Rajiv Gandhi University of Health Sciences s1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE AND AJITH KUMAR V ADDRESS 1ST YEAR M. Sc NURSING, BRITE COLLEGE OF NURSING, Sy.No.69, BWSSB COLONY PIPELINE ROAD CHIKKAGOLLARAHATTI MAGADI MAIN ROAD VISHWANEEDAM POST BANGALORE – 560091.

2. NAME OF THE INSTITUTION BRITE COLLEGE OF NURSING, BENGALURU

3. COURSE OF STUDY AND 1ST YEAR M.Sc NURSING SUBJECT COMMUNITY HEALTH NURSING

4. DATE AND ADMSSION TO THE 01/05/2011 COURSE

“A STUDY TO ASSESS THE 5. TITLE OF THE TOPIC KNOWLEDGE AND KNOWLEDGE OF PRACTICE REGARDING ANTI- LARVAL MEASURES AMONG ADULTS AT SELECTED RURAL AREA, BENGALURU” 6.BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Our Health is in Our Hand” “Count Mosquito borne disease out towards – a Mosquito borne free India”.

Mosquitoes are often annoying pests and are carriers of other organisms that cause diseases. They are found all over the world. Control of mosquitoes is important in the present day with rising number of mosquito borne diseases1.

Mosquito borne diseases are the major health problem all over the world. The disease like malaria, dengue, kala-azar, Japanese encephalitis is more fatal than any other diseases. World

Malaria Report ,2008 states that malaria remains as a killer disease with nearly 1 million people losing their lives every year. India is struggling to cope with outbreaks of mosquito borne diseases that kills and infects the people. National Health Policy, 2002 aims to reduce the mortality and morbidity due to malaria, dengue, kala-azar and Japanese encephalitis by 50% by the year 2010 and lymphatic filariasis by the year 2015 along with effective morbidity control2.

According to WHO in South East Asia region, over the past 15 years, dengue fever and dengue hemorrhagic fever has become a leading cause of hospitalization and death among the people. Dengue hemorrhagic fever is the most important emerging disease affecting nearly half of the world’s population. It is estimated that there are between 50 -100 million cases of dengue fever and about 500,000 cases of dengue hemorrhagic fever which require hospitalization every year. Brazil reported 3,50,000 cases and 42 deaths due to dengue. World Malaria Report, 2008 states that the country had an estimation of 10.6 million malaria cases in 2006, accounting for

60% of the malarial incidence in South East Asia. 86% of malaria cases occur in Africa but it nevertheless remains as a global problem also affecting countries in large parts of Asia and Latin

America. Overburdened hospitals and clinics in several cities in the North of India are scrambling to treat thousands of patients suffering due to mosquito borne disease. In West

Bengal 300 people have been affected by mosquito borne disease across the state. More than

4,546 people are affected with chikungunya in Krishnagiri district. An estimated 42,000 people die every week from mosquito borne diseases related to low water quality and absence of adequate sanitation. 3

All the mosquitoes move through their life cycles quickly. Each stage of mosquitoes can be killed differently and it is important to use the right techniques in tandem at their right stages.

There are plenty of potential places where the mosquitoes can develop. Since water is a necessary component of mosquito breeding, it is necessary not to take even the smallest lingering puddle for granted. Therefore, we should take certain necessary step to reduce the number of mosquitoes by eliminating their breeding places before the mosquito problem really starts 3.

The best line of defense for people to protect themselves from mosquito bites is adopting anti-larval measures. It disrupts the development of the larvae and is lethal only at the larval stage of mosquito development. It is the window of opportunity to kill the mosquito larvae before they reach the pupae stage. It controls the amount of mosquitoes that specifically target you. As sanitation plays an important role in breeding of mosquito, the anti-larval measures are very important that place an eminent role in source reduction of mosquitoes in larval stage itself, that enhance human being to lead a healthy life3.

The practice of community health nursing involves the provision of comprehensive nursing care, to the community which is impossible without community participation and awareness. The more man dig, the more indeed their wisdom flows4.

As many deadly diseases spread through the mosquitoes, it is very necessary to reduce the impact of mosquitoes in human beings and for which anti-larval measures is an essential method of source reduction through which many mosquito borne diseases can be reduced.

Hence, the anti-larval measures are simple, cost effective and also environment friendly.

6.2 NEED FOR THE STUDY

Mosquitoes apart from their pestiferous nature, plays an important role in the transmission of human disease. They act as vectors of many diseases. Anti-larval measures such as environmental control method, chemical control method, biological control method are the best method to reduce the number of mosquito by their source reduction in larval stage itself.

