Rajiv Gandhi University of Health Science s2

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

SAKKUBAI.H

FIRST YEAR M.SC. NURSING

CHILD HEALTH NURSING

YEAR 2012 – 13

SRI VENKATESHWARA COLLEGE OF NURSING NO: 98, MARUTHI INDUSTRIAL- ESTATE, PEENYA 2nd STAGE, BANGALORE – 560058

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Ms. SAKKUBAI.H 1ST YEAR MSc. (N) SRI. VENKATESHWARA COLLEGE NAME OF THE OF NURSING, 1 CANDIATE AND NO. 98, MARUTHI INDUSTRIAL ADRESS ESTATE, PEENYA 2ND STAGE, BANGALORE – 560058 Sri. Venkateshwara College of Nursing, NAME OF THE 2 No. 98, Marathi Industrial Estate, INSTITUTION Peenya 2nd Stage, Bangalore – 560058 COURSE OF THE 1ST Year M.Sc. Nursing 3 STUDY AND SUBJECT Child Health Nursing DATE OF ADMISSION 4 TO THE COURSE 13/06/2012 “ A study to assess the level of knowledge regarding prevention of dengue fever among the 5 TITLE OF THE TOPIC mother’s of school age children in selected rural area at Bangalore with the view to develop an information booklet”.

2 6.0 BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION:

“A fever is an expression of inner rage”1

Julia Roberts

Children are a blessing from God. With these blessings also come responsibilities. As stewards of God’s children, parents are responsible for helping children to grow physically, mentally, emotionally, intellectually and spiritually. Mothers have reasonability toward children, too. There is a need to provide a good environment in which children are safe.2

Dengue is emerging as an important mosquito born arboviral disease in the world once known to occur sporadically, Epidemics of dengue have now become a regular occurrence. In the various studies reported about epidemics, it was seen that children below <15 years of age were quite severely affected. The etiological agent of dengue syndrome is dengue virus. Man-Mosquito-man is transmission cycle of dengue fever. Aedes aegypti mosquito is the main vector.3

The incidence of dengue in children is rapidly rising, with an estimation of 50 to 100 million individuals infected worldwide per year and around 500,000 people being admitted to hospital. For the purpose of finding the incidence of infection due to the dengue virus, in a four month period when transmission was expected to be the highest, the serologic test of the paired sample was done by using the inhibition hemoglobin technique and it was found that 4.56% incidence was in the rural area and 56.84% in the urban area.4

3 Children are reacting more than that of adult to dengue by showing death. It is due to three serious forms of dengue attack such as dengue hemorrhagic fever, dengue shock syndrome and dengue encephalopathy. Along with these conditions sometime children are affected by liver problem. The children are showing their reaction through signs and symptoms such as fever headache malign and bleeding manifestations.5

Dengue fever is not only reacted by the children but reacted by their parents also in a variety of ways. Some of them laughed uncomfortably; some rolled their eyes; and a number of them dove right in and said ok let’s talk about this. The parents are exactly what they took into their peer world with all their pressures to conform to risky behavior like drugs and alcohol.6

Prevention is better than cure, so before the onset of dengue fever mothers need to follow preventive measures, such as mother can be maintained by wearing mosquito repellent, avoiding mosquito bite, eliminating pockets of stagnant water, preventing mosquito energy by door closed and windows screen, using mosquito nets etc.So prevention is more important to reduce the mortality and morbidity.7

6.2 NEED FOR STUDY

Dengue fever (DF) is one of the most common widespread vectors borne disease in the world 1, 2. There are currently 2.5 billion people living in areas at risk of dengue fever transmission, with 100 million cases reported annually 5,6. Dengue fever is a flaviviral disease caused by one of four serotypes of dengue virus (DEN 1–4) which are transmitted by mosquito vectors in particular

4 domestic species such as aedes aegypti , and albopictus, which have recently been expanding its geographic distribution as seen in several out breaks 2,7[8].8

