RAJIVGANDHI UNVERSITY OF HEALTH SCIENCES
BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
MS.A.PADMAVATHY
M. Sc NURSING 1 YEAR,
MEDICAL SURGICAL NURSING,
2009- 2010 BATCH.
R.R COLLEGE OF NURSING,
RAJA REDDY LAYOUT,
CHIKKABANAVARA,
BANGALORE- 560090
RAJIVGANDHI UNVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MS.A.PADMAVATHY1 YEAR M. Sc NURSING,
R.R.COLLEGE OF NURSING,
RAJA REDDY LAYOUT,
CHIKKABANAVARA,
BANGALORE – 560090.
2. / NAME OF THE INSTITUTION / R.R. college of nursing
3. / COURSE OF THE STUDY AND SUBJECT / Master’s Degree of Nursing,
Medical surgical nursing.
4. / DATE OF ADMISSION TO THE COURSE / 1/06/2009
5. / TIITLE OF THE STUDY / A study to evaluate the effectiveness of structured teaching program regarding mode of transmission and importance of drug regimen among tuberculosis patients in selected hospitals, Bangalore.
6. BRIEF RESUME OF THE INRENDED WORK
6.1 INTRODUCTION
In the history of medicine there have always been periods when one disease or group of related disease presented an unusually grave threat to the health of the individual and to the community. In the particular period in which we live, we immediately think of heart disease as a leading killer and, increasingly, we are concerned by the growing number of men disabled by chronic respiratory disease, and by the disruption such illnesses are causing in the life of the community as well as of the individual. The National Tuberculosis Association and its affiliated associations throughout in seeking a solution to the health problems presented by all respiratory disease.1
Tuberculosis is a preventable and curable disease like other disease. The disease primarily affects the lungs and causes pulmonary tuberculosis. BCG is a gift to the world given by the scientist bacilli calmette Gwerin 1927. Widely used like bacteria vaccine. It helps to prevent children from tuberculosis. The incidence of TB is now increasing again in most of the developing countries. Particularly in young adults and in low economic groups. TB remains a world wide public health problem despite the fact that the causative organism was discovered more than 100 yrs ago and highly effective drugs and vaccine are available making TB a preventable and curable, disease since 1950’s anti TB treatment has been available, making TB 100% curable.
Globally the DOTS (Directly observed treatment short course) strategy has been recognizes as the best cost effectiveness approach to TB control, to reduce the disease burden and to reduce the spread of infection. The WHO has recommended a multifaceted program, know by acronym DOTS, that promotes effective treatment of drug susceptible TB as the prime method of limiting drug resistance. DOTS were part o f a successful MDR-TB (Multi drug resistant tuberculosis) control program in New York City.2
According to WHO IN 2000, India accounts for nearly one third of total cases of TB every year, approximately 2.2 million develop TB of which about one million positive and highly infectious cases. 3
The problem of TB is acute in the developing countries which accounts for more than three fourth of the cases in the world and where the majority of cases are never diagnosed at all, less get correctly treated. In majority of the developing countries, there has been little improvement in the epidemiological situation. In fact there has been an overall increase in the absolute number of TB cases in these countries during the last three decades, because of the population explosion. TB continues to be a major health problem in India.
An education about the anti TB treatment, controls the disease, cures the disease and reduces the incidence of TB and prevents the evil effects of the disease. For this National TB control program was implemented in 1962 to create a nation wide infrastructure for TB control. The magnitude of human suffering forced the Government of India into launching a revised strategy the revised national TB control program (RNTCP) IN 1993. The main pillar of the program is DOTS which helps to ensure care by providing the most effective medicine and confirming that it is taken. 2
6.2 NEED FOR THE STUDY
TB is the second most common causes of death due to infectious disease at the global level. It affects people of all ages and is highly infectious. WHO published a statistical report on TB in association with world TB day 2004.The report shows that, 40% of the Indian population is infected with the TB. TB remains the single largest infectious disease carrying high death annually, about 5 deaths every minute. Every year about 8 million people develop TB world wide. In India nearly 2 million people develop TB where 4, 50,000 die from it. Nearly one million of them were highly infectious sputum positive two such cases developing every minute.
The national TB institute (2005) reported that annual incidence rate of infection per lakh of population; out of 126 cases follow up at 3 subsequent survey over a period of 5 yrs, 49.2% died 32.5% cured and 18.3% continued to remain sputum positive. With DOTS, health care workers observe patients as they take their medicine. Left alone, many people with TB fail to take entire course of medication, there by contributing to the spread of drug resistant TB. In India TB control project was designed to improve the effectiveness of TB control by expanding the DOTS strategy. It aimed to increase the population covered to 270 million. In 2002 it was restructured to cover 700 million people before it closed. Around 1 billion people in India now have access to DOTS.2
High prevalence and incidence of disease and a high rate of transmission of infection characterize the TB situation in India. The incidence of smear positive pulmonary TB 1.0-2.5/1000. The annual risk of TB infection had been estimated at 1-2%for most of the tuberculin surveys carried out in different areas over different time periods. During nationwide study in 2000-2003, the average annual risk of TB infection (ARTI) in the country was estimated at 1.5%. The proportion of new cases with multi drug resistance (MDR) was relatively low, at 0.5-5.3%. However, the proportion of MDR cases among previously treated cases varied between 8% and 67%.5
The investigator felt that it is very essential to educate the TB patients regarding mode of transmission and prevention of TB. This will improve the patient’s knowledge, quality of life and behavior.
6.3 REVIEW OF LITERATURE
Orenstein EW, et al (2009) conducted a study to evaluate existing evidence regarding treatment regimen for multidrug resistant TB. The study was done in 34 clinical reports with a mean of 250 patients per report met the inclusion criteria. The treatment duration was at least 18 month, and if patients received a DOTS throughout treatment. Studies that combined both factors had significantly higher pooled success proportions (69%, 95% credible interval 64-73%) than other studies of treatment outcomes (58%, 95% credible interval 52-68%) than standardized regimens (54%, 95% credible interval 43-68%), although the difference was not significant. These results underscore the importance of strong patient support and treatment follow up system to develop successful MDR TB treatment program.6
Romon – pardo P, et al (2009) has done a study to stop TB strategy. The DOTS strategy was implemented to control TB in 1993 and new stop TB, highly qualified DOTS expansion, in 2006. DOTS treatment success rates rose steadily from 1995 to 2005, with 88% success rate by the end of 2004. The result shows that, implementation of DOTS should continue in order to meet WHO targets about prevalence and deaths by 2015.7
Shen X, et al (2009) investigated on drug resistant TB in china, during 2000 to 2006. A regional anti TB drug resistance surveillance study was conducted. 8419 pulmonary TB patients, 16.6% had resistant to any first line anti TB drug and 4.09% had MDR. The percentage of TB patient with resistance to any first line anti TB drug and MDR significantly increased during 2000-2003 (P=0.01 and P< 0.01). After improvements in the TB control program in 2004, the increasing trend in drug resistance was contained. The study revealed that improved case management, including DOTS and appropriate treatment regimens, should be sustained to prevent further transmission and development of drug resistant TB.8
Suganthi P et al (2008) conducted a study to assess the knowledge about TB among persons with pulmonary symptoms and TB cases in Bangalore slums. In selected slums, persons with pulmonary TB symptoms identified during house visit and residents with pulmonary TB were interviewed using pre- tested, semi- structured questionnaires. The result shows that, 50% of the 124 persons with pulmonary symptoms interviewed. About 19% had undergone sputum microscopy and 27% chest X ray of 47 pulmonary TB cases interviewed 72% first approached private health facilities; about 50% visited two health facilities before diagnosis and 87% visited two or more facilities before initiating treating; 42 initiated treatment at private health facilities and five who initiated treatment at private health facilities were later referred to government health facilities. The majority of persons with pulmonary symptoms and pulmonary TB cases had poor knowledge about TB. The study revealed that most of the patients with pulmonary symptoms were not aware of the availability of free anti TB services at government health facilities.9
Mangesho PE, et al (2007) conducted a study to assess the community knowledge, attitude and practices towards TB and its treatment in Tanzania. Correct knowledge and positive perception of the community towards TB and its management. Focus group discussions involving men and women were conducted in six villages. Result snows that community knowledge on its cause was poor symptoms of TB as mentioned by community included persistent cough and weight loss. TB was reported to be transmitted mainly through air. Focus group discussants knew that TB cure requires a 8 month period of treatment. The study concludes that rural communities have a low knowledge on the causes and the transmission of TB which is a likely cause of the delay in seeking treatment. An intensive appropriate community health education is required for a positive behavioral change in TB control.10
Kaona FA et al (2004) researched on factors contributing to treatment adherence and knowledge of TB transmission among clients on TB treatment. A household based survey was conduceted in six randomly selected catchments areas of Ndola, where 400 out of 736 clients receiving TB treatment with in the six months period. All clients were interviewed using a pre-tested structured tended to be older and more educated than the females, who reported that TB clients stopped taking their medication with in the first two month of commencing treatment. The major factors leading to non compliance included clients beginning to feel better (45.1and 38.6%), lack of knowledge on the benefit of completing course (25.4%) and TB drugs too strong (20.1% and 20.2%). There was a significant difference in TB knowledge with male than female. This study established that 29.8% of TB clients failed to comply with TB drug raking regimen once they started feeling better.11
Vijay S, Balasangameshwara WH et al, (2004) did a study on initial drug resistance (IDR) among TB patients under DOTS program in Bangalore city. The study was done in 324 new smears positive patients initiated on regimen sputum samples were collected from the patients. Information regarding the previous treatment was elicited using pre test semi structured schedule based on WHO questionnaire. The results indicate to one or more drugs. The resistance to streptomycin was the highest (22.5%) followed by isoniazid (13.7%) and MDR was 2.2%.12
Aaboatwalla M, et al (2003) conducted a study to assess the knowledge of and attitude towards TB in urban and rural communities in Pakistan. Knowledge of symptoms was generally deficient, particularly in rural females. Regarding TB prevention, 22.4% of rural and 14.4% of urban males said completing treatment was importance; only 9.8% of rural and 7.1% of urban females agreed. Doctors were an important source of information in rural areas and 60% of rural males said they would only stop treatment on a doctor’s advice. In contrast, > 65% of respondents in urban areas said they would stop treatment when symptoms ended. The study highlights the need to increase population awareness about TB.13
Khadim MK et al (2003) did a study to explore the factors influencing decision-making process at household level Vis-a vise decision regarding the type of care and the decision to continue treatment. In total, 100 smear positive patients were included in the study. First questionnaire was administered to first 50 randomly selected patients. The ethnographic decision models were developed from the responses. The second questionnaire, derived from these models, was administered to the second group of randomly selected 50 patients to test the predictive ability of the ethnographic decision making. The result shows that, TB was influenced by patient knowledge about the disease itself as well as its severity, infectivity and curability. The ethnographic decision model developed on these results had 80-90% ability to predict the decision making in TB patients. The study concluded that effective health education, easy accessibility to treatment centre and trained and motivated health care providers can go a long way in making National TB control program at success.14