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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