RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the Candidates and Mr. LALHMINGMAWIA Address THANGLUAH 1st year M.Sc. (Nursing) Florence College of Nursing Bangalore 43

Name of the institution

Florence College of Nursing

Course of study and Subject

M.Sc. (Nursing) Community Health Nursing

Date of admission to the Course 28th October 2009

Title of the Topic

Effectiveness

of

video

assisted teaching programme on knowledge regarding

leptospirosis among farmers in selected Bangalore. rural areas,

6. BRIEF RESUME OF INTENDED WORK: INTRODUCTION:

Leptospirosis is severe and contagious bacterial infection. It is caused by exposure to several types of the Leptospira bacteria, which can be found in fresh water that has been contaminated by animal urine. The alternative names of Leptospirosis are Weil disease, Ictehemorrhagic fever, Swine herds disease, Rice field fever, cane-cutter fever, Swamp fever, Mud fever, heamorrhagic jaundice, Stuttgart disease, Canicola fever and, rat fever and farmers disease in india.1

Leptospirosis is essentially animal infection by Serotypes of Leptospira (spirochetes) and transmitted to man under certain environmental conditions. At present, 23 sero groups and 200 serovars have been recognized from various part of the world. It has high prevalence in warm humid tropical countries. The disease manifestations are many and varied, ranging in severity from a mild febrile illness to severe and sometimes fatal disease.2

The some sources of human infection are rats, dogs, cats, livestock and wild animal. Once infected, animal excrete spirochetes in the urine for an extended period of time. Leptospire survival outside the human host is dependent on the moisture content, temperature and pH of the soil and water into which they are shed. The majority of the human cases worldwide result from occupational exposure to rat contaminated water or soil. Occupational groups with a high incidence of Leptospirosis include agriculture workers, person who live or work in rat infested environment, individuals involved in animal and husbandry or veterinary medicine, and laboratory workers.3

Leptospirosis is a zoonotic spirochiteal disease of global importance. The disease continues to have a major impact on people living at urban and rural areas in developing countries. Leptospirosis is underreported due to lack of clinical suspicion and barriers to diagnostic capacity. General physicians often lack familiarity with the broad clinical presentation of leptospirosis. Most commonly, human infection with pathogenic leptospira results in asymptomatic seroconversation and less commonly in a symptomatic illness. When symptomatic, leptospirosis most often manifests as an undifferentiated febrile illness. In endemic areas, factors such as lack of sanitary conditions, mud flooring, together with rainy seasons and flooding catastrophes contribute to periodic outbreaks.4

India is a developing country, about 72-74% of the people live in rural areas. The main source of income is agriculture; several millions of them are either marginal farmers or work on hired labour and struggle for bare necessities of life. It is said that nearly 11% of the total wild animal population is in India. It is usually observed that, animals are house under the same roof as human being. Therefore all possibilities exist for the various diseases to be transmitted by the animals to man.5

6.1 NEED FOR STUDY:

According to WHO, the incidences ranges of leptospirosis from approximately 0.1 1 per 1,00,000 per year in temperate climates to 10 100 per 1,00,000 in the humid tropics. During out breaks and high exposure risk groups, disease incidence may reach over 100 1,00,000. The case-fatality rates in different parts of the world have been reported to range from <5% to 30%. 6

Based on National Epidemiological Surveillance of Infectious diseases (NESID), the report on prevalence of leptospirosis showed that the estimated sources of infection of the 93 notified cases were- Farm workers (31 cases); Leisure activities and labour at the rivers (23 cases); contact with fresh water of other than rivers labour(16 cases); direct and indirect contact with rodents(17 cases); unknown (6 cases). Therefore, the sources of infection are occupational or recreational exposure in environment contaminated with urine of carrier animals, and occupation having a chance of direct contact with urine or blood of infected animals.7

A study was conducted on prevalence of leptospirosis in Kerala, about 37 cases were selected by using simple stratified sampling techniques. The studies showed that people belonging to 30-45 age group were affected more(51.3%), both males and females. There was not a single case in the 015 age groups, with 10.8% belonging to 60 plus age group. As in the other studies, Male cases dominated- of the total, 68% were male and 32% were female. This is despite the fact that more than 50% of those affected are engaged in agriculture work, identified as the major routes of transmission.8