Dengue fever affects over a 100 million people annually hence is one of the world’s most important vector-borne disease. In today population 22.86% of children between 6 to 12 years of age group are affected by dengue in which males were 62.86% female were 37.14% due to the bite of mosquito, by the lack of coater supply and uses of stored water. Children younger than 15 years comprise 90% of DHF subjects in the world.9

Dengue cases across the Asia and western pacific have exceeded 1.2 million in 2008 and over 2.3 million in 2010 based on official data submitted by member states. Recently the member of reported cases has continued to increase in 2010.10

In India there are 37,000 dengue cases in 2012 including 22.7% dengue cases are deaths in a year. The percentage increase in number of cases and deaths between 2011 and 2012 is approximately 97% and 34% respectively, due to bite of mosquito. In Karnataka the incidence of dengue is recorded 2,403 cases but it has the second highest number of deaths.11

A study was conducted to identify the persons with fever in 32 villages and 10 urban areas by mothers trained to use digital thermometers combined with weekly home visits. Dengue related febrile illness was defined using molecular and serological testing of paired acute and convalescent blood samples. Over three years of surveillance 6.12 fever episode were identified with 736 laboratory- conformed dengue virus infection. The incidence was highest among children less than 7years of age (41.1/1,000 person seasons).The distribution

5 dengue was highly focal, with incidence rates in villages and urban areas ranging from 1.5-211,5/1,000 person season median 36.5.The study concluded that dengue fever in Cambodia found a higher disease incidence than reported to the national surveillance system.12

Bangalore city has been in the grip of dengue fever for the last two months. The number of positive cases has raised from 373 to 560. About a third of the dengue cases reported in the state were from Bangalore city limits. According to statistics provided by the department of health and family welfare. In Bangalore city limits, 868 cases were reported and 175 cases were from Bangalore urban districts limits. Because of irregular water supply, the people tend to store water for five to six days and the breed of mosquito thrived in such water. The Bruhat Bangalore Mahanagara Palike has taken up door-to-door survey, spraying operations and forging operations. Even though the incidence was highest in city limits, Private and government hospital are seeming at least eight to ten patients every day with dengue like symptoms, The incidence of dengue tends to be more in the metropolitan cities as the cities are crowded. Storage of water is also a cause of concern which increase the incidence of the disease.13

Prevention of dengue fever in the world is very important to reduce the mortality and morbidity rate especially in children. Vector control by prevention of mosquito breeding in stored water and killing larva are important measures for prevention of dengue fever. Personal protective measures like mosquito net should also be promoted along with effective treatment of infected persons. Isolation of the patient for the first few days of illness under bed-nets is an essential measure as there is no satisfactory vaccine against the disease.14

6 Therefore the researcher found that there is a need to improve the mother’s knowledge regarding prevention of dengue. In some rural area there is lack of health education and knowledge among the mothers regarding dengue fever. So there is a need to prepare an information booklet to educate the mothers regarding prevention and treatment of dengue fever. Hence the researcher felt the need to assess the level of knowledge regarding prevention of dengue fever among the mother’s of school age children in selected rural area with the view to develop an information booklet.

6.3 STATEMENT OF THE PROBLEM:

“A study to assess the level of knowledge regarding prevention of dengue fever among mothers of school age children (6-12 years) in selected rural area at Bangalore with the view to develop an information booklet”

6.4 OBJECTIVES OF THE STUDY

1. To assess the level of knowledge regarding dengue fever among the mothers of school age children.

2. To assess the relationship of knowledge regarding dengue among mothers of school age children.

3. To find out the association between level of knowledge and their selected demographic variables.

4. To develop information booklet on dengue fever.

6.5 OPERATIONAL DEFINITIONS

1. Assess

7 In this study, assess refers to identify the level knowledge in mothers of school age children.

2. Knowledge:

In this study, knowledge refers to the information regarding prevention of dengue fever possessed by mothers as assessed by their response to the structured knowledge questionnaire.

3. Prevention;

In this study, prevention refers to the act of going, or state of being before getting dengue fever.

4. Dengue fever

In this study, dengue fever refers to disease caused by one of a number of Arboviruses that are carried by mosquitoes. These mosquitoes then transmit virus to humans.

5. Mothers:

In this study, mothers refer to those who are haying child between the age group of 6-12years in selected rural area at Bangalore.

6. School age children;

In this study school age (6to12)years children refers a young person attending school and who are in the age group of 6to 12``

8 7. Rural area:

In this study rural area, refers to it is an open swath that has few homes or other buildings and not very many people with lack of education status and lack of knowledge.

8. Information booklet:

In this study information booklet refers an organized material which contains details on the prevention of dengue fever among the mothers’ school age children and measures to modified these factors.

6.6 LIMITATION

1. Data collection period is limited for 4 to 6 weeks.

2. Study will be conducted in selected community area at Bangalore.

6.7 HYPOTHESIS

H1 There is significant increase in knowledge of mothers regarding dengue fever after receiving information booklet than before.

H2 There is a significant association between knowledge of mother on dengue fever and their selected demographic variables.

6.8 REVIEW OF LITERATURE

Review of related literature is an integral component of any study or research project. In enhances the depth of the knowledge and inspires a clear insight in to the crux of the problem. According to pilot and hunger, a thorough

9 literature review provides a foundation upon which to base a new knowledge and generally is well conducted before any data are collected in any study.

A prospective study was conducted with school cohorts from the urban and rural municipal area of Merida to identify the incidence of dengue virus infection in children. The serological tests of the paired samples were done using the inhibition hemagglutination technique .The incidence of dengue virus infections in the city was 4.56%, while that for the rural area was 5.67%.The prevalence of serological reactive against the same virus during second sampling was 56.84% for urban area and 63.70%for the rural area. The study concluded that the average hematocrit value found in school children from the urban area was higher than the rural area.15

A prospective study was conducted to study the clinic-epidemiological profile of children hospitalized with dengue illness at a tertiary care centre in Jaipur. A total of 948 children including 670 boys and 277 girls were diagnosed to have dengue illness during the outbreak. Two Third of the children who were from urban areas with 6 – 12 years were the most commonly affected age group (45.8%), 58.3% cases had dengue fever while 41.7% had dengue hemorrhagic fever. (DHF). Dengue fever with bleed (DFB) accounted for 32% of cases common constitutional symptoms were observed in 44.5% of cases. The study concluded that children between 6 and 12 years were most affected by dengue with larger number of cases from urban areas.16

A cross – sectional study was conducted to identify dengue virus – infected patients under 15years admitted to seven government hospitals. Serum samples were collected from 90 admitted children and also from 80 healthy students. While differentiating dengue cases nine patients had dengue shock syndrome.

10 With serological confirmation primary antibody response was observed in eight (11.3%) and definite secondary infection in 49 (69%) out of 41 Serum samples, 14 (34.1%) were positive for dengue virus isolation. The study concluded that Continuous comparing is required for community participation so as to prevent and control DHF successfully. 17

A Retrospective study was conducted to identify the Epidemic of dengue hemorrhagic fever and dengue shock syndrome in children. A standard protocol technique was used to diagnose manage and monitored all the patients. Out of 134 children 80 were males and 54 were females were studied. Sixty children were less than 6 years of age of which 12 presented during infancy. There were 92 (67%) cases of DHF and 42(33%) cases of DSS. Common symptoms were fever (93%) abdominal pain (49%) and vomiting (68%). The commonest hemorrhagic manifestation was hematomesis (39%) AND spenomegaly 25 %(19%). Serology was positive (1gm hemaglutation anti body titers >1.160). The study concluded that management protocol of DHF / DSS in which fluid therapy is not based on hemutocrit value need to be formulated.18

A prospective study was conducted to find out Eco-Epidemiological analysis of dengue infection during an outbreak of dengue fever in India. Blood samples were collected from 1550 patients experiencing a febrile illness clinical consist with dengue infection. Serological confirmation of dengue infection was done using Dengue Due 1gM and 1gG Rapid strip test. Out of 1550 suspected cases, 893 cases (57.36%) were confirmed as serologically positive. The difference between numbers of serological positive cases during different

11 months was significant (p<0.05). The difference in the rainfall and temperature between three seasonal periods was significant (p<0.05). The study concluded that highlighted rain temperature and relative humidity as the major and important climate factors. Which are responsible for an outbreak of dengue fever.19

A experimental study was reexamined to determine the natural history of wild type dengue virus. Log-normal distribution using the maximum likelihood method and the infectious and extrinsic incubation periods were assessed by proportions of successful transmissions causing clinically apparent dengue. Correlations between the intrinsic incubation period and other variables and univariate associations between clinical severity and serotype were also examined. Mean _+ SD incubation periods were 6.0 1.4 and 5.7 1.5 days for DENU – 4 and DENU – 1 respectively. Even 1 and 2 days before the set of fever 80.0% (95% confidence interval [CI], 44.9% - 100%) and 25% (CI 0% - 67.4%). The study concluded that as incubation period negatively correlated with disease severity.20

A cross sectional study was conducted to assess the dengue related knowledge attitude and practices of residents of Westmoreland. In this study questionnaire technique was used to assess the knowledge, of 192 parents. More than half of the parents (54%) have good knowledge about signs, symptoms and mode of transmission of dengue. Approximately 47% considered dengue to be a serious but preventable disease to which they are vulnerable. Never the less majority (77%) did not use effective dengue preventive methods such as screaming of homes and 51% did not use bed nets. Educational attainment or

12 (2.98;CI, 1.23-1.23) was positively associated with knowledge of dengue. There was no correlation between knowledge about dengue and preventive practice. (p=0.34). The study concluded that the good knowledge about dengue fever among residents of Westmoreland did not translate to adoption of preventive measures.21

A cross-sectional study was conducted among persons visiting a tertiary care hospital in New Delhi to assess the knowledge related to control of dengue fever. A system sampling procedure was adopted and a pretested questionnaire was used. A total of 215 individuals were interviewed majority of the respondents (96.3%) had heard about dengue. Around 89% of the study participants considered dengue as serious problem. Nearly 86% participants were aware of the spread of dengue by mosquitoes while 73% were aware of one of the correct breeding sites of aides mosquito. Mosquito mats/liquidators were used by 61% of respondent, coils by 56% and repellant creams by 22%. The study concluded that awareness regarding dengue and mosquito control measures were satisfactory to an extent and programs should be focused that their knowledge get translated in to practice.22

A cross sectional study was conducted to assess the level of knowledge attitude and practices regarding dengue fever in people visiting tertiary care hospital in Karachi. A convenience sampling technique was used to select 447 visitors; a pre-tested and structured knowledge questionnaire was administered to them through face to face unprompted interview... The knowledge was recorded on scale of 1 – 3, about 89.9% of individual interviewed had heard of dengue fever. Dengue was found to be in 38.5% of the sample literate

13 individual were relatively more well performed about dengue fever as compared to the illiterate people (p < 0.001). Knowledge based upon preventive measures was found to be predominantly focused towards preventive of mosquito bites (78.3%) rather than eradication of mosquito 17.3% .The study concluded that use of anti mosquito sprays was the most prevalent preventive measure.23

A cross-sectional observational study was conducted to determine the prevalence of dengue fever. A standardized questionnaire technique was used to select the hospitalized patients in 2 general hospitals in singapure.One hundred ninty-seven patients were enrold, as samples of whom 119(60.4%) were males and 78(39.6%) were females. One hundred sixty of 197 patients had positive dengue immunoglobulin M serology. The prevalence of dengue-related maculopathy (p<0.001), with a hazard ratio of8.669; sensitivity, 29.6%; and specificity, 95.4%.The study concluded that low complement C3 level in patients suggests that dengue is an immune-mediated disease.24

6.9 MATERIALS AND METHODS

7.0 SOURCE OF DATA:

The data will be collected from the mothers of school age children.

