Rajiv Gandhi University of Health Sciences s36

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE REGARDING SELECTED MOSQUITO BORN DISEASES(DENGUE FEVER, CHIKUNGUNYA MALARIA AND JAPANESE ENCEPHALITIS) AMONG THE MOTHERS OF TODDLERS IN SELECTED COMMUNITY AREAS AT DAVANGERE CITY.”

MISS. CAROLINE SOPHIA

FIRST YEAR M.Sc. NURSING,

CHILD HEALTH NURSING

KUMUDA INSTITUTE OF NURSING SCIENCES,

DAVANGERE – 577 004.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA, INDIA.

ANNEXUTURE - II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

6. BRIEF RESUME OF INTENDED WORK.

6.0. INTRODUCTION :

“MILLIONS OF LIVES COULD BE SAVED BY USING KNOWLEDGE WHAT WE HAVE TODAY.”

Mosquitoes are a vector agent that carries disease causing viruses and parasite from person to person without catching the disease themselves. Epidemic of mosquito borne disease are nowadays major health problem in India. Historically before mosquito transmitted diseases were brought under control, they caused tens of thousands of deaths in most of the countries. Mosquitoes were shown to be the cause by which yellow fever and malaria were transmitted from person to person 1

Now a day the major health problems in India are more in rural as well as urban areas. In rural areas mosquito borne disease are more due to unhygienic practices. Worldwide malariais a leading cause of premature mortality, particularly in children under the age of five with around 2 million deaths annually. According to the centers for disease control,during rainy season mosquito breed in stagnant water. Water storage, containers for drinking, washing, bathing, is the primary source of larval accounting for 90% of the total breeding place. Important breeding place of mosquitoes is in slums, and open drainage, waste disposal. The people living in the hereby area are easily become the victims of vector – borne disease. Recurrent outbreaks of mosquito borne diseases are malaria, dengue fever, chikungunya and Japanese encephalitis. These are major diseases which can be transmitted by mosquitoes.1

6. 1. NEED FOR THE STUDY:

Mosquito are the most important vectors of human infectious disease like malaria, Dengue, Filarias and Chikungunya. This mosquito came more human suffering than any other organism. Over one million people die from mosquito-borne disease every year.2

In recent years mosquito-borne diseases have emerged as a serious public health problem in countries of the South-East Asia region, including India. Many of these particularly Dengue Fever, Japanese Encephalitis (JE) and Malaria now occur in epidemic form almost on an annual basis causing considerable morbidity and mortality. Dengue is spreading rapidly to newer areas, with outbreaks occurring more frequently and explosively. Chikungunya has reemerged in India after a gap of more than three decades affecting many states. Outbreaks have also been reported from Sri Lanka, Mauritius, the Reunion Island and Maldives. The risk factors which play a key role in the spread and transmission of dengue and chikungunya, include globalization unplanned and uncontrolled urbanization, developmental activities, poor environmental sanitation, human behavior relating to water collection, life styles, wide spread travel and human migration, both within the country and across borders. These are causes for much consent and highlight the need to comprehensively address the challenges faced in combating vector born disease in the country. The recent outbreaks of dengue and chikungunya have been widely reported by and discussed both in the electronic and print media. Japanese encephalitis is currently endemic in 135 Districts, 15 States and union territories of India. The outbreak in Uttar Pradesh last year took many lives mostly of children presently, nearly 330 million people are considered to be at risk .3

The Karnataka state in India is endemic for Malaria, Dengue, Japanese Encephalitis and Chikungunya all mosquito-borne disease. Different districts have variable disease rates. During 2000, the state reported a total of 1,09,118 Malaria cases of which 28,065 were of P.Falciparum, of these, Bangalore district accounted for 278 cases of which 143 were of P. Falciparum. The annual parasite incidence (API-cases per thousand populations during the year) was 0.14. Kolar district reported 4,114 Malaria cases and 1,372 P. Falciparum cases. The API was 1.48. There were 189 Dengue cases reported in the Karnataka state 2000, of which 8 were from Bangalore district and 106 from Kolar district. Japanese Encephalitis accounted for 125 cases in the state in 2000 of which 2 were from Bangalore district and 28 from Kolar district. 4

Despite centuries of control efforts, mosquito-borne diseases are flourishing worldwide, with a disproportionate effect on children and adolescents. These conditions are responsible for substantial global morbidity and mortality. Malaria kills more than 1 million children annually. Dengue virus has expanded its range over the past several decades. Chikungunya virus has emerged in the Indian Ocean base in to affect millions. Effects to limit the effect of mosquito-born-diseases in endemic areas face the challenges of controlling mosquito population delivering effective public health interventions. Children require special advice on mosquito avoidance.5

According to K.PARK some 2.5-3 billion people live in areas where dengue viruses can be transmitted. It is estimated that each year 50 million infections occur , with 5,00,000 cases of dengue haemorrhagic fever and at least 12,000 deaths, mainly among children. Dengue is widely prevalent in India. It is reported from 18 states since 1996 with about 450 million population at risk. During 2006 there was 12317 cases and 184 deaths; and during 2007 till the month of July, there were 536 cases and 6 deaths from dengue in the country.6

Chikungunya virus occurs widely in sub-Saharan Africa, India and in many areas in Asia. After 41 years since 1963-1964, during 2006 there was a large out break of chikungunya in India, with 1.39 million officially reported cases spared over 16 states. The outbreak was first noticed in Andhra Pradesh and it sub-sequently spread to tamil nadu. Thereafter, Kerala and Karnataka were affected and then northwards as far as Delhi. During 2007, uptill 12th oct. a further 37,683 cases had been reported by the government of India.6

At present, about 109 countries in the world are considered endemic for malaria. An estimated 3.3 billion people were at risk of malaria in 2006. There were an estimated 247 million episodes of malaria in 2006, with a wide uncertainity interval from 189 million to 327 million cases. Eighty six percent cases were in the Africa region. Among the cases that occurred outside the African region , 80 percent were in India, Sudan, Myanmar, Bangladesh, Indonesia, Papua new guinea and Pakistan. Among the 881,000 deaths in 2006 85 percent were of children under 5 years of age. Malaria continues to be a major health problem in India. In India 27 percent population lives in malaria high transmission areas and 58 percent in low transmission areas. The most affected states are north eastern states, Chhattisgarh, Jharkhand, Madhya Pradesh, Gujarat, Karnataka, Maharashtra, Andhra Pradesh etc.6

Children are the world’s most valuable natural resources and it is the first and foremost duly of every nation to preserve it. Children are real assets of Family, Society and Nation. School children constitute 20% of the total population and are vulnerable for infections. Hence there should be a motto to guide everyone to maintain a good environmental sanitation. As there is more prevalence of ignorance and illiteracy among the public, there is a great need to educate them, especially the children about maintenance of good environmental sanitation to central and prevent mosquito-borne diseases.

Vector-borne infections are major killers, particularly of children in developing countries. Over the past decade, more comprehensive and transparent methods of measuring health have improved understanding of the importance of these diseases.

Despite technological advances and increasing affluence in many regions, vector-borne infectious diseases remain amongst the most important causes of global ill-health. Vector borne disease is not only an outcome but a cause of poverty. Control of arthropod vectors is the primary available intervention for some of the most devastating VBDs, particularly those lacking vaccines such as malaria, dengue, trypanosomiasis, filariasis, leishmaniasis, and Chagasdisease . History shows that vector control when done properly can effectively reduce disease transmission.

Mothers are the back bone of the family and play a major role in the productivity of the community likewise mothers are actively playing a vital role in the control and prevention of vector borne disease. . Mother are the primary care givers and toddlers mostly depend on them but, mothers are unaware about the disease, for that mothers needed to have an adequate knowledge regarding selected mosquito born disease. Structured teaching programme about these diseases for the mother provides an adequate knowledge regarding the disease, its causes and factors, manifestation, and treatment and also a measure to control and prevention. Hence the researcher felt the need to determine the effectiveness of structured teaching programme on selected mosquito born diseases among the mothers The study concluded that there should be a provision not only determine the teaching effect and knowledge but also develop skills among mother and improve their knowledge regarding on prevention and control of mosquito born diseases.

So there is need for planned teaching programme for mothers of toddlers regarding selected mosquito born diseases that will help the mothers to identify and prevent the mosquito born diseases among children. That may also help to spread the awareness from child to family & family to community

6. 2. REVIEW OF LITERATURE:

A review of literature on the research topic makes the researcher familiar with the existing studies and provides information which helps to focus on a particular problem, lays a foundation upon which to base new knowledge. It creates accurate picture of the information found on the subjects’

Review of literature for the present study is explained under the following headings,

1.  Studies on awareness of women regarding selected mosquito born diseases.

2.  Studies related to effectiveness of structured teaching programme on selected mosquito born diseases.

3.  Studies related to prevention of selected mosquito born diseases

1.  Studies on awareness of women regarding selected mosquito born diseases:

A descriptive study conducted to assess the knowledge of cost effective methods of prevention of mosquito bites among the mothers of under five children in the rural and slum areas of Delhi, suggested that prevention of mosquito borne diseases must start on the locality to ensure that people are receptive to the methods to prevent mosquito bites and to make desired behavioral changes easier to adopt. 7

A non-experimental cross sectional study was conducted on knowledge, attitude and practice of prevention of dengue fever among mothers residing in rural area and an urban resettlement colony of East Delhi. A total of 687 subjects (334 rural and 353 urban) were selected by convenient sampling. A pre-structured and pre-tested format questionnaire was administered to the mothers. Nearly 4/5th (82.3%) of mothers were aware of Dengue. More than 2/3rd respondents in urban and 2/5th in rural areas had used some method of mosquito control or personal protection during the epidemic. It has been suggested that prevention of dengue must start within the locality to ensure that the people are receptive to the messages and to make desired behavioral changes easier to adopt. 8

A cross-sectional questionnaire survey of 192 parents attending child health clinics in the Parish of Westmoreland was conducted. More than half of the parents (54%) had good knowledge about signs, symptoms and mode of transmission of dengue. Approximately 47% considered dengue to be a serious but preventable disease to which they are vulnerable. Nevertheless, a majority (77%) did not use effective dengue preventive methods such as screening of homes and 51% did not use bed nets. Educational attainment (OR, 2.98; CI, 1.23, 7.23) was positively associated with knowledge of dengue. There was no correlation between knowledge about dengue and preventive practices (p = 0.34). Radio and TV were the predominant sources of information about dengue fever. 9

A study conducted in Bangalore on knowledge an d practices of women regarding Dengue revealed that correlation existed between knowledge and practice. Women without formal education and older women had relatively little knowledge of Dengue. Therefore these groups may need special attention in future Dengue education programmes. Women with knowledge of Dengue were frequently reported the use of preventive measures indicating value of education programmes as tool in Dengue prevention. 10

2. Studies related to effectiveness of structured teaching programme ` on selected mosquito born diseases:

The quasi-experimental study was conducted to determine the effectiveness of structure teaching programme regarding prevention of chikungunya. Quasi experimental study with 60 samples of adults drawn by purposive sampling and study was conducted in between December 2012 to January 2013 in urban areas of Nagamangala taluk, Mandya district, Karnataka. The mean knowledge score of the adults during pre-test was (43.08±0.05% level) and mean knowledge score of the adults after post-test was (76.17±0.05% level) it signifies there is an enhancement of mean knowledge score about (33.09±0.05% level). In the present study shows providing health education to the community people is increase the knowledge of people regarding prevention of chikungunya. The authors recommended to providing health education to the people by using various A.V Aids in controlling the communicable diseases.11

Chikungunya is a relatively rare form of viral fever caused by an alpavirus that is spread by mosquito bites from Aedes aegypti mosquito. A huge increase in estimated cases occurred at the end of December 2005 culminating in an estimating peak incidence of more than 40,000 cases in 2006. In total 213 deaths have been linked to the disease. So knowledge on Chikungunya should be given prime importance. As mosquito is the only way to break the chain of infection.Further effectiveness of structured teaching programme was tested by inferential statistics using the paired ‘T’ test. A high significant difference (19.7 percent) (P<0.05) was found between pre-test and post test knowledge scores of the respondents, indicating significant increase in knowledge after S.T.P. Hence, H1 is accepted and the S.T.P. was very effective in improving the knowledge of adults.12