A study was conducted on prevalence of leptospirosis among the Pyrexia Unknown Origin(PUO) cases in a Tertiary care Hospital of Kashmir Valley, about 72 in-patients cases were enrolled as participants. All the samples are tested by Lepto Dipstick. The study showed that of the 72 studied cases, 43 were male and 29 female, predominantly in the age group 21 40 years. Results showed that 1 of 15 urban(6.66%) and 14 of the 57 rural (24.56%) patients were positive for leptospira

antibodies respectively. About 13 of the 15 patients who tested positive (86.66%) gave a definite history of animal contact. 9

Human leptospirosis is prevalent in many states in India, sporadically or as outbreaks, especially during rainy seasons. It affects predominantly male adults who work in agriculture, causing severe morbidity and mortality with serious economic repercussions to families and to society. Yet, there is no systematic leptospirosis prevention and control programme in the country and not included under the national health policy. Thus, Personal protection and public health control are relevant in this disease.10

Leptospirosis is a potentially serious but treatable disease. More than half of the total population lives in rural areas and their lives depend mainly on agriculture. Chances of exposure to the risk factors is high due to lack of knowledge about the illness, poor working condition and inadequate housing. Since Leptosporosis is a public health threat and hence, it is necessary to increase awareness and knowledge on leptospirosis among farmers in the rural areas. So, the researcher found it relevant to evaluate the effectiveness of video assisted teaching programme on Leptospirosis

6.2 Review of Literature:

The review of literature is an organized critique of the important scholarity literature that supports a study and a key step in the research process. The overall purpose of review of literature in the research study is to present a strong knowledge base for the conduct of the research project. The main goal of a literature review is

to develop the foundation of a sound study, but it also is used for other scholarity, educational and clinical practice activities. 11

A study on the prevalence of Leptospirosis among the 227 risks groups was conducted in and around Nagpur. The test group included 55 patients of pyrexia unknown origin(PUO), 42 veterinary workers, 38 Hepatitis patients and 25 village farmers. The control group comprised of 27 Syphilis and 40 healthy groups. Test was done either by IgM ELISA and by Microscopic agglutination test (MAT). Out of 160 patients of the test group 56(35.0%) were positive for Leptospiral antibodies. Of these, the positivity was 18(32.73%) amongst Pyrexia unknown origin (PUO), 15 (35.71%) of farm workers, 15(39.47%) of hepatitis and 8(32.0%) of farmers. Leptospirosis antibodies was not detected in any of the control groups. Out of 56 leptospira cases, 39(69.64%) has a history of animal contacts. The result shows that PUO patients with jaundice especially in presence of the history of animal contact should be suspected more.12

A descriptive study was conducted to assess prevalence of leptospirosis outbreak among the 942 clinically suspected cases of leptspirosis admitted into Lokmanaya Tilak Municipal General Hospital, Mumbai. Serum samples were tested by Tek Dri-Dot/Leptocheck. Among 165 positive serra by these test were sent to IRR, Mumbai for detection of leptospira IgM antibodies by ELISA (panbio). About 87 positive sera were also sent to BJ Medical College, Pune for Microscopy Agglutination Test(MAT) for serovar identification. Seropositivity with Leptocheck Tek Dri-Dot/Leptocheck was 34.3 %, IgM ELISA positivity was 69.1% and MAT positivity was 29.9%. Considering at least two of the above three serological test

positive, 127 cases could be diagnosed and only 89.8% of them could be diagnosed by ELISA and rapid test. The study therefore, concluded that alongwith rapid serological test, IgM ELISA should be routinely done for laboratory diagnosis of leptospirosis.13

A descriptive study on prevalence of leptospirosis in Andhra Pradesh was done among 86 suspected cases. Of these, 49(56.97%) serum samples were found positive for leptospirosis by DGM test and IgM antibodies. The mean age of the positive cases were 42.7 years. All the 49 positive cases had fever (100%), Myalgia (42.9%), stiffness of the calf muscles (55.1%) and headache (32.6%) and conjunctival suffusion (2.04%). The studies indicated that transmission was from contaminated stagnant water. The barefooted villagers living with livestock and rodents were significantly associated with seropositivity.14

