Download Rajiv Gandhi University of Health Sciences

RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
NAME OF THE
Mr. GOVINDAPPA D.K
CANDIDATE AND
1st YEAR M.SC. NURSING, N.D.R.K.
ADDRESS
COLLEGE OF NURSING B.M. ROAD
HASSAN,
2
3
4
5
NAME OF THE
N.D.R.K. COLLEGE OF NURSING,
INSTITUTION
HASSAN, KARNATAKA
COURSE OF STUDY AND
MASTER IN NURSING
SUBJECT
COMMUNITY HEALTH NURSING
DATE OF ADMISSION TO
THE COURSE
7- JUN 2007
TITLE OF THE TOPIC
“ASSESS AND COMPARE THE
KNOWLEDGE ON CHIKUNGUNYA
AMONG THE PEOPLE THOSE WHO
ARE RESIDING IN RURAL AND
URBAN AREAS”.
5.1 STATEMENT OF THE
PROBLEM
“A STUDY TO ASSESS THE
KNOWLEDGE ON CHIKUNGUNYA
AMONG THE PEOPLE THOSE WHO
ARE RESIDING IN RURAL AND
URBAN AREAS AT HASSAN
DISTRICT.”
6. BRIEF RESUME OF THE INTENDED STUDY.
6.1. INTRODUCTION.
Developing countries like India carries the major burden of communicable
diseases, especially those which are caused by sub-standard living and environmental
condition. “Vector born” diseases like Malaria, Dengue, Filaria are continuing as a major
health problems despite the persistant efforts being taken to preventcontrol them. In
addition to the threat of reemerging diseases recently India experienced the burden of
emerging infectious disease known as “Chikungunya” Jeoparadising life economy and
health care administration of the country.
The name of the disease ‘Chikungunya’ is derived from the Makonde word that
means. “That which bends up” and is in reference to the stooped posture that develops
due to the arthritic symptoms of the disease1.
Chikungunya is a viral disease transmitted to humans by the bite of infected
mosquitoes. The disease was first described in 1955 by Marion Robinson1 and
W.H.R.Lumsden2 following an outbreak in 1952 on the Makonde Plateau, along the
border between Tanganyika and Mozambique like Malaria and Dengue this infection has
almost become endemic in India especially central and south India2.
Chikungunya virus (CHIKV) is a member of the genus Alphavirus in the family
Togaviridae. CHIKV was first isolated from the blood of a febrile patient in Tanzania in
1953 and has since been identified repeatedly in west central and southern Africa and
many areas of Asia and has been cited as the cause of numerous human epidemics in
those areas since that time, the virus circulates throughout much of Africa with
transmission thought to occur mainly between mosquitoes and monkeys3.
An outbreak of Chikungunya virus is currently ongoing in many countries in
Indian ocean since January 2005. The current outbreak appears to be the most severe and
one of the biggest outbreaks caused by this virus. India, where this virus was last reported
in 1973, is also amongst affected countries. Chikungunya virus has affected millions of
the people in Africa and South East Asia. Since it was first reported in 1952 in Tanzania.
Even then, natural history of this disease is not fully understood. The intra-outbreak
studies, point towards recent changes in the viral genome facilitating the rapid spread and
enhanced pathogencity. The available published scientific literature on chikungunya virus
was searched to understand the natural history of this disease reasons for the current
outbreak and the causes behind re – emergence of the virus in India4.
A study was conducted in May, to assess the prevelance of chikungunya and
assess the factors that leads to prevelance of Chikungunya. The results shows that in
Indian ocean islands 30% to 75% of population were infected in Chikungunya, the study
reveals that the factors that influences the prevelance of Chikungunya are as follows.
Globalization, demographic increase population movements, international trade
urbanization, forest destruction, climate changes, loss in bio-diversity and extreme life
condition such as poverty, famine and war.5
The study was conducted on March a Chikungunya fever outbreak began on the
islands of the Indian Ocean. A real time RT- PCR tast was developed for CHIKV and
designed to detect currently circulating strains of virus as well as other genotypes. The
study design a real time RT – PCR assay was aptimized and evaluated using a panel of 55
clinical serum samples and a synthetic RNA transcript as a positive control. The result
shows the real time RT – PCR was 10 fold move sensitive than a conventional block
based RT – PCR and could detected as low as 20 copies of RNA transcript. This study
concludes that sensitive and rapid real time RT – PCR assay has been developed for
chikungunya virus and tested against current isolates. 6
6.2 NEED FOR THE STUDY
In a developing country, like India carries the major burden of communicable
diseases especially those who are caused by Sub-standard living and environmental
condition. Vector born diseases like Malaria, Dengue, Fileria and recently in India with
multiple outbreaks since 2005. Since Chikungunya appeared in India has no clearing
house for information about the debilitating infection and convalescence. It has also don
nothing to dispel the fear and superstition among ordinary citizens. It has left front line
physicians in towns and cities to find for themselves.
W.H.O. estimated that the Chikungunya has now topped 1.25 million suspected
cases in some districts, the attack rates are as high as 45 percent.Based on feedback from
our readers we will point out the latest research statistics, a suprising vector RT PCR
turnaround time in Pune, the role of NSAIDs, the evolution of the African strain and
more transmission and treatment.The vector institute will be supported by ICMR and
Central Government.the center will be for all vector borne diseases like Malaria, Dengue,
Japanese encephalitis and Chikungunya.Government claims steps have been taken to
control the disease 2,86,201 people in 26 districts have been affected. Government rejects
opposition charge slackness. Chikungunya clases are now being reported in South
Karnataka as well. Bangalore Though the state government claims to have taken adequate
measure to prevent the spread of Chikungunya. Reports of its outbreak continue to pour
in from different places.
According to statistics, Chikungunya has been reported in 2.860 village affecting
2.86 lacks people. Gulbarga, Bidar, Bellary, Davangere, Chickmagalur and Hassan
districts have been the worst hit. Four official committees have been formed to monitor
the situation.
Cases are now being reported in the district of South Karnataka also. The southern
districts
where
Chikengunya
rural(9.190).Bangalore
urban
cases
(2.863).
have
been
Tumkur
reported
(34.312),
are
Bangalore
Kolar
(14.277),
Chickmagalur(3.827), Shimoga(13.853) and Hassan district (9.550). As on June 26. But
the number of people afflicted by the disease in Bangalore urban has risen to 6.950. The
government should allocate more funds and appoint doctors and Para-medical personnel
to treat the patients.
The study was conducted on 2007 to assess factors that trigger the emergence or
reemergence of infectious diseases like Dengue, Fileria, and Malaria etc. The survey
reports shows that Dengue is currently spreading throughout the tropics, while another
arbo virus Chikengunya. Infected 30% to 75% of the populations in many parts of the
India. The study reveals that this prevalence of infectious disease is due to poor
environmental sanitation.7
The study was conducted on 2007 a large Chikungunya virus(CHIKV) outbreak
emerged in 2005 to 2006 in the Indian ocean islands and many parts of the world.
Particularly in reunion island where 35% of 770.000 inhabitants were infected in 6
months. This study shows that CHIKV is spreading rapidly. CHIKV infections confirmed
by serology reverse transcription- polymerize chain reaction (RT-PCR) and /or viral
culture so; this study concludes that Chikungunya virus could spread through out the
world, public should be prepared to encounts this abro viral infection through
maintaining environmental sanitation.8
When the researcher was observed during his community posting , the lack of
knowledge regarding chikungunya among people living in rural and urban area , so the
investigator felt that there is a need for the study , statistics has been reported in 2.860
village affecting 2.86 lacks people , Gulbarga, Bidar, Bellary, Davangere , Chikmagalur,
including Hassan districts have been the worst hit, This incidence made the investigator
to take this study , so the study conducted on rural and urban area people at Hassan
district Karnataka .
6.3 STATEMENT OF THE PROBLEM
“A study to assess the knowledge on Chikungunya among the people those who
are residing in rural and urban areas at Hassan district.”
6.4 OBJECTIVES
1. To assess the knowledge on Chikungunya among the people those who are
residing in rural and urban areas.
2. To compare the knowledge on Chikungunya among people those who are
residing in rural and urban areas.
3.
To identify the association between the knowledge of people and the
demographic variables.
6.5. HYPOTHESIS
H1:-There will be a significant difference between the knowledge scores on
Chikungunya among the people of urban and rural area at Hassan.
H2. :-There will be a significant association between the knowledge scores on
Chikungunya and demographic variables of people.
6.6. ASSUMPTION
1. The urban and rural area people will be having some knowledge regarding
Chickungunya.
2. Demographic variable will be having more influence on the knowledge.
6.7. OPERATIONAL DEFINITIONS

ASSESS - To make the judgment about the understanding knowledge
level of the people living in the rural and urban areas regarding
Chikungunya.

KNOWLEDGE: - It refers to the response of rural and urban area peoples
to the questions stated in the questionnaire.

CHIKUNGUNYA: - Chikungunya fever is a viral disease transmitted to
humans by the bite of infected Aedes Aegypti Mosquitoes.

RURAL: - A group of peoples living in a geographical area where it does
not have much facility and away from the city.

URBAN: - It is an area in a town with better facility.
6.8 CRITERIA FOR SELECTION OF SAMPLES:
Inclusion criteria:
1. Rural and urban people those who are present at the time of study.
2. Those who present and willing to participate at the time of study.
Exclusion criteria:
1. Those who are suffering from chronic diseases, not willing to participate.
6.9. DELIMITATION OF THE STUDY:

Study limited only to rural and urban area peoples.

Study limited to 4 to 6 weeks of duration.

Sample size limited to 200[100 rural 100 urban].
6.10. SIGNIFICANCE OF THE STUDY:
This study explores the knowledge on Chikungunya and information booklet will
give the awareness regarding chikungunya.
1. This study will obtain more information regarding Chikungunya as there are very
little information is available from the previous studies.
2. This study will be determining the extent of the knowledge level on Chikungunya.
6.11 CONCEPTUAL FRAME WORK
Conceptual frame work is based on the Nola. J. Pender Health promotion
model.
6.12 REVIEW OF LITERATURE:
Literature is a standard requisition of scientific research. It means reading and
writing the pertinent information of the attempt in research topic. It also support and
explained why the proposed topics is taken for research and avoid unnecessary
duplication explore the feasibility and illuminate the way of new researcher.
An extensive review of literature was done by the investigator to gain insight into
the selected problem. Review of literature is presented under the following headings.
The study was conducted in 2007 to assess the outbreak of Chikungunya in south
west Indian ocean islands the study was conducted on travelers who developed signs and
symptoms of Chikungunya. The result shows are experience few like symptoms fever
and joint ache 69% have persistant arthologia for less than two months and 13% had it for
less 6% the study reveals that travelers are the one who spreads the disease.9
The study was conducted in 2006 to evaluate the most causative virus of
Chikungunya. Study was conducted on Chikungunya patient by assessing cell culture
CDNA clones of Chikungunya virus and serological test. The result reveals that
Ae.aegypti and Ae.albopictus mosquitos is the most causative pathological organism that
causes Chikungunya in the most individual who are susceptible.10
The study was conducted on 2007 to define optic neuritis associates with
Chikungunya virus infection in a clinical setting. This study was conducted on 14 patients
with clinical features of Chikungunya and where complete optholmic evaluation
performed like Mantoux test., viral test, blood profile, colour vision, nuro imaging, visual
fields, visual evoked potentials, VDRL test and Enzyme linked immunosorbent assay for
Chikungunya virus. Specific immunoglobulin. The results shows 19 eyes (in 14 patients)
had optic nerve infected. This result reveals that there is a chance of optic neuritis in
Chikengunya patients.11
A study was conducted in Germany an ongoing outbreak of chikungunya that has
involved > 1.5 million patients, including travelers who have visited these areas. The
study was conducted on 69 travelers who developed signs and symptoms compatible with
chikungunya fever after returning home from countries involved in the epidemic. The
study results show that all the patients experienced flu like symptoms eith fever and joint
pain. This study concludes that travelers to areas of epidemicity should be informed of
the risk of infection and of adequate preventive measures, such as protection against
mosquitoes.12
A study was conducted in France on 2005 – 2006 a sever outbreak occurred on
reunion islands in the southwestern part of the Indian ocean. Adult patients with acute
chikungunya
and laboratory conformed chikungunya who were referred to Groupe
Hospitalier were included in this retrospective study. The result of the study was
laboratory conformed acute chikungunya was documented in 157 patients. The
conclusion of the study is chikungunya virus can be responsible for explosive outbreaks
of disease. In this era of travel and globalization, chikungunya should be considered in
the deferential diagnosis of febrile polyarthralgia with an abrupt onset.13
The study was conducted in France on 123 patients to asses the consequences of
chikungunya infection. The result shows that there was much outbreak of in African
isolates with clinical manifestation like fever, headache and arthralgia. 14
7. MATERIALS AND METHODS OF STUDY:
7.1. SOURCES OF DATA COLLECTION
Data will be collected from the people those who are residing in rural and urban
areas.
7.2. RESEARCH DESIGN:
An explorative comparative design was chosen for the study.
1. This study will obtain more information regarding Chikungunya as there are very
little information available from the previous studies.
2. This study will be determining the extent of the knowledge level on Chikungunya.
3. This study does not include no manipulation, no control and no randomization.
7.3. METHOD OF COLLECTING DATA:
Data collection is planned through the interview method by using structured
questionnaire on Chikungunya based on the following aspects.
PART –A [Demographic Variables]
Age, Sex, Education, Occupation, Income, Religion, Residing place, Typeof house
Marital stutus, Influence of Mass media
PART – B [Structured questionary on knowledge regarding Chikungunaya. Divided
into following sections.
General Aspects, Causes, Signs and Symptoms, Prevention and control,
Mode of transmission, Management, Government programs.
7.4. SAMPLING PROCEDURE:
1. POPULATION:-Target population: All the peoples those who are residing under
Shantigrama PHC (rural) and Pension Mohalla PHC (Urban) area.All the peoples
in urban and rural area.
2. SAMPLE:-Rural and urban peoples.
3. SAMPLE SIZE:-A total of 200 samples divided equally into two groups as 100
for rural and 100 for urban area.
4. SAMPLING TECHNIQUE:-Non probability convenient sampling is felt to be
suitable for the study.
5. SETTING:-The settings selected for the study is Gadenahalli [Shantigrama PHC].
For rural and Pension Mohalla [Slum] for urban area. Gardenahalli area of Hassan
District which has a population of 1800 and Pension Mohalla 6100 population.
6. PILOT STUDY:-10% of the population [Sample Size] is planned for the pilot
study during the month of June 2008.
8. VARIABLES:8.1. INDEPENDENT VARIABLES:Environment of the public [rural and urban area]
8.2. DEPENDENT VARIABLE:Knowledge of people on Chikungunya those who are residing in rural and urban
area.
9. PLAN FOR DATA ANALYSIS:It includes descriptive and inferential statistics.
1. Descriptive statistics:To describe the demographic variables and level of knowledge number,
Frequency, percentage, mean and standard deviation.
2. Inferential statistics:Chi square test will be used to test the association between the knowledge of
people and the demographic variables.Pearson Chi-Square test , Yates corrected
Chi-square test , Two Sample Binomial proportion test, Student Independent “t”
test , One Way ANOVA “F” test.
10. ETHICAL CLEARANCE:1. INFORMED CONSENT:Has Informed consent will be obtained from the chosen samples
…Yes
Has ethical clearance being obtained from the institution?
….Yes
LIST OF REFERENCE (VANCOUVER STYLE)
A) WEBSITES:1. www.medindia.net chikungunya history.
2. http:// timesofindia.india.times.com
3. www.homeopthyhelps.com/chikungunya.htm
4. Lahariya c, pradhan sk .department of community medicine, lady hardinge medical
college,new delhi, india, [email protected] 2006. Dec; 43(4)
151-00
5. Flahault A.Aumont.G,Boisson V, et al Chikunguya, La Reunion and
Mayotte,2005-2006:an epidemic without a story. Sante publique 2007 may-jun:19.
6. Edwards CJ. Welch S.R. Chamberlain J. et al Molecular diagnisis and
analysis of chikungunya virus J. Clin Virol. 2007.
7. Flahault A [Article in French] L E coledes hautesde sante publique EHESP. Paris et
al 2005-2006 Emerging infections disease; the example of the Indian Ocean
chikungya out break 2005-2006 Bull acad Natl Med.2007.
8. Simon F. Parola P. grandadam M. et al chikanguya infection ; an emerging
rheumatism among travelers returned fron Indian ocean islands, report of cases,
medicine (Battimore 2007).
9. Taubitz W. Cramer P. Kapaum A et al chikungunya fever in travelers : clinical
presentation and course PMIDI : Clin Infect Dis 2007 July 1 ; 45 (1)et al Epub 2007
may 23.
10. Tsetsarkin, Higgs. Mcgee CE et al. infections clones of chikungunya virus La
Reunion isolate) for vector competence studies vector Born Zoonotic Dis 2006 witer
6(4) 325 - 37.
11. Mittal a mittal s Bharati mj et al ,optic nuritis associated with chikungunya virus
infection in south India ,Arch opthalmol,2007 oct;125(10) ; 1381-6.
12. Taubitz W. Cramer JP, Kapaum A, et al Chikungunya fever in travelrs : clinical
presentation and course. Clin Infect Dis. 2007 Jul 1; 45 (1)
13. Borgherini G, Poubeau P, Staikowsky F, et al Outbreak of Chikungunya on
Reunion Island : early clinical and laboratory features in 157 adult patients. Clin
Infect Dis.
2007 Jun 1; 44 (11) : 1401 – 7. Epub 2007 Apr 18.
14. Schuffenecker I, Iteman I, Michault A, et al Genome microevolution of
Chikungunya viruses causing the Indian Ocean outbreak. Plos Med. 2006
Jul; 3(7):e263. Epub 2006 May 23.
Mr. Govindappa.D.K
12
13
14
Signature of the candidate
Remarks of the guide
Name and designation
Forwarded and Approval for
registration
Pro. Bernice Margaret
H.O.D of community Health
Nursing , N.D.R.K .C.O.Nsg,
Pro. Bernice Margaret
14.1 Guide
14.2 Signature
14.3 Head of the department
Pro. Bernice Margaret
H.O.D of community Health
Nursing , N.D.R.K .C.O.Nsg,
14.4 Signature
Forwarded and Approval for
registration
15
Remarks of the principal
15.1 Signature