The most important step in reducing the numbers of mosquito is to eliminate their breeding places. It implies rendering the water unsuitable for mosquito breeding. It is the proven method of larval control and generally produces the results that are permanent. Control of mosquitoes is utmost important in the present day with rising number of mosquito borne illnesses. Mosquitoes need to be exterminated using the right tools and with a little bit of effort. 5 It is hard to comprehend the amount of disease and the resulting sickness, death, and economic loss caused by the mosquito. Some scientist estimates that between 500 and 700 million people get malaria worldwide each year. About 96 lakhs suspected cases of chikungunya have been reported across the country and the health centre provided all technical and logistic support to tackle the diseases. The affected states – Andhra Pradesh, Karnataka, Tamilnadu,

Madhyapradesh, Gujarat and Kerala have been directed to focus on elimination of all potential mosquito breeding places by taking up anti-larval measures. The State Union Health Minister urged the voluntary organization and panchayatraj institutions to work together and check the diseases. 6

A report, that the Salem Corporation has intensified mosquito control measures to check the spread of diseases, as rainwater gets stagnated in several parts, serving as breeding ground for mosquitoes, the civic body has formed a team comprising 120 conservancy workers to carryout garbage removal, drainage clearance and spraying of mosquito repellents in the city and removed the blockages in the drainage channels and drain the stagnated rainwater. Anti-larval measures are carried over and the rainwater got stored in the unusual tyres, pots, tanks and coconut shells were emptied to prevent mosquito breeding. 7

Officials responsible for mosquito control programs make decisions to use pesticides based on an evaluation of the risks to the general public from diseases transmitted by mosquitoes or on an evaluation of the nuisance level that communities can tolerate from the mosquito infestation. Based on surveillance and monitoring, mosquito control officials selected specific pesticides and other control measures that best suit local conditions in order to achieve effective control of mosquitoes with the least impact on human health and the environment. It is especially important to conduct effective mosquito prevention programs by the eliminating breeding habitats or applying pesticides to control the early life stages of the mosquito. Prevention programs, such as elimination of any standing water that could serve as a breeding site, help to reduce the adult mosquito population. 8

More overly, the people are suffering from mosquito borne diseases as mosquitoes are proliferated in lakhs due to poor sanitary conditions. To prevent such outbreaks in the affected states, regions, there is an urgent need for taking appropriate preventive measures. So, it is necessary to educate and bring awareness among the people about sanitation and especially anti- larval measures. It is impossible to achieve this without the participation of general public.

Education and awareness of the public is thus very important for any meaningful action. These anti-larval measures are called for to minimize mosquito breeding and of course, these measures require a trifle of human efforts. 8

During the posting in community area, the investigator found that most of the people are living in poor sanitary conditions and getting affected by mosquito borne diseases, this inspired and kindled the investigator to take measure against the mosquito-borne diseases by making the people use the anti-larval measures, i.e., reducing the numbers of mosquitoes by their source reduction. 6.3 REVIEW OF LITERATURE

Review of literature is a key step in research process. The literature review is to discover what has previously been done about the problem to be studied, what remains to be done, what methods have been employed in other research and how the result of other research in the area can be combined to develop knowledge.9

It is essential step it can be done before and after selecting the problem. It can help to determine what is already known about the topic.9

A study was conducted which aimed to assess the knowledge, attitude and practice of preventive measures on dengue fever in New Delhi. The 338 males and 162 females were interviewed with a pre-designed questionnaire. Overall 500 interviews were taken in 28 days.

Study population largely comprised of adults and literate individuals. Overall 82.4% respondents know that dengue fever is transmitted by mosquito and 54 persons associated dengue with flies / person to person transmission regarding knowledge about breeding 399 (79.8%) respondents know about breeding places of mosquitoes. It has already been sustained that people have good idea about the breeding places of mosquitoes. 326(65.2%) respondents were having redundant tires, plastic pots and they accept the fact that they were never checking them for mosquito breeding. It was concluded that though the knowledge regarding dengue is good, practice of checking cooler, tires and flower pots is quite poor. 10 A study was conducted on knowledge, attitude, belief and practice on malaria and its control among ‘gond’ ethnic tribals” of Mandla District. About 98% tribals believed malaria was transmitted by drinking of bathing in contaminated water. Tribals did have knowledge about mosquito breeding in stagnant water (43%). Further, did not understand the relevance of DDT spray for control of mosquitoes. Therefore, there is an urgent need to build up information, education and communication (IEC) programmes for greater acceptance of the malaria control programme.11

A study conducted on factor favouring houseplant container infestation with Aedes aegypti in Brazil, the objectives of this study were to characterize flower pots and vases as larval habitats with respect to the quantities present and infested, the specific locations of the mosquito larvae and to examine factors affecting acceptance of control measures. The results showed an average of more than four potential plant related larval habitats of which only 0.4% were occupied by the vector. Plant related containers represented 31% of all the containers with Aedes aegypti larvae. 12

A study was conducted on a saline solution The Kochi Corporation in Kerala tried out a novel and cost effective method of reducing the mosquito population at the larval stage itself.

The salinity of water in canals and stagnant pools is increased by adding sea water. The experiment was successful and mosquito larvae were found morbid in the canal portions where salinity was increased. When the salinity levels reaches 30 parts per thousand or PPT mosquito larvae cannot survive beyond 3 hours. Even at lower concentrations of 15 PPT, they are dead in

12 hours.13 A study was conducted on spatial distribution of mosquito larvae and the potential for targeted larvae control in Gambia. During the rainy season the peak period of malaria transmission, breeding sites were 70%. More likely to have anopheline larvae, habitats most often colonized by anopheline larvae were the largest waterbodies situated near the landward edge of the flood plain where culicine larvae were present. In wet season 49% of sites had anophelines versus 19% in the dry season. Larval control initiated at the end of the dry season and run throughout the rainy season could help to reduce transmission.14

A study was conducted to identify anopheline breeding in river bed pools in SriLanka.

Anopheline mosquito larval surveys were carried out to their prevalence in their areas, larva were collected in separate containers, staged and identified at their third and fourth stages.

During each survey, the surface area and depth of pools were recorded. River bed pools below dams contained stagnant clean water with little or no aquatic vegetation-anopheline mosquito breeding was seen through the year in each study site. Thirteen anopheline species, including 10 potential vectors were found breeding in river bed pools. 15

A study was conducted on the investigation of the outbreak of the dengue and dengue haemorrhagic fever and urgent need for taking appropriate preventive measures in Ludhiana. The number of cases reported during the outbreak was 720, with 19 deaths. Aedes surveys were carried out in some of the affected localities revealed the presence of Aedes aegypti. The values of houses and container indices on Ludhiana city during the survey were 32.8% and 29.16% respectively. Breeding of Aedes mosquito were detected in various types of containers such as earthenpots, flower vases, plastic containers etc. to prevent such outbreaks, the district malaria corporation office was involved in anti-larval measures by using malarial and fenthion. 16

A study was conducted on Investigation of dengue fever outbreaks and effectiveness of using temephos in two villages of Dharmapuri district in Tamilnadu. Epidemiological, virological and entomological investigations were carried out. Surveys of larval and adult Aedes mosquitoes were carried out before and after anti-larval and anti-adult measures were implemented. Application of temephos and fogging with pyrethrum 2% extract were found to be effective against immatures and adults respectively. 17

A laboratory investigation was undertaken to study the cyclic usage of field recommended doses of Bacillus thuringiensis, Bacillus sphaericus with deltamethrin 2.8 EC to attain better control of mosquito larvae. To understand the susceptibility status of the culexquinque fasciatus larvae in the field, the collected larvae were exposed to the above treatments of biopesticides and were monitored for their persistency until 50% mortality was obtained. The larvae that survived in each treatment were transferred to the concentration of deltamethrin that gave 50% mortality observations on larval mortality after the treatment with deltamethrin were recorded after 24 hours. The results revealed 54% of larval mortality on the

17th day application. 18

A study was conducted on Control of vectors and incidence of malaria in an irrigated settlement scheme in SriLanka by using the insect growth regulator pyriproxyfen as a larval control agent with the aim of reducing malaria vector populations and incidence of malaria was conducted in 12 villages. All villages in the study area were under residual house spraying with lambdacyhalothrin water dispersible powder. The villages were stratified into 6 villages with high malaria incidence and 6 villages with low incidence, with each group 3 villages were randomly assigned for larval control by treating all the mosquito breeding areas with pyrifroxygen. The field of bioassays indicated that a single treatment of pyriproxyfen effectively inhibited the emergence of adult mosquitoes for a period of 190 days. 19

A study was conducted on the effectiveness of methoprene for controlling mosquito populations in Ontario that carry West Nile virus. The breeding site preferences of culex pipiens and other mosquito populations include standing water in discarded tires, various containers, ditches, catch basins and storm drains. Methoprene is advertised as a safe, effective for practical method for controlling mosquito populations in these breeding sites. 20

6.4 PROBLEM STATEMENT

A STUDY TO ASSESS THE KNOWLEDGE AND KNOWLEDGE OF PRACTICE

REGARDING ANTI-LARVAL MEASURES AMONG ADULTS AT SELECTED RURAL

AREA, BENGALURU.

6.5 OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding anti-larval measures among adults.

2. To assess the knowledge of practice regarding anti-larval measures among adults.

3. To find the association between knowledge regarding anti-larval measures with selected

demographic variables.

4. To find out association between knowledge of practice regarding anti-larval measures

with selected demographic variables. 6.6 OPERATIONAL DEFINITION

 Assess: Refers to an activity to estimate the knowledge level of adults regarding anti-

larval measures

 Knowledge: Refers to the known information regarding anti-larval measures among

adults.

 Knowledge of practice :refers to the information regarding anti-larval measures

followed by the adults.

 Anti-larval measures: Use of insect control measures designed to destroy larval insects

especially disease transmitting mosquitoes.

 Adults: Refers to persons who are in the age group 20-50 years

6.7 INCLUSION CRITERIA

1. Adults who can speak Kannada.

2. Adults who are willing to participate in the study.

3. Adults who are available during the study.

6.8 EXCLUSION CRITERIA

1. Adults who already had previous exposure to the programme on

anti-larval measures. 6.9 ASSUMPTIONS

1. Adults will have some knowledge regarding anti-larval measures.

2. Adults will have some knowledge of practice regarding anti-larval measures.

7. MATERIALS AND METHODS

7.1 Source of data: Adults in a selected rural area, Bangalore

7.2 Method Of Data Collection

7.2.1 Research design: Descriptive survey design.

7.2.2 Research Approach: Descriptive approach.

7.2.3 Setting of the study: Selected rural area, Bengaluru.

7.2.4 Sampling technique: Non-Probability Convenient Sampling Technique.

7.2.5 Sample size: 80 family members.

7.2.6 Method of data collection: Structured interview schedule will be used to

collect the data

7.2.7 Tool for data collection:

Structured interview schedule consists of

Part – I: Demographic data.

Part – II: Knowledge questionnaire on knowledge regarding anti larval measures.

Part – III: Knowledge questionnaire on knowledge practice regarding anti larval

measures. 7.2.8 Method of data analysis: The investigator will use appropriate

technique for data analysis and present in the form of table, graph,

diagrams. The data will be analyzed by using inferential and descriptive

statistics.

7.2.9 Duration of the study: 30 days.

7.2.10 Variables:

. Dependent variable: Knowledge and knowledge of practice

. Attribute variables: Age, sex, education, occupation, income and

source of information

7.3 ETHICAL CONSIDERATION

7.3.1 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE

CONDUCTED ON THE PATIENT OR OTHER HUMAN OR ANIMALS?

7.3.2 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

8. REFERENCES

1. Ataru Tsuzki, Trang Huynth, Takashi Tsunoda, et.al. A study to evaluate the effects

of existing practices of residents in reducing preadults aedes aegypt. 2008.

2. Borror. D.J., D.M. De Long and CA. Triplehorn. An introduction to the study of

insects. 1981.

3. Dengue Bulletin. Current status of dengue, dengue hemorrhagic fever. 1998. Vol-22.

Pp. 48 – 51.

4. Dr. Mrs. Kasthuri Sundar Rao. Textbook of introduction to community health

nursing. 2000. Pp 132 – 141.

5. Park.K. Preventive and social medicine. 2009. Pp. 623 – 28.

6. PTI News. Centre taking all steps to check Chikunguniya. 29.07.2006

7. The Hindu. Operation chikungunya from September 6- October 16 in Krishnagiri.

8. National Pesticide Information Centre. Larvicides for mosquito control. 2007.

9. A.P Jainco. A Text book on nursing research. 2005

10. S.Matta, S.Bhall, et.al. Knowledge attitude and practice of preventive measures. 2006

11. Neeru Singh, M.P. Singh, et.al. Knowledge, attitude, belief and practice on malaria

and its control. 2006 12. Macoris M.L, Mazine C.A, et.al. Factor favoring house plant container infestation

with Aides aegypti. 1997

13. Dr. V.K. Gopalan. A study on saline solution. 2002

14. Kasumathie P.H, et.al. Identify anopheline breeding in river bed pools,.2006

15. Kuldip Singh Gill, D.Bora, et.al. Investigation of the outbreak of the dengue and

dengue hemorrhagic fever. 1996

16. Susana K Madrieta, Angelita salarda, et.al. An experimental study on use of

premethrin treated curtains for control of mosquito vectors for dengue. 1999

17. Yapabandara. A.M, Curtis. C.F. Control of vector and incidence of malaria in an

irrigated settlement scheme in SriLanka by using the insect growth regulator

pyriproxyfen. 2004. Pp.27.

18. Micucci.S, Hamilton. Effectiveness of methoprene for controlling mosquito

populations. 2004 9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)

PROF.VIMALA 1.8 GUIDE

1.9 SIGNATURE

1.10 CO-GUIDE (IF ANY) Miss. SHEEBA

1.11 SIGNATURE

1.12 HEAD OF THE DEPARTMENT PROF.VIMALA

1.13 SIGNATURE

12 1.14 REMARKS OF THE PRINCIPAL THE STUDY IS INTERESTED AND FEASIBLE 1.15 SIGNATURE