Rajiv Ghandi University of Health Science
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE, KARNATAKA.
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING THE PREVENTION AND MANAGEMENT OF SELECTED PARASITIC INFESTATIONS IN PREGNANCY AMONG REPRODUCTIVE AGE WOMEN RESIDING AT A SELECTED RURAL AREA IN BANGALORE.”
SUBMITTED BY,
MRS. SHILPA GRACE MATHEW,
1ST YEAR M.Sc. NURSING,
BHAGATH COLLEGE OF NURSING,
UTTARAHALLI,
BANGALORE- 560061.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE 1 BANGALORE, KARNATAKA. PROFORMA SYNOSPSIS FOR REG ISTRATION OF SUBJECT FOR DISSERTATION
1. Name of the Candidate and Mrs SHILPA GRACE MATHEW
Address 1ST YEAR M.Sc. NURSING
BHAGATH COLLEGE OF NURSING
NO.60, UTTARAHALLI MAIN ROAD,
UTTARAHALLI DOBLI,
BANGALORE-560061
2. Name of the Institution Bhagath College Of Nursing, Bangalore
3. Course of study 1st Year MSc. Nursing,
Obstetrical and Gynaecological Nursing
4. Date of admission to course 01.06.2012
5. Title of the Topic:
“ A Study To Evaluate The Effectiveness Of Structured Teaching Programme Regarding The Prevention And Management Of Selected Parasitic Infestations In Pregnancy Among Reproductive Age Women Residing At Selected Rural Area In Bangalore”
6. Brief resume of the intended work: 6.1 Need for the study Enclosed 6.2 Review of literature Enclosed 6.3 Objectives of the study Enclosed 6.4 Operational definitions Enclosed 6.5 Hypothesis of the study Enclosed 6.6 Assumptions of the study Enclosed 6.7 Delimitations of the study Enclosed 6.8 Pilot study Enclosed 6.9 Variables Enclosed 7. Materials and methods 7.1 Source of data- Data will be collected from women residing at selected community area, 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? Yes 7.4 Has ethical clearance been obtained from your institution? Yes Ethical Committee’s Report is here with enclosed. 8. List of references Enclosed
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
2 PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 Name of the Candidate and Address MRS. SHILPA GRACE MATHEW 1ST YEAR M. SC NURSING BHAGATH COLLEGE OF NURSING, NO.60,UTTARAHALLI MAIN ROAD, UTTARAHALLI DOBLI, BANGALORE: 560061.
2 Name of the Institution Bhagath College of Nursing.
3 Course of Study and Subject 1st Year M.Sc. Nursing,
Obstetrical and Gynaecological Nursing
4 Date of Admission to Course 01/06/2012
5 Title of the Topic
“ A Study To Evaluate The effectiveness Of Structured Teaching Programme Regarding The Prevention And Management Of Selected Parasitic Infestations In Pregnancy Among Reproductive Age Women Residing At Selected Rural Area In Bangalore.”
