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Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION DISSERTATION PROPOSAL “A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF YOUNG ADULTS REGARDING THE PREVENTION AND MANAGEMENT OF CHIKUNGUNYA AT SELECTED RURAL AREA IN BANGALORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET.” SUBMITTED BY, Mr. JOBIN P. JOY, 1ST YEAR M.Sc. NURSING, ROYAL COLLEGE OF NURSING, UTTARAHALLI, BANGALORE-560061 1 Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore PROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. Name of the Candidate and Address Mr. JOBIN P. JOY, 1ST YEAR M.Sc. NURSING, ROYAL COLLEGE OF NURSING, 7TH MAIN, 1ST BLOCK, UTTARAHALLI, BANGALORE-560061 2. 3. Name of the Institution Course of study 4. 5. Date of admission to course Title of the Topic: Royal College Of Nursing, Bangalore 1st Year M.Sc. Nursing, Medical-Surgical Nursing 01.06.2012 “A Descriptive Study To Assess The Knowledge Of Young Adults Regarding The Prevention And Management Of Chikungunya At Selected Rural Area In Bangalore With A View To Develop An Information Booklet.” 6. 7. Brief resume of the intended work: 6.1 Need for the study 6.2 Review of literature 6.3 Objectives of the study 6.4 Operational definitions 6.5 Assumptions 6.6 Delimitations of the study 6.7 Pilot study 6.8 Variables Materials and methods Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed 7.1 sources of data- Data will be collected from young adults residing at selected rural area in Bangalore. 7.2 Methods of data collection- structured knowledge questionnaire. 7.3 Does the study require any interventions or investigation to the patients or other human being or animals? No 7.4 Has ethical clearance been obtained from your institution? Yes ethical committee’s report is here with enclosed. 8. List of references Enclosed 2 Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. Name of the Candidate and Address Mr. JOBIN P. JOY, 1ST YEAR M.Sc. NURSING, ROYAL COLLEGE OF NURSING, 7TH MAIN, 1ST BLOCK, UTTARAHALLI, BANGALORE-560061 2. Name of the Institution Royal College Of Nursing 3. Course of study and subject 1st Year MSc. Nursing Medical-Surgical Nursing 4. Date of admission to course 5. Title of the Topic: 01.06.2012 “A Descriptive Study To Assess The Knowledge Of Young Adults Regarding The Prevention And Management Of Chikungunya At Selected Rural Area In Bangalore With A View To Develop An Information Booklet.” 3 6. BRIEF RESUME OF THE INTENDED WORK: INTRODUCTION “The only purpose for which power can be rightfully exercised over any member of a civilized community against his will is to prevent harm to others.” John Stuart Mill A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, "disease" is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviours, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one's perspective on life, and their personality.1 Infectious diseases, also known as transmissible diseases or communicable diseases comprise clinically evident illness (i.e., characteristic medical signs and/or symptoms of disease) resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism. In certain cases, infectious diseases may be asymptomatic for much or even their entire course in a given host. In the latter case, the disease may only be defined as a "disease" (which by definition means an illness) in hosts who secondarily become ill after contact with an asymptomatic carrier. An infection is not synonymous with an infectious disease, as some infections do not cause illness in a host.2 Chikungunya infection causes an illness with symptoms similar to dengue fever, with an acute febrile phase of the illness lasting only two to five days, followed by a prolonged arthralgic disease that affects the joints of the extremities. The pain associated with CHIKV infection of the joints persists for weeks or months, or in some cases years.3 The incubation period of chikungunya disease ranges from one to twelve days, usually two to three. Its symptoms include a fever up to 40 °C (104 °F), a petechial or maculopapular rash of the trunk and occasionally the limbs, and arthralgia or arthritis affecting multiple joints. Other nonspecific symptoms can include headache, conjunctivitis, slight photophobia and partial loss of taste. Typically, the fever lasts for two 4 days and then ends abruptly. However, other symptoms—namely joint pain, intense headache, insomnia and an extreme degree of prostration—last for a variable period; usually for about five to seven days. Patients have complained of joint pains for much longer time periods; some as long as two years, depending on their age.3 Chikungunya is a viral disease that is spread by mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash. The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common. There is no cure for the disease. Treatment is focused on relieving the symptoms. The proximity of mosquito breeding sites to human habitation is a significant risk factor for Chikungunya. The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of Chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in Europe, in a localized outbreak in north-eastern Italy. The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for chikungunya as well as for other diseases that these species transmit. Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes. This requires mobilization of affected communities. During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.4 6.1 NEED FOR THE STUDY “An ounce of prevention is worth a pound of cure.” Henry de Bracton India is undergoing an epidemiologic, demo-graphic and health transition. The expectancy of life has increased, with consequent rise in degenerative diseases of aging and life-styles. Nevertheless, communicable diseases are still dominant and constitute major public health issues. The research strategy adopted by the Council is a balance between the upstream (fundamental and basic) and downstream (product development/evaluation and operational) research.5 Through the network of its disease-specific Institutes/Regional Medical Research Centres and extramural research programme, the Council is supporting and encouraging biomedical research in communicable diseases. New viral and bacterial infections have been identified. Monitoring of anti-microbial resistance to commonly used drugs is being extended to include more organisms. Disease surveillance at the molecular level has been expanded and strengthened. Studies to assess disease burden not only in terms of 5 morbidity and mortality but also economic are high on the Council’s agenda. Feasibility of effective strategies under field conditions for control of infectious diseases is being demonstrated. Research support to eradicate target diseases has been intensified. Development and evaluation of diagnostic tools, drugs and vaccines is being undertaken. Programme relevant research to strengthen the national health programmes and human resource development are an integral part of the efforts of the Council towards control of communicable diseases.5 From February 2006 to 10 October 2006, the WHO Regional Office for South-East Asia has reported 151 districts in 8 states/provinces of India affected by chikungunya fever (see below). The affected states are Andhra Pradesh, Andaman & Nicobar Islands, Tamil Nadu, Karnataka, Maharashtra, Gujarat, Madhya Pradesh, Kerala and Delhi. More than 1.25 million suspected cases have been reported from the country, which 752,245 were from Karnataka and 258,998 from Maharashtra provinces. In some areas reported attack rates have reached 45%.6 A team from the Ministry of Health and Family Welfare, health officials from Kerala and staff from the WHO India Office and Regional Office for South-East Asia investigated the outbreak in Kerala. They carried out clinical and epidemiological examinations of suspected cases in hospitals and at home, and collected clinical samples. An entomological survey revealed high densities of Aedes albopictus in the affected areas as well as in areas not affected by the disease.6 For personal protection, individuals should take measures to protect themselves against the bites of the mosquitoes which transmit the virus (including Aedesaegypti), which are active during the daytime. Elimination of breeding sites can contribute to the reduction of mosquito densities. As a result, a key recommendation from the investigation team is for urgent vector control measures coupled with an intensive awareness campaign in the community. Health care staff at all levels, government officials and nongovernmental organizations are called upon to assist in this information and health education campaign. The Communication-for-Behavioural Impact methodology has been successful in mobilizing affected populations for vector control activities.6 A study was conducted at National Institute of Malaria Research, ICMR, New Delhi, India to know the distribution and determinants of chikungunya fever outbreak in India. On the basis of high and low incidence of chikungunya fever, two districts from each State and two wards from the selected district were taken for random selection of 1000 households from 10 districts and 5 States. Semi-structured questionnaires were administered to individuals, patients, qualified health professionals and to stakeholders for collecting information. The educational background and occupation of the respondents showed variations across the study States. Only in high incidence ward of Maharashtra, water storage period for 3-6 days and emptying, drying of water containers on weekly basis was noted. The study through knowledge, attitude, belief, practice (KABP) 6 obtained individual's perception of chikungunya fever, its prevention and control. Patients' expenditure on treatment was mainly recorded less than Rs 500 across study States. Health facility survey obtained an overview of the capacity of local health facilities. Stakeholders' perception regarding chikungunya fever was also noted. The study revealed differences in awareness of chikungunya, cause of the disease, vector responsible, mode of transmission, biting time and elimination of breeding of mosquitoes statistically significant among high and low incidence wards of all the States. Expenditure on treatment was independent of economically active status and loss of man-days across all the States. Education and occupation did not have any relation with emptying/drying of water containers in high incidence wards. Strengthening of surveillance, information, education and communication (IEC) activities along with case management facilities may be provided by the State health department for prevention of chikungunya outbreaks in future.7 So the researcher intended to assess the knowledge of young adults regarding the prevention and management of chikungunya at selected rural area in Bangalore and develop and administer an information booklet regarding the prevention and management of chikungunya based on the knowledge of young adults. 7 6.2 REVIEW OF LITERATURE Researchers almost never conduct a study in an intellectual vacuum; their studies are usually undertaken within the context of an existing knowledge base. A Literature Review helps to lay the foundation for the study and can also inspire new research ideas. “Review of Literature is a summary of research on a topic of interest, often prepared to put a research problem in the context as the basis for an implementation project”. A literature review helps to play the foundation for the study and can also inspire new research ideas.8 A study was conducted at Centers for Disease Control and Prevention (CDC) on Chikungunya outbreak - cambodia, february-march 2012. They described the characteristics of a local outbreak linked with chikungunya reemergence in a rural Asian setting. Sporadic cases of chikungunya were identified in Cambodia in 2011. Antibodies to CHIKV have been detected in serum collected in Cambodia in 2007, but the strain could not be identified for those cases. On March 7, 2012, several cases of rash with fever were reported among village residents of Cambodia. Subsequent field investigation revealed that four of six blood samples from affected persons were positive for CHIKV by polymerase chain reaction (PCR) at U.S. Naval Medical Research Unit 2 in Phnom Penh. Investigators from the Cambodian Communicable Disease Control Department, National Malaria Center, local health centers, and village authorities conducted a seroprevalence study of village residents on March 26 to gather information for response planning and control efforts. The outbreak affected families throughout the village, and 44.7% of the population tested had evidence of infection by CHIKV, which affected all age groups.9 A study was conducted on Sterile insect technique: targeted control without insecticide & found that Sterile insect technique (SIT) is a method of disease vector control technique that consists of releasing overwhelming numbers of sterile males. This method provides an environmentally friendly alternative to insecticides. Another advantage of SIT in comparison with other methods is to provide a targeted speciesspecific approach. In Reunion Island, SIT has been proposed as a basis for developing a viable method of vector control against Aedes albopictus and Anopheles arabiensis. The technique has already been successfully tested on fly and mosquito species for more than 40 years.10 A study was conducted on changes in the legally mandated distribution of competency for mosquito control based on experience on Reunion Island & the purpose is to describe the legal framework for controlling mosquito vectors of diseases transmissible to human beings in certain locations such as Reunion Island. A distinction is made between general legal measures for insect vector control and specific measures for mosquito control. Regionalization is a major factor in the legal framework for insect vector control, thus limiting the 8 scope of action by the prefecture. Another factor involves the increasing role of an important new player, i.e., the regional health agencies. Mosquito vector control raises the need to impose and enforce measures on the general public as well as private citizens.11 A study was conducted at USA on cross-protective immunity against o'nyong-nyong virus afforded by a novel recombinant chikungunya vaccine. Emerging mosquito-borne alphavirus infections caused by chikungunya virus (CHIKV) or o'nyong-nyong virus (ONNV) are responsible for sporadic and sometimes explosive urban outbreaks. Currently, there is no licensed vaccine against either virus. A highly attenuated recombinant CHIKV candidate vaccine (CHIKV/IRES) was developed & that in preclinical studies was demonstrated to be safe, immunogenic and efficacious. In this study they investigated the potential of this vaccine to induce cross-protective immunity against the antigenically related ONNV. They demonstrated that a single dose of CHIKV/IRES elicited a strong cross-neutralizing antibody response and conferred protection against ONNV challenge in the A129 mouse model. Moreover, CHIKV/IRES immune A129 dams transferred antibodies to their offspring that were protective, and passively transferred anti-CHIKV/IRES immune serum protected AG129 mice, independently of a functional IFN response. These findings highlight the potential of the CHIKV/IRES vaccine to protect humans against not only CHIKV but also against ONNV-induced disease.12 A study was conducted at Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore on early neutralizing IgG response to Chikungunya virus in infected patients targets a dominant linear epitope on the E2 glycoprotein. They studied the antibody response against the CHIKV surface antigens in infected patients. With plasma samples obtained during the early convalescent phase, showed that the naturally-acquired IgG response is dominated by IgG3 antibodies specific mostly for a single linear epitope 'E2EP3'. E2EP3 is located at the N-terminus of the E2 glycoprotein and prominently exposed on the viral envelope. E2EP3-specific antibodies are neutralizing and their removal from the plasma reduced the CHIKV-specific antibody titer by up to 80%. Screening of E2EP3 across different patient cohorts and in non-human primates demonstrated the value of this epitope as a good serology detection marker for CHIKV infection already at an early stage. Mice vaccinated by E2EP3 peptides were protected against CHIKV with reduced viremia and joint inflammation, providing a pre-clinical basis for the design of effective vaccine against arthralgia-inducing CHIKV and other alphaviruses.13 A study was conducted at French Institute of Pondicherry, on chikungunya outbreak in the metropolis of Chennai, India, 2006. In the metropolis of Chennai, the first laboratory-confirmed chikungunya cases had an onset of symptoms at the end of May 2006. The authors reviewed surveillance data in which a suspected case of chikungunya was defined as a patient presenting with fever and arthralgia at a medical camp in Chennai on and after June 20, 2006. Over the same period, larval indices for the vector Aedes aegypti. From June 20 to October 10, 2006, reported 4,760 suspected cases of chikungunya. Control measures included removal of breeding sites, 9 daytime fogging against adult mosquitoes, and information campaigns. The early detection and effective prevention of future outbreaks rely on strengthened human and entomological surveillance, participation of private medical practitioners in case reporting, and community involvement to reduce potential breeding sites of the vector.14 A study was conducted at National Institute of Malaria Research (ICMR), Poojanahalli, on comparative efficacy of two poeciliid fish in indoor cement tanks against chikungunya vector Aedes aegypti in villages in Karnataka, India. The study showed that only 18% of respondents knew of the role of mosquitoes in fever outbreaks, while almost all gained new knowledge from the IEC campaigns. In Domatmari. Indoor cement tanks were the most preferred Ae. aegypti breeding habitat, and had a significant impact on Aedes breeding (Breteau Index) in all villages in the one-week period. In the one-month period, the impact was most sustained in Domatmari then Srinivaspura and Balmanda. After fish introductions, chikungunya cases were reduced by 99.87% in Domatmari, 65.48% in Srinivaspura and 68.51% in Balmanda.15 A study was conducted at division of Vector-Borne Infectious Diseases, Centers for Disease Control & Prevention, Fort Collins on Genomic evolution and phenotypic distinctions of Chikungunya viruses causing the Indian Ocean outbreak. The most commonly used application of cutting edge tools has been to track the movement of the virus over time and space. While this is an important concept for identifying areas that remain at risk for outbreaks, these post genomic era tools can also be applied to the highly significant tasks of understanding how viral micro evolutionary changes can affect both invertebrate transmission and vertebrate virulence. Significant alterations in the patterns of CHIKV movement have already been identified using micro evolutionary studies. These approaches now need to be further expanded to aid in expanding vaccine, therapeutic and control options.16 A study was conducted at France on Insecticide susceptibility of Aedes aegypti and Aedes albopictus in Central Africa. Aedes aegypti and Ae. albopictus were sampled in six urban localities. Larval bioassays, carried out to determine the lethal concentrations and resistance ratios suggested that both vector species were susceptible to Bti (Bacillus thuringiensis var israeliensis) and temephos. Bioassays were also performed on adults using WHO diagnostic test kits to assess phenotypic resistance to deltamethrin, DDT, fenitrothion and propoxur. These experiments showed that one population of Ae. aegypti and two populations of Ae. albopictus were resistant to DDT. Resistance to deltamethrin was also suspected in Ae. albopictus from Yaound. All other field mosquito populations were susceptible to deltamethrin, DDT, fenitrothion and propoxur. No increase in the knockdown times was noted in the Yaoundé resistant population compared to other Ae. albopictus populations, suggesting the possible involvement of metabolic resistance to deltamethrin and DDT.17 10 A study was conducted at Bruno Kessler Foundation, Trento, Italy on transmission potential of chikungunya virus and control measures: the case of Italy. For this they developed a model describing the temporal dynamics of the competent vector, known as Aedes albopictus, explicitly depending on climatic factors, coupled to an epidemic transmission model describing the spread of the epidemic in both humans and mosquitoes. The cumulative number of notified cases predicted by the model was 185 on average, in good agreement with observed data. The probability of observing a major outbreak after the introduction of an infective human case was estimated to be in the range of 32%-76%. They found that the basic reproduction number was in the range of 1.8-6 but it could have been even larger, depending on the density of mosquitoes, which in turn depends on seasonal meteorological effects, besides other local abiotic factors. These results confirm the increasing risk of tropical vector-borne diseases in temperate climate countries, as a consequence of globalization. This result showed that an epidemic can be controlled by performing a timely intervention, even if the transmission potential of Chikungunya virus is sensibly high.18 A study was conducted on effectiveness of a multiple intervention strategy for the control of the tiger mosquito (Aedes albopictus) in Spain. This study was undertaken to evaluate the effectiveness of four complementary and combined strategies to minimize the presence of the invasive mosquito Aedes albopictus, firmly established in Spain. A quasi-experimental design including six neighbourhoods was performed in 20082009. The abundance of mosquitoes was monitored through ovitraps. The multiple intervention strategy consisted of four actions: source reduction; larvicide treatments (Bacillus thuringiensis israelensis and diflubenzuron); adulticide treatments (alfacipermetrin); and cleaning up uncontrolled landfills. The results showed the number of eggs significantly reduced in the areas with intervention. In 2008, the accumulate median of eggs was 175 and 272 in the intervention and control areas, respectively. In 2009, these medians were 884 and 1668 eggs. In total, 3104 households were visited and 683 people were interviewed. During inspections inside the houses, the cooperation of citizens in 2009 was 16% higher than that in 2008 (95% CI 13-19%). These findings suggest that the strategy was effective in reducing the number of eggs.19 A study was conducted at Environmental Health Institute, National Environmental Agency, Singapore on Entomological investigation and control of a chikungunya cluster in Singapore. A total of 173 adult mosquitoes were caught using both the sweep-net method and the BG Sentinel Traps in and around the affected workers' quarters. Of these, 120 were Aedes albopictus and the rest were Culex quinquefasciatus. More than 2700 Ae. albopictus larvae were also collected from 33 breeding habitats detected. No Aedes aegypti was found. During the preintervention period, 6 out of 71 adult female Ae. albopictus were found positive for the chikungunyavirus (CHIKV). Vector control measures resulted in a 90% reduction of adult Ae. albopictus caught by BG Sentinel Traps. Postintervention surveillance revealed the presence of CHIKV-positive mosquitoes. These findings led to continued intensive vector control operation in the affected area that further reduced vector population and interrupted the transmission of the disease. The incrimination of Ae. albopictus as a major vector 11 involved in the transmission of A226V CHIKV had led to the revision of chikungunya control strategy in Singapore.20 A study was conducted at Division of Biodefense Vaccines, USA on a complex adenovirus vaccine against chikungunya virus provides complete protection against viraemia and arthritis. They described a recombinant chikungunya virus vaccine comprising a non-replicating complex adenovirus vector encoding the structural polyprotein cassette of chikungunya virus. A single immunisation with this vaccine consistently induced high titres of anti-chikungunya virus antibodies that neutralised both an old Asian isolate and a Réunion Island isolate from the recent epidemic. The vaccine also completely protected mice against viraemia and arthritic disease caused by both virus isolates.21 12 6.3 OBJECTIVES OF THE STUDY 1. To assess the knowledge of young adults regarding the prevention and management of Chikungunya. 2. To find out the association between the knowledge of young adults regarding the prevention and management of Chikungunya and selected demographic variables. 3. To prepare an Information Booklet regarding the prevention and management of Chikungunya based on the knowledge of young adults. 6.4 OPERATIONAL DEFINITIONS 1. Assess- Assess refers to process of the critical analysis, valuation and judgement of the knowledge of young adults regarding the prevention and management of Chikungunya. 2. Knowledge- Knowledge is defined as an expertise, and skills acquired by young adults regarding the prevention and management of Chikungunya through education and experience. 3. Young adults- It refers to the people aged between 18 to 35 years and are residing at selected rural area in Bangalore. 4. Prevention: These are the remedial measures against the chikungunya inoder to decrease its incidence in the rural area. 5. Management: It refers to the actions taken against the Chikungunya in home as well as the health care institutions in order to reduce and eliminate the symptoms. 6. Chikungunya: Chikungunya is a viral disease that is spread by mosquitoes from person to person. 7. Rural area: This is a geographical area where people with complexities of physical and behavioural characteristics living together and governed by a gram panchayat. 8. Information Booklet: A small thin book which contains the information regarding the prevention management of Chikungunya. 6.5 ASSUMPTIONS 1. The young adults may have some knowledge regarding the prevention management of Chikungunya. 2. The knowledge of young adults may have some knowledge regarding the prevention management of Chikungunya can be measured by using a structured knowledge questionnaire. 3. The knowledge of young adults may have some knowledge regarding the prevention management of Chikungunya can be improved by administering an information booklet. 6.6 DELIMITATIONS OF THE STUDY 1. The study is limited to the young adults residing at selected rural area in Bangalore. 13 6.7 PILOT STUDY The study will be conducted with 10 samples. The purpose to conduct the pilot study is to find out the feasibility for conducting the study and design on plan of statistical analysis. 6.8 VARIABLE A quantity that can assume any of a set of values is called variables. Dependent variable: knowledge of young adults regarding the prevention and management of Chikungunya. Extraneous variable: Age, type of family, occupation, per capita monthly income, educational status and sources of information. 7.1 MATERIAL AND METHODS 7.1 SOURCE OF DATA The data will be collected from the young adults residing at selected rural area in Bangalore. 7.1.1 RESEARCH DESIGN The Descriptive Design The design adopted for this study is descriptive in nature. 7.1.2 RESEARCH APPROACH Descriptive Survey approach. 7.1.3 SETTING OF THE STUDY The study will be conducted at selected rural area in Bangalore. 7.1.4 POPULATION All the young adults who meet the inclusion criteria and are residing at selected rural area in Bangalore. 7.2. METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE) The data collection procedure will be carried out for a period of one month. The study will be conducted after obtaining permission from concerned authorities. The investigator will collect data from young adults by 14 using structured questionnaire to assess knowledge of young adults regarding the prevention and management of chikungunya. Data collection instruments consist of the following sections. Section ‘A’: Demographic data Section ‘B’: Structured questions to assess the knowledge of young adults regarding the prevention and management of Chikungunya. 7.2.1 SAMPLING TECHNIQUE Sampling technique adopted for the selection of sample is non-probability convenience sampling. 7.2.2 SAMPLE SIZE The sample consists of 60 young adults who are residing at selected rural area in Bangalore. SAMPLING CRITERIA 7.2.3 INCLUSION CRITERIA 1. Young adults residing at selected rural areas in Bangalore. 2. Young adults who are willing to participate in the study. 3. Young adults who are available at the time of study. 7.2.4 EXCLUSION CRITERIA 1. Young adults who are all selected for pilot study. 2. Young adults who has unsoundness of mind. 3. Young adults who cannot read and write Kannada or English. 7.2.4 TOOL FOR DATA COLLECTION Structured knowledge questionnaire is used to collect data from young adults who are residing at selected rural area in Bangalore. 7.2.5 DATA ANALYSIS METHOD The data collected will be analysed by using descriptive and inferential statistics. Descriptive statistics: Frequency and percentage will be used for analysis of demographic data and mean, mean percentage and standard deviation will be used for assessing the level of knowledge. 15 Inferential statistics: chi-squire test will be used to find out the association between the knowledge and selected demographic variables. 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? Since the study design is descriptive in nature, investigation or interventions are not required. 7.4 ETHICAL CLEARENCE Yes, ethical committee’s report is here with enclosed. The main study will be conducted after the approval of research committee of the college. Permission will be obtained from the head of the primary health centre. The purpose and details of the study will be explained to the study subjects and assurance will be given regarding the confidentiality of the data given. 16 8. LIST OF REFERENCES: [VANCOUVER STYLE FOLLOWED] 1. Wikipedia. [homepage on the Internet]. 2011 [cited 2012 Nov 12]. Available from: Available from: http://en.wikipedia.org/wiki/Disease 2. Wikipedia. [homepage on the Internet]. 2011 [cited 2012 Nov 12]. Available from: http://en.wikipedia.org/wiki/Infectious_disease 3. Wikipedia. [homepage on the Internet]. 2011 [cited 2012 Nov 12]. http://en.wikipedia.org/wiki/Chikungunya 4. Media centre [homepage on the Internet]. 2011 [cited 2012 Nov 10]. Available from: http://www.who.int/mediacentre/factsheets/fs327/en/ 5. ICMR [homepage on the Internet]. 2011 [cited 2012 Nov 8]. Available from: http://icmr.nic.in/annual/comm.htm 6. 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[homepage on the Internet]. 2011-04-5 [cited 2012 Nov 14]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21466887 20. Tan CH, Wong PS, Li MZ. Pubmed. [homepage on the Internet]. 2011-03-11 [cited 2012 Nov 14]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21395419 21. Wang D, Suhrbier A, Penn-Nicholson A. Pubmed. [homepage on the Internet]. 2010-06-12 [cited 2012 Nov 14]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21320541 18 9. Signature of the candidate. 10. Remarks of the guide. 11. Name and designation. 11.1 Guide 11.2 Signature 11.3 Co-guide 11.4 Signature 11.5 Head of the department 11.6 Signature 12. 12.1 Remarks of the chairman and principal. 12.2 signature 19