RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

STATEMENT OF PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

PROGRAMME ON PREVENTION MANAGEMENT OF CHIKANGUNYA AMONG

PATIENTS (20-40 YEARS) ADMITTED IN MEDICAL WARD IN SELECTED

HOSPITAL AT BANGALORE

SUBMITTED BY:

MR.TONY.A.KADUKUMACKAL

M.Sc.(N) 1ST YEAR NURSING

MEDICAL SURGICAL NURSING

SRILAKSHMI COLLEGE OF NURSING

BANGALORE

2008-2009

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,ANNEXUREII

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSETATION

1 NAME OF THE CANDIDATE AND ADRESS

MR. TONY A. KADUKUMACKALSRI LAKSHMI COLLEGE OF NURSING # 127/1, SRI GANDADAKAVAL, MAGADI MAIN ROAD, VISHWANEEDAM POST, SUNKADAKATTE, BANGALORE-91

2 NAME OF THE INSTITUTION

SRI LAKSHMI COLLEGE OF NURSING # 127/1, SRI GANDADAKAVAL, MAGADI MAIN ROAD, VISHWANEEDAM POST, SUNKADAKATTE, BANGALORE-91

3 COURSE OF STUDY AND SUBJECT

M.Sc., NURSING I YEARMEDICAL SURGICAL NURSING

4 DATE OF ADMISSION TO COURSE

17.06.2008

5 TITLE OF THE TOPIC “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED PROGRAMME ON PREVENTION MANAGEMENT OF CHIKANGUNYA AMONG PATIENTS (20-40 YEARS) ADMITTED IN MEDICAL WARD IN SELECTED HOSPITAL AT BANGALORE

6. BRIEF RESUME OF INTENDED WORK

6.1 INTRODUCTION

“PREVENTION IS BETTER THAN CURE”

Chikungunya is a crippling disease caused by a buggy creek virus or

better known as chikungunya virus (CHIKV). Belonging to the genus alpha viruses of the

family Toga viridae. It is characterized by joint pains, muscle aches, headache and ragh.

Chikungunya has become global concern due to an escalation in the disease breaks, in

Africa, India and south east Asian countries.

Though the infection does not lead to death, the aliasing rise in the clinical

episodes since 2005, caused panic in many of the countries.1

The epidemics were a consequence of heavy rains favoring the active breeding of

these mosquito species in Urban habitats that synchronize with humans, who serve as

reservoir hast for the chikungunya virus.2

In India chikungunya was first 193 at Calcutta. Chikungunya is not considered to

be fatal. However, in 2005-2006, 200deaths has been associated with chikungunya of

Reunion Island and widespread outbreak in southern India.

According to Hindu newspaper dated on July 10th2006. the Karnataka state, the southern

districts were chikungunya cases have been reported are Bangalore rural (9190),

Bangalore urban (2863), tumkur (34312), kolar(14277), chikmangalore(3827) and

shimoga(13853) as on june 216. but the number of people afflicted by the disease in

Bangalore urban has risen to 690. in southern India, chikungunya epidemics are

apparently depending and accelerating with an estimated 180000 cases to date.

The only way to control communicable diseases like chikungunya is proper

sanitation and preventive intervention among community through health care delivery

system. The present concept of health is prevention of disease and promotion of health

that can be achieved through placing peoples hand and peoples in involvement in health

care services and health sanitation programmes.

6.2 NEED FOR THE STUDY:-

India on the other hand reported 1.39 million cases of chikungunya. India also had

a massive chikungunya epidemic in 2006. chikungunya had reemerged in India after

1973 where the attack rate was 37.5%. in this epidemic attack rate was 45%. More than

1.39 million cases across 10 states were reported by the government of India during

period. This is most likely an underestimate by a factor of five to ten given the poor

disease reporting system in India.

Chikungunya fever is an emerging public health problem. However, there is

insufficient scientific information on it. In order to strength prevention and control

measures and to be more effective and efficient, an operation research is needed.