6. BRIEF RESUME OF THE INTENDED WORK
3 INTRODUCTION
“The single most undiagnosed health challenge in the
history of the human race is parasites”
-Dr. Ross Anderson
Infestation refers to a state of being invaded or overrun by pests or parasites. It can also refers to the actual organisms living on or within a host.1Infestations are a particular concern during pregnancy since some infections are more severe in pregnant women or may harm the foetus or new-born. So it is important to take steps to decrease the chance of developing harmful illness during pregnancy.2
Parasites usually enter the body through the mouth or skin. Parasites that enter through the mouth are swallowed and can remain in the intestine or burrow through the intestinal wall and invade other organs. Parasites that enter through the skin bore directly through the skin or are introduced through the bites of infected insects. Malarial parasites infest and affect the components in the blood of the host. Some parasites enter through the soles of the feet when a person walks barefoot or through the skin when a person swims or bathes in water containing the parasites. Parasites are spread through blood transfusions, through injections with a needle previously used by an infected person, or from a pregnant woman to her foetus. Maternal malarial infection can lead to anaemia in mother and results in abortion, low birth weight and even intra uterine death of baby. 3
A parasite does not kill a host, but it can affect the growth, ability to reproduce, and survival. It can sometimes lead to the host's premature death. Parasitic infestations may adversely affect fertility or reproductive capacity of the host in three ways. First, the infesting organism can result in sufficient debilitation or anatomic damage to the genital tract so that either conception is impossible or normal implantation does not occur. Second, parasitic infestations may be severe enough to adversely affect the mother’s health to the point where medical intervention to terminate the pregnancy is required. Third, protozoan parasites may infect and cross the placenta to produce adverse foetal effects including foetal infection, still birth, intra uterine growth restriction and congenital infection.4
Amoebic dysentery or Amoebiasis is one of the most common parasitic diseases. It often seen in tropical and subtropical regions with crowded living with lack of sanitation. The condition is characterized by diarrhoea, vomiting and weakness. It is caused by a protozoan known as Entamoeba histolytica. It is spread through food or water contaminated with stools. It can also be spread from person to person particularly by contact with the mouth or rectal area of an infected person. Risk factors for severe amebiasis include pregnancy. The fluid loss
4 and electrolyte imbalance adversely affect the outcome of pregnancy resulting in low birth weight and can also cause amoebic liver abcess.5
Toxoplasmosis is caused by Toxoplasma gondii a parasite of birds and mammals. Cats are the only definitive host and thus the only source of infective oocytes, but other mammals and birds can develop tissue cysts. Although these infections are typically asymptomatic, infection during human pregnancy can cause severe disease in the foetus. Cat owners can reduce their pets’ exposure risk by keeping all cats indoors and not feeding them raw meat. Humans usually become infected through ingestion of oocyte-contaminated soil and water, tissue cysts in undercooked meat, or congenitally.6
Malaria infection is endemic across the tropics and subtropics; affects people in more than 90 countries; causes 300–500 million infections each year; and is estimated to lead to approximately 1 million deaths each year. Most infections and the most severe morbidity and mortality are caused by, Plasmodium falciparum and is the only human malaria parasite that is more common in pregnant than in nonpregnant women and is the only human parasite with a clear and substantial adverse effect on pregnancy, nutrition during pregnancy and pregnancy outcome resulting in anaemia, low birth weight, intra uterine growth retardation or congenital infection.
6.2 NEED FOR THE STUDY
“Pregnancy is special, let make it as safe” -WHO Theme 1998
Malaria is one of the most prevalent and serious infectious disease problems throughout the tropical and subtropical areas of the world. There are at least 1 million deaths annually due to malaria. Analysis of three years of data from a malaria clinic operated by the Indian Council of Medical Research (ICMR) in the Government Medical College Hospital in Jabalpur, central India, showed high malaria prevalence among pregnant women, which was statistically highly significant compared with the situation among nonpregnant women. Cerebral malaria was a common complication of severe Plasmodium falciparum infection, with a high mortality during pregnancy. Pregnant women with falciparum or vivax malaria were significantly more anemic than noninfected pregnant women or infected nonpregnant women. The average weight of 155 neonates from infected mothers was 350 g less that of 175 non infected mothers. The study conclude that pregnant women from this geographical area require systematic intervention owing to their high susceptibility to malaria during pregnancy and the puerperium.8
