الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Burkitt lymphoma is a cancer of mature B-lymphocytes. It is a form of non-Hodgkin lymphoma, which is a type of cancer that originates in cells of the immune system, called lymphocytes. Mothers of children with cancer attributed meaning to the care experience when trying to cope with the emotional, social, physical, financial, family-related, information and moral overload (Hassan et al., 2020).
Subjects and Methods:
Research design:
A descriptive correlative design was used to achieve the aim of the current study.
Study Setting:
This study was conducted at Borg Al-Arab university hospital (Out-patients clinic in the pediatric oncology center) because 60 cases of children with Burkitt’s lymphoma and their mothers come to follow up, to take orders for chemotherapy sessions and seek counseling for any health problem in other special clinics.
The sample was collected from Bourg Al-Arab university hospital paediatric oncology centre which is the only hospital receive paediatric oncology cases in Alexandria and it offers health service for cancer children for 4 provinces (Alexandria, Beheira, Kafr El-Sheikh, Matrouh).
Bourg Al-Arab university hospital received 750 cases of Hodgkin and non-Hodgkin lymphoma children in the time period between 2018 to 2022 according to statistical records in Bourg Al-Arab university hospital.
The sample was collected from 60 cases of Burkitt’s lymphoma whose came to outpatient clinic in 6 months.
That was Bourg Al-Arab university hospital permitted to enter according to the location policy due to the Corona disease.
Subject:
The study was subjects included 60 of mothers and their children with Burkitt’s lymphoma aged from 6-18 years old.
Sampling type:
A purposive sample was used.
Size of study subjects:
This study included 60 cases of children with Burkitt’s lymphoma representing the total participant from the previously mentioned settings, under the following criteria
The inclusion criteria
Age of children from 6year to 18 year old.
Children receive chemotherapy in hospital.
Mothers and children consent to participate in our study.
The sample size was estimated using the following equation
Sample size:
where n is the sample size, Z is the statistic corresponding to level of confidence, P is expected prevalence and d is precision, for estimating sample size in descriptive studies where Burkitt’s Lymphoma prevalence was 10 %. The recruited number was 60 mothers with children diagnosed with Burkitt’s Lymphoma .
Thompson, S.K. (2012). Sampling. Third Edition. Hoboken, NJ: John Wiley & Sons, Inc.
Tools of Data Collection:
The data in this study were collected by using two tools:
First tool:
A Structured interview questionnaire for mothers and their children with Burkitt’s Lymphoma was prepared by the investigator based on reviewing the recent related literature (Kanbar, et al. 2019; Fioretti, & Smorti, 2016; Bemis, et al., 2015), and written in the simple Arabic language that included six parts.
Part I:
A) Socio-demographic characteristics of mothers which include (age, marital status, level of education, residence, occupation, family income) Questions No 1:6.
B) Socio-demographic characteristics of a child with Burkitt’s lymphoma which include (age, sex, educational grade, and child rank) Questions No 7:10.
Part II:
Assessment of family health status for children with Burkitt’s Lymphoma through:
a. Genetic diseases: (If have genetic diseases, types of genetic diseases) Questions No 11:12.
b. Medical history :(family members with chronic illness, degree of kinship, chronic illness, infectious diseases, current medical history) Questions No 13:17.
c. Medical records: to assess the health status of children with Burkitt’s Lymphoma, it consisted of 9 items including; complaints of Burkitt’s lymphoma, stage of malignancy, chemotherapy protocol, number of days of chemotherapy cycle, number of radiotherapy sessions, computed tomographic findings, chest X-ray findings, physical examination findings, and clinical prognosis. staging (chemotherapy protocol) CT scan, PET scan, bone marrow biopsy, blood tests, ultrasound. Question No 18(Englund et al., 2018).
Part III:
Assessment of a child with Burkitt’s lymphoma health needs: (physical needs, social needs, financial needs, psychological needs) Questions No 19:22
Part IV:
Assessment of health problems of a child with Burkitt’s lymphoma: (mass size and appearance, tumour metastasis, digestive symptoms, skin side effects, pain side effects, chemotherapy, and radiotherapy side effects) Questions No 23:29
Part V:
Mothers’ knowledge about Burkitt’s lymphoma :(definition, types, staging, tests and analysis, predisposing factors, signs and symptoms, diagnosis, treatment options and plans, side effect and complications) Questions No 30:39
Part VI:
Mother’s attitude (which mean management action) regarding the management of their children with Burkitt’s Lymphoma which includes (shock, confusion, anxiety, and guilty)Question No.40-42
Tool II: Assessment of the mother’s practices towards the child with Burkitt’s lymphoma according to his needs and problems: (general activities, personal hygiene, healthy nutrition, mouth health, rest and sleep, exercises, psychological support, protection from injury and infection, caring of the surrounding environment, follow up, bleeding protection, overcoming the symptoms of anemia, stress, immune deficiency, pain) Question No 1:15.
Tools validity:
Testing validity of the proposed tools by Content validity was conducted to determine the appropriateness & relevance of each item to be included in the questionnaire. After the construction of data collection tools (questionnaire sheets), the content validity of the tools was judged by five jury members having experience in nursing community health Faculty of Nursing, Ain Shams University. Based on their recommendation corrections, addition, and/or omission of some items were done.
Tool’s reliability:
Testing the reliability of the proposed tools was done with Cronbach’s Alpha test. The result was:
Data collection tools No. of items Cronbach’s Alpha
Reliability of Health needs 20 .875
Reliability of Health problems 50 .624
Reliability of knowledge 52 .646
Reliability of knowledge 85 .911
Reliability of attitude 16 .783
II. Operational Design:
The operational design for this study included three phases namely: the preparatory phase, the pilot study, and fieldwork.
A-Preparatory phase:
During this phase reviewed the previous and current available related literature to be acquainted with the subject. Also, local and international related literature and knowledge aspects of the study using books, and articles. Magazines and the internet to modify tools for data collection for preparation of tools and the theoretical part.
B-Pilot study:
- A Pilot study conducted on 10% of the total number of mothers with children investigated and ensured the feasibility and applicability of the study also the clarity and time needed for the tools to be filled in.
- It took around 20-30 minutes to fill in the sheets. Those pilot study respondents were included in the main study sample as no modifications were done.
C- Fieldwork:
The fieldwork of the study extended through 3 months.
Data collection was carried out in the period from the beginning of May 2022 and was completed by the end of August 2022. After securing the official approval for conducting the study.
The investigator met the director of the outpatient clinic to determine a suitable time for data collection and seek their support.
The investigator introduced herself to Mothers and children with Burkitt’s Lymphoma and collected data two days per week, which are (Tuesday, Wednesday, and Thursday) from 99.00 am to 3.00 pm.
The investigator distributed the tools to participants and asked them to fill after clarifying the aim of the study and its implication.
Data was collected by using the study tool by the investigator; clarifications were given whenever it was needed with reassurance about the confidentiality of any obtained information.
The investigator checked each filled questionnaire to ensure its completeness.
Ethical consideration:
Before the actual work of the research study, ethical approval was obtained from the scientific research ethical committee at the Faculty of Nursing Ain Shams University In addition, written consent was obtained from Mothers and children with Burkitt’s Lymphoma to participate in the study after explaining the aim of the study, Privacy and the confidentiality was assured. Also, Ethics, values, culture, and beliefs were respected and the subjects were informed about their right to withdraw at any time without giving any reason and that the collected data will be kept confidential.
III. Administrative Design:
Before starting the study, official and formal letters were issued from the Faculty of Nursing, Ain Shams University to the Directors of the study settings, explaining the aim of the work, and the expected benefits. Ensuring the confidentiality of the information obtained. Individual oral consent was also obtained from each participant in the study. Ethical approval was obtained from the scientific research ethical committee at the Faculty of Nursing Ain Shams University In addition, written consent was obtained from Mothers and children with Burkitt’s Lymphoma to participate in the study
IV. Statistical Design:
Descriptive statistics were used to summarize the demographic characteristics of the patients. Data were revised, coded, analyzed, and tabulated using number and percentage distribution and carried out using the Statistical Package for Social Sciences (SPSS) version 26. Appropriate statistical methods were applied (percentage, mean and standard deviation, independent t-test, F-test, and Pearson correlation). Regarding P value, it was considered that: non-significant (NS) if P> 0.05, Significant (S) if P< 0.05, Highly Significant (HS) if P< 0.01.
Results:
The findings of the current study can be summarized as:
• According to the demographic characteristics of the mothers, regarding age, it shows that 60% of them their age ranged from 25 to 34 years. The mothers’ average age was 29.82±6.152, the marital status analysis shows that 88.3% of them were married. Regarding education, 45% of mothers reported being secondary educated, and 51.7% their residence was urban area. Regarding the mothers’ job it shows that 23.3% of them work and 71.4% of them worked in nongovernmental organization. Regarding their income 85% of mothers reported not enough income.
• According to the demographic characteristics of the children; regarding age it shows that 66.7% of them their age ranged from 6 to less than 9 years and the mean of age was (8.43±3.572) years, 70% of them were male. Regarding educational level 50% of them not enrolled. In relation to birth order, it was found that 58.3% of them were first child.
• According to the present family history of children with Burkitt’s Lymphoma, it shows that 50% of them had transmission of genetic diseases and 51.7% of the children had present family health problems and 32.3% of the kinship were siblings. Also, it shows that 48.4% of their families infected with COVID 19.
• According to medical records 68.3 % of children had abdominal pain, 78.4 %of them had stage II of malignancy, and 21.7 % of them their chemotherapy protocol was CYM II. Regarding number of days of chemotherapy cycle 76.6 % of them had 4-5 numbers and 33.3% of them had solid abdominal mass as a result of computed tomographic findings. Additionally, 78.3 % had normal chromosome account and 38.3 % of children had Bulky mass in abdomen and 70% of them their mass size decreased.
• According to health needs 63.3 of children not achieved health needs and 36.7% of them achieved health needs.
• According to health problems 97.7% of children did not have health problems and 3.3% of them had health problems.
• According to total knowledge about mothers’ management for their children with Burkitt’s lymphoma Figure 4 explains that 91.7% of mothers had unsatisfactory knowledge while 8.3% of them had satisfactory knowledge.
• According to total reported practice regarding mothers’ management for their children with Burkitt’s lymphoma (83.3% and 78.3%) of them had satisfactory practice about child health needs and child health problems. Additionally, it shows that 81.7% of mother had total satisfactory practice.
• According to the mothers’ attitude regarding management for their children with Burkitt’s lymphoma, it shows that 91.7% of them had negative attitude toward the disease of their children meanwhile 8.3% of them had negative attitude toward the disease of their children.
• According to statistical relation between Mothers Total Knowledge, Total Practices and their Total Attitude Related to management for their children with that highly positive correlation between mothers’ practice and mothers’ knowledge regarding management for their children with Burkitt’s lymphoma whereas P value < 0.001. Meanwhile it shows that there was no significant correlation between mothers’ attitude and mothers’ knowledge whereas P value > 0.05.
• According to relation between mothers’ demographic characteristics and knowledge related to management for their children with Burkitt’s lymphoma table (15) reveals that higher educated mothers had highest mean (15.63±6.80) of knowledge with statistically significant relation, whereas p value ≤ 0.05. Comparing to no working mothers it shows that working mothers had high score of knowledge (13.43±6.97) with statistically significant relation whereas p value ≤ 0.05. Also, it reveals that mothers with governmental work had highest mean of knowledge (19.50±2.12) with statistically significant relation, whereas p value ≤ 0.05. Additionally, it reveals that mothers with enough income had highest mean of knowledge (10.98±6.27) with statistically significant relation, whereas p value ≤ 0.05.
• According to relation between mothers’ demographic characteristics and practice related to management for their children with Burkitt’s lymphoma table (16) reveals that mothers aged from 35 to 44 years had highest mean (212.23±10.35) of practice with highly statistically significant relation, whereas p value ≤ 0.001. Also, higher educated mothers had highest mean (216.38±11.03) of practice with statistically significant relation, whereas p value ≤ 0.05.
• According to relation between mothers’ demographic characteristics and attitude related to management for their children with Burkitt’s lymphoma table 17 reveals that statistically insignificant relation among mothers’ demographic characteristics and their attitude, whereas p value >0.05.