTION WISE PRESENTATION OF DATA

The obtained data was entered in the master sheet for tabulation and statistical
processing was done in SPSS 27. The data analyzed were organized and presented as

Section 1: Frequency and distribution of socio demographic variables of Upper

Primary school children

Section 11: Frequency and distribution of knowledge regarding food and

waterborne disease

Section 111: Association between the knowledge regarding food and waterborne
disease among upper primary school children and selected socio demographic
variables.

20
 SECTION 1

Socio demographic variables of upper primary children

Table 1: Distribution of frequency and percentage on socio demographic variables

of Upper Primary school children

N=175

SL.NO DEMOGRAHIC VARIABLES FREQUENCY PERCENTAGE

1. Age (years)

10 29 16.65%

11 64 36.1%

12 52 29.7%

13 30 17.1%

2. Sex

Male 85 48.6%

Female 90 51.4%

3. Religion

Hindu 34 19.4%

Christian 37 21.2%

Muslim 104 59.4%

21
4. Education (standard)

5 62 35.4%

6 64 36.6%

7 49 28.0%

5. Type of family

Nuclear family 127 72.6%

Joint family 48 27.4%

6. Education of father

Primary 26 14.9%

Secondary 17 9.7%

Degree 62 35.4%

Post graduated 70 40.0%

7. Education of mother

Primary 63 36.0%

Secondary 49 28.0%

Degree 31 17.7%

Post graduated 32 18.3%

22
8. Occupation of father

Private sector 26 14.9%

Government 17 9.7%

Self-employed 62 35.4%

Coolie 70 40.0%

9. Occupation of mother

Private sector 24 13.7%

Government 18 10.3%

Self-employed 22 12.6%

Home maker 111 63.4%

10. Monthly income (Rs)

>7008 36 20.6%

3504- 7007 69 39.4%

2102- 3503 39 22.3%

1051- 2101 15 8.6%

< 1050 16 9.1%

11. Previous knowledge

Yes 143 81.7%

No 32 18.3%

23
Table 1: describes the demographic variable of the upper primary children, age
group of 10 years were 29(16.6%) , 11 years were 64(36.6%) , 12 years were
52(29.7%) and13 years were 30(17.1%). Out of 175 children 85(48.6%) were male
and 90 (51.4%) were females among the participants 34(19.4%) were Hindu,
37(21%) were Christian and 104(59.4%) were Muslim from the majority of samples
64(36.6%) were studying in 6th standard 62(35.4%) were 5th standard and 49(28.0%)
are studying 7th standard. 127(72.6%) belongs to nuclear family and 48(27.4%) were
belongs to joint family.

The data shows that the educational status of the father 26(14.9%) had primary
education, 17(9.7%) had secondary education 62(35.4%) were graduated 70(40.0%)
were postgraduate educational status of the mother 63(36.0%) were had primary
education, 49(28.0) had only secondary education, 31(17.7%) were graduated and32
(18.3%) were post graduated.

Occupation of the father 26(14.9%) were worked in private sector, 18(10.3%) had
government job, 22(12.6%) were worked as self-employed and 70(40.00 were have
coolie workers. Occupation of the mother shows that 24(13.7%) were worked in
private sector 18(10.3%) have government job, 22(12.6%) were self-employed and
111 (63.4%) were home makers.

Monthly income of the family showed 36(20.6%) had Rs >7008, 69(39.4%) had Rs
3504-7007, 39(22.3%) had Rs 2102-3503, 15(8.6%) had Rs 1051-2101 and 16(9.1%)
had Rs < 1050

From the majority of the sample 143(81.7%) were had previous knowledge and
31(17.7%) did not have previous knowledge on food and waterborne disease

24
 SECTION 11

Figure 3: Frequency and distribution of knowledge regarding food and

Water borne disease

N=175

KNOWLEDGE
48

28.6

23.4

poor
Moderate
good

Figure 3: shows frequency and distribution of knowledge regarding food and

waterborne disease. Majority 48.0% had moderate knowledge, 28.6% had poor
knowledge and only 23.4% had good knowledge

25
Figure 4: Frequency and percentage of upper primary school children with

their sex.

N = 175

SEX

49% sex male

51% sex female

Figure 4: the frequency and percentage of upper primary school children with their
sex. Out of 175 children 85(48.6%) are male and 90 (51.4%) are females

26
Figure 5: Frequency and percentage distribution of upper primary children
with their educational status

N= 175

EDUCATIONAL STATUS

28%
35.4% 5th standard
6th standard
7th standard

36.6%

Figure 5: the frequency and percentage distribution of upper primary children with
their educational status 62(35.4%) were 5th standard and 64(36.6%) were studying in
6th standard and 49(28.0%) studying 7th standard.

27
Figure 6: Frequency and percentage of upper primary school children with
their religion

N= 175

RELIGION

19.4%

Hindu
59.4% 21%
Christian
Muslim

Figure 6: the frequency and percentage distribution of upper primary school children
with their religion out of 175 samples 34(19.4%) were Hindu, 37(21%) were
Christian and 104(59.4%) were Muslim

28
 Section 111
Table 2: Association between the level of knowledge regarding food and

Water borne disease with socio demographic variables

N=175

KNOWLEDGE

Poor Moderate Good Total

N % N % N % N % 2 df p

Age

10 10 20.0 12 14.3 7 17.1 29 100

11 19 38.0 26 31.0 19 46.3 64 100 6.152 6 0.406

12 11 22.0 31 36.9 10 24.4 52 100

13 10 20.0 15 17.9 15 12.2 30 100

Sex

Male 33 66.0 39 46.4 13 31.7 85 100 10.902 2 0.004*

Female 17 34.0 45 53.6 28 68.3 90 100

Education

5th 20 32.3 23 37.1 19 30.6 62 100

6th 18 28.1 33 51.6 13 20.3 64 100 5.322 4 0.256

7th 12 24.5 28 57.1 9 18.4 49 100

Religion

Hindu 14 41.2 14 41.2 6 17.6 34 100

Christian 8 21.6 15 40.5 14 37.8 37 100 8.120 4 0.087

29
 Muslim 28 29.9 55 52.9 21 20.2 104 100

Education of father

Primary 22 27.5 44 55.0 14 17.5 80 100

Secondary 16 31.4 25 49.0 10 19.6 51 100 13.268 6 0.039*

Degree 8 28.6 12 42.9 8 28.6 28 100

PG 4 25.0 3 18.8 9 56.3 16 100

Education of mother

Primary 19 30.2 34 54.0 10 15.9 63 100

Secondary 18 36.7 22 44.9 9 18.4 49 100 9.213 6 0.162

Degree 7 22.6 14 45.2 10 32.3 31 100

PG 6 18.8 14 43.8 12 37.5 32 100

Monthly income

>7008 8 22.2 18 50.0 10 27.8 36 100

3504- 7007 17 24.6 31 44.9 21 30.4 69 100

2102- 3503 12 30.8 21 53.8 6 15.4 39 100 8.819 8 0.358

1051- 2101 5 33.3 8 53.3 2 13.3 15 100

< 1050 8 50.0 6 37.5 2 12.5 16 100

Previous knowledge

Yes 45 31.5 6.8 47.6 30 21.0 143 100 4.333 2 0.115

No 5 15.6 16 50.0 11 34.4 32 100

*significant at 0.05 level

30
Table 2: Describe the association between the selected demographic variable
with their level of knowledge on food and waterborne disease

According to sex majority of male children (66.0%) have poor knowledge and
(31.7%) have good knowledge. In case of females (68.30 have good knowledge and
(34.0%) have poor knowledge regarding food and waterborne disease and
2=10.902 and p value is 0.004. so, it is found that the gender of the children and
knowledge level on food and waterborne disease are statistically significant

Regards to education of father (56.3%) whose had post graduated, (55.0%) with
primary education had moderate knowledge and (31.4%) with secondary education
have poor knowledge,2 =13.268 and p value = 0.039 revealed that the education of
father and level of knowledge on food and waterborne disease are statistically
significant

According to age group 11-year-old children (46.3%) had good knowledge, age
group 12years (36.9%) have average knowledge and age group 10 (20.0%) have poor
knowledge. About food and waterborne disease, 2 = 6.152and p value = 0.406. it
reveals that there is no significant relationship between knowledge of food and water
borne disease with age of children

Regards to religion children comes under Christians (37.8%) had good knowledge,
Muslims (52.9%) had moderate knowledge and Hindu (41.2%) had poor knowledge
about food and waterborne,2 = 8.120 and p valve =.087 hence it reveals that there is
no significant relationship between knowledge of food and waterborne disease and
religion of the children

According to the education level 5th standard students (30.6%) have good knowledge
and 7th standard students (24.5%) had average knowledge about food and waterborne
disease and 2 = 5.322 and p valve = 0.256 it reveals that there is no association
between knowledge and education of the child

According to education level of mother majority (54.0%) have primary education

and (18.8%) had post graduated had poor knowledge. the 2 = 9.213 and p value
=0.162 and it is statistically no significant association with mother’s education and
knowledge of children

With regards to family monthly income (53.8%) have income Rs 2102- 3503 /- had
moderate knowledge and (24.6%) have income of Rs 2102- 3503 ad poor knowledge
and (30.4%) have income of Rs 2102- 3503 /- had good knowledge about food and
waterborne disease and 2 =8.819 and p value = 0.358 and it is not statistically
significant association with monthly income and knowledge of children

According to the previous knowledge of the students, majority children does not
have previous knowledge and (50.0%) have moderate knowledge and (21.0%) with
previous knowledge have good knowledge about food and waterborne disease and 2

31
=4.333 and p value =0.115 and was not having any significant association between
previous knowledge and level of knowledge of student

32
Figure 7; Associations between upper primary children level of knowledge
regarding food and waterborne disease according to their sex

N=175

80
66 68.3
70
60 53.6
50 46.4

40 34 31.7
30
20
10
0
poor moderate good

Male Female

*significant at 0.05 level

Figure 7 shows that the association of level of knowledge regarding food and
waterborne disease according to their sex. In case of male children majority of
(66.0%) have poor knowledge and (31.7%) have good knowledge. In case of females
(68.30 have good knowledge and (34.0%) have poor knowledge regarding food and
waterborne disease and 2=10.902 and p value is 0.004. so it is found to be
statistically significant

33
Figure 8; Associations between upper primary school children level of
knowledge regarding food and waterborne disease with education of father

N= 175

55 56.3
60
49
50 42.9

40
31.4
27.5 28.6 28.6
30 25
17.5 19.6 18.8
20

10

0
Primary Secondary Degree PG

poor moderate good

*significant at 0.05 level

Figure 8 shows that upper primary school children (56.3%) whose father have post
graduated, (55.0%) with primary education had moderate knowledge and (31.4%)
with secondary education have poor knowledge, 2 =13.268 and p value = 0.039
reveals that is statistically significant

34
 RESULT
Results are important in every research study. It seeks to answer the research
question

So as to solve the research problem or it help to identify the problem evidence-based

practice in research

OBJECTIVES

The objectives of the study were

1. To assess the level of knowledge regarding food and waterborne disease among
upper primary children

2. To determine significant association between levels of knowledge regarding Food

and waterborne disease among upper primary school children and selected socio
demographic variables

HYPOTHESIS

H1: There will be good knowledge regarding food and waterborne disease

H2: There will be a significant association between levels of knowledge

regarding Food and water borne disease among upper primary school children with
their selected Demographic variables

35
 Result of the study

The result of the study is presented under the following heading

Socio demographic variables

Among the samples, majority of participants 64 (36.6%) were 11 years of age,

52 (29.7%) were 12 years, 30 (17.1%) were 13 years and 29 (16.6%) were 10 years.

Most of the participants 90 (51.4%) were females and 85 (48.6%) were males.

Among the participants 104(59.4%) were Muslims majority were 34 (19.4%) were
Hindu, 37 (21.2%) and were Christians.

Majority of the participants 64 (36.6%) were studying in 6th standard, 62(35.4%)

were studying in 5th standard and 49 (28.0%) were studying 7th standard.

Most of the sample 127 (72.6%) were belong to nuclear family and 48 (27.1%) were
belong to joint family.

Among the samples, the educational status of the father shows that 70(40.0%) post
graduated, 62(35.4%) graduated, 17(9.7%) had secondary education and 26(14.9%)
primary education.

Among the samples the educational status of the mother 32(18.3%) were post
graduate, 31(17.7%) were graduate, 49(28.0%) were have secondary education and
63(36.0%) were had primary education.

Most of the samples, Occupation of father 70(40.0%) were worked as coolie,

26(14.9%) were worked in private sector, 17(9.7%) were worked in government, 62
(35.4%) were self-employed.

Occupation of mother, most of the mothers were homemakers 111(63.4%)

24(13.7%) were worked in private sector, 18 (10.3%) worked in government sector
22(12.6%) were self-employed.

Monthly family income showed that 36 (20.6%) of were more than Rs >7008,
69(39.4%) were had income of Rs 3504- 7007, 39(22.3%) were had Rs 2102- 3503,
15(8.6%) have income of Rs 2102- 3503 and 16(9.1%) have Rs < 1050.

From the majority of the sample 143(81.7%) have previous knowledge and (31%)
have no previous knowledge.

36
Level of knowledge regarding food and waterborne disease

Majority of 48.0% had moderate knowledge, 28.6% had poor knowledge and only
23.4% had good knowledge

Association between level of knowledge and socio demographic data

There is a statistically significant association between level of knowledge regarding

food and waterborne disease with selected socio demographic variables like sex and
education of the father and there is no statistically significant association with other
socio demographic data and age, education, religion, education of mother, family
monthly income and previous knowledge were not having any significant
association.

37
 DISCUSION
Discussion of the study refers to the evaluation of the study the findings have been
discussed with reference to the objectives and hypothesis of the related study

The objectives of the study were

1. The first objective was to assess the knowledge regarding food and
waterborne disease among upper primary school children

Out of 175 samples majority 48.0% had moderate knowledge, 28.6% had poor
knowledge and 23.4% had good knowledge on food and waterborne disease. These
results are congruent with the findings of a study conducted to assess knowledge
regarding waterborne disease among school children of Government high school,
Ernakulum. The study sample consists of 500 school children aged 11-14 years with
equal number. The result showed that the majority of the participants (80.4%) had
heard about waterborne disease. But only (40.2%) had good knowledge.

2.The second objectives were to determine significant association between levels

of knowledge regarding Food and waterborne disease among upper primary
school children and selected socio demographic variables.

In this study there is significant association between level of knowledge regarding

food and waterborne disease with selected socio demographic variables like sex and
education of the father and no significant association found between age, education,
religion, education of mother, family monthly income and previous knowledge.
These results are congruent with the findings of a study conducted in Kochi, Kerala.
Regarding food and water borne diseases and its prevention among upper primary
school children. And there was a significant association was found between
knowledge level and sex of the school children. And no association was found
between age, waste disposal, and source of drinking water, type of drinking water
and drainage with the knowledge level of students. “The study revealed that the
importance of implementing structured teaching program for school children on
various topics as it would help to improve knowledge and follow healthy practices
through which the children can build up a healthy generation.” [1]

From this study understood that majority of the upper primary school children have
adequate knowledge regarding food and waterborne disease. However, there is a
need of continuing education, training and awareness campaign to improve the
knowledge level

38
 CHAPTER 3

LIMITATION, SCOPE FOR FUTURE STUDIES

Limitation

The study had several limitations that should be acknowledged

1. The size of sample was limited, which may affect the generalizability of the
result.
2. Sampling method used was convenient sampling, which may not be
represented of the larger population.
3. The data collection method relied on self-reported measures, which may be
subjected to biases.
4. The measurement tools used were limited to a questionnaire, which may not
capture the full complexity of the issue.
5. Available time for conduct of study was limited to 6 weeks.
6. Only upper primary school children were included

39
Scope for future studies

This study provides a foundation for future research in this area. Some potential
avenues for future studies include;

 Could aim to recruit a larger and more diverse sample to increase the
generalizability of the results.
 Could use more sampling method, such as random sampling or stratified
sampling, to increase the representatives of the sample.
 Examine additional variables that may influence the relationship between
knowledge level and factors
 Explore the role of context e.g., cultural, socioeconomic in shaping the
relationship between knowledge level and factor
 Similar study may be replicated on a large sample, there by findings can be
generalized for a large population.
 A comparative study can be carried out in private or government schools.

40
 CHAPTER 4

CONCLUSION, POLICY IMPLICATION

Conclusion

The study concludes that upper primary school children have inadequate knowledge
about food and waterborne disease only 23% have good knowledge. This highlight is
the need for targeted education and awareness programs to improve children’s
knowledge and prevent the spread of these diseases. The study finding emphasize the
importance of promoting sanitation and hygiene practices, ensuring access to safe
drinking water and provide health education programs on proper food handling and
preparation practices

 The present study emphasizes the need for develop and implement targeted
education programs to improve children’s knowledge about food and
waterborne disease
 The study suggests that the health professional who are the first person who
come to contact with the people in the community. So, they need to give to
appropriate and accurate information about the health issues of food and
waterborne diseases
 The present study suggest that need for promoting sanitation and hygiene
practices in home, schools and communities
By taking these steps, we can create a healthier and safer environment for upper
primary school children in relation with food and waterborne disease.

41
 Policy implication

The study has implicated for Nursing Practice, Education, Administration and

Nursing Research

Nursing practice

Nurse can conduct regular teaching sections on food and waterborne disease in the
hospital. The nurse should take important role in infection prevention

Nursing education

Nurse Educator focuses more attention on training of nursing students. So they can
impart appropriate knowledge to upper primary school children regarding food and
waterborne disease. It helps to emphasis on health information to community using
various teaching methods. Students will do demonstration at community visit. They
should educate on food and waterborne disease and their prevention preschool
children’s in anganwadis

Nursing administration

Nurse Administrators can educate nursing personal and involve them in health
education measures for upper primary school children regarding food and waterborne
disease. so that they can give education to secondary school children

Nursing research

The nurses come to know about their level of knowledge regarding food and
waterborne disease. Studies will improve the quality of nursing care. And study helps
to insight in to the development of teaching module and for improving the
knowledge and nursing management of food and waterborne disease

42
 CHAPTER 5

SUMMARY
Food and water are the basic necessities of life. Food and waterborne disease are
illness caused by contaminated food and water often results from poor sanitation,
hygiene and food handling practices and preparation in contaminated water source.
Food and waterborne disease are a significant concern among upper primary school
children. These diseases can cause a range of illness, from mild to severe, and can
even be life threatening, Mainly the food and water borne disease caused by bacteria
viruses, and parasites etc. and these are leads to sever diarrheal and dehydration,
malnutrition and even death and it affect the growth and development of children.
The preventive measures will help to improve sanitation and hygiene by providing
adequate waste disposal facilities, promoting hand washing, use of safe water and
practice proper food handling while preparation and transportation

The present study was conducted to assess the knowledge regarding food and
waterborne e disease among upper primary school children in selected schools of
Thiruvananthapuram district. For this study convenient sampling technique were
used and 175 samples were selected main objectives were to “Assess the level of
knowledge regarding food and waterborne disease among upper primary children”
and to determine significant association between levels of knowledge regarding Food
and waterborne disease among upper primary school children and selected socio
demographic variables. The conceptual framework for the study is based on Nola p
Pender, Health Promotion Model and it provide comprehensive framework for
achieving the objectives. A quantitative approach was used with descriptive research
design. The sample was selected with convenient sampling technique. The research
tool was semi structured questionnaire with two sections. The pilot study was done
on 17 samples and the main study was done by 175 sample of selected population the
obtained data were analyzed in terms of objectives and hypothesis using descriptive
and inferential statistics.

Major findings of the study

 Majority of participants 64 (36.6) were in the age of 11 years.

 Regarding the sex 90 (51.4) were females.
 Majority of the samples 104(59.4) were Muslims.
 Large number of the participants 64(36.6) were studying in 6 th standard.
 Majority of the samples127 (72.6) were belong to nuclear family
respectively.
 Educational status of the father and mother 70 (40.0) and 32(18.3) were post
graduated.

43
 In case of occupation of the father most of them 70(40.0) were worked as
coolie.
 Large proportion of the participants monthly income of the family 69(39.4)
were Rs 3504- 7007/month.
 Majority of the participant’s 143(81.7%) have previous knowledge
 There was a significant association between knowledge regarding food and
waterborne disease with selected socio demographic variables like sex and
education of the father

44
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24. Wikipedia. Wikipedia homepage [Internet][cited 2025 Apr 24]. Available

from: https://en.m.wikipedia.org
25. World Health Organization. Drinking-water: key facts [Internet]. Geneva:
WHO; [cited 2025 Apr 24]. Available from: https://www.who.int/news-
room/fact-sheet/detail/drinking-water
26. World Health Organization. WHO homepage [Internet]. Geneva: WHO;
[cited 2025 Apr 24]. Available from: http://www.who.int
27. Government of Kerala. Department of General Education - Kerala [Internet].
[cited 2025 Apr 24]. Available from: http://education.kerala.gov.in

28. National Geographic Society. Education [Internet]. Washington, D.C.:

National Geographic Society; [cited 2025 Apr 24]. Available from:
http://education.nationalgeographic.org

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29. Centers for Disease Control and Prevention. CDC homepage [Internet].
Atlanta (GA): CDC; [cited 2025 Apr 24]. Available from:
http://www.cdc.gov
30. Illinois Department of Public Health. IDPH homepage [Internet]. [cited 2025
Apr 24]. Available from: http://dph.illinois.gov
31. National Center for Biotechnology Information. PubMed Central (PMC)
homepage [Internet]. Bethesda (MD): NCBI; [cited 2025 Apr 24]. Available
from: http://pmc.ncbi.nlm.nih.govhttp://education.nationalgeographic.org

48
 ANNEXURES
ANNEXURE A

Blank data sheet

Sam ag se religi Fam Educat Educat Occupa Occupa Inco Previo

ple e x on ily ion of ion of tion of tion of me us
no Typ father mothe father mother knowle
e r dge
1
2
3
4
5
.
.
.
.
171
172
173
174
175

49
 ANNEXURES B

Investigator’s declaration / statement

I have accurately read out the participant information sheet to the potential
participant, and have to the best of my ability made sure that the participants
understands the procedures followed . I confirm that the participant was given an
opportunity to ask questions about the study and all the questions have been
answered correctly and to the best of my ability. I confirm that the individual has not
been coerced into giving consent, and the consent has been given freely and
voluntarily.

A copy of participant information sheet and informed consent has been provided to
the participant.

Name of the Invigilator: Lintu v babu

Signature of the Invigilator:

Place:

Date:

50
 ANNEXURES C

Participant Information Sheet

I Lintu.V.Babu, 1st year, MSc Nursing, Child Health Department. Doing a study on
“A STUDY TO ASSESS THE KNOWLEDGE REGARDING FOOD AND
WATERBORNE DISEASE AMONG UPPER PRIMARY SCHOOL CHILDREN
IN SELECTED SCHOOLS IN THIRUVANANTHAPURAM DISTRICT”. I will be
recording relevant history and physical parameters. Investigation reports will be
recorded.

I am inviting all the participants to participate in the study. The relevant

information regarding the study will be provided to you, and after due consideration,
you can decide whether to participate in this study or not. You are also free to discuss
about the study with anyone you feel comfortable. Any doubts or clarifications while
going through the information will be explained to you. Risks and its related to this
study if present should be explained.

Your participation in this study is entirely voluntary. You may stop

participating in the study at any time that you wish

The information collected for this study and during the publication of the
study your personal data will be kept confidential. The results of the study may be
published so that the health care professionals may learn from this study.

There will be no financial burden for you in this study.

I have obtained permission to conduct this study from Scientific Committee

and Ethics Committee of this institution.

If you have any questions you may ask them now or even after the study has
started. If you wish to ask questions later you may contact:

Name of the Investigator: Lintu. V. Babu

Signature of the Investigator:

Designation: 1ST Year MSc Nursing

Department: Child Health Nursing

Mobile number: 8086733547

Email id: [email protected]

Place:

Date:

51
 ANNEXURES D

Guardian Information Sheet

I Lintu. V. Babu, 1st year MSc Nursing, child health department. Doing a topic on “A
STUDY TO ASSESS THE KNOWLEDGE REGARDING FOOD AND
WATERBORNE DISEASE AMONG UPPER PRIMARY SCHOOL CHILDREN
IN SELECTED SCHOOLS OF THIRUVANANTHAPURAM DISTRICT”. I will be
examining your child and recording relevant history. Investigation reports will be
recorded.

I am inviting all the participants to participate in the study. The relevant information
regarding the study will be provided to you and your child, after due consideration,
you can decide whether your child can participate in this study or not. You are also
free to discuss about the study with anyone you feel comfortable. Any doubts or
clarifications while going through the information will be explained to you.

Your child's participation in this study is entirely voluntary.

The information collected for this study and during the publication of the study, your
child's personal data will be kept confidential. The results of the study may be
published so that the health care professionals may learn from this study.

There will be no financial burden for you and your child in this study.

I have obtained permission to conduct this study from Scientific Committee and
Ethics Committee of this institution.

If you have any questions you may ask them now or even after the study has started.
If you wish to ask questions later you may contact:

Name of the Investigator: Lintu. V. Babu

Signature of the Investigator:

Designation: 1ST Year MSc Nursing

Department: Child Health Nursing

Mobile number: 8086733547

Email id: [email protected]

Place:

Date:

52
 ANNEXURES E

Informed Consent of Guardian

I confirm that I have read, and it has been read to me, and understood the parent
information sheet for the above the study and had the opportunity to ask questions
and have been answered to my satisfaction.

I understood that my child’s participation in the study is voluntary and that I am free
to withdraw my child any time, without giving any reason, without my child’ s
medical or legal rights being affected.

I understood that the Institutional Human Ethics Committee and the regulatory
authorities will not need my permission to look at my child’s health records both in
respect of the current study and any further study that may be conducted in relation
to it even if my child withdraws from the study trail. I agree to this access. However I
understood that in this study my child’s personal data will not be revealed.

I agree not to restrict the use of any data or results that arise from the study provided
such a use is only for scientific purposes. I have no objection in publishing this
study.I understand that there is no financial burden in my child’s study.

After understanding all these, I consent voluntarily to participant my child in this

study.

Name of the Parent/Guardian:

Signature of the Parent /Guardian:

Name of the Impartial Witness :

Signature of the Impartial Witness:

Address of the Impartial Witness:

Place:

Date:

53
 ANNEXURES F

Informed Assent

I confirm that I have read, and it has been read to me, and understood the participant
information sheet for the above study and had the opportunity to ask questions and I
have been answered to my satisfaction.

I understood that my participation the study is voluntary and that I am free to

withdraw at any time, without giving any reason, without any medical or legal rights
being affected.

I understood that the Institutional Human Ethics Committee and the regulatory
authorities will not need my permission to look at my health records both in respect
of the current study and any further study that may be conducted in relation to it even
if I withdraw from the study. I agree to this access. However, I understood that in this
study my personal data will not revealed.

I agree not to restrict the use of any data or results that arise from the study provided
such a use is only for scientific purposes. I have no objection in publishing this study.

I understand that there is no financial burden for me in this study.

After understanding all these, consent voluntarily to participate in this study.

Name of the Participant:

Signature of the Participant:

Place:

Date:

54
ANNEXURE G

55
ANNEXURES H

56
ANNEXURES I

57
ANNEXURES J

58
ANNEXURES K

MASTER SHEET

59
60
61
62
 ANNEXURES L

TOOLS FOR DATA COLLECTION

Section-A

A. Demographic variables of students

Please put tick mark on the appropriate space [ ] provided

1. AGE (years)

10 []

11 []

12 []

13 []

2. Gender

Male []

Female []

3. Religion

Hindu []

Christian []

Muslim []

4. Education

5 []

6 []

7 []

63
5. Type of the family

Nuclear []

Joint []

6. Education of father

Primary []

Secondary []

Graduate []

Post graduate []

7. Education of mother

Primary []

Secondary []

Graduate []

Post graduated []

8. Occupation of father

Private sector []

Government []

Self-employed []

Coolie []

9. Occupation of mother

Private sector []

Government []

Self-employed []

Housewife []

64
 10. Monthly income (in rupees)

< 2000 []

2001-5000 []

5001-10,000 []

Above 10,000 []

11. previous knowledge through

Yes []

No []

SECTION B
Questionnaire for assessing knowledge regarding food and water borne disease
1. Which age group is high risk for foodborne illness

a. Elderly people []

b. Pre-school age []

c. Infant []

d. Toddler []

2. What are the sources of drinking water

a. Ground water []
b. River []
c. Lakes []
d. Rainwater []

3. What are the qualities of poor water

a. Colourless and clear []
b. Free from odour and smell []
c. Free of impurities []
d. All the above []

65
4. What is the importance of drinking water in daily life
a. prevent dehydration []
b. improve physical performance []
c. regulate body temperature []
d. all above []
5. Which of the following are the primary causes of water pollution
a. Plants []
b. animals []
c. human activities []
d. none of these []
6. What are the common food and water borne disease
a. cholera []
b. diarrhoea []
c. hepatitis A []
d. all above []
7. Which of the following is a characteristic of contaminated water
a. foul smell []
b. dark colour []
c. bad taste []
d. all the above []
8. Which of the following is the waste water
a. water trickling from a damaged taps []
b. water coming out of a shower []
c. water flowing in a river []
d. water coming from a laundry []
9. How are waterborne disease transmitted
a. through fesces []
b. through contaminated water []
c. through person to person []
d. all the above []

