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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA SYNOPSIS PROFORMA FOR THE REGISTRATION OF SUBJECTS FOR DISSERTATION SUBMITTED BY: Mr. KANTARAJU.S I YEAR M.Sc. NURSING COMMUNITY HEALTH NURSING [2012-2014 BATCH] ADICHUNCHANAGIRI COLLEGE OF NURSING, B.G.NAGARA, NAGAMANGALA TALUK, MANDYA DISTRICT-571448 1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 01. NAME OF THE CANDIDATE AND ADDRESS MR.KANTHARAJU.S 1ST YEAR M.SC. NURSING, ADICHUNCHANAGIRI COLLEGE OF NURSING, B.G.NAGAR,MANDYA(D) 02. NAME OF THE INSTITUTION ADICHUNCHANAGIRI COLLEGE OF NURSING, B.G.NAGAR,MANDYA(D) 03. COURSE OF THE STUDY AND SUBJECT MASTER OF SCIENCE IN NURSING (COMMUNITY HEALTH NURSING) 04. DATE OF ADMISSION TO THE 14-08-2012 COURSE 05. 5.1 TITLE OF THE STUDY STATEMENT OF THE PROBLEM “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING GLOBAL WARMING AND ITS IMPACT ON HEALTH”. “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTERED TEACHING PROGRAMME ON KNOWLEDGE REGARDING GLOBAL WARMING AND ITS IMPACT ON HEALTH AMONG B.Ed STUDENTS IN SELECTED COLLEGE,NAGAMANGALA.” 2 6.0 BRIEF RESUME OF THE INTENDED WORK. INTRODUCTION “Global warming is too serious for the world any longer to ignore its danger or split into opposing factions on it”. -TONY BLAIR The term global warming was probably first used in its modern sense on 8 august 1975 in a science paper by Wally broecker in the journal science called “Are we on the brink of a pronounced global warming”. Global warming is the increase of earth’s average surface temperature due to effect of greenhouse gases, such as carbon dioxide emission from burning fossil fuels or from deforestation, which trap heat that would otherwise escape from earth. This is a type of green house effect.1 Global warming is all about adverse climate change caused by trapping of green house gases (CO 2) in the earth atmosphere that affects biodiversity and causes a serious health hazards. Counter measures to facilitate living in hotter temperature like air conditioning and refrigeration will unfortunately consume more electricity from power plants that burn coal, releasing CO2 .This will further spike global warming and have a seriously damaging influence on human health. External forces refer to processes external to the climate system that influence climate. Climate responds to several types of external forcing, such as radiative forcing due to changes in atmospheric composition; change in solar luminosity, volcanic eruption and variation in earth’s orbit around sun.2 The greenhouse effect is the process by which absorption and emission of infrared radiation by gases occurs in atmosphere and surface. It was proposed by Joseph Fourier in 1824 and was first investigated quantitatively by Svante Arrhenius in 1896. Naturally occurring amounts of green house gases have a mean warming effect of about 330C.The major greenhouse gases are water vapor, which causes about 36 to 70% of the green house effect; CO2 which causes 9-26%, methane (CH4) which causes 4-9% and Ozone (O3) which causes 3-7% of greenhouse effect. Cloud also affects the radiation balance, through cloud forcing similar to green house gases. Human activity since the industrial revolution has increased the amount of green house gases in atmosphere leading to increased radiative forces from CO2, Methane, trophospheric 3 ozone, CFCs and Nitrous oxide. The concentration of CO2 and Methane have increased by 56% and 148% respectively since 1750.These values are much higher than at any time during the last 800000 years, the period of which reliable data have been extracted from ice cores. The fossil fuel burning has produced about three quarters of increase in CO2 from human activity over the past 20 years.1 Human beings have increased the CO2 concentration in the atmosphere by about thirty percent, which is an extremely significant increase, even on inter-glacial timescales. It is believed that human beings are responsible for this because the increase is almost perfectly correlated with increases in fossil fuel combustion, and also due other evidence, such as changes in the ratios of different carbon isotopes in atmospheric CO2 that are consistent with "anthropogenic" (human caused) emissions. Deforestation is responsible for 25% of all carbon emissions entering the atmosphere, by the burning and cutting of about 34 million acres of trees each year.2 6.1 Need for Study Nowadays global warming is considered as a burning problem and it is being a challenge to the entire world and its scientific society. Global warming is a worldwide environmental problem by which there is an abnormal increase to the level of temperature, particularly in a natural environment. Global Warming is the observed and projected increase in the average temperature of earth’s atmosphere and oceans due to greenhouse gas emissions like CFC, CH4, N2O, CO, Hydro carbons on account of human activities. The effects of Green house gas due to increase in Green House Gas warms the planet; decrease in Green House Gas cools the planet. Unfortunately there is a steep increase of the temperature in the last three decades. Global warming is not only affecting the nature, but it affects the life and homes of millions of people.10 . The U N Intergovernmental panel on climate change [IPCC] which draws upon the collective wisdom of many hundreds of scientist from around the world. The IPCC projects global temperature increases of 310 degree F in the next 100 years and says that human activity is the cause of most of the observed and projected warming. Warmer temperatures lead to greater concentrations of ground level ozone, which forms on hot, sunny days when pollution from cars and sources mix. 4 4 Higher temperature over the coming decades are excepted to cause more smoggy days and heat waves, contributing to a greater number of illness and deaths in the united states, according to international climate scientist. Smog can damage lung tissue, increasing respiratory and heart disease and death. Even modest increase in smog can cause asthma in children. Smog related death from climate change is projected to increase by about 4.5 % from the 1990s to 2050s, According studies at Columbia and Johns Hopkins universities. A scientist at Yale University, Michelle Bell, looked at the 50 largest cities in eastern United States and found that the health alert days would go up by 68 percent over the next decades.3 Increased frequency and severity of heat waves will lead to more heat stroke and other heat related illness and death. Senior citizens and children are particularly vulnerable to these effects. The word has already seen the effects of heat on human health. The summer 2003 heat wave in Europe that claimed 35,000 was likely made worse by global warming and in the summer of 2007, Greece suffered massive heat waves and recorded wildfire.Airpollution worsens as temperature increase and higher levels of ozone smog and other pollutants have been directly linked with increased rates of respiratory and cardiovascular disease and cardiac dysrryhthmia.5 Currently malaria, diarrhea, malnutrition flows related to climate change cause about 150,000world death annually, according to WHO. With warming temperature, the breeding cycle of malaria-mosquitoes is shortening, which means more mosquitoes and malaria each year. The same effect will likely be seen with other vector borne disease such as dengue fever, which has infected 60,000people in one outbreak in brazil’sriode feneiro this year alone. Rising temperature and varying rainfall patterns could affect staple-crop production and food security.5 Rising sea levels make coastal areas more susceptible to storm surges and flooding that result from severe weather. Just last year almost 7million people were displaced by flooding in dhaka.Bangladesh and in 2004, floods there killed more than 700.1990s, more than 16,000 deaths occurred world wide as a result of weather related disasters. WHO now says that 150,000 deaths are attributable to the effect of climate change. Many people are under the mistaken impression that only if the polar ice caps melt will sea level rise. In fact average sea level around the world has already risen 4-8 inches in the past 100 years due to global warming and is expected to rise another 4-35 inches by 2100.the primary reason for this rise is that 5 water expands as it warms. The second reason is that glaciers all over the world are melting and land based ice melts, the water runs to the sea and increases its level. Thousands of small islands are threatened by the projected sea level rise for the 21st century.6 Each of us can reduce our contribution to global warming by using less greenhouse-gas-producing energy: driving less, choosing fuel efficient cars and appliances (like refrigerators and water heaters), and using solar energy where feasible for water and space heat. We can encourage our political and business leaders to institute policies that will save energy and develop alternative energy sources that do not release carbon dioxide. We can preserve existing forests and plant new ones. But even if we take aggressive action now, we cannot completely prevent climate change because once carbon dioxide is in the atmosphere, it remains there for about a century, and the climate system takes a long time to respond to changes. But our actions now and in the coming decades will have enormous implications for future generations 6 Here the researcher would like to assess the knowledge of B.Ed students regarding global warming and its impact on health using structured questionnaire .A structured teaching program will be conducted to increase knowledge on global warming and its impact on health. If the B.Ed students gain adequate knowledge regarding global warming, they will be able to teach students and their relatives in home. 6.2 REVIEW OF LITERATURE Review of literature is defined as broad, comprehensive in depth systematic and critical review of scholarly publications unpublished scholarly print materials, audiovisual materials and personal communications. Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systemic examination of publications relevant to research project.7 Martiello MA, in division of public health, university of Siena, Italy conducted a study regarding “High temperature and health outcomes”. The aim of the study was to analysis the relationship between high temperature and population health impacts, in terms of mortality and morbidity. A literature search was conducted using midline to collect data from studies on heat waves temperature health impacts curves, risk factors and preventive measures. The result of the study showed an increase in deaths may relate that a forward shift of deaths may only explain a very quantity of the excess mortality observed during major 6 heat waves. Moreover, the results seem to exclude that ozone acts as a confounding variable, whilst it remains a potential effect modifier8 Walker R School of Public Health, La Trobe University Victoria conducted a study regarding health promotion intervention to address the climate change using a primary health care approach. This project explored the literature in which key concepts in primary health care and promotion are overtly applied to the problem of climate change. This paper contains a discussion of the literature relevant to health promotion principles and intervention strategies for addressing climate change mitigation and adaption in primary health care sector. The review of literature indentified in electronic database using two sets of search term. Set A consisted of climate change (or) global warming (or) green house effect and set B Consisted of 11-key concepts in primary health care and health promotion. the result of the study show that discussion of major categories of health promotion intervention, namely health communication ,community building and setting approaches uses examples drawn from literature on community resilience and summer heat. These interventions are all applicable to the primary health care sector9 N.Sasikumar conducted a study regarding awareness of global warming the graduate teacher trainees. To identify the level of awareness regarding global warming and to enhance the same among future secondary school teachers. The study was conducted in graduate trainees of college of education, Karaikudi Town, Sivagangi District, Tamilnadu state. The authors used purposive sampling and samples are collected only from graduate teacher trainees. The total respondent of the graduate teacher training colleges is 300.out of 300 the authors selected only 290 samples from the respondent of graduate teacher training and result of the study shows that graduate teacher training of government college of education have awareness on global warming which is more than the private graduate teacher trainees. It is suggest that the above study may be undertaken with all the government colleges of education graduate teacher trainees. The same present study can be conducted to high school students and diploma teacher trainees. The authors conclude that students belong to arts group graduate trainees have low awareness on global warming than the students of graduate trainees.10 Sharmila, Conducted a study regarding college students knowledge about global warming, physical science and engineering. The study was intended to find out the knowledge of global warming among the 7 college students in Madurai district, Tamilnadu, India.Random sampling technique was used to compose a sample of 1168 college students. The result revealed that male and female students, rural and urban area students, arts and science group students exhibited significant difference but nuclear and joint family students had no significant difference in respect of their knowledge of global warming.11 Joyce A Dixons s. the department of each social and community health, Australia conducted a study regarding reducing the environmental impact of dietary choice: prospective from a behavioural and social change approach. Climate change is recognized as a significant public health issue that will impact on food security. Increased consumption of plant based food is a recommended strategy to reduce human impact on the environment and is also now recognized as a potential strategy to reduce the high rates of some chronic disease .Formative research under taken in this study discovered that people realized the benefit of fruit and vegetable consumption, but there were barriers related to incorrect perception of recommended serving size, and lack of time and knowledge about how to prepare meals with vegetables. This study shows that a well developed messages based on a thorough understanding of the determinants of that behavior can influence dietary practice.12 Raoloz V School of population health, university of Queensland, Brisbane, conducted a study on surveillance of dengue fever virus: a review of epidemiological models and early warning systems. This study AIMS at analyzing the different modeling methods and their output in terms of act as an early warning system.Epidemological models attempt to predict future outbreak using information on the risk factor of disease. In the context, modeling focuses on transmission patterns between the different animal, human (or) vector components as well as including parameters which affect these pathways such as environmental, climatic (or) geographic ones. The output of model can help in decision making processes concerning control purpose, surveillance methods and hopefully also as a good predictive tools. This study shows that Varity and depth of models for dengue fever surveillance and their use as early warning tools.13 Sokolow S conducted a study regarding effects of a changing climate on the dynamics of coral infectious disease; a close examination of the coral disease literature reveals many hypothesized mechanisms for how coral disease may be linked to climate change. However, evidence has been largely circumstantial, and much uncertainty remains. The published evidence supports the hypothesis that coral 8 infectious diseases are emerging and demonstrates that coral disease research has been exponentially expanding over the last few decades. Current research suggests that environmental factors, such as ocean warming, altered rainfall, increased storm frequency, sea level rise, altered circulation, and ocean acidification may play a role in coral disease. These climate variables likely alter coral epidemiology through effects on pathogen growth rates, transmission, virulence, and susceptibility. In a rapidly changing global environment, the consequences of increasing coral disease may be severe, leading to elevated extinction risk and loss of critical reef habitat. Current evidence is still preliminary but is increasingly suggestive that mitigating the effects of climate change may help reduce the emergence of disease and improve the health of coral reef ecosystems.14 Stuen S,Seksjon for smafeforking,Institute for produksjonsdyrmedisin,Norges veterinaerhogskole,4325 Sandnes conducted a study regarding human anaplasmosis- a hidden disease in Norway.tick and tick borne infections will most probably increase in Norway due to global warming,regrowth of pasture and increase number of cervids.The article provides a review of A.phagocytophilum infection in mammals, with a special focus on human anaplasmosis.It is based on relevant literature and the author’s extensive research on this bacterium. The result of the study shows that infection is widespread in animal along the coast of southern Norway, only few human cases have been reported so for. Even though infection with A phagocytophilum mainly presents as a influenza-like disease it may have a fatal out come.human-ana+plasmosis should be considered as a differential diagnosis when faced with a patient with influenza-like symptoms 1-3 weeks after a tick-bite.15 Mr.Wassel JJ Novant health concord North Carolina, USA; conducted study regarding “Public health preparedness for the impact of global warming on human health” ;Objectives of the study was to assess the changes in weather and weather associated disturbances related to global warming. The impact on human health of these changes; and the public health preparedness mandated by this impact. In this study they reviewed sixty-seven journal articles and concluded that the projections and signs of Global environmental changes are worrisome, and there are reasons to believe that related information may have been conservatively interpreted and presented in the recent past. We must begin greening our own lives and clinical practice and start talking about these issues with patients. As we build walk able neighborhoods, 9 change methods of energy production and make water use and food production and distribution more sustainable, the benefits to improved air quality, a stabilized climate, social support and individual and community health will be dramatic.16 Emch M, conducted a study regarding Seasonality of cholera from 1974-2005. The seasonality of cholera is described in various study areas throughout the world. In this study Cholera data are compiled from 1974 to 2005 from the World Health Organization Weekly Epidemiological Reports, a database that includes all reported cholera cases in 140 countries. The data are analyzed to measure whether season, latitude, and their interaction are significantly associated with the country-level number of outbreaks in each of the 12 preceding months using separate negative binomial regression models for northern, southern, and combined hemispheres. The results suggest that cholera outbreaks demonstrate seasonal patterns in higher absolute latitudes, but closer to the equator, cholera outbreaks do not follow a clear seasonal pattern. He findings suggest that environmental and climatic factors partially control the temporal variability of cholera. These results also indirectly contribute to the growing debate about the effects of climate change and global warming. As climate change threatens to increase global temperature, resulting rises in sea levels and temperatures may influence the temporal fluctuations of cholera, potentially increasing the frequency and duration of cholera outbreaks. 17 Romero V, conducted a study regarding Kidney stone; global picture of prevalence, incidence, and associated risk factors. The prevalence and incidence of nephrolithiasis is reported to be increasing across the world. In this study they review information regarding stone incidence and prevalence from a global perspective. Data were collected from the identified literature and sorted by demographic factors and time period. A total of 75 articles were identified containing kidney stone-related incidence or prevalence data from 20 countries; 34 provided suitable information for review. Data regarding overall prevalence or incidence for more than a single time period were found for 7 countries (incidence data for 4 countries; prevalence data for 5 countries). The body of evidence suggests that the incidence and prevalence of kidney stones is increasing globally. These increases are seen across sex, race, and age. Changes in dietary practices may be a key driving force. In addition, global warming may influence this trends.18 10 A study was conducted in California by D.C.Donaldson and W.R.Keatinge regarding impact of global warming on health and mortality; the initial concern about the possible effects of global warming on infectious has declined with the realization that the spread of tropical disease is likely to be limited and controllable. However the direct effect of heat already causes substantial number of deaths among vulnerable people in the summer. Action to prevent these deaths from rising is the most obvious medical challenge presented by a global rise in temperature.19 The centre for health and the global environment, Hayward Medical School, USA conducted a study regarding “Is global warming harmful to health?”In that study there was a projection from computer models predict that global warming will expand the incidence and distribution of many serious medical disorders. Global warming aside from directly causing death by drawing or starvation, promotes by various means by emergence, resurgence and spread of infection diseases. This article addresses the health effect of global warming and disrupted climate patterns in detail. Among the greatest health concerns are diseases transmitted by mosquitoes such as malaria, dengue fever, yellow fever and several kinds of encephalitis. Such disorders are projected to become increasingly prevalent because their insect carriers are very sensitive to meteorological conditions. In addition floods and droughts resulting from global warming can each help trigger out breaks by creating breeding grounds for insects whose desiccated eggs remain viable and hatch in still water .Other effects of global warming on health include the growth of opportunist populations and the increase of the incidence of water borne diseases because of lack of clean water.20 United Nations Conference on the Environment and Development (UNCED) in Rio de janerio.A study was conducted to public health effects of global climate change and ozone depletion. the data were obtained from articles accessed through the national library of medicine’s Medline data base and from personal communication with key investigators. The result of the showed that dengue fever, cholera and red tides may continue to threaten coastal populations as phytoplankton blooms proliferate in warmer, nutrient rich waters and increased UV-B radiation contributes to cataracts, skin cancer and immunosuppression.The study recommended that internationally co-ordinate monitoring for the emergence of epidemics, laboratory and field studies of vector ecology and elaboration of UV-B effect on the human immune system21 11 6.3 STATEMENT OF THE PROBLEM “A STUDY TO ASSESS THE EFFECTIVENESS OF STURCTERED TEACHING PROGRAMME ON KNOWLEDGE REGARDING GLOBAL WARMING AND ITS IMPACT ON HEALTH AMONG B.ED STUDENTS IN SELECTED COLLEGE, NAGAMANGALA”. 6.4 OBJECTIVES OF THE STUDY 1. To assess the existing knowledge regarding Global warming and its impact on health among the B.Ed students. 2. To assess the post test knowledge regarding global warming and its impact on health among the B.Ed students. 3. To assess the effectiveness of a structured teaching programme on Global warming and its impact on health among the B.Ed students. 4. To associate the knowledge regarding Global warming and its impact on health with demographic variables. 6.5 HYPOTHESIS H1. There will be a significant difference between the mean pre test and post test knowledge score regarding Global warming and its impact on health among the B.Ed students in selected college. H2. There will be a significant association between level of knowledge regarding Global warming and its impact on health among the B.Ed students in selected college with their selected demographic variables. 12 6.6 OPERATIONAL DEFINITIONS 1. Effectiveness: It refers to the way by which an action produces an intended or desired outcome. In this study it refers to an extent to which the structured teaching programme regarding global warming and its impact on health has achieved the desired effect and improves the knowledge of B.Ed students in selected college. 2. Structured Teaching programme: It refers to a systematically developed instructional aids designed to impart knowledge regarding Global warming and its impact on health. 3. Global warming: Global warming is all about adverse climate change. Global warming is an increase in the earth’s average atmospheric temperature that causes corresponding changes in climate and that may results from the green house effect. 4. Knowledge: It refers the response and level of understanding of B.Ed students regarding global warming and its impact on health. 5. Impact: A high force or a shock over a short time or a long time periods. 6. Health Health is a complete state of physical, mental and social well being and not merely the absence of disease or infirmity 7. B.Ed students: Those students who are studying bachelor of education in selected college. 13 6.7 ASSUMPTIONS 1. B.Ed students in selected college may have inadequate knowledge regarding Global warming and its impact on health. 2. Knowledge regarding Global warming and its impact on health can be measured by questionnaire. 3. Knowledge regarding Global warming and its impact on health will be enhanced among B.Ed students in selected college after conducted of structured teaching programme. 6.8 MATERIALS AND METHODS 1. Sources of data The data will be collected from the B.Ed students in selected college, Nagamangala. 2. Method of collection of data Structured Questionnaire. 3. Research design Quasi experimental-one group pretest posttest design. 4. Research approach An evaluative research approach. 5. Setting of the study The study will be conducted among B.Ed students in selected college, Nagamangala. 6. Population The population of the present study comprises of all B.Ed students in Nagamangala. 7. Sample size The sample size will be 60 B.Ed students. 8. Sampling technique Simple random sampling technique will be used. 7.1 Sampling Criteria Inclusive criteria a) All male and female B.Ed students studying in selected college. b) B.Ed students who are willing to participate. 14 Exclusive criteria a) B.Ed students who are not willing to participate. b) B.Ed students who are not present at the time of study. 6.9 LIMITATIONS OF THE STUDY Study is limited to 1) 60 B.Ed students in selected college of Namangala, Mandya(D) Karnataka 2) A period of 4-6 weeks 7.0 SIGNIFICANCE OF THE STUDY Increases the knowledge of B.Ed students regarding global warming and its impacts on health 7.1 TOOL FOR DATA COLLECTION The tool consists of the following sections. Section A- Demographic variables Section B- Structured questionnaire to assess the knowledge of B.Ed students regarding Global warming and its impact on health. 7.2 VARIABLES INDEPENDENT VARIABLES:o Effectiveness of structured teaching programme regarding global warming DEPENDENT VARIABLES:o Knowledge regarding global warming 7.3 PLAN FOR DATA ANALYSIS The data collected will be analysed by using descriptive and inferential statistics. Descriptive statistics Frequency, percentage distribution mean, median, mode and standard deviation will be used to analyze the knowledge regarding global warming and its impact on health 15 Inferential statistics Paired‘t’ test will used to compare the pre and post test knowledge regarding global warming and its impact in health. Chi-square test will be used to analyze association between pre test knowledge with selected demographic variables. 7.4 Does the study require any investigations or interventions to be conducted on patients or other human or animals…? Yes, structured teaching programme will be administration for degree students. 7.5 Has ethical clearance been obtained from your situation…? 1. Permission will be obtained from the research committee of Adichunchanagiri College of nursing, Nagamangala. 2. Permission will be obtained from the concerned authorities of the colleges. 3. Informed consent will be taken from the samples, confidentiality and privacy of data will be maintained. 16 8.0 LIST OF REFERENCES 1. Introduction of global warming available from: URL:http://www.en.wikipedia.org 2. Adverse climate changes available from: URL:http://www.medindia.net 3. Climate change available from http://www.stgate.com/global warming health effects smog-heat waves. 4. Health effects of global warming available from: URL:http://www.medindia.net 5. The human side of global warming available from http://www.american progress.org 6. Carnegie Mellon university, teacher’s guide to high-quality education material on climate change and global warming. 7. BT Basavanthappa. Nursing research: Review of literature. New Delhi: Jaypee brothers; 2003. p48 8. Martiello.High temperature and health outcomes, division of public health, University of siena, Italy. Scand j public health, 38:826-37, 2010 dec 9. Walker R, health promotion intervention to address climate change using a primary health care approach, La trobe university, Victoria 10. N.Sasikumar, Awareness of global warming among the graduate teacher trainees, research center for research in education. Journal of education and practice, JSSN2222-1735, Vol 2, No 9, 2011 11. Sharmila V.College student’s knowledge about global warming, physical science and engineering, International journal of current research 12. Joyce A, Reducing the environmental impact of dietary choce: perspectives from a behavioural and social approach, each social and community health, vic3134, Australia. 13. Racloz V, Surveillance of dengue fever virus:a review of epidemiological models and early warning systems, University of queen land,Austtrilia. 14. Sokolow S. Effects of a changing climate on the dynamics of coral infectious disease. Journal for Health care Quality.2009 Nov; 14(3); p5-18 15. Stuen S, Human anaplamosis – a hidden disease in Norway, Norges veterinaerhogskole. 16. Wassal JJ.Public health preparedness of the impact of global warming on human health. Disaster medical journal.2009 July; 4(4); p217-225. 17 17. Emch M. Seasonality of cholera from 1974 to 2005: a review of global patterns. International journal for health Geographics.2008 june20 (7); 30-31. 18. Romero V. Kidney stone; global picture of prevalence, incidence, and associated risk factors. A journal of review on Urology.2010, 12(2-3)86-96 19. W R Keatinge. Impact of global warming on health and mortality. South med Journals.2004, 97(11).p494-582 20. Center for health and global environment, Hayward medical school, USA.Study about is Global warming harmful to health available from: URL: http://www.ncbi.nlm.nih.gov 21. UNCED.Conducted a study regarding health effects of global climate change and ozone depletion in Rio De Janerio 22. Denise F Polit, Cherly Tatano Back. Nursing research Data analysis and interpretation. Williams and Willkims publications: New Delhi; 2008. P506-642. 23. Barbara Hazard Munro. Statistical methods for health care research: statistics. Philadelphia: Lippincott; 3rdedition. p73. 18 Inferential and descriptive