“ A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING VAGINAL
CANDIDIASIS AND ITS PREVENTION AMONG WOMEN ATTENDING AT
HSK HOSPITAL AND RESEARCH CENTRE, BAGALKOT”.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MRS. SAVITA R. ANGADI
SHRI. B.V.V.SANGHA’S SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, BAGALKOT, KARNATAKA. 2012
1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
01. NAME OF THE CANDIDATE MRS. SAVITA.R.ANGADI 1 YEAR M.SC. NURSING,. AND ADDRESS: SHRI.B.V.V.SANGHA’S, SAJJALASHREE INSTITUTE OF NURSING SCIENCES, BAGALKOT. KARNATAKA 02. NAME OF THE INSTITUTION: SHRI.B.V.V.SANGHA’S, SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, BAGALKOT. KARNATAKA 03. COURSE OF STUDY AND M. Sc. NURSING 1st YEAR. SUBJECT: (OBSTETRIC AND GYNECOLOGICAL NURSING)
04. DATE OF ADMISSION TO 30 /06/ 2012 COURSE:
05. TITLE OF THE TOPIC:
“ A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING VAGINAL
CANDIDIASIS AND ITS PREVENTION AMONG WOMEN ATTENDING
AT HSK HOSPITAL AND RESEARCH CENTRE, BAGALKOT”.
2 6. BRIEF RESUME OF THE INTENDED WORK.
INTRODUCTION:
“Knowledge in youth is wisdom in age”
Genital tract infections are among the most common medical problems in women. Vaginal discharge cause women to seek treatment from health care providers however, some of these infections remain asymptomatic .anatomy predisposes women toward greater risk of genital infection and also accounts for greater difficulty in diagnosis and treatment. Genital tract infections are often referred to as vaginal infection.1
Vaginal candidiasis is very common yeast infection of the vagina.
is caused by a fungal micro-organism called candida albicans is also called as vaginal thrush, that occurs when there is over growth of the fungus is always present in the body in small amounts. However when an imbalance occurs, such as when the normal acidity of the vagina, changes or when hormonal balance changes, candida can multiply. When that happens, symptoms of candidiasis appear 2
Vulvo vaginal candidiasis (VVC) is common clinical problem in women of reproductive age throughout the world particularly in hot, subtropical climates.
Annually in the united states there are approximately 13 million cases of vulvo vaginal candidiasis (VVC), resulting in 10 million gynecologic office visits per year. It is estimated that 75% of women will experience at least one episode in their lifetime, with a projected 50% of all women experiencing multiple episodes3.
Candida albicans is a dimorphic commensal organism of the urogenital tracts and has been identified as the main pathogenic agent in vulvo vaginal candidiasis
(VVC), accounting for approximately 85-90% of patient with positive cultures.4
3 Traditionally it has been assumed that changes in host vaginal environment promote the dimorphic transition from blastospore to hyphae resulting in a shift from asymptomatic colonization to symptomatic vaginal candidiasis5.
Vulvo vaginal candidiasis (VVC) is a mucosal infection of the urogenital tract of women and is primary caused by candida albicans. Vulvovaginal candidiasis (VVC) is characterized by itching, burning, soreness, abnormal vaginal discharge, dysparunia, and phenotypical signs such as vaginal and vulvar erythema and edema. That have been linked to idiopathic vulvovaginal candidiasis (VVC) include changes or imbalance in reproductive hormones, as a result of oral contraception, pregnancy, or hormone replacement therapy (HRT), as well as antibiotic usage, and diabetes mellitus6.
Most episodes of vulvovaginal candidiasis respond well to treatment with currently available antifungals. While acute vulvovaginal candidiasis is largely treatable with current chemotherapeutics, there remains a subset of the population (5%-
10%of women diagnosed with vulvo vaginal candidiasis) that exhibit recurrent vulvovaginal candidiasis (RVVC). Recurrent vulvovaginal candidiasis is defined as having three or more episodes per annum7.
Recurrent vulvovaginal candidiasis (RVVC) can be further broken down into two subgroups: primary and secondary recurrent vulvovaginal candidiasis. Primary infections are idiopathic and do not correlate to any known predisposing factors identified with acute vulvovaginal candidiasis. Secondary infections are defined as frequent episodes of acute vulvovaginal candidiasis brought on by unavoidable predisposing factors such as diabetes mellitus or hormone replacement therapy.