5 Malaria is endemic in areas of the world in which the anopheles mosquito exists and the infected human population remains above a critical density required for sustained transmission. The anaemia of pregnancy is potentiated during malarial infection. Multiple studies have shown a direct correlation between maternal malarial infection and second-trimester human abortion, intrauterine death with macerated stillbirths, and fresh stillbirths due to intrapartum asphyxia. The anaemia produced by Plasmodium falciparum infection usually is seen after 20 weeks of pregnancy, and may induce congestive heart failure because of the reduced red cell mass.9
Malaria in pregnancy is one of the most important preventable causes of low birth weight deliveries worldwide. It is also a major cause of severe maternal anemia contributing to maternal mortality. It is estimated that 40% of the world's pregnant women are exposed to malaria infection during pregnancy. Fetal and perinatal loss has been documented to be as high as 60–70% in non-immune women with malaria. Preventive strategies include regular chemoprophylaxis, intermittent preventive treatment with antimalarial and insecticide-treated bednets.9
A study conducted by Begstrom el al. in 2004 concluded that malaria is a major public health problem in endemic, tropical and subtropical countries and a major cause of fetal and maternal morbidity and mortality. Another study conducted by Face and Jenkins in 2002 concluded that the morbidity due to malaria are complications arising from febrile illness, hypoglycemia, cerebral involment, pulmonary edema and puerperal sepsis.10
Toxoplasmosis is an infection from a microscopic parasite called Toxoplasma gondii. Although the infection generally causes a mild, symptomless illness in people with healthy immune systems, it's risky during pregnancy because the parasite may infect the placenta and unborn baby. Researchers estimate that over 4 million births in the United States each year, between 400 and 4,000 babies are born with toxoplasmosis known as congenital toxoplasmosis. This infection can be mild or severe, causing stillbirth, long-term structural and neurological damage, and other devastating effects. Experts estimate that about half of toxoplasmosis infections are caused by eating raw or undercooked infected meat, but you can also get the parasite by eating unwashed contaminated produce, drinking contaminated water, or handling contaminated soil, cat litter or meat and then touching your mouth, nose, or eyes. Most people infected after births are asymptomatic, some may develop fever, malaise, and lymphadenopathy. Congenital toxoplasmosis often results in debilitating ocular disease.11
Historically, women demonstrating exposure to Toxoplasma gondii prior to pregnancy through serology were considered safe from future infection and risk to the fetus. At times, apparent recrudescent infections during pregnancy can occur in immuno competent mother although few cases have been report. A case of maternal T. gondii infection and subsequent fetal infection was reported in a 31-year old French woman with serological evidence of previous T. gondii exposure. The strain isolated from this pregnancy is likely to be the
6 same strain as in the original infection. Systematic education and serological screening of pregnant women are the most reliable and currently available strategies for the prevention, diagnosis, and early treatment of the infection in the offspring; this is largely because toxoplasmosis in pregnant women most often goes unrecognized.11
A systemic review of Medline, EMBASE and Global Health databases undertaken using predetermined search criteria was conducted to present the prevalence of parasitic infections in developing world over the last 30 years with the initial search of 8580 results. The study revealed that the high prevalence of Malaria and Toxoplasmosis is in India and of Hook worm is Nepal. The also highlighted the large burden of maternal parasitic infections globally.12
Amoebiasis is the third leading cause of death due to parasitic infections and is responsible for about 40000- 100000 deaths a year according to a study conducted by Sebastiaan et al. in 2007. Ten per cent of the world population, including 2–5% in the United States and up to 80% in some tropical countries, is infected with the intestinal protozoan Entamoeba histolytica. The primary habitat of the parasite is the ileum and colon. Amoebiasis is more likely to affect people who live or have travelled in developing countries, where sanitation and hygiene is poor. It occurs when a person eats or swallows something that has been infected with the Entamoeba histolytica parasite. It is especially common in parts of the world where human excrement is used as fertilizer. Infected pregnant women may have bloody, dysenteric stools with moderate abdominal pain and tenderness. The diarrhea is marked, and secondary signs include fluid loss and electrolyte imbalance, which may adversely affect the outcome of pregnancy.13
The researcher had gone through an experience during the final year of graduation. During community postings, a pregnant woman named Kavitha, who has diagnosed as anemia due to previous infection with malarial parasite, had given birth to a low birth weight preterm baby. The woman was unaware about the complications of malaria during pregnancy and its effect on the baby. This is the reason why the researcher intended to give a structured teaching programme to the reproductive age women regarding prevention and management of parasitic infestations in pregnancy.
