Proforma Synopsis for Registration of Subject for Dissertation

Rajiv Gandhi University Of Health Sciences, Karnataka,

Bangalore.

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME REGARDING CHILDHOOD POISONING AND ITS MANAGEMENT AMONG MOTHERS OF TODDLERS RESIDING AT RURAL UTTARAHALLI, BANGALORE CITY”.

SUBMITTED BY,

Mr. JERIN.E.VARGHESE, 1ST YEAR M.Sc NURSING, BHAGATH COLLEGE OF NURSING, #60, UTTARAHALLI MAIN ROAD, UTTARAHALLI HOBLI, BANGALORE- 560061.

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 1 Name of the Candidate and Address Mr.JERIN.E.VARGHESE 1ST YEAR M.SC NURSING BHAGATH COLLEGE OF NURSING NO-60, UTTARAHALLI MAIN ROAD UTTARAHALLI HOBLI BANGALORE-560061

2 Name of the Institution Bhagath College of Nursing, Bangalore.

3 Course of study and subject 1st Year M.Sc. Nursing, Paediatric Nursing.

4 Date of admission to course 01-10-11

5 Title of the Topic :

“ A Study To Assess the Effectiveness of planned Teaching Programme Regarding Childhood Poisoning and its Management Among Mothers Of Toddlers residing at Rural Uttarahalli, Bangalore City”.

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 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 mothers who are residing at Uttarahalli, 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

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 Name of the Candidate and Address Mr.JERIN.E.VARGHESE

2 1ST YEAR M.SC NURSING BHAGATH COLLEGE OF NURSING NO-60, UTTARAHALLI MAIN ROAD UTTARAHALLI HOBLI BANGALORE-560061

2 Name of the Institution Bhagath College of Nursing, Bangalore-560 061.

3 Course of study and subject 1st Year M.Sc. Nursing, Paediatric Nursing.

4 Date of admission to course 01-10-11

5 Title of the Topic :

“ A Study To Assess the Effectiveness of planned Teaching Programme Regarding Childhood Accidents And its Management Among Mothers Of Toddlers residing at Rural Uttarahalli, Bangalore City”.

6 .BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Children are living jewels dropped unstained from heaven”

Robert Pollock

3 A child is the purest form of a human being as he is not yet molded by the harsh realities of life. As each child looks at the world through innocent eyes all they can see, the ways of life and the way they think their life should be. We owe our children, the most vulnerable citizens in our society, they are like flowers and they fills our life with joy and fragrance.

Accidents are one of the five leading causes of death in industrialized and developing countries. Injuries arising from accidents are an increasing public health problem. Yearly, 10% of children suffer an accident for which it is necessary to contact the health services.

Children, being less aware of danger, are one of the most vulnerable groups. Younger children are more vulnerable indoors, while older ones are more at risk outdoors. There appear to be "gender types" of accidents; males tend to have more accidents outdoors while females tend to have accidents indoors. Accidents are also related to the prevailing socioeconomic and cultural conditions1.

Poisons are substances that are harmful when they get into the body. Poisons also are called toxins, toxic substances, or hazardous substances. Poisoning occurs when a toxin is swallowed (ingested), breathed in (inhaled), absorbed through the skin, or injected, or gets into the eyes. Poisoning can be a medical emergency. In most cases, poisoning occurs in the home, is acute (i.e., develops suddenly) and unintentional (accidental), and involves children under the age of 6. Personal care products (e.g., cosmetics, creams, lotions, mouthwash), household cleaning products and chemicals (e.g., pesticides), and over-the-counter or prescription medications (e.g., pain relievers, cough and cold medicines, vitamins) are common causes for acute childhood poisoning. Some types of childhood poisoning develop over time, due to repeat or chronic (i.e., long-lasting) exposure to small amounts of the toxic substance. Lead poisoning, which is more common in young children and can cause serious neurological damage, usually develops slowly over time when a child is exposed to lead. Lead is a highly-toxic metal that can build up in the body and damage the nervous system (e.g., brain, spinal cord, nerves). Lead may be present (usually in

4 small amounts) in contaminated soil and dust, paint and paint chips (e.g., house paint prior to 1978), toys made outside of the United States, and plumbing (e.g., pipes, faucets) 2.

The signs of poisoning includes burns or redness around the mouth and lips, Breath that smells like chemicals, Burns, stains, and smells on your child, her clothes, or elsewhere in the house, Vomiting, difficulty breathing, sleepiness, confusion, or other strange behavior, Seizures, Unconsciousness

Poisoning prevention is an important part of child care. Parents and caregivers should keep all potential poisons out of the reach of children, should supervise young children at all times, and should not rely on child-resistant packaging and child safety latches to prevent poisoning.

The Childhood Poisoning Prevention Program (CLPPP) was established for the prevention, screening, diagnosis, and treatment of lead poisoning, including the elimination of sources of poisoning through research and educational, epidemiologic, and clinical activities as may be necessary. CLPPP provides a range of both primary and secondary prevention services to the children of the Commonwealth of Massachusetts, their families and others with an interest in the prevention of lead poisoning. In order to accomplish the fundamental goals of identifying lead poisoned children and ensuring that they receive medical and environmental services as well as preventing further cases of lead poisoning, CLPPP has developed linkages with a wide array of professionals and programs that provide services to children. CLPPP also provides coordinated and comprehensive nursing case management3.

6.1 NEED FOR THE STUDY “ The Ancient Greeks pointed out that a community is like a living organism and children belong to the community. Therefore, when something bad happens to one of them the entire community suffers. It takes a village to raise a child”.

5 Childhood poisoning is a major cause of morbidity in the developing as well as the developed world. Inspite of the success of some interventions to prevent accidental poisoning in the pediatric population toxic ingestions continue to be a common occurrence. Globally, the pattern of childhood poisoning is changing rapidly.

Suspected poisoning in children results in about 40 000 annual Emergency Department attendances in England and Wales, with approximately half of these admitted for observation or treatment. The majority of poisonings are accidental, especially in the under-5 age group, although intentional overdoses and substance abuse are seen in older children. Rarely, children present with symptoms as a result of deliberate administration of compounds by adults.

Deaths in children from poisoning are becoming increasingly rare with only two deaths reported in 2006 and a decline in mortality rates of ~85% since 1976. Factors responsible for this decline include the introduction of child-resistant containers, reducing the pack sizes of aspirin and acetaminophen, and more effective management and the support provided by the National Poisons Information Service. The NPIS has provided information and advice to health-care professionals since 1963 by telephone and now has an internet-based database. Appropriate advice often prevents unnecessary hospital admissions and also reduces morbidity and mortality.

According to statistics from the National Safety Council, U.S. poison centers receive a call about exposure to poison every 15 seconds, and children younger than three years of age are involved in 40% of these cases. Ingestion was the cause of poisoning in over 75% of the cases4.

The most significant portion of these poisonings involved common household substances that can be found in almost every home, such as prescription drugs and vitamins, cosmetics, and cleaning products. A large portion of these poisonings also involved houseplants.

The researchers evaluated patient records from the National Poison Data System of the American Association of Poison Control Centers. They looked at the years 2001 to 2008 and focused on children age 5 years and younger. All the children were evaluated at a health care facility after being unintentionally exposed to over-

6 the-counter or prescription medication. The researchers categorized the doses as those the child took by mistake or an error made by an adult giving the child medicine.

The researchers looked at visits to emergency departments, hospital admissions, injuries, and trends. They evaluated a total of 453,559 records. In 95% of cases, the child got into the medicine. Most problems occurred after children got into prescription medicines. Children getting into prescription medicines accounted for more than 248,000 emergency department visits, nearly 42,000 hospital admissions, and more than 18,000 injuries. Most often, the drug ingestions that caused the most serious illnesses involved opioid painkillers, sedatives, and heart medicines.

The Retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The analysis of the data indicated that pediatric poisonings constituted 0.23-3.3% of the total poisoning. The mortality ranged from 0.64-11.6% with highest being from Shimla. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra were probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra5.

A Hospital - record based study was conducted in Sundarban of West Bengal to explore the profile of mortality and morbidity pattern of acute accidental poisoning among children. Three years retrospective data of childhood accidental poisoning cases were collected from the indoor admission registers and case history sheets of 11 Block Primary Health Centers of the region. A total of 1056 children with accidental poisoning were admitted during those three years of which 58% were males. Mean age of males was slightly higher than females in all the three years. Organophosphorus pesticide poisoning was the commonest6.

These studies show that the poisoning is a common public health problem among children even in the developed countries. There is a need to give adequate knowledge to the mothers regarding childhood poisoning and its management.

6.2 REVIEW OF LITERATURE

7 Review of Literature is an essential step in the development of a research project. It helps to develop an insight into the area of investigation and directs the researcher to develop a plan.

According to Faye Abdellah, “A review of literature is an important step in the development of a research project and it also provides useful comparative material when the data collected is analyzed”.

1. Review related to prevalence of childhood poisoning

A Retrospective analysis of accidental poisoning in children admitted to the Pediatric Ward of Krishna Hospital and Medical Research Centre, Karad over the past five years was done. Overall incidence of accidental poisoning in children was 1.8%. Mean age of children was 6.5 years, with male-female ratio 2:1. Oral poisoning was more common in children below 5 years whereas parenteral poisoning was common in children above 5 years. Kerosene oil was the commonest oral poison .Oral poisoning was more common in summer and parenteral in the rainy season. Rural children were more commonly involved than urban children7.

The study was conducted on epidemiology of poisoning. Childhood poisoning is usually accidental and tends to be associated with a low morbidity and mortality. In Western Europe and North America, it is most often due to household products and pharmaceuticals; in developing countries, paraffin, traditional medicines, snakes bites and insect stings are more commonly involved. In adults, self-poisoning is usually deliberate and has a higher morbidity and mortality rate. Analgesics and psychotropics predominate in Western Europe and North America as causes of admission to hospital, though carbon monoxide is responsible for most deaths. In developing countries, accidental and deliberate pesticide poisoning is probably the commonest cause of adult deaths8.

8 The study was conducted on profile of poisoning admissions by department of pharmacy. There were 21 714 admissions reported with 779 deaths. The case-fatality rate was 35.88/1000 admissions. The majority of admissions (89.7%) and deaths (98.9%) occurred in adults. Some 55.1% of all admissions were female, mostly involving pharmaceutical agents. Overall, the majority of poisoning admissions were due to pharmaceutical agents, with agents classified as non-opioid analgesics, anti- pyretics and anti-rheumatics the most common. Pesticides accounted for the largest number of fatalities. Most cases of poisoning admissions occurred due to accidental exposure (47%), followed by cases of intentional self-harm (20.7%)9.

This Retrospective study was undertaken to describe the epidemiological features of accidental poisoning in children less than 13 years old who were admitted to the Emergency Paediatrics Unit .One hundred and thirteen (0.74%) out of 15,196 children were admitted for accidental poisoning. Their ages ranged from 6 months to 12 years. Children aged 0 to 2 years accounted for 80 (70%) cases. There were 69 males and 44 females with a male: female ratio of 1.6:1. Fifty-nine (98.3%) out of 60 children were from low social background. Kerosene and food poisoning accounted for 89 (78.8%) and 19 (16.8%) of all cases of poisoning respectively. Respiratory symptoms dominated the clinical presentation in 71 (62.8%) cases10.

The study was conducted on accidental poisoning of children by japan poison information center. The JPIC is the only poison information center admitted by the Ministry of Health and Welfare to provide toxicological information to medical personnel and the general public, and has two offices on duty in alternating 24 h shifts. Every year, JPIC receives about 30,000 inquiries. About 82% of these inquiries are from the general public and 84% of the patients are children 5 years and younger. We contrasted the data in the fiscal year 1991 with the data of the American Association of Poison Control Centers. Child poison exposure in Japan is characterized by a high exposure rate of children under 1 year of age to (mostly) household products. The JPIC also analyzed the cause of tobacco ingestion. We report the accidental poisoning of children in Japan11.

2. Review related to causes of childhood poisoning

9 The study was conducted on fatal poisoning in childhood due to accidental, deliberate, or undetermined poisoning (n=702) decreased substantially with time, and by 2000 numbered 14 and 10, respectively. Accidental deaths declined from 151 in 1968 to 23 in 2000, but homicides and open verdicts varied from 5 to 20 per year, with no clear trend. Deaths attributed to carbon monoxide and to 'other gases, fumes or vapours totalled 2431. Overall, 10% of these deaths were either certified as homicides or open verdicts. However, homicide or open verdict was recorded in half of the 47 fatal opiate poisonings12.

The study was conducted on fatal poisoning with antipsychotics drugs. We analysed deaths due to poisoning involving antipsychotics in England and Wales, 1993-2002, by age, sex, intent, and agents involved. The number of deaths involving antipsychotics increased from around 55 per year 1993-1998 to 74 in 2000, and then fell to 53 in 2002. Around 25% of deaths had a verdict of accidental death and in about 60% of deaths a verdict of suicide or an open verdict was recorded. There were no deaths involving thioridazine in 2002, following its removal from use in 2001. Age-specific death rates were highest in those aged 30-39 and 40-49 years, and were very low in those aged under 20 and 70 or over. Death rates in males were greater than in females13.

A Retrospective study from a tertiary care teaching hospital in Kolkata revealed 3.6% of total paediatric admissions were due to poisoning. Majority of the cases included oral/chemical poisoning followed by biological/envennomation. Kerosene was the commonest among all poisoning. Most of the cases were accidental14.

The study was conducted on unintentional household poisoning in children. In this article, we aim to provide clinicians dealing with poisoned children an overview of the problem and specific guidance on the identification and management of significant poisoning. Substances most frequently ingested by children in the developed world include household chemicals, medication, and plants. Although the great majority of such poisonings has no or limited clinical effects, it puts substantial burden on health care systems. Importantly, a few poisons can kill after ingestion of

10 very small amounts. Unintentional poisoning in developing countries can be much more serious, following ingestion of kerosene, caustic agents, herbal remedies, insecticides or herbicides16.

A Retrospective study covering a period of 2 years from January 2005 to December 2006 at Charles de Gaulle Pediatric University Hospital in Ouagadougou. Of 9390 admissions during the study period, 123 children, or 1.3%, were admitted for poisoning. Mothers of more than half (61%) of the children poisoned worked in the home. Household products accounted for 44.7% of AAPs, followed by drug (22.7%) and food (22%) poisoning. Kerosene and other petroleum products topped the list of household products, with 54.5%. Tranquilizers (46.4%) and dairy products (37%) dominated the drug and food poisoning categories. Immediate outcome was fatal in 3% of cases, and three quarters of these deaths occurred during drug poisoning of children aged 1 to 4 years17.

6.3 OBJECTIVES OF THE STUDY:

 To assess the knowledge of Mothers of Toddlers regarding the Childhood

Poisoning and its management.

 To develop and conduct a planned teaching programme regarding Childhood

Poisoning and its management among Mothers of Toddlers.

 To evaluate the effectiveness of planned teaching programme among Mothers

of Toddlers regarding Childhood Poisoning and its management.

 To find out the association between knowledge score and selected

demographic variables.

6.4 OPERATIONAL DEFINITIONS:

11  ASSESS: Assess refers to process of the critical analysis and evaluation or

judgment of the status or quality regarding childhood poisoning and its

management.

 EFFECTIVENESS: Effectiveness is the extent to which an activity fulfills its

intended purpose of function.

 PLANNED TEACHING PROGRAMME: Refers to organized group

teaching for 45-60 minutes in lecture cum discussion method to impart

knowledge for Mothers of Toddlers regarding child abuse and its prevention

 POISONING: A substance that causes injury, illness, or death, especially by chemical means.  MOTHERS: Refers to the age group between 21 and 45, who are

participating in the pre-test, planned teaching and post-test residing in

Uttarahalli.

 TODDLER: Refers to the child group between 1 to 3 years of age.

6.5 HYPOTHESIS OF THE STUDY:

 H1: There will be statistically significant difference between pre and post-

test knowledge scores of the experimental group regarding Childhood

Poisoning and its management among Mothers of Toddlers.

 H2: There will be statistically significant association between knowledge

score and selected demographic variables.

6.6 ASSUMPTIONS:

12  Mothers of Toddlers have some knowledge regarding childhood poisoning

and its management.

 Mothers of Toddlers knowledge regarding Childhood Poisoning and its

management can be measured by using a structured knowledge

questionnaire.

6.7 DELIMITATIONS OF THE STUDY:

 The study is limited to Mothers of Toddlers at selected areas of Uttarahalli in

Bangalore.

 The study is limited to Mothers of Toddlers who are able to read or write

Kannada or English.

6.8 PILOT STUDY:

The study will be conducted with 10 samples. The purpose to conduct a pilot study is to find out the feasibility for conducting the study and design on plan of statistical analysis.

6.9 VARIABLES:

A concept which can take on different quantitative values is called variables.

Dependent variables: Knowledge of Mothers of Toddlers regarding Childhood

13 Independent variables: Planned teaching programme on Childhood Poisoning and its management

Extraneous variable: Age, Gender, Educational status, Occupation, Habits and

Income.

7. MATERIALS AND METHOD

7.1 SOURCE OF DATA:

The data will be collected from Mothers of Toddlers who are residing at Uttarahalli,

Bangalore.

7. 1.2 RESEARCH DESIGN:

The research design adopted for the study is Pre experimental design. (One group- pre-test post-test design).

7.1.3 RESEARCH APPROACH:

Evaluative research approach.

7.1.4 SETTING OF THE STUDY

The study will be conducted at selected areas of Uttarahalli, Bangalore.

7.1.5 POPULATION:

All Mothers of Toddlers who meet the inclusion criteria.

7.2 METHODS OF COLLECTION OF DATA (INCLUDING SAMPLE

PROCEDURE)

14 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 the sample by using a structured knowledge questionnaire, before and after planned teaching programme regarding Childhood

Data Collection instrument consist of following sections

Section A: Demographic data.

Section B: Question related to assess the level of knowledge regarding childhood poisoning and its management.

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 Mothers of Toddlers in selected areas of Uttarahalli,

Bangalore.

SAMPLING CRITERIA

7.2.3 INCLUSION CRITERIA

 Mothers of Toddlers who are staying in selected areas of Uttarahalli.

 Mothers of Toddlers who are willing to participate in the study.

15  Mothers of Toddlers who are able to read or write Kannada or English.

 Mothers of Toddlers who are in the age group of 21-45 years.

 Mothers of Toddlers who are available at the time of data collection.

7.2.4 EXCLUSION CRITERIA:

 Mothers of Toddlers who are not mentally healthy.

 Mothers of Toddlers who are selected for pilot study.

7.2.5 TOOL FOR DATA COLLECTION

A structured knowledge questionnaire is used to collect the data from the Mothers of

Toddlers.

7.2.6 DATA ANALYSIS METHOD

The data will be analyzed 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 deviations will be used for assessing the level of knowledge.

Inferential statistics:

Chi Square test will be used to find out the association between knowledge and selected demographic variables. Paired‘t’ test will be used for assessing the effectiveness of planned teaching programme. Product Moment Correlation

16 Coefficient ‘r’ will be used to find out the comparison of pre and post-test knowledge scores.

7.3 DOES THE STUDY REQUIRE ANY INVESTGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR

OTHERHUMAN OR ANIMALS:

Since the study is Pre experimental in nature, investigations are not required but interventions are required.

7.4 ETHICAL CLEARENCE

The main study will be conducted after the approval of research committee of the college. Permissions will be obtained from the head of the institution. The purpose and details of the study will be explained to the study subject and assurance will be given regarding the confidentiality of the data collected.

7.5 REFERENCES:

1. Wong, Leung PW. Childhood injuries and Accidents. Available from: http://www.whattoexpect.com.

2. Polit D F, Hungler B P. Essentials of Nursing Research, Philadelphia B Lippincott

Company; 2003. Available from : URL: http://www.globalgraphics.com .

17 3. Study on childhood poisoning programme; Available from: http://www.mass.gov .

4. National Study on Childhood poisoning ; Available from:URL:http://arpan.org.in.

5. Dutta AK, Seth A, Goyal PK, Aggarwal V. Poisoning in children. 1998 May- Jun;65(3):365-70. Available from: URL:http://pediatrics.aapublications.org

6. Chowdhury AN, Banerjee S, Brahma A, Biswas MK. A study on mortality and morbidity pattern of acute childhood poisoning. 2008 Jan-Mar;52(1):40-2. Available from:URL:http://www.eric.ed.gov.

7. Kumar V. Accidental poisoning.1991. Jul;28(7):731-5. Available from:URL://http://eprints.qut.edu.au.

8. Meredith TJ. Epidemiology of poisoning. 1993 Sep;59(3):251-6. Available from: Available from: http://www.ncbi.nlm.nih.gov .

9. Rajasuriar R, Awang R, Hashim SB, Rahmat HR. Profile of poisoning admissions. 2007 Feb;26(2):73-81.Available from: URL:http://www.elsevier.com.

10. Goto K, Kuroki Y, Shintani S, Kusakawa S. Accidental poisoning of children. 1993 Jun;35(3):193-200. Available from: http://www.ncbi.nlm.nih.gov

11. Flanagan RJ, Rooney C, Griffiths C. Fatal poisoning in childhood. 2005 Mar 10;148(2-3):121-9.Available from:URL:http://www.dailytimes.com.pk

12. Griffiths C, Flanagan RJ. Fatal poisoning with antipsychotic drugs.2 005 Nov;19(6):667-74.Available from:URL:http://www.thefreelibrary.com.

18 13. Krenzelok EP. The Pittsburgh Poison Center profile of an American poison information center. 2005;62(6):538-42.: Available from: http://www.ncbi.nlm.nih.gov

14. Flanagan RJ, Rooney C, Griffiths C. Fatal poisoning in childhood. 2005 Mar 10;148(2-3):121-9. Available from: URL: http://www. pubmed.com.

15. Abdellah, F .G. & Levin. E. Better Patient Care Through Nursing Research.2nd ed.

New York: Mac Millan Publishing Co, 1979.

16. Basu K, Mondal RK, Banerjee DP. Epidemiological aspects of acute childhood poisoning among patients. 2005 Jan-Mar;49(1):25-6.Available from: Available from: http://www.ncbi.nlm.nih.gov

17. Meyer S, Eddleston M, Bailey B, Desel H, Gottschling S, Gortner L. Unintentional household poisoning in children. 2007 Sep-Oct;219(5):254-70. Available from:URL:http://www.aifs.gov.au.

18. Kouéta F, Dao L, Yé D, Fayama Z, Sawadogo A. Acute accidental poisoning in children. 2009 Apr-Jun;19(2):55-9. Available from: http://www.ncbi.nlm.nih.gov

19. Oguche S, Bukbuk DN, Watila IM. Pattern of hospital admissions of children with poisoning. 2007 Jun;10(2):111-5. Available from: URL: http:// Available from: http://www.ncbi.nlm.nih.gov

19 9 Signature of the candidate

1 Remarks of Guide 0

1 Name and Designation of- 1

11.1 Guide

11.2Signature

11.3Co-Guide

11.4Signature

11.5Head of the Department

20 11.6 Signature

12 12.1 Remarks of the Chairman &Principal

12.2 Signature