6. BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the study
“The ultimate measure of a man is not where he stands in moment of comfort and convenience but where he stands at time of challenges and controversy.”
Martin Luther King (Jr)
“The history of the human species, it has been said, is the history of infectious disease”. Over the centuries, humans have been exposed to a vast amount and array of contagious conditions, including the Black Death and other forms of plague, typhoid fever, cholera, malaria, influenza, and the acquired immunodeficiency syndrome, or AIDS. Only in the past few hundred years have scientists begun to have any sort of accurate idea concerning the origin of such diseases, through the action of micro organisms and other parasites.1
The H1N1 form of swine flu is one of the descendants of the Spanish flu that caused a devastating pandemic in humans during 1918 -1919. It would have been persisting in pigs and was then circulated into humans during the 20th century, contributing to the normal seasonal epidemics of influenza. In the year 2009 H1N1 has rapidly became a serious threat world wide. The pandemic calls for urgent preparedness to mitigate its impact as much as possible.2
As of 22 November 2009, worldwide more than 207 countries and overseas territories or communities have reported Over 482300 laboratory confirmed cases of pandemic H1N1 including over 7826 deaths.3
In India the swine flu death has reached over 561 and total number of affected cases is over 1174864.Maharashtra which continuous to have the highest number of death from swine flu pandemic, has a death toll that has gone up to220, the highest number of death is from Pune. According to health officials of Karnataka total number of positive cases is 793. The death toll due tothe H1N1 virus in the state reached 69, While 16 were from Bengaluru.5The WHO has raised pandemic alert to the highest level which is 6.6
The advent of a new H1N1 many countries have begun mass immunization programme. The government ofIndia went on high alert mode in preparation for the possibility of the deadly swine flu and has already stored 1 million oseltamivir tablets as a preventive measure during community outbreak of H1N1.7
Sebastain M R, Lodha R, Kabra S K, department of paediatrics, all India institute of medical science,New Delhi described that the currently circulating strain of swine origin influenza virus of the H1N1 strain has undergone triple reassortment and contains genes from the avian, swine and human virus. It is transmitted by droplet or fomites. Common clinical symptoms are indistinguishable by any viral respiratory illness, and include fever cough sore throat and mayalgia preventive measures include social distancing practicing respiratory etiquette, hand hygiene and use of chemo prophylaxis and antiviral drugs.8
Chathurvedi.S of department of community medicine, UniversityCollege of medical science, Delhi says that non-pharmaceutical intervention would be the only preventive modality available in large part of the world.9
Since swine flu first emerged in April 2009, it has sparked panic. it took the HINI virus only nine weeks to spread across continents from Mexico. The WHO 2009 figures of H1N1 across the world have brought out that youth is more affected by it and 41.6% of the people tested positive for H1N1 flu in India are from urban area. It is observed that youths are at a risk of getting the disease because they travel and socialize more than other age group.10
So the investigator rightly felt that the youths in this area should be adequately informed about swine flu and its prevention. Keeping the above fact in mind, the investigator is making an attempt to assess the knowledge of youths regarding swine flu and its prevention in selected urban areas of Bangalore south.
6.2 Review of literature
Anand K, Zarychanski R, Pinto R,Cook DJ, Marshall J, Lacroix J et al (2009)conducted a study on critically ill patients with 2009 H1N1Infection in Canada which described characteristics, treatment, and outcomes of critically ill patients in Canada with H1N1infection.A prospective observational study of 168 critically ill patients with H1N1infection,in 38 adult and paediatrics intensive care units. Results showed critical illness occurred in 215 patients with confirmed,probable, or suspected community-acquired 2009 influenza A(H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A(H1N1), the mean age was 32.3 (21.4) years, They concluded that Critical illness due to H1N1 in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multi system organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies.11
Seale H, McLaws ML, Heywood AE, Ward KF, Lowbridge CP, Van D et al (2009) conducted a study on the community's attitude towards swine flu and pandemic influenza. It was a Cross-sectional survey of Sydney residents during WHO Phase 5 of H1N1. Members of the public were approached in shopping and pedestrian malls in seven areas of Sydney. Results showed that out of 620 respondents, 596 (96%) were aware of pandemic (H1N1) in 2009, but 44% (273/620) felt they did not have enough information about the situation. More than a third 38%; (235/620) ranked their risk of catching influenza during a pandemic as low. They concluded that emphasising the efficacy of recommended actions like hand hygiene, risks from the disease and the possible duration of the outbreak may help to promote compliance with official advice.12
Rubin GJ, Amlot R, Page L, Wessely S (2009) conducted study on Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak. A cross sectional telephone survey was performed. The participants were 997 adults aged 18 or more who had heard of swine flu and spoke English. Results showed that 37.8% of participants reported performing any recommended behaviour change 4.9% had carried out any avoidance behaviour. The results support efforts to inform the public about specific actions that can reduce the risks from swine flu and to communicate about the government's plans and resources. Additional research is required into differing reactions to the outbreak among ethnic groups.13
