Rajiv Gandhi University of Health Sciences s288

Rajiv Gandhi University of Health Sciences

Bangalore, Karnataka

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Mr.JAYAPRAKASH.T.S

1st YEAR M.Sc. NURSING

COMMUNITY HEALTH NURSING

YEAR 2010-2012

CAUVERY COLLEGE OF NURSING

#42/2B, 2C, THERESIAN COLLEGE

SIDDARTHA LAYOUT

MYSORE

KARNATAKA

RAJIV GANDHI UNIVESITY OF HEALTH SCIENCES

BANGALORE – KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / MR. JAYAPRAKASH. T.S.
1st YEAR M.Sc. NURSING
CAUVERY COLLEGE OF NURSING,
SUBASH NAGAR,
MYSORE – 570 007
2. / NAME OF THE INSTITUTION / CAUVERY COLLEGE OF NURSING,
MYSORE – 570 007
3. / COURSE OF STUDY AND SUBJECT / 1st YEAR M.Sc NURSING
COMMUNITY HEALTH NURSING
4. / DATE OF ADMISSION TO THE COURSE / 01-06-2010
5.1 / TITLE OF THE STUDY / TO COMPARE THE KNOWLEDGE REGARDING REVISED NATIONAL TUBER CULOSIS CONTROL PROGRAMME (RNTCP) AMONG URBAN AND RURAL HEALTH WORKERS IN SELECTED PHC’S OF MYSORE DISTRICT.
5.2 / STATEMENT OF THE PROBLEM / A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING REVISED NATIONAL TUBER CULOSIS CONTROL PROGRAMME (RNTCP) AMONG URBAN AND RURAL HEALTH WORKERS IN SELECTED PHC’S OF MYSORE DISTRICT.

6.BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Slogan for world TB day 2010

On the more against Tuberculosis to accelerate action.

Tuberculosis is a major public health problems in India. India accounts for 1/5th of Global TB incident cases. Each year 2 million people in India develop the TB of which around 0.87 millions are infectious cases. It is estimated that annually around 330,000 Indians die due to TB.

Since 1993, the Government of India (GOI) has been implementing the WHO Recommended strategy via RNTCP: The Revised strategy was pilot tested in 1993 and launched as a National Programme in 1997. By March 2006. The programme was implemented. Nation wide in 633 district covering 1114 (100% million population. Phase II RNTCP started from October 2005 which is a step towards achieving TB related targets of millennium development goals.1

Since 2006, RNTCP is implementing the WHO recommended “STOP TB Strategy” which is addition to DOTs, address all the Newer issues and challenges in TB control.

All sub centers, PHCs to function as a DOT’s Centre. To deliver treatment as per RNTCP. Guidelines and treatment of common complications of Tuber Culosis and site effects of drugs. Records and reports on RNTCP activities as per guidelines.

The goal of TB control programme is to decrease the mortality and morbidity due to TB and cut the transmission of infections until TB cases to be a major public health problem in India. To achieve and maintain a cure rate of at least 85% among new smear positive cases.2

India as an on going national TB Programme since 1962 programme reviews show that only 30% of estimated tuberculosis patients were diagnosed and only 30% of those were treated successfully based on findings and recommendations of the review in 1992. The Govt of India evolved a revised strategy and lunched the RNTCP in the country.

6.2 NEED FOR THE STUDY

According to TBC India 2007, 1/3 of world populations infected with TB bacilli, 75% of which are pulmonary cases, 90% of infected population are asymptomatic, 50% mortality rate in rest of 10% if untreated. Most common mode of transmission via aerosol droplets 22% of infection rate 10-15% secondary cases from a active but untreated pt per year.