A descriptive study on prevalence of human leptospirosis among hospital cases of erode, South India was performed by using isolation and serological test such as the microscopic agglutination test(MAT) and IgM-based enzyme-linked immunosorbent assay. Out of 29 patients, 26(89.7%) were diagnosed as having leptospiral infection. Case fatality rate was 3.4%. The age of patients ranged between 10-70 years and median age was 42.5 years. The study results showed that that 93.1% of the patients were male and all patients, excepts one were agriculture labourer. This study concluded that leptospirosis is a potential health hazard of Agriculture Workers.15

A serological survey of Leptospira infection in Nepal by one-point microcapsule agglutination(MCA) test was done among 200 patients(104 males and 96 females) attending out patient department. Among 200 serum samples taken32%(64 out of 200) of the subjects possessed antibodies to leptospira. The

Leptospira-antibody prevalence was dependent of gender and geographical areas(P>0.05). The antibody prevalence in different age and ethnic groups ranged from 27.5 34.0% and 28.5 40.0% respectively. The difference was not significant (P>0.05%). The reports of the results suggested that Leptospira infections are uniformly distributed in different age, sex, ethnics and geographical areas. 16

A study to investigate the risk factors for mortality in patients with Leptispirosis during an epidemic outbreak in northern Kerala was done through clinical examination, laboratory investigation and leptospira serology -Microscopic agglutination test(MAT). Of the 468 cases suspected to have leptospirosis, serology could be done in 360 patients. Of these, MAT was positive in 282 patients. Case fatality rate was 6.03%.Out of 282 seropositive cases 58.9 % were men and 29% were engaged in agriculture occupations. The result shows that majority of the patient (62.9%) had either fissures or other wounds on the feet and no patient had direct occupational exposure to animal.17

A leptospirosis clinical-epidemiology study was made in humans and reservoirs. Interviews and serological analyses were made on 400 persons from an open population; 439 probable cases of leptospirosis and 1060 animal reservoirs(cows, pigs, dogs, rats and opossums). IgM Leptospira Dipstick and Microscopic agglutination Test(MAT) was used to detect human antibodies to

leptospiras and serovars respectively. Leptospirosis in humans was 2.2/1,00,000 inhab. In 1998, 0.7/1,00,000 in 1999 and 0.9/1,00,000 in 2000. Overall seroprevalence was 14.2%, relatively unchanged from seroprevalences observed 20 years ago highest seroposivity was found in people over 56 years of age, predominating males over females.Leptospirosis cases were more frequent in rural areas. Contacts with rodents and natural water sources were significant factors (p<0.05). Human cases (74%) occurred during the rainy season. The study concluded that leptospirosis is still a serious illness with important clinical and epidemiological implications. 18

A clinical study of human leptospirosis was conducted for a period of three years in the city of Chennai, Tamil Nadu. Test was done by Dark Field Microscopy Test. The study results showed that out of 165 samples tested for thrombocytopaenia, 37% of the cases are found to have fall in platelet count. Administering high doses of Penicillin can improve the Platelet count within 10 days. The study concluded that though leptospirosis is a common bacterial disease with a well-known treatment regimen, improper diagnosis can result in death. 19

A literature review addressed to the issues on epidemiology, diagnosis and clinical management of leptospirosis which confront public health responses, and highlights the progress made towards understanding the leptospira genome, biology and pathogenesis. The recent finding showed that Leptospirosis has spread from its traditional rural base to become the cause of epidemics in poor urban slum communities in developing countries. The overall disease burden is underestimated, since leptospirosis is a significant cause of undifferentiated fever and frequently not

recognised. Barriers to addressing this problem have been the lack of an adequate diagnostic test and effective control measures. China and Brazil countries have completed the sequence of the leptospira genome. Together with new genetics tools and proteomics, new insights have been made into the biology of leptospira and the mechanisms used to adapt to host and external environments. Surface protein exposed proteins and putative virulence determinants have been identified which may serve as sub-unit vaccine candidates. Future challenges will be to translate these advances into public health measure for developing countries. 20

6.3 STATEMENT OF PROBLEM A study to evaluate the effectiveness of Video Assisted Teaching Programme on knowledge regarding Leptospirosis among farmers in selected rural areas, Bangalore.

6.4 OBJECTIVE OF THE STUDY The objectives are: to assess the knowledge of farmers regarding Leptospirosis. to organise a video assisted teaching programme on leptospirosis. to evaluate the effectiveness of leptospirosis. to find out the association between knowledge of farmers regarding leptospirosis with socio-selected demographic variables. video assisted teaching programme on

6.5 HYPOTHESES H1- The mean post-test knowledge scores of the farmers regarding leptospira infection will be significantly higher than the mean pre-test knowledge scores. H2- There will be significant association between the mean pre-test knowledge scores and the selected socio-demographic variable.

