Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

SYNOPSIS

FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 Name of the Candidate AMANPREET KAUR CHAHAL

2.Name of the Institution Diana College of Nursing

No. 68, Chokkanahalli,Hegde nagar main road,

Jakkur Post, Bangalore – 64

3. Course of Study and Subject 1st year M.sc. Nursing

Community Health Nursing.

4. Date of Admission to Course 09-06-2010

5. Title of the Topic

A study to assess the awareness on dengue

fever among high school teachers in selected

government schools, Bangalore rural

district, Karnataka with a view of

developing an information booklet.

6. Brief resume of the intended work:

Introduction

As I see it- everyday you do one of two things: build health or produce disease in yourself.

- Adelle Davis

Health is the precious possession of all human beings as it is an asset for an individual and

community as well. Like health disease is a dynamic process and it is just the opposite of

health. (1)

One of the important reasons for higher death rate in developing countries is death due to

infectious diseases. Effective control of communicable diseases is necessary for national

development and economic self dependence. (2)

In fact at the end of 19th century when public health nursing emerged as a nursing specialty,

communicable diseases were the leading cause of death and illness. The death due to

infectious disease account for 15 to 25% of all deaths in developing countries including India.

Communicable disease not only causes a great loss of life but they also cause great suffering

and disabilities. (3)

Dengue fever is one of the most emerging communicable diseases of the tropical and sub-

tropical regions, affecting urban and periurban areas. It is estimated that each year 50 million

infections occur, with at least 5, 00,000 cases of dengue haemorrhagic fever and at least

12000 deaths, mainly among children, although fatalities could be twice as high. The increase

of dengue fever is due to uncontrolled population growth and urbanization without

appropriate water management. (4)

The first recognized Dengue epidemics occurred almost simultaneously in Asia, Africa, and

North America in the 1780s; shortly after the identification and naming of the disease in

1779.Epidemic dengue has become more common since the 1980s. By the late 1990s, dengue

was the most important mosquito-borne disease affecting humans after malaria, with around

40 million cases of dengue fever and several hundred thousand cases of dengue hemorrhagic

fever each year. It was identified and named in 1779. It is also known as break bone fever,

since it can be extremely painful. Unlike malaria, dengue is just as prevalent in the urban

districts of its range as in rural areas. Dengue is transmitted to humans by the Aedes

(Stegomyia) aegypti or more rarely the Aedes albopictus mosquito. The mosquitoes that

spread dengue usually bite at dusk and dawn but may bite at any time during the day,

especially indoors, in shady areas, or when the weather is cloudy. (5)

India is one of the seven identified countries in the South-East Asia region regularly reporting

incidence of Dengue Fever/Dengue Haemorrhagic Fever outbreaks and may soon transform

into a major niche for dengue infection in the near future. The first confirmed report of

dengue infection in India dates back to 1940s, and since then more and more new states have

been reporting the disease which mostly strikes in epidemic proportions often inflicting heavy

morbidity and mortality, in both urban and rural environments. Until mid-1990s, dengue was

reported from only three of the four South Indian states, namely, Andhra Pradesh, Karnataka

and Tamil Nadu.(6)

6.1. Need for study

Come then, let us play at unawares,

And see who wins in this sly game of bluff,

Man or mosquito.

- D H Lawrence.

As there are changes in the global climate, the vector of the dengue virus - the Aedes

mosquito - has spread considerably over the past decades. Dengue is currently the most

common arboviral infection worldwide. It is endemic in almost all tropical and sub-tropical

regions of the world; meaning that approximately 40% of the world population is at risk of

acquiring a dengue infection. (7)

Dengue fever is an acute, infectious, commonest arboviral disease, caused by dengue viruses,

transmitted from person to person, by the bite of infective, female, aedes mosquito.(8)

Dengue fever usually starts suddenly with a rapidly climbing high fever, that's why the

temperature in dengue fever is called a 'saddleback' type temperature, severe headaches,

retro-orbital pain behind the eye, nausea & vomiting, loss of appetite, rashes develop on the

feet or legs 3 to 4 days after the beginning of the fever, swelling and pain in muscles and

joints. The joint pain in the body has given dengue fever the name that is "break bone fever”.

The common symptoms of dengue fever may go in around 10 days, but complete recovery

from dengue fever can take more than a month.(9)

About two-thirds of the world's population lives in areas infested with dengue vectors, mainly

Aedes aegypti. It is estimated that up to 80 million persons become infected annually from

dengue fever. (10)

Dengue is a tropical disease affecting 110 countries throughout the world and placing over 3

billion people at risk of infection. According the World Health Organization 70 to 500

million persons are infected every year including 2 million who develop hemorrhagic form

and 20,000 who die. Children are at highest risk for death. (11)

According to The World Health Report, WHO, 2004 About 12,000 deaths occur from dengue

in South East Asia in 2002. (12)

According to data collected by the UN body, the highest number of reported cases in Asia in

year 2010 till August are in Indonesia (80,065) followed by Thailand (57,948) and Sri Lanka

(27,142). (13)

In 2003 only 8 countries in South East Asia Region reported dengue cases. As of 2006, ten

out of the eleven countries in the Region (Bangladesh, Bhutan, India, Indonesia, Maldives,

Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste) reported dengue cases. (14)

In India, an epidemic occurred in 1996 in Delhi. About 10,000 cases and 400 deaths were

reported. During 1997, another epidemic occurred in Maharashtra. During 2003, there were

about 12750 cases with 217 deaths in country. Thus, Dengue fever is an emerging public

health problem in India, with cyclic epidemics. (8) During 2005 there were 11928 cases and

156deaths, and during 2006 till 31st august, there were 1235 cases and 10 deaths in the

country. (4)

On Sep 8, 2010 Delhi reported 74 cases of dengue taking the total number of people infected

with the vector-borne disease to1491.The city has been witnessing over 70 new dengue cases

daily in recent days. (15)

The dengue fever, which caused over a dozen deaths in Bangalore during monsoon in 2009,

has surfaced again following the rains. An average of around six cases per week was reported

during 2010. No casualties have been reported. Every day there are two-three cases being

reported. (16)

The global spread of dengue fever within and beyond the usual tropical boundaries threatens

a large percentage of the world's population. This situation has worsened in the recent past

and may continue to do so in the future. Efforts to decrease transmission by vector control

have failed, and no effective antiviral treatment is available or foreseeable on the immediate

horizon. A safe and effective vaccine protective against all serotypes of dengue viruses is

sorely needed. (1)

A resurgence of dengue indicates that much of the poor health emanates from a lack of basic

amenities such as sanitation, clean water and housing, coupled with a lack of awareness about

the need to take precautionary measures against preventable and infectious diseases. (17)

During the community health nursing experience and by studying the increased incidences of

dengue in India, Hence, the need was felt by the researcher to assess the awareness of the

high school teachers related to dengue fever so as to prevent dengue in future.

6.2 Review of literature

The review of literature is to obtain comprehensive knowledge and in depth information

through systematic and cultural review of scholarly publications, unpublished scholarly print

materials, audio visual materials & personal communications.

The review of Literature will be organized under following headings:

A .Literature related to incidence and prevalence of dengue fever

B .Literature related to general information of dengue fever.

C .Literature related to prevention and control of dengue fever.

A. Literature related to incidence and prevalence of dengue fever:

According to WHO report, during the 19th century, dengue was considered a sporadic

disease that caused epidemics at long intervals, a reflection of the slow pace of transport and

limited travel at that time. Today, dengue ranks as the most important mosquito-borne viral

disease in the world. In the last 50 years, incidence has increased 30-fold. (18)

A study was conducted on Dengue/dengue hemorrhagic fever: history and current status. it

was concluded that Each year there are an estimated 50-100 million dengue infections,

500000 cases of DHF that must be hospitalized and 20000-25 000 deaths, mainly in children. (19)

A study was conducted on Environmental factors and incidence of dengue fever and dengue

hemorrhagic fever in an urban area, Southern Thailand. A total of 287 cases of DH/DHF

occurring in the year 1998 were selected for this study and the location of their homes

mapped. It was concluded that DF/DHF incidence for each block was strongly associated

with the percentages of shop-houses, brick-made houses and houses with poor garbage

disposal. DF/DHF control should be emphasized for the areas which have a predominance of

these housing types. (20)

WHO reports shows that during epidemics of dengue, infection rates among those who have

not been previously exposed to the virus are often 40% to 50%, but can reach 80% to 90%.

An estimated 500 000 people with DHF require hospitalization each year, a very large

proportion of whom are children. About 2.5% of those affected die. Without proper

treatment, DHF fatality rates can exceed 20%. Wider access to medical care from health

providers with knowledge about DHF - physicians and nurses who recognize its symptoms

and know how to treat its effects - can reduce death rates to less than 1%. (21)

A study shows that Dengue fever is found mostly during and shortly after the rainy season in

tropical and sub tropical areas of Africa, South East Asia and China, Caribbean island and

central and South America, Australia and South and Central America. Worldwide more than

100 million cases of dengue infection occur each year. (22)

Officials at the WHO say Asia, home to 70 percent of the at-risk population, has seen a rise in

dengue mainly because of higher temperatures due to climate change, rising populations and

greater international travel. (13)

According to reports, In India, dengue infection has occurred several times. 457 patients and

4 deaths due to dengue fever were reported in 2000. In 2002-2003, 15 deaths have been

reported till October2002. On 30 October 2003 Dengue fever disease outbreak was reported.

From 1 June to 28 October 2003, 1723 laboratory confirmed cases of dengue fever have been

reported in Delhi and surrounding areas. (1)

Times of India of October 2010 reported that in New Delhi, total number of infected cases

reached to 4,679. There were a total of 1,153 cases in the city, with three fatalities reported in

2009. In 2008, there were 1,312 cases and two deaths. The number of cases has surpassed the

entire total from the outbreak of 2006 - 3,366 reported cases - that was considered severe.

Directorate of National Vector Borne Disease Control Programme reported that In India total

19143 dengue cases and 82 deaths till 31st October 2010. (23)

A study was conducted on profile of dengue cases admitted to a tertiary care hospital in

Karnataka, southern India among 344 cases. It has been concluded that Deaths were reported

in nine cases, with the majority of deaths occurred in 2003. (24)

B .Literature related to general information of dengue fever.

It has been studied that dengue is derived from the Swahili phrase "Ka-dinga pepo", which

describes the disease as being caused by an evil spirit. The Swahili word "dinga" may

possibly have its origin in the Spanish word "dengue" meaning fastidious or careful, which

would describe the gait of a person suffering the bone pain of dengue fever. Alternatively, the

use of the Spanish word may derive from the similar-sounding Swahili. Slaves in the West

Indies who contracted dengue were said to have the posture and gait of a dandy, and the

disease was known as "Dandy Fever.” (5)

Dengue is an acutely infectious mosquito borne viral disease characterized by episodes of

saddle back fever, muscle and joint pain, accompanied by an initial erythema. It is a life

threatening fever and is transmitted through aedes mosquito an indoor vector of man. (22)

A study was conducted on application of Geographical information system (GIS) modeling

for dengue fever prone area based on socio-cultural and environmental factors among 37

Dengue Confirm Samples. It was found that out of thirty socio-economic and socio-cultural

variables, six variables such as housing pattern/densities, frequency of cleaning of water

storage containers, frequency of cleaning drainage/garbage, no of flower pot /home garden,

mosquito protection measure/awareness and storage of water are significantly contributing

for dengue incidences. (25)

A study was conducted on Distribution of dengue virus types in Aedes aegypti in dengue

endemic districts of Rajasthan, India. Adult Ae. aegypti were collected from the human

dwellings of urban, peri-urban and rural settings of four dengue endemic districts of

Rajasthan, India. Total 498 adult Ae. Aegypti were tested. It has been concluded that in

desert and semi-arid areas of Rajasthan, where people possess tendency of over- and

sustained storage of domestic water, present observations on occurrence of all four dengue

virus types may have important bearing on the epidemiology of DHF in the area. (26)

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously

bitten an infected person. The mosquito flourishes during rainy seasons but can breed in

water-filled flower pots, plastic bags, and cans year- round. One mosquito bite can inflict the

disease. The virus is not contagious and cannot be spread directly from person to person.