7 6.2 REVIEW OF LITERATURE
A ‘literature review’ is a body of text that aims to review the critical points of current knowledge including findings as well as theoretical and methodological contributions to a particular topic.
Review of literature is classified under following headings:
6.2.1 Literature related to Malaria during pregnancy.
6.2.2 Literature related to Toxoplasmosis infestation during pregnancy.
6.2.3 Literature related to Amoebiasis during pregnancy.
8 6.2.1 Literature related to Malaria during pregnancy.
A cross-sectional study was conducted to investigate the effect of Plasmodium falciparum and intestinal helminthic coinfection on maternal anaemia and birth outcomes of 746 women who delivered in two hospitals in Kumasi. Data were collected using an investigator-administered questionnaire and from patients' medical records. Blood was collected for determination of Plasmodium falciparum and haemoglobin levels. Adverse pregnancy outcomes were high (44.6%). Coinfection was associated with 3-fold increase in low birth weight. This study demonstrates that women with malaria and intestinal helminthic coinfection are at particular risk of adverse birth outcomes.14
A hospital based survey was conducted about parasitic infestations and anaemia during pregnancy in the Kassena- Nankana district of Northern Ghana on 300 pregnant women on their first consultation to antenatal services from August- November 2005. Stool specimens were examined by the concentration method whilst blood specimens are examined microscopically. One in four women was found to be infected with one or two of the helminths. Haemoglobin levels of mothers without any parasite was within the normal range, on the other hand, mothers with co-infection were within the moderately anaemic range. More than half of the women are found with Plasmodium parasite. Eventhough, the anaemia caused by these parasites on the whole, are not severe, the study recommended, an integrated programme for the control of these parasites in order to reduce the degree of anaemia during pregnancy.15
A fever case management [CM] approach using sulfadoxine-pyrimethamine (SP) was compared with two presumptive intermittent SP treatment regimens in the second and third trimesters in pregnant primigravidae and secundigravidae in an area of intense Plasmodium falciparum malaria transmission in western Kenya. The investigation evaluated efficacy of the antimalarial regimens for prevention of placental malaria and examined the effect of human immunodeficiency virus infection on antimalarial drug efficacy and adverse drug reactions. Less than 2% of women reported adverse drug reactions, with no statistically significant differences between HIV-positive and HIV-negative women. Intermittent treatment with SP is safe and efficacious for the prevention of placental malaria in pregnant primigravidae and secundigravidae in sub-Saharan Africa.16
During a prospective antimalarial treatment and prophylaxis trial in pregnant women in Malawi, three groups receiving a chloroquine regimen and one group receiving a mefloquine regimen, they examined women at their first antenatal clinic visit to evaluate these issues and to verify that subjects in the study treatment/prevention arms were similar. Among 4,127 women with enrolment blood smear results, 1,836
9 (44.5%) were parasitemia the highest infection rates and densities were observed in primigravidas followed by second pregnancies and subsequent pregnancies. Significant risk factors for parasitemia at first antenatal clinic visit in a multivariate model included low gravidity, high transmission season, no use of prophylaxis before first antenatal clinic visit, young age < 20 years, human immunodeficiency virus infection, low haematocrit, short stature, and second trimester compared with third trimester. The study concluded that targeting malaria control efforts to women in their first or second pregnancy and during the high transmission season will be an important strategy to reach most parasitemic women and minimise resource expenditure.17
A multicentre, open-label equivalence trial was conducted in Benin from July 2005 through April 2008 for increasing resistance to sulfadoxine-pyrimethamine (SP), we evaluated the efficacy of mefloquine (MQ) for intermittent preventive treatment during pregnancy (IPTp). Women of all gravidities were randomized to receive SP 1500 mg of sulfadoxine and 75 mg of pyrimethamine or 15 mg/kg mefloguine in a single intake twice during pregnancy. The primary end point was the proportion of low–birth-weight infant. The per-protocol analysis showed consistent results. Mefloquine was more efficacious than sulfadoxine-pyrimethamine in preventing placental malaria and clinical malaria; Mefloquine proved to be highly efficacious clinically and parasitologically for use as intermittent preventive treatment during pregnancy but, its low tolerability might impair its effectiveness and requires further investigations.18
A longitudinal design study was conducted to assess the prevalence incidence and clinical markers of pregnancy- associated malaria in a rural district of Ghana on January 2003 to June 2003. The study was conducted on 294 pregnant women enrolled and followed, actively and passively, monthly and weekly after delivery. A structured questionnaire was completed after explaining the study to the women in their language. Peripheral blood samples and placental smears are examined after delivery. The study concluded that the prevalence of peripheral Plasmodium falciparum was related to parity, the highest among primigravida, followed by secundigravida and lowest in multigravida and considered pregnancy associated malaria as a major public health problem. It also focussed on increased public education, the use of insecticide treated bednets and intermittent prevention treatment as well as adequate treatment of malaria with effective antimalarial drugs.19
6.2.2 Literature related to Toxoplasmosis infestation during pregnancy.
A study was conducted on prenatal management of 746 pregnancies at risk for congenital Toxoplasmosis in England on February 1988. They developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of foetal blood and amniotic fluid, testing of foetal blood for toxoplasma-specific IgM and nonspecific measures of infection, 10 and ultrasound examination of the foetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy. They conclude that prenatal diagnosis of congenital toxoplasmosis is practical and the prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease. The aim of this study is to increase our alertness and monitoring in case of toxoplasmosis during pregnancy, given that when diagnosed it can be effectively treated.20
A study was conducted on Toxoplasmosis during pregnancy on a case of a healthy 26 years old adult woman, found with toxoplasmosis during the 13th week of pregnancy. The role of frequent maternal and foetus immunological tests, PCR-tests of the amniotic fluid and ultrasound screening of the fetes throughout pregnancy was of great value. The patient was treated with spiramycin from the 16th week of pregnancy. The patient was subjected to caesarean delivery at the 36th week of pregnancy due to preterm contractions and history of previous caesarean delivery. The new born was a healthy girl with a birth weight of 2880 grams. A two-year follow up of the baby revealed no medical condition. Maternal infections are a serious medical condition during pregnancy. Toxoplasmosis when diagnosed on time and treated properly can lead to healthy offspring.21
A study was conducted by bibliographic literature search using MEDLINE to review the effectiveness of health education on toxoplasma-related knowledge, behaviour, and risk of seroconversion in pregnant women. Four studies met the inclusion criteria. All had serious methodological flaws. A Belgian study reported a significant decrease in the incidence of Toxoplasma seroconversion after the introduction of intensive counselling for pregnant women about toxoplasmosis. In Poland, a significant increase in knowledge was observed after a multi-pronged, public health educational program was launched. In Canada, an increase in knowledge and prevention behaviours was reported in the intervention group receiving counselling by trained facilitators compared with the control group. In France, no significant changes in risk behaviour were observed following a physician delivered intervention. There is suggestive evidence that health education approaches may help reduce risk of congenital toxoplasmosis but this problem requires further study using more rigorous research design and methodology.22
A study was conducted on Toxoplasma in bone marrow transplant (BMT) recipients on April 2002 in UK. There was a report of two cases of toxoplasmosis: one of successfully treated cerebral toxoplasmosis after peripheral blood stem cell transplantation, and a fatal case of pulmonary toxoplasmosis in a bone marrow transplant recipient. They have systematically reviewed the 110 published cases of toxoplasmosis following BMT. They analysed the pre-transplant and clinical features bone marrow transplantation recipients developing toxoplasmosis, together with the diagnostic procedures used and treatment given. Overall mortality rate was 80% and that attributed to toxoplasmosis was 66%. Variables influencing outcome were: site of Infection and
11 conditioning regimen. Underlying disease, among patients diagnosed before death, was the most significant factor influencing outcome.23
A study was conducted to examine the relation between Toxoplasmosis and Psychiatric disorders in USA on patients with psychiatric disorders and mothers of schizophrenics. The results showed elevated levels of antibody of T.gondii in the serum and CSF. The study concluded that ‘Infectious Causation of Psychiatric Disorders’ should be active focus of research. And establishing role of Toxoplasma gondii in etiopathogenesis in many psychiatric disorders might lead to new medication for this prevention and treatment.24
6.2.3 Literature related to Amoebiasis during pregnancy.
A study was conducted on the impact of food- and waterborne parasitic diseases that are common in the United States on women during pregnancy. The level of knowledge of 1200 obstetrician-gynaecologists about diagnosis and treatment of toxoplasmosis, cryptosporidiosis, giardiasis, amebiasis, cyclosporiasis, trichinellosis, ascariasis, and taeniasis was estimated by means of a questionnaire developed by the Centres for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynaecologists (ACOG). Of the 1200 obstetrician-gynaecologists surveyed, 521 (43%) responded. Therapeutic considerations for these diseases during pregnancy are discussed. After completion of the article, the reader was able to list the various common protozoal diseases, to outline the clinical manifestations as well as route of spread for each of the protozoal diseases, and to outline potential therapies for each of the protozoal diseases.25
A study was conducted on sociodemographic, nutritional, immunologic, parasitic, and infant risk factors for birth weight, LBW, and small-for-gestational-age (SGA) status in a cohort of 822 HIV-positive women enrolled in a clinical trial of vitamin supplementation and pregnancy outcomes in Dar es Salaam, Tanzania. Women were enrolled at prenatal care clinics during their second trimester, at which time blood, stool, urine, and genital specimens were collected, and anthropometric measurements and sociodemographic data were recorded. Birth weight was measured at hospital delivery. The intestinal parasites Entamoeba histolytica and Strongyloides stercoralis were predictors of LBW despite their low prevalence in the cohort. They concluded that Prevention of HIV disease progression and vertical transmission, improved nutritional status, and better management of malaria and intestinal parasitic infections are likely to reduce the incidence of LBW in Tanzania.26
12 A study was conducted on amoebic peritonitis in pregnancy in the United Kingdom on 22 year old white women at 13 weeks of gestation and was her second pregnancy. Initially all examinations were normal and the women gradually developed clinical symptoms by 32 weeks and went to spontaneous labour. A hepatic abscess due to Entamoeba histolytica is revealed during emergency Caesarean Section. They concluded that pregnancy lowers immunity to many parasitic infections including amoebiasis and thus patient with sub-clinical infestations may develop, clinical symptoms curing pregnancy27
A study was conducted on the basis of Cochrane Infections Diseases Group Specialized Register, Central [2008, issue3] in September 2008, to evaluate anti- amoebic drugs for treating amoebic colitis. Randomised controlled trials of anti-amoebic drugs given alone or in combination, compared with placebo or other anti- amoebic drug for treating adults and children diagnosed with amoebic colitis. Two authors independently assessed the eligibility and methodological quality of trials and extracted and analysed the data. Author concluded that Tinidazole is more effective in reducing clinical failure compared with metronidazole and has fewer associated adverse effects. Combination drug therapy is more effective in reducing parasitological failure compared with metronidazole alone. Further trials for the efficacy of anti- amoebic drugs, with better methodological quality are recommended and more accurate tests to detect Entamoeba histolytica is needed.28
6.3 OBJECTIVES OF THE STUDY
1. To evaluate the knowledge of reproductive age women regarding prevention and management of selected parasitic infestations in pregnancy in terms of pre-test..
2. To develop and conduct structured teaching programme for the reproductive age women regarding prevention and management of selected parasitic infestations in pregnancy.
3. To evaluate the effectiveness of structured teaching programme by comparing the pre and post-test knowledge score of the reproductive age women regarding prevention and management of selected parasitic infestations in pregnancy.