6.6 OPERATIONAL DEFINITION OF TERMS In this study it refers to:Evaluate: Finding the values of video assisted teaching programme on knowledge of farmer regarding leptospirosis. Effectiveness: Determine the extent to which the video assisted teaching programme has achieved desire effect as measure in terms of significant gain in the post-test knowledge scores of farmers and graded as adequate, moderately adequate and inadequate knowledge. Video assisted teaching programme: Systematically developed audio-visual aids designed for selected group of farmers to provide information about leptospirosis such as, causes, risk factors, pathology, clinical manifestation, diagnosis and treatment. Knowledge: The level of understanding of the farmers regarding leptospiral infection in terms of their gain in the knowledge scores as measured by the correct responses to the items in the tool.

Leptospirosis: Any infectious disease due to a serotype of Leptospira, manifested by lymphocytic meningitis, hepatitis, and nephritis, separately or in combination, and varying in severity from a mild carrier state to fatal disease. Farmers: Persons who owns or manages farm (age between 20 60 yrs)

6.7 ASSUMPTION The study is based on the following assumptions: Farmers from the rural areas are more prone to get leptospira infection. Video assisted teaching programme may be more effective to impart the knowledge for illiterate farmers. Explaining about the study may help to get co-operation.

6.8 DELIMITATIONS The study delimited to farmers: Males and females age between 20 - 60yrs. Who are residing at selected rural areas. Who speaks Kannadda.

7 MATERIALS AND METHODS 7.1 Sources of Data Farmers in a selected rural areas.

7.2 METHOD OF DATA COLLECTION Research Method Research design : : Pre-experimental method. One group pre-test and post-test design. Purposive sampling techniques. 60 farmers. Dodda Gubbi Village, Bangalore District.

Sampling Technique : Sample Size Setting of the Study : :

7. 2.1 CRITERIA FOR SELECTION OF SAMPLE INCLUSION CRITERIA This study includes farmers who are:1. available at the time of study 2. willing to participate in the study 3. able to speak Kannada.

EXCLUSION CRITERIA This study includes farmers who are:1. below 20 and above 60 years of age. 2. having communication problems.

7. 2.2 DATA COLLECTION Data collection tool will be a structure interview schedule, which consists of demographic profile and questions to assess the knowledge of the subjects regarding leptospirosis. A video assisted teaching programme will be prepared regarding leptospiral infection focusing on aspect such as causes, risk factor, pathology, clinical manifestation, diagnosis and treatment.

Content validity of the tool will be ascertained with the help of guide and experts in the field of Community Medicine and Nursing.

Reliability of the tools will be established by split half method. The tentative period for data collection will be December 2010.

7. 2.3 DATA ANALYSIS METHOD Data will be analyzed by using descriptive and inferential statistics. Descriptive statistical analysis such as mean, median, standard deviation and percentages distribution will be done. Inferential statistics such as t test will be done to find out significance difference between the pre and post-test knowledge scores and Chi-square test will be done to find out be significant association between knowledge scores and the demographic variables.

7.3

DOES

THE

STUDY

REQUIRE

ANY

INVESTIGATION

OR

INTERVENTION TO BE CONUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS ? No.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED ? Yes; Administrative permission will be obtained from the concerned authority. Confidentially and anonymity of the subjects will be maintained.

8. LIST OF REFERENCE:
1. Goldman L, Ausiello D, Leptosiposis. Cecil medicine. 23rd eds. Philadelphia, Pa: Saunders Elsevier; 2007, Chapter 344.

2. Park K, Parks text book of preventive and social medicine. 19th eds. 2007, M/s Banarsidas Banot, jobalpur. P-243.

3. Berhman E. Richard, Kliegman M. Robert, Jenson B. Hal, Nelson textbook of pediatrics. 16th eds. 2000, W.B. Saunders Company, Philadelphia, chapter 217, P-908.

4. Cachay ER, Vinetz Jim, A global research agenda for leptospirosis. J Postgard Med. 2005; 51:174-8.

5. Ghulani KK, Community health nursing. 1st ed. 2008, Kumar Publishing house, N. Delhi, P-290.

6. Human Leptospirosis: Guidance for diagnosis, surveillance and control. WHO Library Cataloguing in publication data, Annexure-I, 2003.

7. IASR, Leptospirosis in Japan, November 2003 - 2007. Vol. 29: No. 1(No. 355).

8. George Mathew, Socio-economic and cultural dimensions and Health seeking behaviour for Leptospirosis: a case study of Kerala. 2007; 9;381398.

9. Shaheen Rubeena, Shah Azra, Prevalence of Leptospirosis among the PUO cases in tertiary care hospital of kashmir valley. Vol. 3, No. 5(2006-11 2006-12).

10. John TJ, The prevention and control of human leptospirosis. J postgrad Med 2005; 51:205-9.

11. Lobiondo-Wood Geri, Haber Judith, Nursing research. 6th ed. MOSBY Elsavier, Missouri, P-78.

12. Angnani R, Pathak AA, Mishra M, Prevalence of leptospirosis in various risk groups. Indian journal of Medical Microbiology, (2003) 21(4): 271-273.

13. Mathur M, De A, Turbadkar D, Leptospirosis outbreak in 2005: LTMG, hospital experience. Indian J Med. Microbiol. 2009 Apr-jun; 27(2): 153-5.

14. Shohan L, Shyamlal B, Kum TS, Malini M, Rav K etal, Studies on leptospirosis outbreak in peddamandem mandal of chittoor district, Andhra Pradesh. J Commun. Dis 2008 June:40(2) 127-32.

15. Natarajaseenivasa

Kalimuthusamy,

Prabu

Nagarajan,

Selvanyaki

Khrisnamamy, Raja Sudalaimuthu Savalaikarankulam Suresh, Ratnam Sivalingam, Human leptospirosis in erode, south India; serology, isolation and characterization of the isolates by randomly amplified polymorphic DNA(RAPD) fingerprinting. Jpn. J. infect. Dis., 57,193-197,2004.

16. Rai Kumar Shiba, Shibata Hiroshi, Sumi Katsumi, Uga shoji, Ono Kazuo, Strestha Govinda Hari etal., Serological study of Leptospira infection in Nepal by one-point MCA methods. J infect Dis Antimicrob Agents 2000; 17:29-32.

17. Pappachan MJ, Mathew Sheela, Aravidan KP, Khader Aysha, Bhargaran PV, Kareem Abdul MM, etal., Risk factors for mortality in patients with leptospirosis during an epidemic in northern Kerala. National Medical Journal India 2004;17:240-3.

18. Vado-Solis Ignacio, Cardenas-Murrufo Maria F, Jimenez-Delgadillo Bertha, Alzina-Lopez Alejandro, Laviada-Molina Hugo, Suarez-Solis Victor etal, Clinical epdemiological study of leptospirosis in humans and reservoirs in Yucatan, Mexico. Rev. inst. Med. Trop. S. Paulo, 44(6): 335-340, 2002.

19. Ghouse and Ali Mohamed M.G. Leptospirosis: challenges for doctors. The Hindu, Online edition of Indias National Newspaper. Wednesday, Aug, 17, 2005. Chennai, Tamil Nadu. http://www.hindu.com/2005/08/17/stories /2005081714300500. htm

20. Mcbride AJ, Athanazio DA, Reis MG, Ko Al, Leptospirosis. Goncalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazil. Curr Opin Infect Dis. 2005 Oct;18(5):376-86.

ELECTRONIC SOURCES 1. www.googles.com 2. www.pubmed.com 3. Indian Medical Association

SIGNATURE OF THE CANDIDATE: This study will help to maintain the normal

10

REMARKS OF THE GUIDE: ecological system.

11 11.1 11.2

NAME AND DESIGNATION: GUIDE NAME: SIGNATURE OF THE GUIDE:

R. CHITRA Associate Professor

11.3 11.4

CO-GUIDE NAME: SIGNATURE OF THE CO-GUIDE:

11.5

HEAD OF THE DEPARTMENT NAME: R. CHITRA

11.6

SIGNATURE OF THE H.O.D: This study is feasible to REMARKS OF THE do and most relevant to the field of Community Health Nursing

11.7

CHAIRMAN AND PRINCIPAL: SIGNATURE OF THE PRINCIPAL: