Rajiv gandhi university of health sciences, bangalore, karnataka. Proforma for registration of subject for dissertation



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION



1.


Name of the candidate and address.


Mr. SUNIL SAHU
1st Year M. Sc. Nursing,

Florence college of Nursing

Bangalore-43



2.


Name of the Institution

Florence college of Nursing






3.


Course of study and subject


M. Sc., NURSING

Community health Nursing





4.

Date of admission to course

16.05.2008


5.


Title of the topic

“A study to evaluate the effectiveness of structured teaching programme on cholera among rural high school children in selected rural high schools, Bangalore.”




6. BRIEF RESUME OF THE INTENDED WORK:
6.1 INTRODUCTION:
“Infectious diseases will last as long as humanity itself”
The term “infection” implies that an organism capable of causing disease is present and multiplying within the body. The term “disease” as implied to the interaction between the organism and the body that is infected. Among the infectious diseases, Cholera is a serious acute infection disease, which occurs in epidemic form in certain part of India and also certain adjacent areas of south-east Asia.1

Cholera is an acute diarrhoeal disease caused by vibrio cholerae 01(classical or E1. Tor) Cholera has been present in India since ancient times. During the 19th century, several pandemics of cholera originated from India and spread to western countries. Currently the 7th pandemic which began in 1961 in Indonesia is still continuing. It has involved more than 80 countries in Asia, Africa and Europe. This pandemic is due to El tor vibrio which has replaced the classical type of cholera to a great extent.2

Children are usually the first to get sick and die from infectious diseases like cholera, measles and hepatitis due to poor food and water sanitation, which claim the lives of 3.4 million children every year. Recognizing its significance to children and their families, UNICEF has been working in the area of water, environment and sanitation for almost 40 years and supports these programmes in 86 countries in all regions of the developing world.3

In the school period, children acquire an increased cognitive skill which allows them to make decisions about health behavior. They will select and pursue. By the end of middle childhood, children can assume personal responsibility for self care in the areas of hygiene, nutrition, exercises, recreation, sleep and safety. Health education is a primary component of comprehensive health care and health education programmes are designed to promote desire health behavior among school childrens through guided learning and modeling.4



6.2 NEED FOR THE STUDY:

Cholera sometimes known as Asiatic cholera or epidemic cholera, is an infectious gastroenteritis, and an acute diarrhoeal disease caused by the bacterium vibrio cholerae 01 (classical or El Tor). Transmission to humans occurs through ingesting contaminated water or food. The major reservoir for cholera was long assumed to be humans themselves, but considerable evidence exist that aquatic environment can serve as reservoirs of the bacteria.5

One of the worst diarrhoeal diseases is cholera, because it causes severe symptoms and high case fatality rates. Since 2000, around 850,000 cases of cholera in 93 countries have been reported officially. This is probably an underestimation, since some countries do not report cholera cases. The statistics for a low, medium and high human development index (HDI) are significant. The numbers of cholera cases for low HDI countries was 520,000, for medium HDI states 245,000, and those with high HDIs 698.6

During 2005, the larger endemic foci of cholera were found in Delhi (945 cases), Tamil Nadu (724 cases and 1 death), Maharashtra (724 cases and 1 death), West Bengal (235 cases), Andhra Pradesh (165 cases), Karnataka (214 cases and 1 death), Kerala (27 cases and 1 death) and Gujarat (82 cases and 2 deaths). The total numbers of cases reported were 3156 with 6 deaths, a case fatality rate of 0.19%. An outbreak of cholera was reported in guinea Bissau that there were 4,871 cases and 72 deaths. Of these, 915 were children, 0 to 14 years of age.2

A study was conducted on the prevalence of cholera gastroenteritis among childrens. The study comprised of 3595, childrens. The study result revealed that vibrio cholerae 01 could be isolated from 31.7% of total specimen studies; infection occurred more often in male children and was observed during summer monsoon season. The study concluded that out of total cholera cases (1141) 35.1% occurred in the age group in > 5-12 years.7

A study was conducted on the incidence of cholera outbreak among young children, in three regions of (Indonesia, Mozambique and kolkata) India. The study report shows the highest incidence of cholera occurs in kolkata and Mozambique. The lowest cholera rate was with 0.5 cases per 1000 young children per year .The study concluded that children tend to have disease more in endemic areas, because adults develop immunity but children, being newly expose, do not yet have this immunity. The authors suggested that an “improvement of water supply and sanitation is the best strategy against cholera and other diarrhoeal disease.8

A study was conducted on “private demand for cholera vaccines”among house holds with childrens. The main objective of the study is to measures the private demand for oral cholera vaccine. The study sample consisted of 800 households with children less than 18 year old were randomly selected. The study revealed that median respondent willingness to pay for 50% effective/3 –year vaccine was estimated to be approximately $5, although 17% of study sample would not pay for a cholera vaccine. The study concluded that perceived private economic benefit of a cholera vaccine were high, but not evenly distributed across the population.9

Since cholera has the potential of rapid spread leading to an acute public health problem, special attention is required to be given to the surveillance and prompt follow up action on reported cases of cholera. Based on the above facts and figures, investigator’s personal experience motivated to conduct the present study with the help of a structure teaching plan regarding cholera to improve the knowledge of high school children.10


6.3 REVIEW OF LITERATURE:
The review of literature in a research report is a summary of current knowledge about a particular problem and includes what is known and not known about the problem. The literature is reviewed to summarize knowledge for use in practice or to provide a basis for conducting a study. Review of literature section includes a description of the current knowledge of a particular problem, the gaps in this knowledge base and the contribution of the study to the development of knowledge in this area.11

An epidemiological study was conducted on incidence and molecular analysis of Vibrio cholerae associated with cholera outbreak in Orissa, India. Rectal swab collected from 107 hospitalized diarrhea patients were bacteriologically analyse to isolates and identify the various entero pathogens. The result shows that about 72.3% were positive for vibrio cholerae 01, 7.2% for vibrio cholerae 0139, 1.2% for E-coli and 1.2% for Shigella type 6. The study concluded that drinking water scarcity and poor sanitation were thought to be responsible for these outbreaks. Timely reporting and implementations of appropriate control measures could eliminate these problems in epidemic areas.12


A descriptive study conducted on prevalence of cholera by national Institute of cholera and enteric disease in Calcutta, India. The study result shows that there were 4,958 reported cases of cholera with 32 deaths in 1994. In 1998, they observed an increase of incidence of cholera due to frequent flood in the areas of west Bengal, Orissa and Bangladesh, that is (10,000) and new strains of bacteria also have been found.13
A study was conducted on epidemiology of cholera, in Chennai, India. About 26, 502 rectal swabs from patients suspected to cholera were collected. The result shows that 6035 (22.8%) specimens yielded Vibrio cholerae. About 4,046(67%) of them were 01 serotype; followed by 1529 (25.3%) 0139 serotype and 448 (7.4%) non – 01 serotypes other than 0139 were encountered. The study concluded that Vibrio cholerae 01 has been found to be responsible for epidemic of cholera.14
A study was conducted on occurrence, significance and molecular epidemiology of cholera outbreak in West Bengal, in India. A total 22 rectal swab and 22 stool samples were collected from the two cholera outbreak sites. The study results show that both outbreaks were caused by Vibrio cholerae 01. Stoppage of sources of water contamination and chlorination of drinking water resulted in terminating the two outbreaks. The study concluded that vaccination is an attractive diseases prevention strategy although long-term measures like improvement of sanitation and personal hygiene, and provision of safe water supply are important, but require time and are expensive.15

A study was conducted to investigate risk factors and clinical characteristics for Vibrio Cholerae infection in children. About 313 children with epidemic cholera were compared with children with non cholera associated diarrhea. The study result shows that among 306 patients 14 years of age or younger, vibrio cholerae was isolated form specimens of 310 patients (49%). Cholera was clinically characterized by watery diarrhea, abdominal pain, muscles cramps and vomiting, which leads to more severe dehydration and hospitalization more often than in non cholera cases? The study concluded that non portable water and uncooked food were identified as risk factor for cholera.16



A study was conducted to investigate the severity of cholera as related with nutritional status among childrens .The samples consist of 97 male children hospitalized with cholera. Stool and urine samples were analyzed 54 of the patient were severe dehydrated (plasma-specific gravity, 1,034) and 43 were moderately dehydrated. The study result shows that 95% of children patient were below their median in weight as related to height and that more than 15% of children shows 2nd degree protein –calorie malnutrition. About 30 to 70 % increase in duration of diarrhea was seen in patient with severe malnutrition. The study concluded that malnutrition enhance risk of infection and particularly of diarrheal diseases, which result in increase fluid will lose and electrolyte.17
A study was conducted on efficacy of Elisa test in diagnosing cholera by National Institute of Cholera and Enteric Diseases, Calcutta, India. About 5 batches of rectal swab cultures in alkaline-peptone water were collected form 6,497 patients with watery diarrhea. The Vibrio cholerae 0139 isolations from the rectal swab cultures and the antigen detection assays. (i.e., the MAb-based dot-blot ELISA) were performed by different laboratories. The study shows that among 6497 samples tested, the dot-blot ELISA correctly identified 42 of 42 Vibrio cholerae 0139, positive samples and gave result of positive for three samples which were cultured negative for Vibrio cholerae 0139. The diagnostic sensitivity, specificity, and efficacy of the dot-blot ELISA were 100,99.95, and 99.26%, respectively. The study concluded that the ELISA is easy to perform and relatively inexpensive. It can test multiple samples at a single time, does not require special equipment, and does not produce great quantities of contaminated waste. The assay is recommended as a rapid screening test of cholera cases caused by Vibrio cholerae 0139.18
A study was conducted to evaluate efficacy of packaged rice oral rehydration solution among children with cholera and cholera like illness. About 167 boys aged 5 to15 years with acute dehydrative cholera and cholera like diarrhea were selected and received packet form of rice ORS. The study results shows that the mean (± SE) stool output was 20% less in the rice ORS group during first 8 hrs of treatment (p<0.05). But output during the other periods were similar in the two groups, although children in the rice ORS group had slightly more vomiting on day one (p<0.05). The study concluded that a package rice ORS was more effective and safety also.19

A study was conducted to assess the effectiveness of cholera prevention activities in urban and rural communities during the cholera epidemic. They surveyed 67 urban and 61 rural house holds to determine diarrhea rates, sources of cholera prevention information, and knowledge, attitude, and practices regarding ten cholera prevention measures. The result shows that 25% of 482 urban and 11% of 454 rural household members had diarrhea during the first 3-4months of epidemic. About 93% of rural and 67% of urban respondents believed, they could prevent cholera. About 75% of respondents drank untreated water and 91%ate unwashed produce, both were identified as cholera risk factors in that study. The study concluded that direct interpersonal education by community-based personal may enhance the likelihood of translating education into changes in health behavior. 20

A study was conducted toward the effectiveness of public health measures for cholera prevention in rural community. About 438 children fecal samples were collected and children were recommended with cholera prevention measures such wash hands before meals, and after defecations, drinking purify water and to eat well cocked food. The results shows that parasitic infection occurred in 131 of the 438 children (30%) and children were older and more often had an infected sibling. The study concluded that the prevalence of parasitic infection was relatively high and indicate that some resident of this community may not have fully embraced the public health education effort promoted for prevention of cholera. 21





6.3 STATEMENT OF THE PROBLEM:

“A study to evaluate the effectiveness of the structured teaching programme on cholera among high school children in selected rural high schools, Bangalore”.


6.4 OBJECTIVES OF THE STUDY:



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