Table 1. The reported number of chikungunya fever cases in India.

State No. of districts affected

Total fever cases suspected chikungunya

No. of samples sent to NIV/NICD

No. of confirmed cases

No. of confirmed deaths

Period of reporting (upto)

Andhra Pradesh

20 1,10618 1,224 150 1 04.8.06

Karnataka 27 6,70,438 4,376 266 0 05.8.06Maharashtra 31 2,16,455 4,443 507 0 26.7.06Tamil Nadu 34 43,580 413 59 0 25.7.06Madhya Pradesh

4 44,966413 59306 4 0 31.7.06

Gujarat 12 22,963 317 26 0 28.7.06Kerala 1 13 0 03 0 27.7.06Total 129 11,09,033 10,809 1015 0

An article on “ entomological studies during outbreak of chikungunya in

marathwada region of maharashtra (India)”. A total of 34,725 cases of fever with

arthralgia of 34,725 cases of fever with arturalgia were reported in 2006 from 15 districts

of maharashtra with no death. The outbreak affected 258 villages and municipal areas

with a total population of 9,42,328. the 473 serum samples from various affected districts

tested and result showed that 169 were found positive for chikungunya fever and 25 for

dengue fever. This study concludes that further education to be given to the public to

prevent this disease.

Various factors that affect chikungunya fever include mutation of the virus, lack

of herd immunity and insufficient vector control activity. It has been observed that in

addition to urbanization and population movement creating larger slum areas and

increasing population density have significantly contribute to the spread of chikungunya

climate change and social behavious play a significant role in chikungunya out break

surveillance and response system inplace and it can be achived through multi sectoral

approach and community participation to help detect and respond to the first signs of

chikungunya.

There is no specific treatment for chikungunya fever and no vaccine is available

for this disease. The only way to prevent chikungunya is through vector control and

prevention of further transmission through early case detection and prompt treatment.

The nurse with updated knowledge of prevention concepts has a major role in

reducing the intensity of complications caused by chikungunya and prevent death of

affected victing. So she or he being one of the members of health provides or health team

comes in contact with the society.

By understanding the importance of people participation it is the responsibility of

the nurses to educate and provide finest counseling for the individuals of the society and

society as a whole with the least most correct information. Ultimately it is the moral

responsibility of nurses to encourage and educate individual family and the community to

participate in health education programmes which will result in increase in knowledge

and adopting standard life styles that contributes to the reduction of incidence and

prevalence of commincable disease like chikungunya and its complications.

The above facts and studies create an insight in the investigation mind that is

improving the knowledge of patients through structured teaching programme reduce the

incidence of some communicable disease especially chikungunya and its complication.

The overall aim of the present study is to asses the effectiveness of structured teaching

programme about the knowledge of prevention and management of chikungunya among

patients. During this clinical experience the investigator came across with the more cases

of chikungunya. The investigator feels that the women’s are the basic care gives for their

family members. So by educating a woman she will educate the whole family about

prevention of chikungunya and its complications

6.3 STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON PREVENTION AND MANAGEMENT OF

CHIKUNGUNYA AMONG FEMALE PATIENTS (20-40 YEARS) ADMITTED IN

MEDICAL WARD IN SELECTED HOSPITAL AT BANGALORE”

6.4 OBJECTIVES OF THE STUDY:

To assess the level of knowledge regarding prevention and management of

chikangunya among female patients

To evaluate the effectiveness of the structured teaching programme on knowledge

regarding prevention and management of chikangunya among female patient.

To compare the level knowledge regarding prevention and management of

chikangunya among female patient between the experimental and control group

To associate the level of knowledge among female patient with selected

demographic variable.

OPERATIONAL DEFINITIONS:

1. Assess:

It is the statistical measurement of knowledge on prevention and

management of chikangunya as observerd by close-ended questionnaire.

2. Effectiveness:

The changes in the level of knowledge after the structured teaching

programme on prevention and management of chikangunya among female

patient being measures through the structured tool.

3. structured teaching programme:

It is a planned instruction regarding prevention and management for

chikangunya. It consists of definition, causes, signs & symptoms,

prevention and management of chikangunya. It will be explained to the

female patient for 20-30 minutes after the pretest.

4. Prevention:

Prevention means educating the female patient how to avoid chikangunya.

5. Female Patient:

The women who are between 20-40 years of age who have been admitted

for the treatment.

6. Medical ward:

It is the ward where the female patient are admitted with their medical

disease condition.

ASSUMPTION

1. Adults have poor knowledge about management and prevention of chikangunya.

2. Structured teaching programme will enhance the knowledge of adults regarding

management and prevention of chikangunya.

3. Enhancement of knowledge regarding management of chikangunya may prone a

way for prevention of chikangunya.

6.7 HYPOTHESIS:

H1: There will be a significant difference the pretest and posttest level of

knowledge regarding prevention and management of chikangunya among female

patients.

6.8 REVIEW OF LITERATURE:

A study on “ chikangunya epidemic on break in Mauritius (2006)”. Chikangunya

epidemic out breaks have affected more than 1 million people in 2005-2006 in many

Indian ocean islands and in India. It was observed that the onset of the 2006- out break in

February followed an abnormally high rainfall in the third week of January 2006. 51% of

the surveyed population was found to be suspected chikangunya.

A study on “ Mucocutaneous features or chikangunya fever” was carried out in

West Bengal, India. Twenty six serologically proven cases of chikangunya fever (CF)

with rash from the district of 24-proganas (North) in the eastern Indian state of West

Bengal were subjected to detailed clinical study. Result showed that most (19.2%) patient

developed rash after defervescence. Most (57.7%) patient developed rash within the first

2 days of fever.

An investigation of chikangunya out break cases was carried out in Bhilwara

District, Rajasthan during Aug-Sep-2006.Out of 40 sers sample tested, 12 showed H1

antibodies for chikangunya virus in high titres and another five were positive for IgM

antibodies against chikangunya. The clinic epidemiological, laboratory and

entomological investigations confirm that this episode of fever was due to chikangunya

fever. Strengthening and intensification of surveillance along with educating the

community were recommended for control of outbreak.

A retrospective study was carried out to find out characteristics, frequency and

locations of ocular lesions found I the participant in super speciality eye hospital and

postgraduate institute of ophthalmology. Narayana Nethralaya, Bangalore, India. Nine

chikangunya patients with ocular involvement. All patients with chikangunya infection

presenting with ocular complaints. The result fo the study was 9 patients with ocular

lesions to the best of our knowledge, similar ocular manifestations associated with

chikangunya infection have not been reported.

7 MATERIAL AND METHODS OF STUDY:-The study is designed to determine the effectiveness of structured teaching

programme on prevention and management of chikangunya among patients admitted in

medical ward in selected hospital at Bangalore.

7.1 SOURCE OF DATA:

The data will be collected from patients admitted in medical ward hospital at

Bangalore.

7.2 METHODS OF COLELCTION OF DATA:

Structured questionnaire & structured teaching programme on management &

prevention of chikangunya.

7.2.1 RESEARCH DESIGN:-

This study has evaluate research approach.

7.2.2 RESEARCH DESIGN:-

A true experimental research design with pretest and post test with control group,

which includes manipulation, control and randomization.

Group Pretest Intervention Post test

Patients admitted

in medical ward

in selected

hospital at

Bangalore

Randomization

Control group 01 …………… 02

Randomization

Experimental

group

01 X 02

Key: - 1- Pretest on knowledge of prevention and management of chikangunya. X-

planned intervention ( structured teaching programme) on knowledge of prevention and

maangment of chikangunya.

2 – Posttest on knowledge of prevention and management of chikangunya.

7.2.3 SETTING OF THE STUDY:

Study will be conducted in Vani Vilas hospital at Bangalore.

7.2.4 POPULATION:

Sample comprises to 60 patients 30 patients in experimental group & 30 patients

in control group.

7.2.6 SAMPLING TECHNIQUE:

Probability nethod-dimple randomization by using lottery method, will be used.

7.2.7 SAMPLING CRITERIA:

INCLUSION CRITERIA:-

1. Patients who are in 20-40 years of use group.

2. patients who are willing to participate

3. Patients who are admitted in medical ward.

EXCLUSION CRITERIA:-

1. Patients who are unconscious and critically ill.

2. Patients with sensory deprivation

7.2.8 DATA COLLECTION TOOL:-

Data will be collected with structural interview schedule.

The structured interview schedule consists of 2 parts.

Section A:- Semi structured questionnaire seeks information about demographic data.

Section B:- Structured questionnaire seeks information about knowledge on prevention

and management of chikangunya.

7.2.9 DATA ANALYSIS METHOD:-

1. The data collected from patients will be grouped and analysed by statistical

measure in term of objective.

2. The data analysis will be include descriptive statistics such as frequency, mean,

mean percentage and standard deviation to interpreted knowledge scores,

demographic variables and emotional well being assessment.

3. inferential statistics such as ‘t’- test and chi-square will be used to see the co-

relation between selected demographic variables with emotional well being of

patients in selected area.

4. These all findings will be document in tabulation, graphs and diagrams.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO BE

CONDUCTED ON PATIENTS?

NO.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION

YES

Permission will be obtained from

The research committee of the Sri Lakshmi College of Nursing

Authorities of selected hospital at Bangalore.

Informed consent will be taken from the patients who are willing to participate

in the study.

8. LIST OF REFERENCES:

1. Dr.J.S.Yadav. A special issue on Chikungunya. ENVIS News Letter 2006.

Sep: Vol 3[2].

2.Ashok Swaroop, Arvind Jain, Maniram Kumar, Naveen Parihar, Sachin Jain.

Chikungunya fever. Indian Academy of Medicine.2004; April-June:Vol 8 [2]

3. Chikungunya wreaking havac in most parts of State. The Hindu. Online edition of

Indian’s National Newspaper Monday, jul 10, 2006.

4. Report of Experts. Prevention and control of Chikungunya in South-East Asia.

World Health Organization. 2007; Sep 27-29.

5. C Jairaj kumar,C.Arvind Baboo, B. Unni Krishnan, Arunachalam kumar, Tom

Jose, Aunsha Philip etal. The Socio economic impact of the Chikungnuya vral

epidemic in India. Open Medicine.2007;Vol1[3].

6. Dileep Mavalankar, Priya Shastri, Tathagata, jeram Parmar, Ramani,

Karaikurichi.e.tal. Increased mortality associated with Chiungnuya epidemic,

Ahmedabad, India, Emerging Infectious Disease.2008;March

7. Report of Experts. Annuala of Troical Medicine and Public health. World Health

Organisation.2008; March10

8. Chandrakanth Lahariya, S.K. Pradhan. Emergence of Chikungunya virus in India

sub continent after 32 years; a review. Vector Borne disease. 2006;Dec:151-160.

9. Upadhyayla SN Murthy, Narahari Dhanwada, Neelima Arora. Chikungnuya

Outbreak in Kurnool District, Andrapradesh. The Internet journal of

health.2007Vol6[2].

10. R.S.Sharma. Entomological Studies during outbreak of Chikungnuya in

Marathwada region of Maharastra, India, Indian Journal for the practicing

Doctors. 2006;Nov-Dec:Vol3[5].

11. Denise.F.pilot.Cherry1 Tataro Beck. Nursing Research Priciples &

Methods.200;7th edition:88-91.

12. Chhabra M, Mittal V, Bhattacharya D, Rana U, Lal S. chikungunya fever; a re-

emerging, Indian J Med Microbial. 2008 jan-Mar;26(1):5-12

13. Bandyapadhyay D,Ghosh SK Mucocutaneous features of chikungunya fever

astudy from an outbreak from an outbreak in West Bengal, India, Int J Dermatol.

2008 Nov:47(11):1148-52

14. Kumar K, Chhabra M, Katyal R, Patnaik PK, Kukreti H, Rai A, Saxeba VK,

Mittal B, Lal S. Investigation of an outbreak of chikungunya in Malegaon

Municipal areas of Nasik district, Maharastra, India and its control. Vector Borne

2008; Jun; 45[2]:157-63

15. Jain SK, Kumar K, Bhattacharya D, Venkatesh S, Jain DC, Lal S. Chikunghunya

viral disease in district Bhilwara, Rajastan, India. Communicable Disease. 2007;

March; 39[1]:25-31.

16. Lakshmi V, Neeraja M, Subbalaxmi MV, Parida MM, Dash PK, Santhosh SR,

Rao PV. Clinical features and molecular diagnosis of chilungunya fever from

South India, Infectious Disease. 2008; May 1; 46[9]:1436-42

17. TS Selvavinayagam. Chilungunya fever outbreak in Vellore, south India. Indian

Journal of Community Medicine. 2007; Oct; 32[4]:286-287.

18. Dr. S.K.Ramchurn, Dr. S.S.D.Gprah. Mr.D. Mungla, Ms.B.Ramsurrun, Mr. V.

Pydiah, Mr. Summon e tal. A study of the 2006. Chikungunya epidemic outbreak

in Mauritis 2006; Feb;

19. Daonda Sissoma, Amrat Maendandze, Denis Malvy, Claude Giry, Khaled

Ezzedine, jean Louis e tal. Seroprevalence and risk factors of chikungunya virus

infection in Mayotte, Indian ocean, 2005-06: A Population based Survey.2008;

May;26

20. Mahendradas P, Ranganna SK, Shetty R, Balu R, Narayana KM, Babu RB, Shetty

BK, Ocular Manifestations associated with chilungunya. Opthamology. 2008;

Feb;115[2]:287-91

21. Economopoulou A, Dominguez M, Helynck B, Sissoko D, Wichmann O, Quenel

P, Germonneau P, Quatresous I. Atypical Chilungunya virus infections: clinical

manifestations, mortality and risk factors for severe disease during the 2005-06

outbreak on Reunion. Epidemioloi Infection.2008; Aug 11;1-8

22. Tournebize P, Charlin C, Lagrange M. Neurological Manifestations in

Chilungunya: About 23 cases collected in Reunion Island. Rev Neurol[paris].

2008;Oct 3.

23. Yoosuf AA, Shiham I, Mohamed AJ, Ali G, Luna JM, Pandav R, Gongal GN,

Nisaluk A, Jarman RG,Gibbons RV. First report of chilungunya from the

Maldive. Trans R Soc Trop Med Hyg. 2008; Oct 16.

24. Lamballerie XD, Boisson V, Reynier JC, Enauly S, Charrel RN, Flahault A,

Roques P, Grand RL. On Chilungunya Acute Infection and Choloroquine

Treatment. Vector Borne Zoonotic Disease, 2008; July 11.

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 GUIDE MR. I. CLEMENTPROFESSORMEDICAL SURGICAL NURSINGSRILAKSHMI COLLEGE OF NURSINGBANGALORE.

11.2 SIGNATURE

11.3 CO.GUIDE

11.4 SIGNATURE

12 HEAD OF THE DEPARTMENT MR. I . CLEMENTPROFESSORMEDICAL SURGICAL NURSINGSRILAKSHMI COLLEGE OF NURSINGBANGALORE

12.1 SIGNATURE

13 REMARKS OF CHAIRMAN/PRINCIPAL

13.1 SIGNATURE