In the revised national tuberculosis control programme (RNTCP) the first step in quality control of sputum microscopy starts at the Sub-District level (50,000) population where the Senior. TB laboratory Supervisor (STLS) cross check all the smear positive slides and 10 to 20% of smear negative slides obtained from microscopy centers.3

Tuberculosis is a major public health problem in India. India accounts for 1/5th of global TB incident cases. Each year 2 million people in India develop the TB of which around 0.87 millions are infectious cases. It is estimated that annually 330,000 Indians dies due to TB.14

Revised National Tuberculosis control programme phase III will cove 102 districts over a period of 5 years with world Bank Assistance. In the year of 1997-98 itself. 39 districts will be covered with a population of 124.74 million (5) the revised programme is proposed to extended in a phased manner through the country during the ninth five year plan period.4

World tuberculosis day is a world wide event that aims to raise public awareness of tuberculosis and the efforts made to prevent and treat the disease. This event held on March 24th every year and its is prompted by organization such as world Health Organization. Same day as celebrated as World TB Day.5

The Study was conducted by National Tuberculosis Institute Bangalore 2009. To study the impact of RNTCP on mortality among tuberculosis patients in Bangalore and to correlate mortality trends with programme indicators. A study shows statistically significant decline in tuberculosis mortality rate among new smear positive cases after implementation of RNTCP (2=4.478P<0.05).6

Under India’s revised National Tuberculosis control programme (RNTCP) 15% of previously treated patients are reported in 2006 chort defaulted from Anti-Tuberculosis treatment in the rural areas7.

All district TB Centers Taluk Hospital & PHC’S and sub centers are to be worked as a DOT’S centers. In that health workers in the PHC’S need to play main roll in primary case detection.

The study was conducted to assess the knowledge of Health workers in the PHC’s regarding TB control and Management in the Lucknow District. This study used as self reported questionnaire based on RNTCP technical and operational guidelines. 141 Health workers recruited through census sampling. This study was conducted in Lucknow, India February, March-2007. Results: Among 141 Health workers 71% of Urban Health workers have better knowledge in case detection and Dots strategy. Studies have shown they are interested in active participation in National programme.18

The study was carried out to assess the knowledge of health workers in the urban and rural PHC’S of Gujarath Districts 700 samples of health workers from the different taluks of Ahamedabad they are interviewed with structured questionnaires regarding Data collection and maintenance of records reports of TB Patients results- among 700, 400 health workers had good knowledge in case detections and maintains of records and reports according to RNTCP guidelines Conclusions:- There is a need improvement in knowledge of PHC’S Staffs in the rural area.16

From above studies of research shows that there is a lack of knowledge of rural health workers in DOT’S strategy.

Hence with the evidence of above content and researchers felt its need to compare the knowledge on RNTCP among urban and rural health workers.

6.3 STATEMENT OF THE PROBLEM

A comparative study to assess the knowledge regarding revised national tuberculosis control programme (RNTCP) among urban and rural health workers in selected PHC’S of Mysore district.

6.4 OBJECTIVES OF THE STUDY:

1) To assess the knowledge of Urban Health workers Regarding RNTCP.

2) To assess the knowledge of Rural Health workers Regarding RNTCP.

3) To compare the knowledge of Urban and Rural Health Workers Regarding RNTCP.

4) To find the Association between the selected demographic variables with knowledge of urban and Rural Health workers Regarding RNTCP.

6.5 HYPOTHESIS

H1 The Urban Health workers will have better knowledge than the Rural Health workers regarding RNTCP.

H2 There will be significant Association between selected demographic variable with urban and rural Health workers regarding RNTCP.

6.6 OPERATION DEFINITIONS.

Assess : Assess refers to estimation of knowledge status of Health workers

regarding RNTCP.

Knowledge : Knowledge refers to knowing of facts regarding RNTCP among Urban

and Rural Health Worker which is assessed by using structured

interview schedule.

Urban : Urban refers to Health workers working in densly populated

area or concerned within a city with much facilities.

Rural : Rural refers to a area / village as very low density of population with

lack of facilities.

RNTCP : Revised National Tuberculosis Control Programme began as

a Pilot in 1993 and was launched as a national programme in

1997. This programme knowledge will be assessed and

compared among urban and rural health workers.

Health Worker: Health workers refers to the people engaged in actions

Whose primary intent to enhance the Health in the PHC’S and to

whom, knowledge is been assessed by structured interview

schedule.

6.7 ASSUMPTION

v The Urban Health workers will have better and much knowledge due to much exposing to current medias & newer implementation from programme.

v The Health Workers in the PHC’S of Rural areas will have much interest in learning the present implementation in RNTCP programme.

v The Rural Health workers will have lack of knowledge due to unequitable staffing pattern and community participation for newer implementation from the programme.

6.7 DELIMITATION

v The duration of study limited to 4-6 weeks.

v The study is limited to only Health workers working in selected PHC’S of urban and rural areas of Mysore district.

v The study is limited to only the Health workers who can understand Kannada & English.

6.9 CONCEPTUAL / THEORETICAL FRAME WORK.

The conceptual framework of this study is based on Ludwig Von Bertalanffy General open system theory.

6.10 REVIEW OF LITERATURE

INTRODUCTION

Review of literature is an on going process and covers the entire planning stage. A good research does not exist in vacuum.

A review of literature involves a systemic identification, location, securitization and summary of written materials that contains information on a research problem.

This Chapter is dealing with section are following.

Section – 1 Studies related to knowledge of Health workers regarding RNTCP.

Section – 2 Studies related to Rural Health Workers regarding RNTCP.

Section – 3 Studies related to Urban Health Workers regarding RNTCP.

Section – 1

Studies related to knowledge of Health workers regarding RNTCP:

Study was conducted assess the knowledge and practices for tuberculosis among health workers in PHC’S in various parts of the Delhi in 1995 objective: To investigate the knowledge of health workers regarding RNTCP programme. A pre tested survey questionnaires was performed among the 204 health workers attending seminars on tuberculosis in various taluks of Delhi. Results:- In a suspected case of tuberculosis sputum examination was advised by only 12% health workers, while 89.5% would recommended for chest X-Ray for treating tuberculosis 187 health workers had positive knowledge in sputum examination. Conclusion:- Among this health workers there is a marked reliance on sputum collection is being neglected for initial diagnosis.17

Section – 2 Studies related to Rural Health Workers regarding RNTCP.

The study was conducted to learn the involvement of Rural Health workers in case finding, sputum collection and follow up care of TB patient in rural areas. Design- Health workers of Rural areas in Haryana were identified and invited for training in RNTCP guidelines. Patients and Health workers are interviewed at the end of project to assess there perception. Result: Among 146 health workers 72% were trained in RNTCP guidelines and in that 14 agreed to provide the DOTS strategy result shows that there is a need in training health workers of rural PHC’s to improve the knowledge of rural health workers and better implementation of programme.11

The study was conducted to learn the pattern of health care seeking of tuberculosis patients is important for identification of factors which might influence delayed reporting of tuberculosis patients. Consecutive 301 pulmonary TB patients belonging to any other categories under RNTCP. Delay was identified as the time over 3 weeks that the case took to report to the area of TB facility. 43.2% patients in the rural PHC’s. This shows the lack of education to the rural peoples to approach the treatment which is available in the PHC’s. This made the health workers in the rural PHC’s is difficult to implement and active participation in the programme.12

This study was carried out to learn the involvement of rural health workers in RNTCP. For successful implementation of DOT’s in India many factors have played important part and one of which is the lack of facility in the rural PHC’S(Drug supply, Inequitable staffing pattern) of rural areas and training to staffs of rural PHC’S. The conclusion has made that there is necessary in improvements of PHC’S of rural areas and training of PHC staffs including health workers of rural areas for the better implementation of the programme.13

This study was carried out to learn the Role of rural health workers in the RNTCP, Rural health workers in the rural PHC’S play an important role in successful DOTS, an element of RNTCP. The involvement of rural health workers in the rural PHC’S in an area with poor health structure. Many studies have shown health workers in rural PHC’S have performed less supervision than the health workers in the urban PHC’S. Result- For the successful involvement of rural health workers in the rural PHC’S needs proper training and supervision from District Tuberculosis centre.14

Section – 3 Studies related to Urban Health Workers regarding RNTCP.

The study was conducted to evaluate the effectiveness of Urban health workers in PHC’S in DOTS. A field report from Haryana, North India, Treatment success rate was recorded in the TB register of new sputum smear positive cases, receiving DOTS from the Urban health workers was comparable with that the patients receiving DOTS from the rural health workers (78% v/s 77%). The proportion of patients with urban health workers increased significantly with time (13% in 2000 and 25% in 2002). In this model the urban health workers involvement in an urban TB control programme, the primary responsibility for returning late patients to treatment was with the staff of rural health workers.10