7.1METHODS OF DATA COLLECTION:

I. Research design

Descriptive design

II. Research variables:

14 1. Study variables

a. Dependent variables: Knowledge of mothers regarding dengue fever.

b. Independent variables: Information booklet on dengue fever.

2. Demographic variables

Demographic variables include; Age, religion, educational status, occupation, age at marriage, number of children, income and residence etc.

III. SETTINGS

The study will conducted in selected rural area at Bangalore.

IV. POPULATION

Population will be mothers of school age children in selected rural area at Bangalore.

V. SAMPLES

Mothers of school age children who full fill the inclusive criteria in selected rural area in Bangalore are considered as sample and sample size is 100.

VI. SMPLING TECHNIQUE

Sampling technique adopted for the selection of sample is “stratified simple random sampling.”

VII. CRITERIA FOR SAMPLE SELCTION

INCLUSION CRITERIA

1. Mothers having school age child between the age group of 6-12 years.

15 2. Mothers who can understand English or Kannada.

EXCLUSION CRITERIA

1. Mothers who are not willing to participate.

2. Mothers who are not available during the collection collection of data.

VIII. TOOL FOR DATA COLLECTION

Data collection tool consists section A section B.

Section A: The demographic variables of the mother of school age children includes age, religion, educational status, occupation, age of marriage, number of children, income and residence.

Section B: Structured knowledge questionnaire will be administered to assess the level of knowledge of mothers of school age children regarding prevention of dengue fever.

IX. METHOD OF DATA COLLECTION

After obtaining permission from the consent authorities of the selected community area the investigator will obtain consent from the mother of school age children. The investigator will personally assess the pre test level of knowledge of the mothers regarding prevention of dengue fever by using a structured knowledge questionnaire and on the same day distribute the information booklet on prevention of dengue fever.

Duration of study: 4-6 weeks.

X. PLAN FOR DATA ANALYSIS

16 1. Frequency and percentage analysis will be used to describe the demographic variables.

2. Descriptive analysis such as mean standard deviation and mean score which will used to assess the level of knowledge.

3. The paired t-test will be carried out to assess the statistical significance.

XI. PROJECTED OUT COME

The mother of school age children may have inadequate knowledge regarding prevention of dengue fever. Information booklet will improve their knowledge and will help them to prevent mortality and morbidity of the dengue fever and will prevent the disease in early stage.

7.4 Dose the study requires any investigation or intervention to the patient or other human being or animal?

Yes, Information booklet will be distributed regarding prevention dengue fever.

7.5 Has ethical clearance been obtained from your institution?

Yes, permission will be obtained from the ethical committee of Sri Venkateshwara College of nursing and selected rural area.

17 8. LIST OF REFERENCE

1. www.brainyquote.com/../fever.html

2. An introduction to children’s Ministry, www.gci.org/children/ministry.

3. Parul Datta “PEDIATRIC NURSING” first edition,2007, peg; no- 235 and seroprevalence and trend of dengue,Available at Ijpm.mui.ac.ir/../626.

4. Faran-Ale, The incidence of dengue virus infection in children, Nov 1991 pag no-780-784 Available at http://www.ncib.nim.mih.gov/pumed/1768354

5. Parul Datta “PEDIATRIC NURSING” First edition 2007 peg no- 236

6. Attia Z Taha .PARENTS REACTION TO DENGUE IN COMMUNITY;2002 pag no. 27-30.

7. .Rsoenfedt, Vesikari T, pang XL, etal.MOTHERS KNOWLEDGE REGARDING DENGUE: 2004

8. Racloz V, Ramsey R, Tong S, Huw.Survillance of dengue fever. Published: May 22 2012dol:10.1371/journal.pntd.ooo1648. Available at www.plosnted.org/article/info%2534d...

18 9. WHO Global burden of dengue. Available at http://www.who.in/media center/factsheet/fs117/en.

10. WHO Dengue and severe dengue. http://www.who.in/media center/factsheet/fs117/en.

11. Health.india.com>HOME>.2012 India dengue report:

12. Vong S, Dengue incidence in urban and rural Cambodia: result from population-based active feversurvillance, Institut Pasteur-Cambodia, Phnom Penh, Cambodia.dol:10.1371/journal.pntd.0000903.Nov 2010. Available at http:www.ncbi.nml.nih.gov/pubmed/211520

13. Staff Reporter”THE TIMES OF INDIA”incidence of dengue in Bangalore. Available at http://www.the hindu.com/

14. Parul Data “PEDIATRIC NURSING” First Edition; 2007,p no-237

15. Farfan –Ale, Dr.Hideyo Noguchi, Universidad Autonomy de Yucatan, Merida, Mexico. The incidence of dengue virus infection in children 8 to14 years old residing in the urban and rural areas of the city of Merida, Yucatan. Bol Med Hosp Infant Mex.Article in Spanish, 1991 Nov, pag.780-784. Available at http:www.ncbi.nlm.nih.gov/pubmed/1768354

16. Kulkarni MJ, Clinico-epidemiological profile of children hospitalized with dengue. Department of pediatrics, sir padampat Mother and child health institute, SMS Medical College, Jaipur, and Rajasthan, India. Indian J pediatric. Oct 2010; 77 (10):1103-7.doi:10.1007/s12098-010-0202-2Epub. Available at http://www.ncbi.nlm.nih.gov/pumed/20890686

19 17. Kittigul, Leera suankeow, Kedsuda sujirarat, Dusit Yoksan, Sutee.Dengue hemorrhagic fever: knowledge, attitude and practices in Ang Thong province, Thailand.journal Article.16th-Jun-2003;. Available at http://imsear.hellis.org/handle/123456789/35199

18. Aggarwal A, An Epidemic of Dengue Fever and Dengue Shock Syndrome in children in Delhi. Department of pediatrics, Kalawati Saran Children s Hospital, New Delhi, India.Aug1998; 35(8):727-32. Available at http:www.indian pediatrics.net/.peg; no-727-732.Aug1998.

19. Anita Chakravarti and Kumaria.Eco-epidemiological analysis of dengue infection during an outbreak of dengue fever, India. Department of microbiology, Maulana Azad Medical College, Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg New Delhi-110002, India. Virology Journal2005, 2:32dol:10.1186/1743-422X-2-32. Available at http:www.virologyj.com/content/2/1/32.

20. Hiroshi Nishiura and Scott B.Halstead. Natural History of Dengue Virus (DENV).Department of Medical Biometry, University of Tubingen, Germany, Westbahnhofstr55, D-72070 Available at http://jid.oxfordjournals.org/content/195/7/10.

21. West Indian Med J. Knowledge, attitudes and practices regarding dengue infection in Westmoreland, Jamaica. December 2010 in final edited form as; West Indian Me, peg no.139-146. Jan2010. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996104.

20 22. NAM J Med, High Level of awareness but poor practices Regarding Dengue FEVER Control: no; 278-282, June 2012. Available at http:www.ncdi.nim.nih.gov/pmc/articles/ PMC3385365/.

23. Imtiaz Jehan, Knowledge, Awareness and practices regarding Dengue fever among the Adult population of Dengue Hit Comopolitan. Department of community health science, Aga Khan University, Karachi, Pakistan. Available at http://www.plosone.org/articles/info %2F10.1371%2Fjournal.pone.0002620

24. Su DH,Prevelance of dengue maculopathy in patients Hospitalized for dengue fever.Singapur National Eye center singapur.sep;114(9):1743-7.June 2007. Available at http:www.ncbi. nml.nih.gov/pub med/17561258.

21 9. Signature of the candidate:

10. Remarks of the guide:

I.1 Name and designation of the guide:

I.2 Signature:

I.3 Co-guide:

I.4 Signature:

22 I.5 Head of the department:

I.6 Signature

12.1 Remarks of the principal:

12.2 signature: