MR.HAREESHA.B
I YEAR MASTER OF SCIENCE INNURSING
COMMUNITY HEALTH NURSING
2011-2013
SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD, TUMKUR-572102
RAJIV GANHDI UNIVERSITY OF HEALTH SCIENCES
1 / NAME AND ADDRESSS OF THE CANDIDATE / MR.HAREESH.B1st YEAR MSC NURSING
SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTER
TUMKUR-572102
2 / NAME OF THE INSTITUTION / SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTER
TUMKUR-572102
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION TO THE COURSE / 11-07-2011
5 / TITLE OF THE PROBLEM / “FIRST AID MANEGMENT OF SNAKE BITE AMONG FARMERS"
5.1 / STATEMENT OF THE PROBLEM / ‘’A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING ON KNOWLEDGE REGARDING FIRST AID MANAGEMENT OF SNAKE BITE AMONG FARMERS IN SELECTED AREAS OF TUMKUR DISTRICT’’
KARNATAKA, BANGALORE.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FORDISSERTATION
6. BRIEF RESUME OF THE INTENTED WORK
6.1 Introduction
Farmers are the back bone of our India. Farmers contributing the 40% of the Indian total population, the future of our country depend on the health and wealth of the farmers. The farmers undergoing some accidental problems which lead to increase in mortality rate, of which snake bite is one of the major health hazard for farmers.
The health of the farmers living in the rural areas is more prone to the accidental medical emergencies, because of their life style, knowledge, practices, and the occupation. The rural people have limited knowledge about the medical emergencies due to some traditional practices. The main occupation of the farmers is agriculture or farming. According to Indian farmers association the farmers are defined as ‘the peoples who are cultivating and farming and cope of the crown’.
Farmers live in huts, wattle, daub houses or mud houses, under sanitary conditions waste materials, dry cow dung, dry fire wood and farm tools are often kept close to their houses. This encourages rats, mice, lizards; they are the prey of snakes. Moreover because of heavy rain during monsoon the holes and the burrows occupied by snakes and rats are filled with water during this period grass is grown up due to water logging and mud. It is a routine practice to walk bare foot blindly in grown grass and crops at times snakes are trodden .fatal snake bites in developing countries like India are far too common to feature on local news paper headlines. Thus in farmers snake bites are more likely to occur during essential activities such as agricultural work and are thus hard to avoid.Snakebite is a major problem, where rural dwellings, farmers working bare-footed in fields or sleeping outdoors are predisposing factors to frequent contact with poisonous snakes. Recently the curtailment of electric power has increased incidence of snake bite cases in rural areas particularly the formers have to work even in night for watering the crops1.
India has remained notorious for its venomous snakes and the effects of their bites. With its surrounding seas, India is inhabited by more than 60 species of venomous snakes – some of which are abundant and can cause severe envenoming. Spectacled cobra (Naja naja), common krait(Bungarus caeruleus), saw-scaled viper(Echicarinatus) and Russell's viper (Daboia russelii) have long been recognized as the most important, but other species may cause fatal snakebites in particular areas, such as the central Asian cobra (Naja oxiana) in the far north-west, monocellate cobra (N. kaouthia) in the north-east, greater black krait (B. niger) in the far north-east, Wall's and Sind kraits (B. walli and B. sindanus) in the east and west and hump-nosed pit-viper (Hypnale hypnale) in the south-west coast and Western Ghats.
A snake bite is venomous injection by the snake which causes life threatening or death. Most of the snake bites are venomous, the three toxins which may causes death they are haemotoxin, neurotoxin and cytotoxin.Some snakebite victims survive with permanent physical sequelae due to local tissue necrosis and, sometimes psychological sequelae. Because most victims are young, the economic impact of snakebite can be considerable.
first aid is defined as ‘Simple emergency medical care procedures intended for lay rescuers to perform before emergency medical professionals are available’. Some of first aid measures are, check that the snake is no longer around threatening the safety for all keep the victim and reassure them, immobilize the bitten limb with a splint or stick, then immediately transport the victim to hospital3.
Snakebite is a common acute medical emergency faced by the farmers. The farmers may not know about the first aid management. They need to know about it.Mud houses with grooves in wall and the basement give easy shelter for snakes, during night hours fast transport is not available, victims are carried in a bamboo basket, bullock cart or on the back. at times vital time is often lost by taking victims to the mantrik (healer),western- style treatment at primary health centers adequate anti-venom is not available, at the times medical officer remain absent during night hours , thus ignorance of conventional treatment of snakebite by doctors further delays proper treatment of victims and contributes to morbidity and mortality.Snakebite remains an underestimated cause of accidental death in modern India.
