RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (in block letters) / MEENA K.I YEAR M. Sc. NURSING
INDIRA NURSING COLLEGE
FALNIR
MANGALORE - 575002
2. / Name of the Institution / INDIRA NURSING COLLEGE
FALNIR
MANGALORE - 575002
3. / Course of Study and Subject / M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / Date of Admission to the Course / 14.7.2008
5. / Title of the study
A STUDY TO ASSESS THE KNOWLEDGE ON PRACTICE REGARDING PREVENTION OF VAGINAL CANDIDIASIS AMONG ADOLESCENTS IN A SELECTED HOSTEL AT MANGALORE WITH A VIEW TO PREPARE AN INFORMATION LEAFLET
6. / Brief resume of the intended work
6.1 The need for the study
Children are the mirror of a nation. They are our future and most precious resources. The quality of tomorrow’s world and perhaps even its survival will be determined by the wellbeing, safety, physical and intellectual development of children today. Achieving independence within the family is an important goal of adolescence. Adolescents are information-seekers mostly regarding health and beauty because they are often in a state of rapid physical growth, mental turmoil and indecision about future goals. During adolescence important physiological and emotional changes occur to which greater attention is now being paid by midwives as well as gynaecologists. Being a mother is one of the major intentions as well as responsibility of a girl. So, to have an effective motherhood she should take care of her reproductive organs.1
In a healthy female the fallopian tubes, the cavity of the uterus and the upper third of cervical canal are free of micro-organisms. The lower third of the cervical canal always contains micro-organisms, especially in vagina. In a healthy female Doderlines bacillus is the only organism found in upper two-thirds of the vagina but in the neighbourhood of the vulva both saprophytic and parasitic organisms can usually be demonstrated. The vaginal acidity is due to lactic acid which may be present as much as 0-6%. The pH value is 5-7 in the newborn and reaches 6-8 in children and falls to four at puberty. It is important to note that bacteria and fungus will harvest in low pH value.2
A descriptive study was conducted in 2007 to assess the epidemiology of vaginal candidiasis among women in a selected hospital at Punjab. The data was collected from randomly selected 350 women between 16-45 years. Out of them 70.4% having candidiasis were adolescents. The study revealed that most adolescents got vaginal candidiasis following menstruation.3
Vaginal candidiasis remains one of the most common infections of the lower genital tract, usually caused by Candida albicans. WHO states that around 75% of women in the world come across vaginal candidiasis at least once in their lifetime. Naturally women aged 15 – 55 years harbour Candida albicans in the vagina. Most have no symptoms and is harmless to them. The overgrowth of this creates problems. This overgrowth is hastened by
low immune status; changing lifestyle patterns such as wearing tight pants/jeans; using of one napkin for a prolonged time during menstruation; using of hi-fi deodorant chemicals; using unclean mugs and buckets for perineal wash; using of wet panties; wearing polyester clothing during summer etc. The incidence rate of candidiasis among adolescents is increasing day by day.4
A descriptive study was conducted on incidence of vaginal candidiasis among university students at Canada. Sample was selected through random sampling. Data were obtained through questionnaire and interview method. The results indicated that more than 50% of girls had come across vaginal candidiasis and undergone irrelevant treatment.5
Common conditions affecting the vulva are missed because of atypical presentations and information. The most common misdiagnosis is candidiasis. Vaginitis is one of the most common complaints in clinical medicine and vaginal candidiasis is one of the most common causes. The result is that most adolescent girls and adult females and their caregivers mistakenly assume that an itchy, burning vulval irritation, whether it is caused by a dermatitis, bacterial vaginitis or UTI caused by yeast. Most of the clients do not know to consult the appropriate caregivers. All the symptoms, especially painful fissuring and itching, start first. Painful fissuring is found classically periclitoraly, in the in-labial sulcus and in the small folds around the introitus.6
The investigator in her clinical experience has witnessed most of the adolescent girls visiting gynaecologists in the outpatient department with itching problems which results in sleeping disorders, lack of attention in their studies. Investigator, in her live experience has come across vaginal candidiasis during her pre-university course and saw a majority of classmates had the same problem that was severe in those who stayed in the hostel. The late adolescent period is the major period in girl’s life. So proper knowledge needs to be instilled in the adolescent girls. This has motivated the investigator to take up this study with in a view to prepare an information leaflet on prevention of vaginal candidiasis.
6.2 Review of literature
A descriptive study was conducted at a selected general hospital at Pune in 2005 to study the epidemiology, aetiology and rate of incidence of vaginal yeast infection. A total of 500 patients attending gynaecological OPD were tested for the presence of yeast using vaginal swabs from the vagina. Out of 500 studied cases 59% were adolescent girls, 34% were diabetic women, 4% were using contraceptives, 2% were cancer patients and 1% were hysterectomy clients. Candida albicans was the highest among adolescent girls (p< 0.001) compared with other age groups. So the study revealed that attention must be paid to the profound increase in vaginal yeast infection among patients with different predisposing factors.7
A cross-sectional study was conducted at Iilala Municipal Hospital at Dar-Es-Salaam, Tanzania in 2003 to determine the prevalence and risk factors for vaginal candidiasis among 464 females seeking primary health care. Data was collected through vaginal smear analysis and interview schedule. Among the subjects, 38.1% were adolescent girls with curdy white discharge, 14.7% with genital ulcers, and 58.6% with genital pruritus. This study revealed that high prevalence of vaginal candidiasis among adolescent girls with white discharge and pruritus should be considered.8
An exploratory study was conducted in south Asia in 2000 to study the perceptions and experiences of 50 females regarding vaginal thrush. Data was collected through interview method. The result of this study indicated that majority females felt that white discharge was coming out since the bones were washing out and there lies a significant major disease. Fifty percent of them did not undergo treatment, and the only treatment was yoghurt. The older adults had the attack of four times in their life time. The study showed that more than 50% had the belief that vaginal thrush may cause great misery and embrassement.9
A cross-sectional survey study was conducted at University of Michigan in 1992-1993 to determine the epidemiology of vulvovaginal candidiasis among university students. Sample was randomly selected from all female students. Data was collected through interview method and structured questionnaire. A clinical diagnosis of vulvovaginal candidiasis was reported by 37.5% of respondents. The majority of ages who came across
vaginal candidiasis were late adolescents. In proportional hazards model for age at first diagnosis, vulvo-vaginal candidiasis was associated with initiation of sexual activity (Rate ratio, (RR) =2.9;95% confidence interval (CI)=2.2, 38%),oral contraceptive use (RR=1.7, CI=1.4), white race (RR=3.1, CI=1.7), Black race (RR=5.9, CI=3.9). The study revealed that majority of cases were late adolescent girls and needed special attention.10
A descriptive study was conducted at University of Jose, Nigeria in 1982 to study the prevalence rate of vaginalcandidiasis among the university students. The sample size was 150 students selected by random sampling technique. Data was collected through structured questionnaire and interview schedule. Results showed that mean percentage scores for having candidiasis was higher (75.2%) in undergraduate girls than postgraduate girls (24.8%).11
6.3 Statement of the problem
A study to assess the knowledge on practice regarding prevention of vaginal candidiasis among adolescents in a selected hostel at Mangalore with a view to prepare an information leaflet.
6.4 Objectives of the study
1. To assess the knowledge on practice regarding prevention of vaginal candidiasis among adolescents using a structured questionnaire.
2. To find out association between knowledge on practice regarding prevention of vaginal candidiasis and selected demographic variables.
3. To prepare an information leaflet on prevention of vaginal candidiasis for adolescents residing in hostel.
6.5 Operational definitions
1. Knowledge on practice: In this study the knowledge on practice refers to information regarding the routines followed by adolescents in order to prevent infection to genital organs assessed from the response to the structured questionnaire
2. Vaginal candidiasis: In this study vaginal candidiasis is the fungal infection of vagina caused by Candida albicans with odour, thick, white or yellow discharge
that might be accompanied by itching, burning and swelling which make walking and urinating very painful.
3. Adolescents: In this study adolescents are the girls in the age group of 15-18 years residing in the selected hostel.
4. Information leaflet: In this study it refers to written material on vaginal candidiasis, its meaning, incidence, causes, treatment and prevention through systematic collection and analysis of data and organisation of content based on the knowledge on practice detected towards the prevention of vaginal candidiasis.
6.6 Assumptions
1. Adolescents residing in hostels will have some knowledge regarding prevention of vaginal candidiasis.
2. Adolescents will open up honestly to questions related to knowledge on practice regarding prevention of candidiasis.
3. Adolescents will have interest to know about the different practices for prevention of vaginal candidiasis.
4. Information leaflet will impart knowledge on practice regarding prevention of vaginal candidiasis.
6.7 Hypotheses
The hypothesis will be tested at 0.05 level of significance.
H1: There will be significant association between knowledge on practice and selected demographic variables of adolescents regarding the prevention of vaginal candidiasis.
6.8 Delimitations
The study is delimited to:
- Adolescents residing in the selected hostel.
- Adolescents who can be communicated in English
- Adolescents aged 15-18 years.
7. / Material and methods
7.1 Source of data
Data will be collected from adolescents those who are residing in the hostel.
7.1.1 Research design
Descriptive design will be used for the study.
7.1.2 Setting
The study will be conducted in the selected hostel in Mangalore were adolescents are residing. The hostel would comprise more than 100 inmates. In each room there would be four beds and dormitories. The hostel has six common bathrooms for each dormitory. The hostel is three kilometres away from the investigator’s institution.
7.1.3 Population
The population in this study would comprise of all the adolescents in the age group of 15-18 years residing in the selected hostel at Mangalore during the data collection period.
7.2 Methods of data collection
7.2.1 Sampling procedure
Purposive sampling technique will be used for this study.
7.2.2 Sample size
In this study sample size consists of 60 adolescents those who are residing in hostel.
7.2.3 Inclusion criteria for sampling
· Adolescents who are willing to participate in the study.
· Adolescents who are in the age group of 15-18 years and residing in the selected hostel.
· Adolescents who are present during the data collection period.
7.2.4 Exclusion criteria for sampling
· Adolescents who are not willing to participate in the study.
· Adolescents who have already received training on prevention of vaginal candidiasis.
· Adolescents with skin infections.
7.2.5 Instruments intended to be used
· Section A: Demographic proforma
· Section B: Structured questionnaire on knowledge on practice regarding prevention of vaginal candidiasis.
7.2.6 Data collection method
· Prior permission will be obtained from selected hostel authorities.
· Purpose and need for study will be explained to adolescents who are residing in the hostel and written consent will be taken.
· The sample will be selected through purposive sampling technique.
· Knowledge on practice regarding prevention of vaginal candidiasis will be assessed through structured questionnaire.
7.2.7 Data analysis plan
The data will be analysed using both descriptive (mean, median, mean percentage and standard deviation) and inferential (chi-square test) statistics on the basis of the objectives and hypothesis of the study.
7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.
Yes. Study requires intervention to be conducted on humans.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes. Ethical clearance will be obtained from the ethical committee of the institution/college of nursing.
8. / References
1. Marlow DR, Redding BA. Textbook of paediatric nursing; 2002.
2. Hawkins J. Shaw’s textbook of gynaecology. J and A Churchill; 1992.
3. Gill JN, Aggarwal P. An epidemiological study of vaginal candidiasis in women of childbearing age. Indian Journal of Medical Microbiology 2007;25:175-6.
4. Jack DS. Vulvovaginitis .Dermatologic clinics 1998 Oct;16:124
5. Ezoke ACJ. The study on incidence of vaginal candidiasis among university students. Indian Journal Dermatol Venearol Leprol 1985;51:332-4.
6. Paradise JE, Campose IM, Friedman HM. Vulvovaginitis in pre-menarchal girls. Journal of Paediatrics 2001;14:193
7. Shafik AS, Hassan MY, Eldin A. The study non epidemiology, aetiology and rate of incidence of vaginal infection. JASMR 2007;2(2):115-7.
8. Namkinga LA. The cross-sectional study on prevalence and risk factors for vaginal candidiasis among female seeking primary health care. East African Medical Journal. 2005;82(3):139-44.
9. Chappel A. The exploratory study on perception and experience of females regarding vaginal candidiasis. Health Education Research and Theory and Practice 2001;16(1):9-19.
10. Geiger MA, Foxmann B, Gillepk WB. The cross-sectional survey to determine the epidemiology of vulvovaginal candidiasis among university students. American Journal of Public Health 1995;85:1146-8.
11. Oghonnal CIC, Kozarz W. The study on prevalence rate of vaginal candidiasis. Journal Mycopathologica 1984;99(3):135-41.
9