4 Women who are diagnosed with recurrent vulvovaginal candidiasis usually respond favorably to antifungal therapies with very little resistance.7
Vulvovaginal candidiasis is one of the common infections that midwives deal with daily. Yeast infections are not always preventable, however, they are associated with specific risk factors that midwives can counsel women to avoid or alter.
A diagnosis of yeast infection was made on fallowing advice was given.8
Keep the genital area clean and dry. Avoid soap and rinse with water only.
Avoid douching. Although many women fell cleaner if they douche after
menstruation or intercourse, it may actually worsen vaginal discharge because it
removes healthy bacteria lining the vagina that protect against infection.
Eat yogurt with live cultures or take lactobacillus acidophilus tablets when you
are on antibiotic to prevent yeast infection.
Use condoms to avoid catching or spreading sexual transmitted infection.
Eat yogurt with live cultures or take lactobacillus acidophilus tablets when you
are on antibiotic to prevent yeast infection.
Use condoms to avoid catching or spreading sexual transmitted infection.
Avoid using feminine hygiene sprays, fragrances, or powders in the genital
area.
Avoid wearing extremely tight-fitting pants or shorts with may cause irritation.
Wear cotton underwear or cotton- cloth pantyhose.
Avoid underwear made of silk or nylon because these materials are not very
absorbent restricts airflow.
This can increase sweating in the genital area, with can cause irritation.
Use pads not tampons.
5 Keep your blood sugar level under good control if you have diabetes.
Many women use antivaginal candidiasis passaries and creams micanazole, clotrimazole, econazole to treat a straightforward bout of thrush. Passaries and creams are recommended especially for pregnant or breastfeeding women to avoid side effects.8
Oral treatments fluconazole or itraconazole are simpler and convenient than passaries and creams, but they can have side effect. That is nausea, vomiting, headache, diarrhea, constipation, blouting, an upsetstomach.Vaginal candidiasis if it is acute meance fluconazole tablet providing only once. If symptoms severe or having repeated vaginal candidiasis infection may need to take every week to prevent new infection.9
6.1 NEED FOR THE STUDY:
‘No Man is a good doctor who has never been sick himself’
Although vaginal candidiasis is a common infection among women that is associated with considerable morbidity and health care cost. Three of every four women experience at least one bout of vulva vaginal candidiasis.1
Candida species are part of the lower genital tract flora is 20 to 50% is healthy asymptomatic women vulvovaginal candidiasis is common in adults is 50% of female university students will have had at least one physician diagnosed episode by age 25, as many as 75% of premenopausal women report having had at least one episode, and 45% of women have two or more episodes vulvovaginal candidiasis is less common in postmenopausal women, unless they are taking estrogen therapy.10
6 Colonization with candida occurs in 3to 4% of prepubertal girls, candidal infection is most in children who had have recent antibiotic therapy, are immune suppressed , over who where diapers. It is uncommon in normal prepubertal girls, in whom it is frequently over diagnosed.11
In a study conducted at gent university hospital was the course of fourteen weeks+,612 patients (237 post menopausal) participated the participant include both those who had complaints of vaginal candidiasis and those who did not, samples from each participant were taken from the lateral vaginal wall and were identified for yeast colonization. This study showed that yeast was present in 20.1% of the curable sample and 18.6% post menopause women.12
In a longitudinal study of 1248 asymptomatic women ages 18 30 yrs, conducted over a period of four hospital visits in one year .1248 asymptomatic participated in this study yeast was present in 70% of unknown at least once and in
39% of the women during are four visits over a one year period.13
A disruptive study of pregnant women routinely antenatal clinics to determine the prevalence of candidiasis was carried out at labia state university teacling.aba one hundred and five women were randomly sampled. High vagina swab were colleted and examined microscopically. The prevalence of vaginal conditions was
42.9%. It was common or the younger women between the ages of 23 39 yrs and in primi gravida. the attack rate was hiches in the third trimester of pregnancy.14
In the US showed that 6.5 % and 8% of older than 18 yrs repeated
7 and episodes of vulvo vaginal candidiasis during the 2 month and 1 yr period to the survey, respectively. In condition the total annual cost for dealing with vulvovaginal candidiasis was estimated at $1.8 billion .the high incidence and associated health care cost of vulvo vaginal candidiasis highest the need for the development of effective agent for its prevention.15
Many women who suffer from vulvovaginal candidiasis already use these agents without prescription .in a survey carried out by prepubertal 73% of 117 women in the year age between 18 to 70 yrs self reported having bad symptoms of vulvo vaginal candidiasis in the past and 35% reported that these symptoms appeared after antibiotic course. Lactobacillus products were used by 40% and 435 of these women for presentation and a treatment of post antibiotic vulvovaginal candidiasis respectively.16
The complication includes for vaginl candidiasis are, pelvic inflammatory diseases, infertility, ectopic pregnancy, pelvic abscess, menstrual disorder, spontaneous abortion and premature birth. It now well established that presence of infective vaginal discharge greatly facilitates transmission and acquisition of HIV between sexual partners.17
While acute vulvovaginal candidiasis largely treatable with current chemo therapeutics .there remains subsets of population (5 to 10%) of women diagnosed with vulvoa vaginal candidiasis that exhibit recurrent vulvo vaginal candidiasis is defined as having three or more episodes per annum.17
Hence, the investigator felt that to need to improve the knowledge of
8 women regarding vaginal candidiasis and its prevention. So that they can take care of themselves and they can educate other women regarding vaginal candidiasis and its prevention.
6.2 REVIEW OF LITERATURE:
A cohort study was conducted to find out the epidemiologic features of vulvo vaginal candidiasis among reproductive age women in India. They examined the incidence, prevalence and risk factors for vulvo vaginal candidiasis among 898 women.
The data were gathered by structured interview and a pelvic examination. The results revealed that the positive predictive values for diagnosis of vulvo vaginal candidiasis using individual signs or symptoms were low (<19/) There was no strong evidence for association between socio demographic characteristics and the prevalence of vulvo vaginal candidiasis [prevalence12%] where as women assessed to be negative for bacterial vaginosis [prevelence6.5%] The study concluded that women with bacterial vaginosis higher prevalence of vulvo vaginal candidiasis. 18
A descriptive study was conducted to find out the prevalence of vaginal candidiasis in women complaing of vaginal discharge in Bagdad. They selected
100 females attending the gynecological clinics in a hospital at Bagdad between the periods from January 2004 to September2004. Results revealed that candidiasis was detected in 36% of the studied groups. It was seen in 50% of women complaing vaginal discharge and 15% of diabetic women without vaginal discharge.
Candida albicans infection was significantly associated with age, menstrual status and marital status of women. The study concluded that candidiasis is a common infections
9 agent among married women with vaginal discharge.19
A study was conducted to know the vaginal douching, its prevalence, and its association with vaginal candidiasis in Cambodia. They selected 451 females aged 15-49yrs attending MCH clinics in 7 provinces of Cambodia. Data were examined by using standard diagnostic procedures specific to each pathogen. The results revealed that the proportion of participants who douched at least once a week was 76.7%
Douching was significantly more prevalent in urban than in rural women. Frequently was douching was significantly associated with genito-urinary symptoms, which were must prevalent in participants who douched from several times a week to once a day.
Genito-urinary symptoms were less prevalent in those who douched more than once a day. Douching was significantly associated with vaginal candidiasis; They concluded that vaginal douching was very common in Cambodian women visiting MCH clinics.
Further investigations are warranted to elucidate the reasons for douching. In addition women should be informed that douching may endanger their reproductive health. 20
A prospective study was conducted to examine the risk factors for recurrent vulvo vaginal candidiasis in women receiving maintenance antifungal therapy in Philadelphia. 65 women aged more than 18yrs with recurrent vulvo vaginal candidiasis who attended vaginal candidiasis clinics were selected. The results of vulvo vaginal candidiasis recurrence was 41%.Almost two fifth of the women reported activity limitations because of vulvo vaginal candidiasis episodes,
Behavioral factors that were associated significantly with increasing vulvo vaginal candidiasis recurrence >/=2fold included wearing panty liners and consuming cranberry juice or acidophilus containing products. The study concluded that the use of panty
10 liners, consumption of cranberry juice, or acidophil containing products, a history of bacterial vaginosis, and age <40yrs were positively associated with a symptomatic vulvo vaginal candidiasis episode. 21
A descriptive study was conducted to find out the relationship between family planning method, individual hygiene, and fertility with vaginal infection among the women in Iran. They selected 266 females attending the midwifery unit of selected health centers in Isfahan city due to one of the common vaginal infections
[gardenerella, candidiasis vaginitis, trichomonal vaginitis and Chlamydia].The data were gathered by conducting interview using a questionnaire with both open and closed ended questions. The results revealed that a significant relationship was found between suffering from vaginitis and demographic and individual factors like women’s job
(P=0.001), their educational level (P=0.006), body mass index (P=0.01), and their weight (P=0.02). However there is no significant relationship was found between suffering from common vaginal infections and individual health factors. The study concluded that knowledge of the factors related to vaginal infection can be instrumental in preventing and reducing the suffering from there infections.22
A study was conducted to evaluate the efficacy of one-day, intermittent, monthly prophylaxis with 400mg itraconazole in the management of recurrent vulvo vaginal candidiasis in Italy. A randomized trial, 57 patients and 57 controls with recurrent vulvo vaginal candidiasis were assigned either to receive one-
day monthly itraconazole prophylaxis for 6 months or no treatment. Clinical and mycologic evaluations were carried out 3, 6 & 12 months after enrollment. The results showed that during the first 6 months of fallow-up, rate of symptomatic recurrences
11 was 36. 4% [20/55] among the treated women and 64.2% [34/53] in the controls. The proportion of patients still asymptomatic after 1yr of fallow-up was 38.9% (21/54) among treated women and 28.855% (15/53) in the controls. The study concluded that one-day monthly, intermittent, itraconazole prophylaxis reduced the rate of recurrence in patients with recurrent vulvo vaginal candidiasis, but the beneficial effect of itraconazole was lost within a few months after cessation of prophylaxis.23
An experimental study was conducted to determine recurrent vaginal candidiasis with weekly teraconazole cream in U.S.A. 22 women age 19-41 yrs with a history of recurrent vaginal candidiasis are selected. The participants were started on weekly applications on teraconazole 0.8% cream for 26 weeks. These women were then followed for an additional 26 weeks after therapy; the participants were interviewed by phone each week concerning symptoms and complaints. Results revealed that 10 patients had symptoms of vaginal candidiasis along the prophylactic phase of the study but candida species were isolated during only 4 of these episodes.
The study concluded that the weekly applications of teraconazole 0.8% cream were effective in preventing recurrent episodes of candidial vaginitis and were well tolerated.
24
A descriptive study was conducted to determine women’s experience and knowledge of the two most common sexually transmitted vaginal infections, vulvo vaginal candidiasis in U.S.In this study 1945 women were selected and data were gathered by online omnibus and an in depth questionnaire. The result showed that almost all (97%) of women who took part stated that they were vulvo vaginal candidiasis and 44% reported having had vulvo vaginal candidiasis,whereas 30% of women had heard of bacterial vaginitis and only 9% thought that they had experience of it. The study concluded that women seem very aware and knowledgeable about
12 vulvo vaginal candidiasis, but the awareness of bacterial vaginitis is low with self reported incidence considerably less than prevalence rate suggesting misdiagnosis.
Increased education and better diagnosis of these two conditions is needed to remove
the stigma and taboo, especially for bacterial vaginitis and to ensure correct diagnosis
with appropriate treatment.25
A descriptive study was conducted at a selected general hospital at pune in 2005 to study the epidemiology, etiology and rate of incidence of vaginal yeast infection. a total 500 patients attending gynecological OPD were tested for the presence of yeast using vaginal swabs from the vagina .out of 500 studied cases 59% were adolescents girls ,34% were diabetic women, 4% were using contraceptives, 2% were cancer patients and 1% were hysterectomy clients .candida albicans was the highest among the adolescent girls compared with other age groups .so the study revealed that attention must be paid to the profound increase in vaginal yeast infection among patients with different predisposing factors.26
6.3 STATEMENT OF THE PROBLEM:
“ A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING VAGINAL
13 CANDIDIASIS AND ITS PREVENTION AMONG WOMEN ATTENDING AT
HSK HOSPITAL AND RESEARCH CENTRE, BAGALKOT”.
6.4 OBJECTIVES OF THE STUDY:
1) To assess the knowledge of woman regarding vaginal candidiasis and its prevention
2) To find out the effectiveness of structure teaching programme on knowledge
regarding vaginal candidiasis and its prevention.
3) To determine the association between knowledge of women regarding vaginal
candidiasis and its prevention with selected socio demographic variables.
6.4 OPERATIONAL DEFINITIONS.
1. ASSESS: In this study assess refers to the measurement of knowledge of women
regarding vaginal candidiasis and its prevention.
2. EFFECTIVENESS: In this study it refers to determining the extent to which the
organized STP has achieved the desired effect in improving the knowledge of women
regarding vaginal candidiasis and its prevention.
3. STRUCTURED TEACHING PROGRAMME: In this study it refers to specific
type of group media activity planned and executed for a group of women regarding
vaginal candidiasis and its prevention.
4. 4. KNOWLEDGE: In this study it refers to the level of understanding of women
regarding vaginal candidiasis and its prevention.
5. VAGINAL CANDIDIASIS: it is infection by fungi of the genus candida generally
candida albicans most commonly involve in skin and vulva.
6. PREVENTION: In this study prevention refers to the advance care for reducing the
occurrence of vaginal candidiasis.
7. 7. WOMEN: In this study it refers to females whose age falls between 14-45years
14 attending in hsk hospital and research centre bagalkot.
6.5 ASSUMPTIONS:
Tool prepared for the study would be sufficient to assess the knowledge of
women regarding vaginal candidiasis and its prevention.
The women will be willing to participate in the study effectively.
The participants will extent their co-operation in providing factual information.
The Structure teaching programme prepared will meet the knowledge demands
of the subject related to vaginal candidiasis and its prevention.
6.6 HYPOTHESIS:
H1: More than 75% of women will have good knowledge regarding vaginal candidiasis
and its prevention
H2: A significant difference will be found between pre-test and post-test knowledge
scores of women regarding vaginal candidiasis and its prevention.
H3: There will be significant assess between pre test knowledge of women regarding
vaginal candidiasis and its prevention with selected socio-demographic variable.
6.7 DELIMITATIONS:
1) The study is delimited to the women who are attending in HSK hospital and research centre bagalkot.
2) The study is delimited to the women whose age falls between 14-45 yrs.
7. MATERIALS AND METHODS:
7.1. SOURCE OF DATA :
The data will be collected from women attending in H S.K hospital and research centre
Bagalkot
15 7.1.1. RESEARCH DESIGN:
Since the aim of the present study is to find out the effectiveness of structure teaching programme on knowledge regarding vaginal candidiasis and prevention among women, a quashi experimental design with pre-test, post-test without control group design is found to be appropriate for conducting the study.
7.1.2. SETTING OF THE STUDY:-
Setting refers to the physical location and condition in which the data is gathered.
The present study will be conducted in H S K hospital and Research centre Bagalkot
7.1.3. POPULATION:-
For the present study target population is the complete set of women whose age falls between 14-45years. For the present study accessible population is women whose age falls between 14-45 years residing in bagalkot.
7.1.4. SAMPLE: - In the present study sample consist of women attending HSK
Hospital and research center bagalkot.
7.2. METHODS FOR COLLECTION OF DATA
7.2.1. SAMPLING TECHNIQUE:-
Convenient sampling technique will be used to select HSK Hospital and simple random sampling technique will be used to select the subject.
7.2.2. SAMPLE SIZE:
A total of 50 women attending HSK Hospital and research centre bagalkot.
7.2.3. DURATION OF STUDY:
Duration of the present study 6 weeks.
16 7.2.4.CRITERIA FOR SELECTION OF SAMPLE:
INCLUSION CRITERIA:
The study includes women who are attending HSK Hospital.
1) The women who are able to read and write Kannada.
2) The women who are available at the time of data collection.
3) Who are willing to participate in the study.
EXCLUSION CRITERIA:
The study excludes the women who are
1) The women who are non co-operative.
2) The women who are unable to attend the questionnaire themselves because
of their physical handicapped.
7.2.5. SELECTED VARIABLES
Variables selected in the present study are
Independent Variable: Structure teaching programme on knowledge regarding vaginal candidiasis and its prevention.
Dependent Variable: Knowledge of women regarding vaginal candidiasis and its prevention.
Socio-Demographic Variables: It includes socio-demographic characteristics of women, age, educational status, occupation, family income, religion.
7.2.6.DATA COLLECTION INSTRUMENT:
The investigator has planned to assess the knowledge of women with help of structured closed ended questionnaire.
It consists of two section namely section1, section2.
17 Section 1: Deals with socio-demographic data related to sample.
Section 2: Deals with the items related to assessment of knowledge regarding vaginal candidiasis and its prevention.
7.2.7. DATA COLLECTION METHOD
The investigators uses self administered questionnaire for data collection.
7.2.8. PLAN FOR DATA ANALYSIS AND PRESENTATION
Numerical data obtained from the samples will be organized and summarized
with the help of descriptive statistics like percentage, mean, median, and
standard deviation.
Testing the level of significance of hypotheses and identifying relationship
between knowledge of women regarding vaginal candidiasis and its prevention
and their socio-demographic variable will be done with the help of inferential
statistical tests like chi-square test, co-efficient correlation and paired-test.
7.2.9.PROJECTED OUTCOME:
The present study will help the women to update their knowledge regarding vaginal
candidiasis and its prevention so that they can take necessary measures to avoid,
lesson and control vaginal candidiasis.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF YES PLEASE DESCRIBE BRIEFLY.
YES
In the recent study investigation is done on human beings that are assessment of women regarding vaginal candidiasis and its prevention. Investigation is given that is administration of structure teaching programme on knowledge regarding vaginal
18 candidiasis and its prevention.
7.4. HAS EHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INVESTIGATION IN CASE OF 7.3?
YES
STEP 1:Formal permission will be taken from,
*Permission will be obtained from the principal of Sajjalashree institute of nursing science, navanagar Bagalkot.
*Permission will be obtained from the institutional ethical and research committee
(Sajjalashree institute of nursing science, navanagar, bagalkot.)
*Permission will be obtained from the concerned head master of selected school of bagalkot.
STEP 2: Written consent will be obtained from participants.
19 8. LIST OF REFERENCES :
1. Text book of maternity and women’s health care 6th edition loodermilk
,pexybobak.profession emirita . sanfransisco state university ,sanfransisco
callifornia.
2. Sobel JD: candidal vulvovaginitis .Clinical obstet gynecology 36; 153-165, 1993.
3. Fidel PL,Jr.History and update on host defense Against vaginal candidiasis. AMJ
Repro Immune (2007) 57:2-
4. Naglik J.R, Chauucombe S.J, Hube B. candida albicans: secreted Asparty
proteinases in virulence and pathogenesis. (2003) Micro Bio Rev.67;3: 400-428.
5. Fidel PL,Jr, Sobel jd. Immuno pathogenesis of Recurrent vulvovaginal candidiasis.
Clinical micro,Rev.(1996) 9; (1):335-348.
6. Sobel J.D, Faro s.,ForceR., Foxman B., Summers P.R, vulvovaginal candidiasis:
Epidemiologic, Diagnostic, and therapeutic considerations. (1998) AM Journal of
Obset Gynecol. 178;203-211.
7 Sobel JD. Pathogenesis and Treatment of recurrent vulvivaginal candidiasis. (1992)
clinical infect Dis. 14: 5148-153.
8 Eckert LO.Lentz G.M., infection Lower genital tract. Vulva, vagina, cervix, toxic
shock syndrome, Hiv infections, in Katz,VL, Lentz. G.M. Lobo RA, Gershenson
DM, eds,Comprehensive gynecology. 5th edition phikedephia, PA Mosby Elsevier,
2007: chap 22.
9 Sobel JD. Flucanazole maintainance therapy in recurrent vulvovaginal
candidiasis,in,Journal of Gynecol obstet 1992,37 (soppl 1): 17-24
10 Goldacre.MJ,Watt B,LoundN,ET AL,Vaginal microbial flora in normal young
20 women Br Med J 1979 1:1450.
11 Geiger AM. foxmanB, Gillespie BW. The Epidemiology of vulvovaginal
Candidiasis among University Students AMJ Public Health 1945;85:1146,
12 Bauters T G M A Dhont et al. (2002) “Preveleeeeence of Vuvalovaginal
CANDIDIASIS AND Susceplibity to flu conazole in women” Mercan journal of
obstetrics and Gynecology 187 (3); 569-74.
13 Begi,R.H.L.A “MEYN,ET AL (2004) Vaginal yeast Colanization in nonpregnant
women; a longitudinal Study” Obstetrics and Gynecology 104(sph):962-30.
14 Journal of Medical Investigation and Practice >vol 2-(2001)> PA Foxman,B,
Barlow,R,DARCYH,etal Candida Vaginitis, Self-reported incidence and associated
costs. Amer Sex Transm Dis Assoc 2000; 27:230-5
15 Foxman, B, Barlow,R,DARCYH,et al candida vaginitis, Self-reported incidence
and associated costs. Amer sex TRANSM DIS Assoc 2000; 27: 230-5.
16 Pioritta M. Gunn J, Chondros P. not thrush again women Experience of post
antibiotic vulvovaginitis MJA2003 ; 174: 43-6.
17 FMOA (federal ministry health (2005) A manual techanical report on the national
hiv/aids syphilis sentinel survey among pregnant women attending antenatal clinics
in Nigeria.PP.1-11.
18 Rathod SD, klausner JD et al, epidemiologic features of vulvovaginal candidiasia
among reproductive age women in India. Infect dis obstetricalgynecological.2012;
2012:859071.doi:1155/2012/859071.epob 2012 oct 15.
19 Waleed I, Alobadi et al prevention of vaginal candidiasis among several groups
women. Journal of Iraqi of medical science,MROG, 2006: vol (1): 13-16
20 Hang LS, yatsuya H, et al vaginal douching in comedian women: its prevalence and
21 association with vaginal candidiasis, Journal of epidemiology. 2010;20 (1): 70-6
epob 2009 dec 12.
21 Patel DA, Gillespie B, et al Risk factor for recurrent vulvovaginal candidiasis in
women receiving maintenance antifungal therapy: Results of prospective cohort
study. Journal of obstetric and gynecology 2004 mar; 190 (3): 644-53
22 Valiani M, Zolfaghari M, et al, The relationship between family planning method,
individual hygiene and fertility with vaginal infections among the women referring
to selected health centers in Isfahan city in Iran. Journal Nurse Midwifery Res.
2011 winter; 16 (1) 83-92.
23 Spinillo A, colonna L. et al managing recurrent vulvo vaginal candidiasis.
Prevention with itraconazole. Journal of reprod med. 1997 feb; 42 (2): 83-7
24 Stein GE mammaw NL et al prevention of recurrent vaginal candidiasis with
weekly terconazole cream an pharmacother. 1996 oct; 30 (10): 1080-3.
25 Johnson SR, Griffiths H, et al Attitudes and experience of women to common
vaginal infections. Journal of lower genital tract disinfection.2010 oct;14 (4): 287-
94.
26 Shafik AS Hassan MY,Elden A.The study non epidemiology, aaaaetiology and
rate of incidence of vaginal infection. JASMR 2007;2(2):115-7
22 9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE This study is feasible and I forward it for acceptance. 11. NAME AND DESIGNATION OF Mrs. JAYASHREE.AWARSANG. Asst. Professor 11.1. GUIDE. Dept. of Obstetrics and gynecological nursing. Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka. 11.2. SIGNATURE
11.3. CO – GUIDE Mrs. KAMALA.K. HOD & Asst,Proffessor Dept. of Obstetrics and gynecological nursing. Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka. 11.4. SIGNATURE
11.5. HEAD OF THE Mrs. KAMALA. K. N. DEPARTMENT. Asst. Professor & HOD Dept. of Obstetrics & Gynecological Nursing. 11.6. SIGNATURE
12. REMARKS OF THE The topic is discussed with the members of CHAIRMAN & PRINCIPAL the research committee and is finalized. she is permitted to conduct the study. 12.1 SIGNATURE
23