66
 10. How can food borne disease transmitted through
a. contaminated food []
b. contaminated hands []
c. contaminated water []
d. others []
11. What is the most common cause of water borne disease
a. contaminated water []
b. untreated water []
c. hardness of water []
d. all above []
12. Which type of food has more chance to get infection
a. vegetables []
b. fruits []
c. meat []
d. dairy products []
13. Which one of this food is likely to contain the most bacteria
a. salted food []
b. tinned food []

c. frozen raw meat []

d. cooked food in room temperature more than 6 hours []

14. What illness is caused by ingested food containing microbial toxin
a. food infection []
b. food poisoning []
c. pathogen overload []
d. food intoxication []
15. What are the causes of food borne disease
a. bacteria []
b. virus []
c. parasites []
d. all above []

67
16. How do you identify contaminated food
a. change in colour []

b. change in odour []
c. change in taste []
d. checking expiry date []
17. A food and waterborne illness outbreak said to be occur when
a. One or more people eating same food []
b. Two or more people eating same food []
c. Five or more people eating same food []
d. 10 or more people eating same food []
18. What are the signs and symptoms of food allergy
a. nausea/ vomiting []
b. diarrhea []
c. abdominal pain []
d. head ache []
19. Signs of dehydration include
a. dry skin []
b. tiredness []
c. slow heart rate []
d. all above []
20. Which of the food is good choice when you have diarrhea
a. bananas []
b. rice []
c. Maida products []
d. milk []
21. How to prevent dehydration followed by diarrhea
a. oral rehydration therapy (ORS) []
b. drinking plenty of water []
c. eating more fruits []
d. soft drinks []

68
 22. What are the risk factors related to food borne disease
a. improper cooling or heating []
b. poor hygiene []
c. dirty or contaminated utensils []
d. all above []
23. At what temperature of boiling water kills the bacteria
a. 100 degree Fahrenheit []
b. 60 degree Fahrenheit []
c. 120 degree Fahrenheit []
d. 160 degree Fahrenheit []
24. Methods used for treat water
a. boiling []
b. chlorination []
c. filtration []
d. all above []
25. The transfer of microorganism from one food to another is called
a. cross contamination []
b. time and temperature abuse []

c. poor personal hygiene []

d. food borne illness []

26. How to prevent cross contamination of food and water borne disease
a. water is properly disinfected []
b. Clean water storage container []
c. food is properly cooked []
d. all above []
27. If a cut on hands and you should eat food what should you do first
a. apply antiseptic []
b. wash the hand []
c. apply bandage on area []
d. put on a finger cot []

69
28. What should you always do before handling food
a. check the time []
b. wash your hand with soap and water []
c. put an apron []
d. doesn’t do anything []
29. What is the most important way to prevent a food borne illness from viruses
a. control time and temperature []
b. prevent cross contamination []
c. practice good personal hygiene []
d. all the above []
30. How can we prevent waterborne disease
a. consume treated or boiled water []
b. wash fruits and vegetables with hot water []
c. wash your hand with soap and water []
d. all above []

70
ANNEXURES M

71
72
73
74
75
76
77
 ANNEXURE N

LIST OF EXPERTS FOR CONTENT VALIDITY

1. Dr. Baburaj. S. M

Professor and Head of the Department

Department of Pediatrics

Dr. SMCSI Medical College and Hospital

Karakonam,

Thiruvananthapuram.

2. Mrs. Kavitha. C. V, MSc (N)

Principal and Head of the Department

Department of Child Health Nursing

Swaraswathy College of Nursing

Karode,

Thiruvananthapuram

3. Dr. Simi Shane

Professor

Department of child health nursing

Institute of nursing science and research

Thalasseri.

78
4. Mrs. Lija c. v.

Associate Professor

Department of Child Health Nursing

Ruckmoni College of Nursing,

Ponambi, Vellarada.

Thiruvananthapuram

5. Mrs. Shibi

Associate Professor

Department of Child Health Nursing

Saraswathy College of Nursing

Karode,

Thiruvananthapuram

79
 ANNEXURES O

PERMISSION LETTERS

80
81
ANNEXURES P

82
 ANNEXURES Q

APPROVAL LETTER FROM ETHICAL COMMITTEE

83
84
ANNEXURE R

PLAGIARISM

85
 ANNEXURES S

STUDY COMPLITATION CERTIFICATE FROM ETHICAL COMMITTEE

86