6.2 Need for the study
Snake bite is primarily a problem of the farmers when they involved in subsistence farming activities. Poor access to health services in these settings and in some instances a scarcity of anti venom often leads to poor outcomes and considerable morbidity and mortality. Many victims fail to reach hospital in time or seek medical care after a considerable delay because they first seek treatment from traditional healers. Some even die before reaching hospital. Hospital statistics on snakebites therefore underestimate the true burden. In addition to mortality, victims are often bitten in an agricultural field or jungle and in many instances the biting species is not identified.
The researchers estimate that worldwide, at least 421,000 envenoming and 1,25,000 deaths from snakebite occur every year. They suggest that, actual number could be as high as 1.8 million envenoming and 94,000 deaths. Their estimates also indicate that the highest burden of snakebite envenoming and death occurs in South and Southeast Asia and in sub-Saharan Africa.In Asia alone, it has been estimated that four million snake bites occur each year of which 50% are envenomed resulting in one lakh annual death. India is the country with the highest annual number of envenoming (81,000) and deaths4. (Nearly 11,000)India has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000.In India~15,000 people are affected every year by snake envenomation. There is one snakebite death for every two AIDS deaths in India. In Karnataka 1,331 deaths in 2007, 1,508 in 2008, 1,162 in 20094.
The maximum number of cases (66%) is in the age group of 11-40 years, while only 8% were above the age of 60 years. The high incidence in the age group of 11-40 years is again because of occupational exposure, this being the productive age group Males has higher fatality rates than females, and the high incidence of snake bites in males is probably due to their lifestyles and occupational exposures as farmers or herdsmen5.
A study was conducted in 05 rural clinicsof Maharashtra, India. The results depicts that 182 cases of snake bite 68(37%)were female.125 (68%) were between age 21-40 years were actively involved in farming.Further results also show that highest incidence reported around 70 bites per 100,000 population and mortality of 2.4 per 100,000 per year. Snake-bite cases were observed in almost all age groups (except >81yr), the majority being in males aged 21-50 yr, while the male to female ratio was 3:16.
Adescriptive study was conducted at Liaquat University Hospital Hyderabad/Jamshoro, since from 1 st January 2006 to December 2006. One hundred cases with historyof snakebite were analyzed. Both genders were included. One hundred cases from both genders, from 8 to 55 years age were reviewed. There were 57 (95%) viper bites (haemotoxic) having haemostatic abnormalities and 3 (5%) elapid (neurotoxic) bites presented with neuroparalytic symptoms. Majority (80%) were bitten on the legs below knee. Some 40% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.5 and male to female ratio was 4:17.
Snakebites are common in the farmers of developing countries. The farmers are the future of our country. The main objective of the study iseducatingthe farmers about the hazards of snake bite, early hospital referral and first aid management.Snakebite control programmes should be prioritized to a level commensurate with this burden. The video assisted teaching helpful to improve the knowledge of farmers regarding the first aid management of snake bite by showing some video clips and slides.
Creating an awareness regarding the first aid management of snake bite through video assisted teaching impart efficient knowledge and skills to reduce mortality rates due to snake bite among farmers. Hence investigator felt the need to assess the knowledge of farmers regarding the first aid management of snake bite.
6.3 Review of literature:
Review of literature is one of the key factors for designing and carrying out research study in any field. The purpose of study of literature in any field is helpful of the individual to find out what has already been done. It also helps us in understanding methodology,analysis of data and formation of conceptual frame
A community-based study was conducted in southeastern Nepal to evaluate the impact of snake bites and determining the risk factors associated with a fatal outcome. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained fieldworkers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. 143 snake bites including 75 bites with signs of envenoming were reported resulting in 20 deaths Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00AMespecially the farmers, were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, and a lack of available transport8.
A retrospective study was conducted in bukjet hospitalNepal over a two year period there were 257 cases of allayed snake bite, 224 included in this study. Various parameters were analyzed like occupation etc; during the period of study there were 3427 admission to the hospital there 590 deaths of which snake bite forms 0.5% and other medical death 0.3%.Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims9.
The epidemiological survey was conducted in sindh medical college at Karachi, to see the community practices regarding the management of snake bite cases in 200 villages from six different districts of Sindh.74.5% of snake bite cases seek the treatment from local doctors while 25.5% use theother measures. 92% of the cases use different First Aid measures while 8% were not using anyFirst Aid measures. 55.5% of the people know about the Anti Snake Venom (ASV) while 45.5%do not know about it. Only 49% of the people were using different preventive measures againstsnake bite10.
The study was conducted of 23,000 deaths from 6,671 randomly selected areas in Andhra Pradesh2001–03. Non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. A total of 562 deaths were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15–29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardized rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8–6.0)the study concludes that the incidences because ofin adequate facilities lack of first aid knowledge. There is a need to educate the rural peoples11.
Retrospective case note analysis of all cases of snakebite admitted to the medical emergency from January 1997 to December 2001 districts of south east Nepal.In 142 cases of snakebite there were 86 elapid bites presenting with neuroparalytic symptoms and 52 viper bites having haemostatic abnormalities. Some 60.6% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.7 and male to female ratio was 4.25:1. Median time to arrival at hospital after the bite was nine hours and mean duration of hospital stay was eight days. Twenty seven cases had acute renal failure and 75% of all elapid bites required assisted ventilation. 17 of 119 patients who received antivenom had an adverse event. The average dose of antivenom was 51.2 vials for elapid bites and 31 vials for viper bites. Overall mortality rate was3.5%.this study suggests that,Snakebites are common in the rural population of developing countries. There is a need to educate the public about the hazards of snakebite, early hospital referral, and treatment12.
A study was conducted at Hong Kong hospital to assess the level of knowledge among the doctors about the treatment of snake bite. A predesigned questionnaire consisting of 29 multiple-choice questions was submitted to physicians likely to treat snakebite victims while receiving such patients. The key finding identified that only 29% of responding doctors were confident about treating snakebites. In the case of ASV selection between the 2 products available that deal with different species, 66% of doctors either were unsure of which to use or believed the 2 ASVs to be the same. The use of inappropriate clinical endpoints for ASV therapy suggests it is being used unnecessarily. There is clear room for improvement in the knowledge base and confidence level of physicians treating snakebites in Hong Kong. The results demonstrate the need for a locally developed and widely distributed snakebite management protocol.13
The most striking results have been obtained by researchers at Hospital Vozandes, in Ecuador, where electrical treatment of snakebite is a government-endorsed program. In this study, 299 snakebite patients were treated with various approaches’ conventional therapy resulted in >20% morbidity and 5% mortality. In the same population, treatment by electrical shock had 1% morbidity and no mortality, a substantial improvement over conventional treatment results.A more comprehensive study of 322 patients treated with electroshock first aid showed very encouraging results. The group who were treated promptly recovered with substantially better mortality and morbidity than would be expected without electroshock first aid14.
A first aid education programme was conducted in tropical lowland of Nepal in madi valley among the students from junior Red Cross circle, well read and write farmers’local healers’ health workers. Evaluationimmediately after the program,revealed 88%particapants opted programme was best 89%developed the ability to recommended first aid.On evaluation after 1 year, 74% participants (n=158) transferred their skill to a total of 2097 locals. But from the systematic sampling (n=360), it was found that 44% locals received the knowledge on snakes and first-aid techniques. Initially, traditional healers convinced to adopt recommended first-aid and anti-venom therapy. But on evaluation after a year, only 40% traditional healers discontinued traditional healing and suggested victims to visit in snakebite treatment centers. Consequently, dependency on traditional healing reduced significantly from 56% to 22%15.
6.4 Statement of the problem
“A study to assess the effectiveness of video assisted teaching on knowledge regarding first aid management of snake bite among farmers in selected areas at Tumkur district”.
6.5Objectives of the study
- To assess the knowledge regarding first aid management of snake bite among
farmers.
- To evaluate the effectiveness of video assisted teaching on knowledge regarding first aid management of snake bite among farmers.
- To find out an association between the pre-test level of knowledge with selected socio-demographic variables.
6.6Operational definitions:
- Effectiveness: It is the expected/desired improvement in the knowledge of formers regarding ‘first aid management of snake bite’ as measured by structured interview schedule as evidenced from the post test knowledge scores.
- Video assisted teaching: It is a systematically developed teaching method on ‘first aid management of snake bite’ for farmers by showing video clips through multimedia.
- Knowledge: It refers to correct response or feedback of farmers regarding first aid management of snake bite as elicited bystructuredinterview schedule.
- Farmers: Men who are in the age group of 25-60years, working in the field, cultivating and cope of the crown are called as farmers.
- Snake bite:A venomous injection by snake to the farmers which leads to medical emergence.
- First aid management: It is the assistance given to the person bitten from the snake in need of urgent medical assistance and it consists of both specific knowledge and skills.
6.7 Assumptions:
1Farmers may have limited knowledge on ‘first aid management of snake bite’.
2Video assisted teaching is one of the best teaching strategies in imparting knowledge on’ first aid management of snake bite’.
6.8 Hypothesis:
H1-There will be significant difference between pre-test and post-test knowledge scores on ‘first aid management of snake bite’ among farmers.
H2-There will be significant association between the pre-test level of knowledge with selected socio- demographic variables.
6.9Variables:
Independent variable:-Video assisted teaching.
Dependent variable:-Knowledge scores.
7.MATERIALS AND METHODS: