Rajiv Gandhi University of Health Sciences, Karnataka
SYNOPSIS
FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the Candidate / Ms. RUPINDER KAUR2. / Name of the Institution / Diana College of Nursing No. 68, Chokkanahalli, Jakkur Post,
Bangalore – 64
3. / Course of Study and Subject / Master of Science in Nursing
Community health nursing
4. /
Date of Admission to Course
/10.06.09
5. / Title of the Topic / Effectiveness of structured teaching module on prevention of malaria among adults residing at rural community Karnataka.
6. Brief resume of the intended work
6.1. Need for the study
“If we cannot live so as to be happy, let us least live so as to deserve it.”
Environment is crucial for the health and wellbeing of individuals and communities. It is the sum of all natural man-made things that surrounds the human being. Healthy environment is one of the factor which influence health of the individuals. It includes physical, social and biological environment.
Biological environment is responsible for the diseases due to poor environment health in terms of unprotected water, air pollution, soil pollution, poor housing and vectors. The poor environment sanitation can lead to various communicable diseases including malaria.(1)
Malaria is an infectious disease which spreads person to person through mosquito which affects both the sexes of all the age groups irrespective of rural and urban community.
Malaria is worldwide problem with transmission in 103 countries affecting more than 1billion people causing between 1 and 3 million death per annum.(2)
It was reported about the global incidence of malaria, that the 2.5 billion people at risk, more than 500 million become severely ill with malaria every year.(3)
It was reported that malaria is endemic in all the seven countries of South East Asia. The total number of cases are almost static in 10 years. Annually 0.2% of the population suffers with malaria. However it is 1.5% in rural area and 60% of deaths due to malaria are reported from rural area. In 1984, there were 24% cases of P. falciparum malaria out of them 57% were in rural area however in 1995 the total cases increased to 36% and rural area proportion increased to 75.(4)
WHO in 2008 reported that Malaria is a major public health problem in the South-East Asia Region with 1256 million people are at risk, 90-160 million infections and more than 120,000 deaths occurring each year. Out of 11 countries of the Region ,10 countries are endemic. Around 40% of the global population at risk of malaria resides in SEA Region and accounts for 8.5% of the global and around 4.1% of the global mortality due to malaria.(5)
It was reported that Malaria is one of the major public health problems in the developing countries. Recent estimates indicate that between 300-500 million clinical cases and between 1.5-2.7 million deaths due to it, occur worldwide annually, 90% of which occur in tropical Africa.It is estimated that 1.2 billion people out of the 1.4billion people of SE Region live in Malarious areas.(6)
It was found that in South East Asia, China had highest burden of malaria. It has identified that rain fall and temperature plays an important role in causing malaria.(7)
Majority of the global cases are found in Africa and Asia with limitation to the rural areas. Asia harbors a great threat in the form of epicenter of multi drug resistant plasmodium falciparum which is gradually encompassing the tropical world. (8)
WHO in 2000 reported that the disease is endemic in 74 developing countries, infecting more than 200 million people. Of these, 20 million suffer severe consequences from the disease.(9)
WHO in 2006 reported that Malaria is one of the leading causes of illness and death in the world. Between 300 to 500 million people contract malaria every year and up to 2.7 million die from it. Nine out of ten of these deaths occur in Africa. The rest occur in Asia and Latin America. (10)
WHO in 2008 reported that India had an estimated 10.6 malaria cases in 2006, accounting for 60% of the malarial incidence in South East Asia. India is among the countries classified as having 95% of the population with moderate to high risk of malaria in the South East Asia.(11)
In India, nine Anopheline vectors are involved in transmitting malaria in diverse geo-ecological paradigms. About 2 million confirmed malaria cases and 1,000 deaths are reported annually, although 15 million cases and 20,000 deaths are estimated by WHO South East Asia Regional Office. India contributes 77% of the total malaria in Southeast Asia. Multi-organ involvement/dysfunction is reported in both Plasmodium falciparum and P. vivax cases. Most of the malaria burden is borne by economically productive ages. The states inhabited by ethnic tribes are entrenched with stable malaria, particularly P. falciparum with growing drug resistance.(12)
National Vector Borne Disease Control Programme in 2008’s report revealed that there were over 1 million cases of malaria in India in 2008 and these figures itself are believed to be a gross underestimation.(13)
It was identified that Mosquito-borne diseases particularly malaria is becoming most dreaded health problems in Dehradun district. The climatic factors particularly temperature and rainfall may alter the distribution of vector species.(14)
It was identified that malaria is a growing concern in India with over 1 million cases of the disease in 2008, half of them of the dangerous Plasmodium falciparum strain.(11)
In the year 2006, a total of 62864 cases of malaria were reported from Karnataka state and Mangalore accounted for 15664 (24%) of these cases. Of the 16446 cases of P. falciparum malaria reported from Karnataka in the same year, 4903 (29%) cases were from Mangalore. And among 29 malaria related deaths from Karnataka, 11 were from Mangalore.
In the year 2007, there has been a marginal decline in the total number of cases in Karnataka state. However, there have been 8 deaths confirmed by the health authorities. The actual number of deaths may be 5-6 times the official figure as all cases are not reported and even among the reported deaths, all cannot be confirmed for want of evidence in the form of a preserved blood smear of the victim.(15)
THE HINDU , May 2006’s report has shown that in Bangalore the stagnant pools of water after the rains a few weeks ago have resulted in an increase in incidence of malaria around the city.(16)
WHO in 2000 reported that Poor sanitation, poor hygiene and inadequate water supply are related to the spread of human parasitic diseases including malaria. Malaria is at first rank in terms of socio-economic and public health importance in tropical and subtropical areas. (9)
The Govt. of India launched National Malaria Control Program (NMCP) in 1953. Later, it was decided by Govt. of India to eradicate the disease and therefore National Malaria Eradication Programme (NMEP) was launched in 1958.
National Anti -malaria Programme (NAMP) was launched in the year 1999 due to resurgence of malaria. Malaria was resurged due to the administration, technical and operational failures in NMEP.(17)
Despite of enormous control efforts, the resurgence is increasing problem of malaria. Despite the introduction of many advanced , rapid and sensitive diagnostic techniques for early detection of disease, life threatening complications do occur with Plasmodium falciparum infections. The fatality rate of falciparum malaria is around 1 percent and 80% of these deaths are caused by cerebral malaria.(2)
Hence it was felt the researcher to educate the adults residing at rural community related to prevention of malaria.
6.2 Review of literature
The term review of literature refers to the activities involved in identifying & searching for information on a topic &developing a comprehensive picture of the state of the knowledge on that topic.(18)
The purpose of review of literature is to obtain comprehensive knowledge and in depth information through systematic &cultural review of scholarly publications, unpublished scholarly print materials, audio visual materials &personal communications.
The review of Literature will be organized under following headings:
A. Literature related to incidence and prevalence of malaria.
B. Literature related to prevention of malaria among adults.
C. Literature related to structured teaching module on prevention of malaria.
D. Literature related to national health programme on malaria
E. Literature related to role of nurse in prevention of malaria.
A. Literature related to incidence and prevalence of malaria.
Malaria is one of the oldest known disease, with the first recorded case appearing in 1700 BC in china. In ancient Chinese , it was called “the mother of fevers”.
Malaria in human is caused by a protozoan of the genus plasmodium and the four sub species, falciparum, vivax, malariae and ovale. Plasmodium falciparum causes the most severe form of the disease in humans. The disease is transmitted through the bite of anopheles mosquito.(19)
A study was conducted on clinical presentations of malaria during an outbreak situation. The study was conducted on 184 cases. He used malaria positivity against different variables such as fever, headache, body ache, chill, rigor, vomiting etc. The study concluded that fever with rigor, body ache, chill, jaundice,spleenomegaly and hepatospleenomegaly as predictive factors for diagnosing malaria.(20)
WHO in 2009 reported that there were 247 million cases of malaria in 2006, causing nearly one million death approximately half of the world's population is at risk of malaria, particularly those living in lower-income countries.(21)
It was reported that malaria was responsible for 75 million attacks,0.75 million deaths and loss of 10,000 million rupees every year.(22)
An estimation of malaria in South East Asia region provided an overview of the malaria situation in the Region. All countries are affected by malaria except Maldives. Each year approximately 2.5 million cases and 4,000 deaths are reported. Among the WHO regions, the South-East Asia Region has a malaria burden second only to Africa. India reported the highest number of malaria cases in the Region and the second highest number of deaths due to malaria.(23)
A study was conducted on Prevalence of malaria in active conflict areas of eastern Burma: a summary of cross-sectional data. Prevalence was estimated from screenings conducted in 49 villages participating in a malaria control program. The study concluded that Prevalence of plasmodium falciparum in a large population in conflict areas of eastern Burma remains high relative to the prevalence reported among populations in neighboring Thailand. There is an immediate need to expand malaria interventions to reduce morbidity and mortality in conflict areas in eastern Burma and to reduce the reservoir of infection that compromises regional disease control efforts.(24)
It was found in 2003 that 20–30 million malaria episodes reported annually, and 74,000 deaths and daily of 0.95 million cases are reported in India.(25)
It was reported that malaria is the most important parasitic disease of the mankind, and the most important cause of morbidity and mortality in the tropical world. About 40% of the world’s population lives in malaria endemic areas at present, 200-400 million cases of malaria occur every year, contributing to an annual mortality of 1-2 million. The incidence of malaria has remained as much for the last two decades.(26)
Malaria is a global problem, about 100 countries are malarious , about half of which are in Sub-Saharan Africa, most of them being caused by plasmodium falciparum. Malaria has been killing about 1.4% million people world-wide every year.
In the South-East Asia Region, except Maldives, all countries have indigenous malaria transmission caused mainly by plasmodium vivax and often plasmodium falciparum, which carries high mortality.
During 2003, about 1.65 million cases were reported with 943 deaths. North-Eastern states contribute to about 10% of total cases.(17)
A study was conducted on determinants of household demand for bed nets for malaria prevention in a rural area of southern Mozambique. The results suggest that either full or partial subsidies may be necessary in some contexts to encourage households to obtain and use nets. Given the possible substitution effects of combined malaria control interventions, and the danger of not taking into consideration household preferences for malaria prevention, successful malaria control campaigns should invest a portion of their funds towards educating recipients of IRS ( indoor residual spraying) and users of other
preventive methods on the importance of net use even in the absence of mosquitoes.(27)
A study was conducted on new strategies for the diagnosis and screening of malaria .the study concluded that thin and thick blood film microscopy are the "gold standard" for malaria diagnosis. In recent years, there have been important developments in malaria diagnostic tests including fluorescence microscopy of malaria parasites stained with acridine orange, dipstick immunoassays that detect species-specific parasite antigens, and more recently, detection of parasite nucleic acids .(28)
B.Literature related to prevention of malaria among adults
In 2006, a study was conducted on A community-based health education programme for bio-environmental control of malaria through folk theatre (Kalajatha) in rural India. This study was carried out under the primary health care system involving the local community and various potential partners . Kalajatha was found to be a very effective medium in promoting health education and possibly behavioural changes to the rural community.(29)
A kap study was conducted study on malaria in Zanzibar: implications for prevention and control. The overall objective of the KAP study was to obtain and interpret detailed grassroots information about Zanzibaris understanding of the causation and transmission of malaria so as to select priority interventions to improve home-based management and prevention of malaria. It was concluded that they are aware about the methods used to prevent malaria, but they use traditional medicine more frequently than the use of a modern health facilities and services.(30)
WHO in 2009 reported that prevention of malaria focuses on reducing the transmission of the disease by controlling the malaria-bearing mosquito. Two main interventions for malaria control are:
· use of mosquito nets treated with long-lasting insecticide, a very cost-effective method;
· indoor residual spraying of insecticides.(21)
It was reported that malaria can be prevented by mosquito screening, protective clothing, insect repellants, by health education, case finding, chemoprophylaxis by choloroquine,myloquine, proguanil, doxycycline, chloroquine co administered with proguanil.(26)