A COMPARATIVE STUDY to Assess the Effectivness of Structured Teaching Programme On
A COMPARATIVE STUDY to assess the effectivness of structured teaching programme on
chikungunya among young adults
in selected urban and rural
areas of raichur
Proforma for registration of subjects for
dissertation
rajkumari gunisana devi
navodaya college of nursing
raichur
November - 2007
Rajiv Gandhi university of health sciences
Bangalore, Karnataka
Proforma for registration of subjects for dissertation
1. Name if the candidate :rajkumari gunisana devi
M.Sc Nursing 1st Year
Navodaya College of Nursing
P.B. No. 26, Mantralayam Road,
Raichur – 584103
2. Name of the Institution:Navodaya College of Nursing
3. Course of the study :M.Sc Nursing 1st Year
and subject Community Health Nursing
4. Date of Admission to :25/05/2007
the course
5. Title of the Topic
A COMPARATIVE STUDY to assess the effectivness of structured teaching programme on
chikungunya among young adults
in selected urban and rural
areas of raichur
6. Brief Resume of the Intended Work:-
6.1. Need for Study:-
"Infectious disease will last as long as humanity itself"
A person is said to be healthy when he or she is completely fit with physically, mentally, spiritually well adjusted with their environment and also if there is no complaints or absence of any discomfort1
There are various factors which affects man's health. A man is prone to get diseases through different mode of transmission such as water borne, air borne, vector borne and formite borne diseases. Among these, the vector borne disease are the one which are transmitted by insects from one person to another person thereby making the epidemic to be originated.1
Communicable disease is defined as an illness due to specific infectious agent or its toxic products which are capable of transmitted by directly or indirectly from one person to other person, animal to other animal or from the environment (i.e. through air, dust, soil, water, food etc.) to man or animal.2
In infectious diseases epidemiology, vector is defined as an arthropod or any living career that transports an infectious agent to a susceptible agent. Some of the vectors borne diseases are malaria, microfilaria, plague, encephalitis, chikungunya fever and schistormiasis etc.2
Chikungunya is a virus disease caused by alpha virus which belongs to the family Togaviridae. The disease was first reported from Tanzania in 1953. Between 1960 and 1980 the virus isolated from numerous countries in Africa and many areas of Asia. The first documented Asian outbreak was in Bangkok in 1958. In India, it was first reported from Calculta in the year 1963 following that Madras in 1964, Maharashtra in 1973 and Andhra Pradesh and Karnataka in 2005.3
An updated articles shows total number of cases reported in our country with chikungunya stands 13, 84,143 out of which Karnataka alone witnesses 7, 62,020 including 26 districts affected. Some of the affected districts are, Gulbarga (68,349), Tumkur (42430), Bidar (42372), Devangere (36686), Kolar (33389), Bagalkot (26179), Raichur (25854), Gadag (25521), Belgaum (22859), Shimoga (20287), Kodagu (4), Dakshin Kannada (9), and Udupi (16) cases. For above 60% of young adults are affected by CHIKV.4
The incubation period of chikungunya virus ranges from 1-12 days. The signs and symptims of chikungunya infection are fever with 102.20F, maculopapular rash usually involving the limbs and trunk, arthralgia or arthritis affecting multiples joints which can be debilitating. There can also be headache, conjunctival infections and slight photophobia, sometimes nausea and vomiting. The viral diagnostic (culture, serological tests and polymerase chain reaction tests) can be used to confirm the chikungunya infection.5
Chloroquine 250mg/day and aspirin are used to treat arthritis lead by chikungunya infection. Homeopathy treatment is also available and is effective and can cure its many symptoms. Ginger chutney, neem chutney, coriander leaves chutney are effective medicine, ganji has to be taken either with butter milk or milk;
the joints can be massaged with pure camphor combined with coconut oil at least thrice each time for 2-3 minutes is necessary. The complications of the chikungunya infection includes meningitis, encephalitis etc.3
Prevention can be done by protecting individual themselves from bites of mosquitoes and it is possible by controlling proliferation of mosquitoes in stagnant water, properly covering all water tanks, people should wear long sleeves shirts and long pants, use of mosquito spray DDT, pyrethrum etc to help to kill adult mosquito and also use of mosquito repellents (coils, cream etc.)3
An article shows that during the rainy season there are at least 2 reported chikungunya outbreaks which indicate that it is a re-emerging disease in Thailand. The outbreak occurs in rural villages and all three larval indices (BI,HI, CI) were very high. The possible vectors in these outbreaks were Aedes aegypti and Aedes albopictus. In the Nong Khai outbreak, blood specimens were taken at 3-5th day after onset and therefore the proportion of positive results was low. IgM antibody of follow up cases declined within 3 months, villages from all three areas with outbreaks metioned that they had no previous experience of this disease. This suggests that chikungunya infection is a re-emerging disease.6
Chikungunya virus infections are affected more in south India. Therefore it becomes very important and necessary to focus to conduct the knowledge assessment of chikungunya virus which will help the people to make aware of this diesase condition. The medical care staffs from the government and other private volunteered organization were performing the campaign in the community area for vector control activities.7
There have been reports of large scale outbreak of chikungunya virus in south India in 2006. At least 80000 people in Raichur, Gulbarga, Tumkur, Bidar, Bellary, Chitradurga, Devangere, Kolar and Bijapur district in Karnataka state are known to have affected since 2005. After flood and heavy rain in Rajasthan nearly 1000 cases were detected in Rajsamond, Bhilwara and Udaipur districts in 2006.3
Majority of the people in the areas of Raichur are found that this chikungunya virus infection is knew disease to them and knowledge pertained by them are very less regarding this particular disease condition. Researcher, found that the drainage available in many parts of Raichur are open type so it makes the favourable places to lay eggs by mosquitoes which are taking a major role in spreading this type of diseases. It is found that the environmental condition in the rural areas are very poor and the people living in those areas are more prone to get infection not only CHIK V but also from many other vector borne diseases. So therefore the researcher felt to conduct a teaching programme on chikungunya to make people to know regarding it which will make them to know how to prevent and its management. Because of the pollution, habits or life-styles even in the urban areas, it is also found poor environmental sanitation. So, finally the researcher felt of conducting a comparative study between urban and rural areas to assess the effectiveness of structured teaching programme on chikungunya.
An article says there is no specific treatment for chikungunya fever. Treatment is symptomatic and there is no vaccine currently available. Prevention is the only best method to control chikungunya7
The study is selected to conduct among young adults in selected urban and rural areas of Raichur. Young adults are more energetic, will pay more attention and interest in learning new knowledge or ideas; they are good learner and can share the
new information and teach to their family members and community people. The programme conducted will make them to know more about chikungunya virus and voluntarily they will participate actively in the prevention, control and management of chikungunya virus. Young adults are the pillars of the society, so the researcher felt strongly that conducting structured teaching programme on them will be more effective than conducting to others. Moreover chikungunya is an existing and re-emerging health problem. And the study conducted so far on this disease are very few, so the researcher felt the need to study on chikungunya will help to gain more knowledge about the disease condition and therefore making community people to take early precautions to reduce morbidity rate.
6.2 Review of Literature:
A review of literature is an important source for development of research project.8
This helps to find out the methods and aspects that must be included in the pertinent data, which in-turn results in new ideas which need to be included in the present study. It helps the investigator to find the comparative data that could be used for supporting present findings and drawing conclusions.9
The following literature is related to the general information and knowledge regarding chikungunya.
An article published on chikungunya epidemic by Mahatma Gandhi Institute of Medical Sciences, Sevagram states that the chikungunya virus is transmitted to human by the bites of mosquito species Aedes aegyptic and Aedes albopectin. The
researcher speculates that mutation of the virus, absence of herd immunity, lack of vector control and globalization of trade and travel contributed to the resurgence of infection. Lastly article suggests that mosquito control is the only appropriate strategy to control the epidemic and per cent future outbreaks.10
An article published on knowledge on chikungunya by Department of Medicine, TN Medical College, Mumbai states that like malaria and dengue, chikungunya infection has also become in India especially in central and south India which shows the symptoms of fever, chills, headache, nausea, vomiting, joint pain with or without swelling, low back pain etc. And therefore suggesting to the travellers visiting endemic areas should be very careful and take precautions to see that they are not bitten by mosquitoes.11
A study conducted in Service de Gynaeco-Obstetrique, Saint Pierre, Reunion Islands shows that since the onset of the chikungunya outbreak, the vertical maternal fetal transmission of the CHIK virus is observed in mosquitoes Report had been made for the first three cases of maternal fetal transmission of CHIK V before 16 weeks gestational age. Investigations are made by +ve findings for specific anti CHIK IgM and have confirmed maternal infection occurred at 12 weeks and 4 days, 15 weeks and 5 days and 15 weeks. Amniocentesis preceded rupture of membranes in all the three cases and fetal deaths were subsequently observed.12
A descriptive study was conducted for a seroprevalence and distribution of Togaviridae among adults from rural villages in Africa. Serum samples 256 adults were tested for the presence of chikungunya and 46.5% were found CHIK
seropositive. Study shows that CHIK seroprevalence rates were lower among individuals living in dwelling with grass or thatched roofs versus corrugated tin and in villages isolated from urban centres.13
An article from National Institute of Virology Pune shows that chikungunya fever is reported in India after 32 years and the cause of the fever is confirmed by Immunoglobin M antibodies and virus isolation. The institute conducted phylogenic analysis based on partial sequences of NS4 and E1 genes showed that CHIK infection was caused by Asian genotype in the previous outbreak whereas the current isolates were by African genotype.14
An article published on development of simple indirect enzyme linked Immunosorbent assay for Immunoglobin M antibody in serum from patients following the outbreak of chikungunya. An ELISA for the detection of anti chikungunya virus Immunoglobin M was prepared and standardized using only reagents which are commercially available. There were 90% agreements between haeme-agglutination inhibition test and IgM ELISA in the diagnosis of acute chikungunya virus.15
6.3 Statement of the Problem:
“A Comparative Study to Assess the Effectiveness
of Structured Teaching Programme on
Chikungunya among Young Adults
in Selected Urban and Rural
Areas of Raichur”
6.4 Objectives of the Study:
1. To assess the knowledge of adults regarding chikungunya in urban and rural areas.
2. To evaluate the effectiveness of structured teaching programme on chikungunya in both urban and rural areas.
3. To compare the post test knowledge scores of young adults between urban and rural areas.
4. To find the relationship between the knowledge of the young adults regarding chikungunya with the selected socio demographic variables in selected urban and rural areas.
6.5 Hypotheses:
H1- There will be a significant difference between the knowledge of young adults regarding chikungunya is selected urban and rural areas.
H2: There will be a significant difference between pretest and post test between the young adults regarding chikungunya in selected urban and rural areas.
H3: There will be association between the knowledge of young adults regarding chikungunya with selected socio-demographic variables (age, religion, socio-economic status, types of family, education background, sources of water, types of drainage system, sources of disposal of wastes, sources of information etc.) in selected urban and rural areas.
6.6 Operational Definitions:
Effectiveness: - It is the extent to which the knowledge of young adults improved with regard to chikungunya after the implementation of structured teaching programme as evidence by the differences in the pre-test and post test scores.
Structured Teaching Programme:- It refers to organize teaching learning activity to impart knowledge among young adults on chikungunya.
Chikungunya: - It is a mosquito transmitted virus belongs to family Togaviridae. It is a responsible for an acute infection of abrupt onset which is characterized by high fever, Arthralgia, or arthritis, headache, nausea, vomiting and low back pain.
Young Adults: - It refers to those people aged between 20-40 years who can able to understand and speak Kannada,Telugu or English and are residing at selected urban and rural areas of Raichur.
7. Materials and Methods
7.1. Sources of Data:-
Design:-The research approach adapted for this study is one group pre and post test experimental design for both urban and rural areas.
For urban, RO1 XO2, where
R:Random
O1:pre test
X:intervention
O2:post test
For rural, RO1 XO2 ,where
R:Random
O1:pre test
X:intervention
O2:post test
Setting of the Study:-
Study will be conducted in selected urban and rural areas of Raichur.Raichur is situated in Northern Karnataka having an area of 60 sq.km. Consisting of 5 towns and 300 villages. The total population is 2,07,996 among which males are 1,04,198 and females are 1,03,179.
By using simple random sampling technique Zaheerabad is selected as study area for urban. It is situated at east of Raichur. It has an area of 0.445 sq. km. the total population is 7923 in which the total population of young adults were 2235, among this population,30 adults will be randomly selected.
All the villages in Raichur were listed out and Chandrabanda village is selected randomly as study area for rural. The population of this area is 24,478 in which total young adults were 7,826. Among this population 30 adults will be randomly selected.
Population:-
The population of this study includes the young adults in the age group between 20-40 years residing at Zaheerabad urban and Chandrabanda rural arrears.The total young adults residing at Zaheerabad were 2,235, and the total young adults residing at Chandrabanda were 7,826.
Sample Size:-
The total population of the study is 60, out of these equal sample (urban 30 and rural 30) will be selected by using simple random sampling technique.
Sampling Technique:-
Simple random sampling technique will be used to select both urban and rural areas.The sample size also will be selected by using same simple random sampling technique.
Inclusion Criteria:-
The study includes young adults who are
- in the age group between 20-40 years.
- residing at Zaheerabad and Chandrabanda areas.
- willing to participate in the study.
- able to speak and read Kannada, Telugu or English.
- available at the time of data collection.
Exclusion Criteria:-
The study excludes adults who are not
- in the age group between 20-40 year.
- residing at Zaheerabad and Chandrabanda areas.
- willing to participate in the study.
- able to speak and read Kannada, Telugu or English.
- available at the time of data collection.
Selected Variables:-
Dependent variables:-knowledge of the young adults regarding chikungunya.
Independent Variables:- Structured Teaching Programme on knowledge regarding chikungunya.
Extraneous Variables:-
1. Age:-Age of the sample is categorized as:-
a) 20-25 years.
b) 25-30 years.
c) 30-35 years.
d) 35-40 years.
2 . Religion:-Religion of the sample is categorized as :-
a) Hindu
b) Muslim
c) Christian
3.Socio -Economic Status:-Socio-economic status is categorized as :-
a) 1000 and less than 1000
b) 1001-2000
c) 2001-3000
d) 3001 and above
4. Types of Family:-Types of family of the sample is categorized as:-
a) Single Family
b) Joint Family
5. Educational Background: - It refers to previous education of the subjects. It is categorized as:-
a) Illiterate
b) Primary Education
c) Secondary Education
d) Graduation
e) Post Graduation
6. Sources of Water:- Sources of water is categorized as :-
a) Tap Water
b) Well Water
7. Types of Drainage System :- Types of drainage system is categorized as :-
a) Open
b) Close
8. Sources of Disposal of Wastes:- Sources of disposal of wastes is categorized as :-
a) Dumping
b) Burial
c) Burning
9. Sources of Information:- Sources of Information includes :-
a) Mass Media
b) Relatives
c) Neighbours
d) Friends
7.2 Methods of collection of data:-
Data Collection Instruments:-
A structured interview schedule will be developed and used for collecting the data. It consists of 2 parts namely Part-I and Part-II. Part-I deals with socio demographic data. Part-II represents the items of knowledge related to chikungunya.
Data Collection Method:-
After obtaining the prior permission and consent from significant authorities of the community and from subjects, the investigator will assess the knowledge of young adults regarding chikungunya by using structured interviewing schedule and then intervenes structured teaching programme. The investigator again will assess the effectiveness of structured teaching programme by giving post test after a gap of 7 days depending on time and convenience of the sample.
Plan for Data Analysis:-
Numerical data obtained from the sample will be organized and summarized from the sample with the help of descriptive statistics.