There must be a person-to-mosquito-to-another-person pathway. (27)

A study was conducted on Clinical manifestations and trend of dengue cases admitted in a

tertiary care hospital, Udupi district, Karnataka among 466 patients. The study concluded that

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. (28)

Dengue fever can occur when a mosquito carrying the arbovirus bites a human, passing the

virus on to the new host. Symptoms of the disease appear suddenly and include high fever,

chills, headache, eye pain, red eyes, enlarged lymph nodes, a red flush to the face, lower back

pain, extreme weakness, and severe aches in the legs and joints. The characteristic

combination of fever, rash, and headache are called the "dengue triad." Most people recover

fully from dengue fever, although weakness and fatigue may last for several weeks. Once a

person has been infected with dengue fever, his or her immune system keeps producing cells

that prevent reinfection for about a year. (29)

The blood examination confirms the clinical diagnosis. Haematocrit increased by 20% or

more of baseline value. Thrombocytopenia occurs. The patient might undergo the stage of

shock due to loss of blood. (30)

C .Literature related to prevention and control of dengue fever.

Primary prevention of dengue mainly resides in mosquito control, i.e. eliminating or reducing

the mosquito vector for dengue. The most effective step to control mosquitoes is, not

to allow water to stand for a long time because it is a fact that Aedes mosquito thrives in

clean water. The mosquito breeds in water-filled flower pots, plastic bags, coolers, open

water storage tanks and cans round the year. One or two spoon of kerosene or petrol oil can

be mixed in cooler water if it is not possible to drain water from the cooler within a week. (31)

Personal prevention consists of the use of mosquito nets, repellents, covering exposed skin

and avoiding endemic areas. Wear long pants and long sleeves, staying indoors two hours

before sunrise and sunset can also help from mosquito bite. (31)

 The strategies for prevention and control of dengue fever are Surveillance for disease and

vector, early diagnosis and prompt case management, Vector control through community

participation and social mobilization and Capacity building. There is no separate programme

for prevention and control of dengue/dengue hemorrhagic fever. States tackle the problem out

of their own resources. (1)

Ministry of health and family welfare suggested some measures to prevent dengue that

includes remove water from coolers and other small containers at least once in a week. Use

aerosol during day time to prevent the bites of mosquitoes. Do not wear clothes that expose

arms and legs. Children should not be allowed to play in shorts and half sleeved clothes. Use

mosquito nets or mosquito repellents while sleeping during day time. (32)

WHO regional communicable disease expert John Ehrenberg described, in the western

Pacific region member states are starting to look into implementing the strategies included in

the dengue strategic plan for the Asia Pacific region 2008-2015 which includes strengthening

national dengue and vector surveillance systems and improving health care workers capacity

to detect dengue early and manage them correctly. As the search for an effective vaccine and

treatment for dengue is still ongoing. Early detection and vector control is still the main tool

in dengue control. (33)

There is no known treatment for dengue, but several preventative steps can be taken. The

most important is to ensure there is no standing water near residential areas where mosquitoes

breed. Spraying insecticide, an approach taken by many city authorities, can also help, as

does applying mosquito repellent and wearing long sleeves and trousers. It is noted that the

mosquitoes which transmit the disease are attracted by dark colours. The mosquitoes can bite

through the leggings thin fabric, so those who wear them are at greater risk of being infected

with dengue. In Sri Lanka, authorities have introduced heavy fines for people with standing

water in their homes, and troops have been deployed to clean up public places. (13)

A study was conducted for entomological studies for surveillance and prevention of dengue

in arid and semi-arid districts of Rajasthan concluded that water storage habits during

summer season emerged to be the risk factor of vector abundance in urban areas of arid and

semi-arid settings. A carefully designed study of key containers targeting cement tanks as the

primary habitats of mosquito control may lead to commendable results for dengue

prevention. (34)

Vector control is implemented using environmental management and chemical methods.

Proper solid waste disposal and improved water storage practices, including covering

containers to prevent access by egg-laying female mosquitoes are among methods that are

encouraged through community-based programmes. (21)

The application of appropriate insecticides to larval habitats, particularly those that are useful

in households, e.g. water storage vessels, prevents mosquito breeding for several weeks but

must be re-applied periodically. Small, mosquito-eating fish and copepods (tiny crustaceans)

have also been used with some success. (21)

A study was conducted on Solutions for Dengue Fever Control Using Geographic

Information Technology. This study describes a solution of using Geographic Information

Technology (GIT) to control Dengue Fever in the Case of Tien Giang Province, based in the

Mekong Delta Area, Viet Nam. This research contributed new and modern technologies to

control DF or Epidemic Hemorrhagic Fever at the provincial/city level, and helped to solve a

really serious health problem for Mekong Delta and then for all of districts in Viet Nam in the

future. (35)

A cross-sectional community-based study was conducted on Awareness about dengue

syndrome and related preventive practices amongst residents of an urban resettlement colony

of south Delhi. The Study reveals that although the awareness regarding dengue and

mosquito control measures was quite high, more emphases should be laid on putting this

knowledge into practice. This can be achieved by more aggressive health education

campaigns in the community through the health workers, and also involving the schools in

the community. (36)

A study was conducted on Community Participation in Dengue Control in Brazil. It has been

found that emphasize the importance of the knowledge about the daily problems faced by the

communities affected and the search for partnership with the community in discussions and

elaboration of proposals for dengue control. (37)

In response to the resolution accepted by the World Health Assembly in 1993, WHO/

SEARO developed a regional strategy for control of DF/DHF in 1995 and revised it in July

2001 with the major component. i.e. establish an effective disease and vector surveillance

system based on reliable laboratory and health information systems. Ensure early recognition

and effective case management of DHF/DSS to prevent case mortality. Undertake disease

prevention and control through integrated vector management with community and

intersectoral participation. (38)

Different countries formulated control programmes as per their priorities, availability of

infrastructure, and resources, etc. Consequently, Thailand, Indonesia and Myanmar

established National Dengue Prevention and Control Programmes followed by Sri Lanka

which has established a National Task Force for control of DF/DHF. India, Bangladesh and

Maldives do not have National Dengue Control Programmes but undertake vector-borne

disease control/malaria control activities for emergency control of epidemics. (38)

During outbreaks, emergency vector control measures can also include broad application of

insecticides as space sprays using portable or truck-mounted machines or even aircraft.

However, the mosquito-killing effect is transient, variable in its effectiveness because the

aerosol droplets may not penetrate indoors to microhabitats where adult mosquitoes are

sequestered, and the procedure is costly and operationally difficult. Regular monitoring of the

vectors' susceptibility to widely used insecticides is necessary to ensure the appropriate

choice of chemicals. Active monitoring and surveillance of the natural mosquito population

should accompany control efforts to determine programme effectiveness. (21)

Statement of the problem

A study to assess the awareness on dengue fever among high school teachers in selected

government schools, Bangalore rural district, Karnataka with a view of developing an

information booklet.

6.3 Objectives of the study:

1. To assess the awareness on dengue fever among high school teachers.

2. To find out the significant association between awareness on dengue fever

and selected demographic variables of high school teachers.

Operational definitions

Assess: It refers to statistical measurement of awareness from the scores obtained from self

administered questionnaire on dengue fever among high school teachers in selected

government schools, Bangalore rural district, Karnataka.

Awareness: It is the correct verbal response of the high school teachers to the questions in

the self administered questionnaire related to dengue fever.

High school teachers: Teachers working in government high schools of Bangalore rural

district.

Dengue fever: It is an acute mosquito-borne disease .It includes meaning, causes, sign and

symptoms, investigations and prevention of dengue fever.

Information booklet: It refers to an educational material developed by the researcher

furnishing information regarding dengue fever.

Hypotheses:

Ho: There is no significant association between awareness scores on dengue fever and

demographic variables of the high school teachers.

Assumptions:

1) High school teachers working in government schools may have some

awareness regarding dengue fever.

2) Information booklet may increase knowledge of high school teachers

regarding dengue fever.

Limitations:

The study is limited to:

High school teachers of government schools.

Bangalore rural district.

7. Materials and methods:

7.1 Source of Data Data will be collected from high school

teachers in selected government schools,

Bangalore rural district.

7.2. Method of Data Collection

Research Design

Non experimental approach with

descriptive design will be used to collect

data on dengue fever.

Setting Selected government schools of Bangalore

rural district will be the setting of the study.

Population High school teachers will be the population

for the study.

Sample The high school teachers working in

government schools will be the sample for

the study.

Sample size and Sampling

technique

60 government school teachers will be

selected by using purposive sampling

technique.

Sampling Criteria Inclusion criteria

High school teachers who will be

available at the time of data

collection.

High school teachers who are

willing to participate in the study.

Exclusion criteria

High school teachers who are in a

probationary period.

Tool

Self administered questionnaire will be

used to collect data on dengue fever among

high school teachers working in

government schools.

Data Collection

Prior to the data collection the investigator

will obtain permission from the concerned

authorities of the selected government

schools. Further, consent will be taken

from every teacher and confidentiality will

be maintained. The data will be collected

by investigator herself by using self

administered questionnaire.

Data analysis, Data Presentation Descriptive and inferential statistics will be

used for data analysis. The collected data

will be organized, tabulated and analyzed

by using descriptive statistics such as

percentage, mean and standard deviation.

The inferential statistics such as chi-square

test will be used. The finding will be

presented in the form of tables, diagram

and figures.

7.3. Yes, the study will be conducted on high school teachers.

7.4 Yes, informed consent will be obtained from concerned authority of institution and

subject prior to study, Privacy, confidentiality and anonymity will be guarded. Scientific

objectivity of the study will be maintained with honesty and impartiality.

Ethical Committee:

Title of the topic

A study to assess the awareness on dengue

fever among high school teachers in selected

government schools, Bangalore rural district,

Karnataka with a view of developing an

information booklet.

Name of the Candidate Ms. AMANPREET KAUR CHAHAL

Course of the subject 1st year M.Sc. (N).

Community Health Nursing.

Name of the guide Prof. Veda Vivek

Head of the Department

Department of community health nursing

Diana College of Nursing, Bangalore – 64

Ethical committee Approved

Members of Ethical committee:

1. Prof. Veda Vivek

Principal and HOD

Department of Community Health Nursing

Diana College of Nursing, Bangalore – 64.

2. Prof. Elizabeth Dora

Head of the Department

Department of Child Health Nursing

Diana College of Nursing, Bangalore – 64.

3. Prof. Kalaivani

Head of the Department

Department of Obstetrics and Gynecological Nursing

Diana College of Nursing, Bangalore – 64.

4. Prof. Vasantha Chitra.D

Head of the Department

Department of Medical Surgical Nursing

Diana College of Nursing, Bangalore – 64.

5. Prof. Kalai Selvi. S.

Head of the Department

Department of Psychiatric Nursing

Diana College of Nursing, Bangalore – 64.

6. Prof. Rangappa

Biostatistician GKVK,

Jakkur International Airport Road, Bangalore.

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c) www.science direct.com

d) www.nursingtimes.com

e) www.altavista.com

f) www.wrongdiagnosis.com

9.Signature of candidate

10. Remarks of the guide

Research topic for this candidate is suitable and it

is relevant to the awareness on dengue fever. There

is a need to assess the awareness on dengue fever

among high school teachers.

11.Name and designation of guide

Prof. Veda Vivek

Principal and HOD

Department of Community Health Nursing,

Diana College of Nursing,

Bangalore – 64.

Signature

Head of Department

Prof. Veda Vivek

Principal and HOD

Department of Community Health Nursing,

Diana College of Nursing,

Bangalore – 64.

Signature

12. Remarks of the Chairman & Principal The selected study is feasible and researchable and

forwarded for needful action.

Signature