4. To find out association between the knowledge level of reproductive age women and selected demographic variables.
6.4 OPERATIONAL DEFINITIONS
13 1. Evaluate: Evaluate refers to the process of determining the knowledge regarding prevention and management of selected parasitic infestations in pregnancy among reproductive age women residing at rural area.
2. Effectiveness: Effectiveness refers to the extent to which the structured teaching programme on prevention and management of selected parasitic infestations in pregnancy fulfils its intended function or purpose.
3. Structured teaching programme: A well planned and systematically organised instructional aid regarding prevention and management of selected parasitic infestations in pregnancy with in a duration of 60 minutes.
4. Prevention: It is a process that aims to differ or eliminate hazards of parasitic infestations in pregnancy. In this study primary level prevention is focussed by providing health education regarding the prevention and management of selected parasitic infestations in pregnancy
5. Management: It is principally the tasks of planning, co-ordinating, motivating and controlling the efforts towards a specific goal or objective. Secondary level of management is focussed in this study.
6. Selected Parasitic infestation: Parasitic infestation refers to a state of being invaded or overrun by parasites. In this study selected refers to Malaria, Toxoplasmosis and Amoebiasis
7. Pregnancy: Pregnancy refers to a period during which the women carries viable products in her uterus.
8. Reproductive age women: It refers to women ranges between the age group of 15-45 years.
9. Residing: In this study residing means the women who are living in a selected rural area permanently or for an extended period.
6.5 HYPOTHESIS OF THE STUDY
H1: There will be statistically significant difference between the pre and post-test knowledge of the reproductive age women regarding prevention and management of selected parasitic infestations in pregnancy.
H2: There will be statistically significant association between the knowledge and selected demographic variables of the reproductive age women regarding prevention and management of selected parasitic infestations in pregnancy.
14 6.6ASSUMPTIONS
1. Women in rural area may have inadequate knowledge regarding the prevention and management of selected parasitic infestations in pregnancy.
2. Women’s knowledge regarding the prevention and management of selected parasitic infestations in pregnancy can be measured by a structured knowledge questionnaire.
3. Women’s knowledge regarding prevention and management of selected parasitic infestations in pregnancy can be improved by administering a structured teaching programme.
4. Effectiveness of structured teaching programme can be assessed by comparing the pre-test and post-test knowledge scores of the reproductive age women residing in a selected rural area Bangalore.
6.7 DELIMITATIONS OF THE STUDY
1. The study is limited only to 60 women who are at the age between 15 to 45 years. 2. The study is limited only to women who are residing at selected rural area, Bangalore. 3. The study is limited only to women who are able to read and understand Kannada or English.
6.8 PILOT STUDY:
The study will be conducted with 10 samples from rural area. The purpose to conduct pilot study is to find out the feasibility for conducting the study and design on plan of statistical analysis.
6.9VARIABLES
A concept that can take on different quantitative values are called variables.
Dependent variable: Knowledge level of the reproductive age women regarding prevention and management of selected parasitic infestations in pregnancy.
Independent variable: Structured teaching programme regarding prevention and management of selected parasitic infestations in pregnancy.
Extraneous variables: Age, educational status, type of family, sources of information, occupation, history of previous parasitic infestations of self, any family members, relatives or friends
15 7 MATERIAL AND METHODS:
7.1 SOURCE OF DATA:
The data will be collected from the reproductive age women who are residing at selected rural area, Bangalore.
7.1.1 RESEARCH DESIGN
The research design adopted for this study is Pre experimental design. One group pre- test and post- test design.
7.1.2 RESEARCH APPROACH:
Evaluative Research Approach will be adopted.
7.1.3 SETTING OF THE STUDY:
The study will be conducted at a selected rural area, Bangalore.
7.1.4 POPULATION:
All the women who meet all the inclusion criteria and residing at a selected rural area, Bangalore.
7.2 METHODS 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 the concerned authorities. The investigator collects data from women by using a structured knowledge questionnaire regarding the prevention and management of selected parasitic infestations in pregnancy.
The data collection instrument consists of following sections
Section A: Demographic Data
16 Section B: Structured questionnaire related to the knowledge of women regarding prevention and management of selected parasitic infestations in pregnancy.
7.2.1 SAMPLING TECHNIQUE:
Non-probability convenience sampling will be used to select the women who are residing at a selected rural area, Bangalore.
7.2.2 SAMPLE SIZE:
Sample consists of 60 women who are residing at selected rural area Bangalore city.
SAMPLING CRITERIA:
7.2.3 INCLUSION CRITERIA
1. Women who are residing at a selected rural area, Bangalore city. 2. Women who are at the age between 15-45 Years. 3. Women who are available at the time of study. 4. Women who are able to read and understand Kannada or English. 5. Women who are willing to participate in the study.
7.2.4 EXCLUSION CRITERIA:
1. Women who are selected for pilot study. 2. Women with sensory or mental disabilities.
7.2.5 TOOLS FOR DATA COLLECTION:
A structured knowledge questionnaire is used to collect the data from the women.
7.2.6 DATA ANALYSIS METHOD:
The data collected will be analysed by using descriptive and inferential statistics.
Descriptive statistics:
Frequency and percentage for analysis of demographic data and mean, mean percentage and standard deviation will be used for assessing the level of knowledge.
17 Inferential statistics:
Chi-square test will be used to find out the association between knowledge of women and selected demographic variables.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR HUMANS OR ANIMALS?
Since the study is pre experimental in nature, interventions are required.
7.4 ETHICAL CLEARENCE:
Yes, ethical committee’s 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 institution. 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 collected.
8. REFERENCE [VANCOUER STYLE]
1. Article on infestation. wikipedia, the free encyclopaedia [homepage on the Internet]. [cited 2012 Oct 12]. Available from: http://en.wikipedia.org/wiki/Infestation
2. Article on infection. wikipedia, the free encyclopaedia [homepage on the Internet]. [cited 2012 Oct 12]. Available from: http://en.wikipedia.org/wiki/Infection
3. Overview of parasitic infections. The merch manual home health hand book [homepage on the Internet]. [cited 2012 Oct 10]. Available from: http://www.merchmanuals.com/home/infections/parasitic_infections/overview_of_parasitic_infections.html -83k
4. Parasites, facts, information. Encyclopaedia of science [homepage on the Internet]. 2002 [cited 2012 Oct 8]. Available from: http://www.parasites.aspxencyclopedia.com/topic/
5. Easmon C. Amoebic dysentery. Net doctor UK [homepage on the Internet]. [cited 2012 Oct 10]. Available from: http://www.netdoctor.co.uk/travel/diseases/amoebic_dysentry.htm
6. Elmore SA, Jones JL, Conrad A. Toxoplasma gondii: epidemiology, feline clinical aspects and prevention. Post graduate medical journal [homepage on the Internet]. 1987 [cited 2012 Oct 9].;63(740) Available from: http://www.cbpv.com.br/artigos/1268917963.pdf
7. Stekette RW. Pregnancy, nutrition and parasitic disease. The journal of nutrition [homepage on the Internet]. 2003 [cited 2012 Oct 7]. Available from: http://jn.nutrition.org/content/133/5/1661s.fulL
18 8. Singh N, Shukla MM, Sharma VP. Epidemiology of malaria in central India. Pubmed [homepage on the Internet]. 1998 [cited 2012 Oct 9].;77(7) Available from:, The global library of women's medicine Web site: http://www.ncbi.nlm.nih.gov/pubmed/10444880
9. Importance and prevention of malaria in pregnancy. The transactions of the royal society of tropical medicine and hygiene [homepage on the Internet]. 2003 [cited 2012 Oct 10].;97(1) Available from:, The global library of women's medicine Web site: http://www.tropicalmedandhygeinejrnl.net/article/Soo35- 9203(3)90012-5/abstract
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20 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
21 12. 12.1 Remarks of the chairman and principal.
12.2 signature
22