Crum- Cianflone NF, Blair PJ, Faix D, Arnold J, Echols S, Sherman SS et al(2009) conducted a study on clinical and epidemiologic characteristics of an outbreak of H1N1 among United States military beneficiaries. Epidemiologic evaluation of H1N1 virus infections diagnosed in San DiegoCounty among 96,258 local US military beneficiaries. 761 patients presented with influenza-like illness and underwent real-time reverse transcriptase polymerase chain reaction (rRT-PCR) testing. Of these patients, 97 had confirmed H1N1 virus infection, with an incidence rate of 101 cases per 100,000 persons. The median age of H1N1 patients with H1N1 virus infection was 21 years. Fever was a universal symptom in patients with H1N1 virus infection; other symptoms included cough, mayalgia or arthralgia ,and sore throat. They concluded that the outbreak primarily affected adolescents and young adults and resulted in a febrile illness without sequelae.14
Han K, Xiaoping Z, Fan H, Lunguang L, Lijie Z, Huilai M et al (2009) conducted a study in 2009 on lack of airborne transmission during outbreak of pandemic (H1N1) 2009 among tour group members in China, .They conducted a retrospective cohort investigation. Secondary cases developed in 9 (30%) tour group members who had talked with the index case-patient .This outbreak was apparently caused by droplet transmission during coughing or talking. Their findings highlight the need to prevent transmission by droplets and fomites during a pandemic.15
La JT, YeungNC, Choi KC, Cheng MY, Tsui HY, Griffiths S(2009) conducted a population based cross sectional survey study on acceptability of H1N1 vaccination during pandemic phase of influenza H1N1 in Hong Kong. Participants were Random sample of 301 adults was interviewed by telephone .45% of the participants reported that they would be highly likely take up vaccination if it was free. Overall 39% of participants believed that H1N1 vaccination would prevent the virus being contracted. They concluded that the uptake of vaccination against H1N1 by the general population of Hong Kong is unlikely to be high and would be sensitive to personal cost. Evidence about safety and efficacy is critical in determining the prevalence of uptake of vaccination.16
Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, Mastorakos T et al(2009) conducted study on Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Twenty vaccinated, antibody-positive health care workers had their hands contaminated with 1 ml of 10(7) tissue culture infectious dose (50)/0.1 ml live human H1N1 virus before undertaking 1 of 5 hand hygiene protocols,soap and water hand washing , or use of 1 of 3 alcohol-based hand rubs, Results showed that there was an immediate reduction in culture-detectable H1N1 after brief cutaneous air drying. They concluded that hand hygiene with soap water or alcohol-based hand rub is highly effective in reducing H1N1 virus on human hands, appropriate hand hygiene may be an important public health.17
Castro-Jiménez MA, Castillo-pabon JO, Rey-Benito GJ, Pulido-dominguez PA,Borboso-R et al.(2009)conducted anepidemiologic analysis of the laboratory-confirmed cases of H1N1in Colombia, A total of 183 laboratory confirmed cases of H1N1 were reported in Colombia, The infection affected younger age-groups and the symptoms most frequently reported were cough, fever and sore throat. Their findings are consistent with recent reports from other countries initiative to reduce pandemic and avian influenza transmission.18
Statement of the problem
“A study to assess the knowledge of youths regarding swine flu and its prevention in selected urban area of Bengaluru south with a view to develop information booklet.”
6. 3 Objectives 0f the study
To assess the knowledge of youths regarding swine flu and its prevention.
To associate the knowledge of youths regarding swine flu and its prevention with selected demographic variables.
To develop an information booklet based on their level of knowledge on swine flu and its
prevention.
6.4 Assumption
- youths will have some knowledge regarding swineflu and its prevention
- There will be a significant association between knowledge of youths regarding swine flu and its prevention with their demographic variable
- The information booklet will increase the knowledge of youths regarding swine flu and its preventionso that they can prevent swine flu and its complication.
6.5OPERATIONAL DEFINITION
Knowledge: Refers to understanding and awareness of youths regarding
Swineflu and its cause, signs and symptoms, mode of transmission,
diagnosticmeasures, treatment and its prevention inselected urban areas of
Bengaluru south
Youths : Refers toMen and women with age between 20- 40 years residing in
selectedUrban areasof Bengaluru south.
Swine flu : Refers to an acute infectious viral disease caused by H1N1 virus.
Prevention :Refers to the precautionary measures taken to avoid the occurrence
Swine flu
InformationBooklet : Refers to a booklet which contains knowledge regarding causes,signs &symptoms,mode of transmission , diagnostic
measures, treatment and prevention of Swine flu.
Selected urban area :Refers to anareawhich comes under Bengaluru Brahhath
Mahanagara Palike,Bengaluru south.
7 MATERIALS AND METHODS
7.1 Sources of data : Data will be collected from youths at
Selected urban area of Bengalurusouth
7.2 Method of Data Collection
7.2.1 Definition of study subject : Youths atSelected urban area of Bengalurusouth
7.2.2 Inclusion criteria and Exclusion criteria
(a) Inclusion criteria: a) Youths willing to participate in the study.
b)Youths present in the community at the time of
the study.
(b)Exclusion criteria : a) Youths affected with swine flu are not included.
b) Youthswho do not know to read and understand
Kannada and English.
7.2.3 Researchdesign : Descriptive research design.
7.2.4 Setting : Selected urban area, Bengaluru south.
7.2.5 Sampling technique : Non probability purposive sampling.
7.2.6(a) Samplesize : 100 youths.
(b) Duration of study : 8 weeks
7.2.7 Tools of research: 1) The structured interview schedule will be constructed in two parts .
Part.- I. Demographic data
Part – II Knowledge questionnaire regarding swine flu and its prevention.
2) The investigator will develop aninformation booklet based on their knowledge scores onswine flu and its Prevention.
7.2.8 Collection of data : The investigator himself collects the data from youths
using structured questionnaire.
7.2.9.Method of data analysis
Presentation : 1) The investigator will use appropriate Descriptive and InferentialStatistics such as mean, median, standard
deviation Chi-square, T- test and other relevant
statistical analysis.
2)The data will be presented in the form of
tables diagrams and graphs where ever necessary .
7.3. Does the study require any investigationsto the patients or other human beings or
animal:
No
7.4. Hasethical clearance obtained from your institution?
- Yes, ethical clearance has been obtained from the concerned authority.
- Informed written consent will be obtained from the participants prior to the study.
- Privacy, confidentiality and anonymity will be guarded.
- Scientific objectivity of the study will be maintained with honesty and impartiality
8.LIST OF REFERENCES.
1. McGraw-Hill.Infectious disease.Dictionary of Scientific and Technical Terms,Sci-Tech Dictionary
2003 [cited 2009 Dec 09];Available from: URL:
diseas.html
2. Swine influenza history. Wikipedia, the free encyclopaedia [cited 2009 Dec 07]; Available from:
URL: # History.html
3.World Health Organization.Pandemic (H1N1) 2009[cited 2009 Nov 27]; Available from: URL
4. Health news. India’s swine flu deaths reach 561. IANS[2009Nov 26]; Available from:
URL:
5. Headlines India. Karnataka swine flu rises to 69 [cited 2009 Sept 16]; Available from: URL:
rises-to-69-22577.html.
6. Archana PB. H1N1 infection in children. Prisom’sNursing Practice 2009;4(3): 80-4.
7. Swine flu: India on high alert plans to stockpile 15 billion oseltamivir pills [cited 2009 April 09];
Available from: URL:
stockpile-15-
billion-oseltamivir-pills/.html
8. Sebastain MR, Lodha R, Kabra SK.Swine origin influenza (swine flu).Indian J
Pediatr2009 Aug;76(8): 833-41.
9. ChathurvediS.Pandemic influenza; imminent threat, preparedness and the divided globe.
Indian Pediatr 2009 Feb; 46(2): 115-21.
10.The Tmes of India. Kolkatha youth more at risk of swine flu:WHO [cited 2009 Aug 18]; Available
from: URL:
11.Anand K, Zarychanski R, Pinto R,Cook DJ, Marshall J,Lacroix J et al. Critically ill patients
with 2009 influenza A (H1N1) infection in Canada. JAMA2009; 302(17): 1872-9.
12.Seale H,McLaws ML, Heywood AE, Ward KF, Lowbridge CP, Van D et al. The communityattitude
towards swine flu and pandemic influenza.Med J Aust 2009 Sep;191(5): 267-9.
13 Rubin G J,Richard A, Lisa P W.Public perception, anxiety, and behaviouralchange in relation
to the swine flu outbreak: a cross- sectional telephone survey. BMJ 2009 jul; 2(339): 2651.
14 Crum- Cianflone NF,Blair PJ,Faix D,Arnold J,Echols S, Sherman SS etal. Clinical and
epidemiological characteristics of an outbreak of an outbreak of novel H1N1(swine origin)
influenza a virus among unite states military beneficiaries. Clin Infect Dis 2009 Dec;49(12):1801-10
15 Han K,Xiaoping Z, Fan H, Lunguang L, Lijie Z, Huilai Metal.Lack of airborne transmissionduring
outbreak of pandemic(H1N1) 2009 among tour group members, China.Emerg Infect Dis 2009 Oct;
15(10): 1578-81.
16 La JT, Yeung NC, Choi KC, Cheng MY, Tsui HY, Griffiths S.Acceptability of A/HINI
vaccination during pandemic phase of influenzaA/H1N1IinHong Kong; population based cross
sectionalsurvey.BMJ 2009 oct;27(339): 4164.
17 Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, Mastorakos T etal.Efficacy
of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on
the hands of human volunteers. Clin Infect Dis2009 Feb; 48(3):285-91
18.Castro-Jiménez MA,Castillo-pabon JO,Rey-Benito GJ, Pulido-dominguez PA,
Borboso-R etal. Epidemiologic analysis of the laboratory-confirmed cases of
InfluenzaA(H1N1)v in Colombia. EuroSurveillance2009 Jul; 14(30):19284.