RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. JAYAVEENA G.T.1 YEAR MSC NURSING
RATHNA COLLEGE OF NURSING
B.M ROAD, HASSAN
KARNATAKA
2 / NAME OF THE INSTITUTION / RATHNA COLLEGE OF NURSING HASSAN, KARNATAKA.
3 / COURSE OF THE STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING, CHILD HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE / 15 – 06 – 2010
5 / TITLE OF THE TOPIC / EFFECTIVENESS OF PROPHYLACTIC INFORMATION ON DENGUE FEVER IN CHILDREN AMONG STUDENTS OF DIPLOMO IN EDUCATION.
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO EVALUATE THE EFFECTIVENESS OF PROPHYLACTIC INFORMATION ON DENGUE FEVER IN CHILDREN AMONG STUDENTS OF SELECTED DIPLOMO IN EDUCATION (D.Ed)INSTITUTES AT HASSAN”
6. BRIEF RESUME OF THE INTENDED WORK
“Children enjoy the present because they have neither a past nor a future”
- JeanDeLa Bruyere (French Writer)
INTRODUCTION
Children are major consumers of health care. In India, about 35 percent of total population is children below 15 years of age. They are not only large in number but vulnerable to various health problems and considered as special risk group. Majority of the childhood sickness on earth are preventable by simple low-cost measures. Children always need special care to survive and thrive. Good health of these members of the society should be ensured as prime importance in all countries. Child health is greatly depending upon family health.1
Dengue fever is a severe, flu-like illness that affects infants, young children and adults. Dengue is the most common disease among all the arthropod-borne viral diseases. Currently dengue ranks as the most important mosquito-borne viral disease in the world. Its incidence has increased to 30-fold.The global prevalence of dengue has grown significantly in recent decades. The disease is now endemic in more than 112 countries in South-east Asia, Western Pacific, Eastern Mediterranean, Africa, South-east Asia and Western Pacific is most seriously affected. Before 1970 only nine countries had experienced dengue hemorrhagic fever epidemic, a number that had increased more than four-fold by 1995 World Health Organization currently estimates there may be 50 million cases of dengue infection worldwide every year around 24,000 deaths.2
By 1997 most of the countries of South-east Asia region have experienced large outbreaks of the disease. Currently Dengue Fever/dengue hemorrhagic fever is endemic in Bangladesh, India, Indonesia, Maldives, Myanmar, Srilanka and Thailand. Approximately 1.3 billion people are living in the endemic areas. Health Organization reported that about 2.5 billion people (40% of the world’s. population) are at risk of developing the disease In India, first major outbreak associated with hemorrhagic manifestation occurred in Calcutta in 1963 followed by a major outbreak in Delhi in 1996 and 2003.3
Dengue, also called classic dengue or break bone fever, is a flaviviral infection found in large areas of tropical and subtropical regions Dengue is a mosquito borne viral infection and is transmitted by Aedes aegypti and Aedes albopictus. Four distinct serotypes of viruses DEN-1, DEN-2, DEN-3 and DEN-4cause dengue. Humans are the main-amplifying hosts of the virus. Dengue may be asymptomatic or may lead to undifferentiated fever, dengue fever or dengue hemorrhagic fever and dengue shock syndrome. Dengue hemorrhagic fever and dengue shock syndrome are leading causes of hospitalization and death especially among children.3
In Cape Verde of Africa, 2009, more than 21,000 suspected cases and 6 deaths (as of December 6, 2009) were reported. Approximately 60 cases were reported in nearby Senegal, according to the United Nation Office for the Coordination of Humanitarian Affairs.4
There is an ongoing 2010 outbreak occurring in Puerto Rico with 5382 confirmed infections and 20 deaths. There is also an ongoing outbreak occurring in Pakistan with more than 5000 confirmed infections and death toll rose to 31. The 2010 and 2009 dengue outbreaks in Key West Floridaare similar to the 2005 Texas 25 cases, and 2001 Hawaii 122 cases, outbreaks.5
InArgentina, 2009, A dengue outbreak was declared the northern provinces ofChaco,Catamarca,Salta,Jujuy,
andCorrientes, with over 9673 cases reported as of April 11, 2009 by the Health Ministry.5
In India by early October more than 590 cases of dengue fever were reported from Delhi and over 367 from neighbouring states that Rajasthan and Chandigarh had come to New Delhi for treatment. Over 214 suspected cases of the diseases were reported from Uttar Pradesh. One person succumbed to the disease and at least five were treated for the dengue fever in Andhra Pradesh. Over 30 people were treated for dengue fever inKolkata, the capital of West Bengal for suspected dengue fever. By October 9, 2006 more than fifty deaths were reported to dengue fever and more than 3613 patients were treated for this disease.6
Dengue infection can cause a spectrum of illness ranging from mild, undifferentiated fever to illness up to 7 days' duration with high fever, severe headache, retro-orbital pain, arthralgia and rash, but rarely causing death. Dengue Hemorrhagic Fever, a deadly complication, includes hemorrhagic tendencies, thrombocytopenia and plasma leakage. Dengue Shock Syndrome includes all the above criteria plus circulatory failure, hypotension for age and low pulse pressure.7
The environmental risk factors for dengue hemorrhagic fever are infestations with Aedes mosquito, hot and humid climates enhancing mosquito breeding, the water storage pattern in the houses, population density and large movement of people towards urban areas early case detection and management reduce morbidity and mortality due to dengue hemorrhagic fever or Dengue Shock Syndrome.
At present there is no specific vaccine or treatment available. So prevention and controlling measures is important. Vector control is by environmental sanitation and chemical methods, proper solid waste disposal, elimination of stagnant water in domestic environment and improved water storage practices. Mosquito control by individual and community action, using antilarval measures. Prevention of dengue fever by using bed nets during and day and night time, wearing of full sleeves shirts and full pants, use of mosquito repellent creams, liquids, coils, mats etc.8
The investigator felt to teach the D.Ed students because they are the future teachers and responsible persons of society.
6.1 NEED FOR THE STUDY
Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of human kind. Child health depends upon prevention of diseases. Prevention is better than cure so Majority of child health problems can be preventable.
Global incidence of dengue has grown dramatically in recent decades. About two fifths of the world's population are now at risk. It is now endemic in more than 112 countries throughout the America, South East Asia, the western pacific islands, Africa and the Eastern Mediterranean World Health Organization currently estimates that there may be 50million cases of dengue infection worldwide every year. The south East Asia region contributes 52% or 1.3 billion cases annually according to med India network Children younger than 15 years comprise 90% of dengue hemorrhagic fever subjects in the world.8
According to minivan news dated July 17th 2010 by aishath sharza Dengue fever is on the rise across the Maldives, especially in Male’, and children are the main victims, according to the Maldivian Centre for Community Health and Disease Control. Official records show 473 cases have been reported for 2010 up to the first week of July, and children aged between one and nine years are the most affected bythe virus. “There have been no fatalities reported so far,” says the Community Health and Disease Control.9
According to Taipei times (Taiwan news in the date of Thursday march than 10,000 dengue fever cases had been recorded in Indonesia as of early this month, including 7,920 cases in Jakarta, of which 13 were fatal.10
In Malaysia, 10,916 cases have been reported so far, with 5,186 cases coming from Selangor, and 20 fatalities. During the first nine weeks of the year, 1,189 dengue fever cases and 16 cases of hemorrhagic dengue fever were reported in Singapore, while 3,953 dengue fever cases were reported in Thailand. In South America, 5,080 confirmed cases of dengue fever, including 113 cases of hemorrhagic dengue fever, have been recorded in Bolivia as of last Thursday, including 22 fatalities. In India the most affected areas are West Bengal, Delhi, Karnataka Tamilnadu, Gujarat, Maharashtra, Rajasthan, Punjab and Haryana.10
Retrospectively analyzed blood for dengue IgM on samples obtained during a community-based surveillance for febrile illnesses in two slum areas of Karachi, Pakistan between June 1999- Dec 2001. Participants were children older than16 years, who had fever 38’C for more than 72 hours. Results: 114 cases were analyzed for dengue IgM ELISA, out of which 54 (47.4%) tested positive. This study has revealed a high incidence of DF of 185/100,000 population per year. The figure springs to 570/100,000 population per year for children older than 10 Conclusions: DF is probably endemic in children in slums of Karachi, and likely to have high incidence rate. Older children are more susceptible to the disease. Further prospectively designed research is needed to confirm this findings.11
According to daily news and analysis Mr. Sriramulu health minister of Karnataka says the number of confirmed dengue cases in the state till Aug- 28 -2010 is 1294 in that 436 cases from Bangalore city.12
A retrospective review of hospital case papers of dengue patients, who were admitted to Pediatric Ward, and PICU, K.I.M.S, Hubli children hospital between July 2003 to June 2004 (one year) was carried out. To find out the clinical profile and outcome of dengue fever cases .It showed 23 DEN2.Eight 35% of these were infants. The symptoms were fever 100%, vomiting 82%,pain abdomen 61% headache 22%, and hepatomegaly 87% G I bleeding 22% and petechiae 18%. There was no mortality in the present study group probably due to early diagnosis, strict monitoring and proper fluid management.13
There is no vaccine available against dengue, and there are no specific medications to treat a dengue infection. This makes prevention is the most important step, Children are vulnerable group of society. So it is the time to act in the root level. The schools would be the best known area to be intervened. Involving the school children in the process will increase their awareness and help them to carry the positive behavior in their homes.Young children are susceptible to dengue as well as adults and the only way to reduce the spread is to eliminate mosquito breeding sites.The disease is transmitted by the Aedes aegypti mosquito and not by person to person contact.
Although the awareness regarding dengue and mosquito control measures was quite high, more emphases should be laid on putting this knowledge into practice in achieving the goals successfully this can be achieved only by more aggressivehealth education campaigns in the schools. Local studies are needed to provide the true picture about awareness regarding dengue syndrome so that appropriate specific action can be taken for control of disease.
An intervention strategy with a mass communication campaign was conducted in 20 Jeddah high schools and 2 school supervision canters, Saudi Arabia to improve the knowledge attitude and practice of the students, teachers and supervisors regarding dengue fever prevention and control. 2693 students, 356 teachers and 115 supervisors selected by a multistage, stratified, random sample technique Results: knowledge attitude and practice towards dengue fever was deficient among target populations, especially among students compared to other two groups School-based educational campaigns and social mobilization for raising knowledge and changing it into sound practice is urgently needed for controlling dengue epidemics in Jedda.14
The Central Board of Secondary Education has recommended a three-step strategy of prevent has recommended a three-step strategy of prevent dengue as there is no vaccine currently available for the disease. These include minimizing breeding sites like stagnant water, uncovered water tanks, rotting garbage and use of larvicides and insecticides.15
Hence the investigator felt the need to prepare the prophylactic information on dengue fever to improve the knowledge of school teachers to motivate and indulge them in short activities with children to get them involved in Sanitary and hygienic measures and searching for mosquito breeding sites and destroying them.
6.2 REVIEW OF LITERATURE
Review of literature is the selection of available documents on the topic which contain information, ideas, data and evidence. It is an examination of the research that has been conducted in a particular field of study.
Reviews of literature are divided into 3 parts.
· Literature related to incidence and prevalence of dengue fever.
· Literature related to knowledge, attitude and practice regarding prevention of dengue fever.
· Literature related to educational interventions on dengue fever.
1.Literature related to incidence and prevalence of dengue fever
A retrospective study conducted in Hospital Tengku Ampuan Rahimah Klang, Malaysia, to find the prevalence of Dengue fever and Dengue hemorrhagic fever. The data was collected through Hospital records from the year 1999 until 2003. A total of 6,577 cases of Dengue fever and 857 cases of dengue hemorrhagic fever were reported. Indicating that Year 2000 onwards, cases of dengue fever had increased tremendously. Most cases occurred in 2003, increasing from 674 in 1999 to 2,813 in 2003.16
A retrospective cross sectional study conducted in Aga khan university hospital Karachi, Pakistan from to find out the demographic and clinical features of dengue fever. Out of a total of 15040 patients 63.2% male and 36.8% female tested positive for dengue IgM antibody. Nausea was common in 124patients. Children presented high temperature than adults. In addition; neutropenia was seen more commonly in children while raised serum ALT levels were seen more commonly in adults. Low total white cell count was more common in patients with dengue fever as compared to Dengue Hemorrhagic Fever, Dengue was circulating throughout the year with a peak incidence in the post monsoon period. Median age of dengue patients has decreased and younger patients may be more susceptible.17
Record-based study conducted in a coastal district of Karnataka To study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital.Study included 466 patients. Males 301 (15-44 years), 267 Results: Maximum number of cases were seen in 2007, 219 and in the month of September, 89.Conclusion:Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases.18