T.JOHN COLLEGE OF NURSING

GOTTIGERE

BENNERGHATTA ROAD

BANGALORE-83

SYNOPSISREGISTRATION OF SUBJECTS FOR DISSERTATION

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA

PREPARED BY,

ASHLY STEPHEN,

I YEAR MSC NURSING,

T. JOHN COLLEGE OF NURSING.

GUIDED BY,

MRS. P NEELAVATHI,

PROFESSOR,

MEDICAL SURGICAL NURSING,

T JOHN COLLEGE OF NURSING.

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS (IN BLOCK

LETTERS)

ASHLY STEPHEN

I YEAR M. Sc. NURSING

T JOHN COLLEGE OF NURSING

GOTTIGERE, BENNERGHATTA ROAD,

BANGALORE-83.

2. NAME OF THE

INSTITUTION

T JOHN COLLEGE OF NURSING

GOTTIGERE ,BENNERGHATTA ROAD,

BANGALORE-83.

3. COURSE OF STUDY AND

SUBJECT

M.Sc. NURSING

MEDICAL SURGICL NURSING

4. DATE OF ADMISSION TO

THE COURSE

13-O6-2012

5. TITLE OF THE TOPIC: “A STUDY TO ASSESS THE EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING PREVENTION

AND CONTROL OF AVIAN INFLUENZA A (H5N1) AMONG WORKERS IN

POULTRY CENTERS IN A SELECTED AREAS AT BANGLORE.”

2

6 BREIF RESUME OF THE INTENDED WORK

INTRODUCTION

Health is man`s greatest possession, for it lays a solid foundation for his

happiness. Good health is a prerequisite of human productivity and the developmental

process. When optimum health is not met, there will be occurrence of a disease.1

The symptoms of human influenza were clearly described

by Hippocrates roughly 2,400 years ago. The disease may have spread from Europe to

the Americas as early as the European colonization of the Americas; since almost the

entire indigenous population of the Antilles was killed by an epidemic resembling

influenza that broke out in 1493, after the arrival of Columbus. The first convincing

record of an influenza pandemic was of an outbreak in 1580, which began in Russia

and spread to Europe via Africa.2

Emerging zoonotic diseases are of increasing regional and global

importance. Approximately 75% of emerging infectious diseases are zoonotic.3 Among

these infectious diseases the most prevalent today is “Avian influenza”. Avian

influenza (also called avian flu, bird influenza, or grippe of the birds), is

an illness caused by a virus called Orthomyxoviride. The virus, called influenza

A or type A, usually lives in birds, and less commonly in pigs but sometimes infects

mammals, including humans. It is called influenza when it infects humans and there

are 16 different avian flu types.4

Zoonosis and human health are matters of particular concerns in India-

because nearly 80% of India’s population is rural and live in close contact with

domestic animals, and often not far from wild ones.5

Bird flu occurs naturally in wild and can spread into domestic poultry, such

as chickens, turkeys, ducks and geese. Certain avian influenza viruses may be

transmitted from infected birds to humans. Influenza can be spread in three main

ways: by direct transmission (when an infected person sneezes mucus directly into the

eyes, nose or mouth of another person); the airborne route (when someone inhales

the aerosols produced by an infected person coughing, sneezing or spitting) and

through hand-to-eye, hand-to-nose, or hand-to-mouth transmission, either from

contaminated surfaces or from direct personal contact such as a hand-shake. Poultry

3

workers are at risk of becoming infected with these viruses if they work directly with

infected animals or animal products.4

People with the most virulent type of bird flu virus-(A) –may develop life

threatening complications, particularly pneumonia (either direct viral pneumonia or

secondary bacterial pneumonia), acute respiratory distress, collapsed lung, kidney

dysfunction and cardiac problems. These are the most common cause of bird flu-

related deaths.4

Prevention and control depend on awareness and protective behaviors of the

general population as well as high risk-groups; poultry workers have inadequate

knowledge regarding avian influenza preventive behavior, and outbreak preparedness

which makes more vulnerable to this deadly infectious disease.

Nurses are enhancing proper knowledge and to the importance of early

initiation of treatment are crucial. Early self-reporting of illness and consultation with

public health officials should be encouraged. Detection of possible human cases of

H5N1 should trigger immediate notification of local, sub-national and national public

health and agricultural authorities to make immediate decisions about the launching of

an investigation.6 Nurses are being asked to play a key role in the process of

developing an effective educational program to enhance awareness of H5N1 and

motivate people to access to health care earlier when H5N1 infection is suspected or

likely.

6.1 NEED FOR THE STUDY

Influenza is truly an international disease. It occurs in all countries and

affects millions of people every year, resulting in significant morbidity, mortality and

burdens on the delivery of health care. The geographical spread of highly pathogenic

avian influenza among poultry and wild bird populations is unprecedented. Growing

numbers of sporadic avian influenza infections are occurring in humans, increasing the

threat of the next influenza pandemic.7

The H5N1 virus subtype - highly pathogenic AI virus- first infected humans

in 1997 during a poultry outbreak in Hong Kong SAR, China. Since its widespread re-

emergence in 2003 and 2004, this avian virus has spread from Asia to Europe and

Africa and has become entrenched in poultry in some countries, resulting in millions of

poultry infections, several hundred human cases, and many human deaths.8

4

According to WHO health survey more than 600 human H5N1 cases have

been reported in 15 countries, in that 60% of the cases has died since 2003.9From the

year of 2003 to 2011 cumulative numbers (608) of H5N1 confirmed human cases is

reported from 15 countries, in those 359 cases have fatalities.10In the year of 2012

January to March 164 humans cases with 17 cases are fatalities and April to August

101 cases with one cases fatalities. H5N1 outbreaks in poultry were reported officially

from the following countries: Bangladesh, Bhutan, China, Egypt, India, Indonesia,

Israel, Myanmar, Nepal, and Viet Nam.11

The first reports of bird flu in India came from the village of Navapur in the

Nan durbar district of Maharashtra on 19 February 2006.12In Assam, nearly 100 people

had reported fever and respiratory tract infections in the districts affected by bird flu.

Assam, West Bengal, Tripura and Manipur states have suffered outbreaks of bird flu

during the years. Millions of chickens and ducks have been slaughtered after the

outbreaks.13

According to Central Poultry Development Organisation over 3,000 turkeys

died due to bird flu at the state-run in Hesaraghatta at Bangalore on 2012 October. The

virus begins to spread more easily among people, infected birds present the greatest

hazard. 14

Highly pathogenic avian influenza A viruses have been associated with

occasional illness and death in humans in Asia, Africa, the Pacific, Eastern Europe, and

the Near East. As per statistical data, highly pathogenic avian influenza A virus is

considered endemic among poultry in six countries (Bangladesh, China, Egypt, India,

Indonesia, and Vietnam). This means the virus is commonly found in poultry in those

countries. Sporadic outbreaks have occurred among poultry workers. Almost all the

investigations of human cases have shown that infection occurred through direct

handling of infected poultry, consumption of uncooked poultry products, or contact

with virus-contaminated surfaces or materials including feathers.15

This is supported by study conducted on avian influenza virus infection in

people occupied in poultry fields in Guangzhou city, with an aim to conduct

serological investigation on H5N1/H9N2/H7N7 infection. The result shows that, 4

were positive to H5-Ab, 146 were positive to H9-Ab and the prevalence of H9 among

people from live poultry retailing (14.96%) was the highest. Prevalence rates of H9

5

were as follows: 8.90% in people working in the large-scale poultry breading factories,

6.69% in the live poultry wholesaling business, 3.75% in the wide birds breeding,

2.40% in the swine slaughtering, 2.21% in the non-poultry retailing, 1.77% in the rural

poultry farmers and 2.30% in normal population. The study conclude that there is high

risk of AIV infection in live poultry retailing, wholesaling and large-scale breading

businesses, with the risk of live poultry retailing the highest.16

A descriptive cross-sectional survey was conducted on knowledge and

practices of poultry workers on prevention of avian flu in Nigeria. The result shows

that 49.1% of samples were aware about avian flu and 46.4% of knew that the disease

was present in Nigeria. Only 50% of those who knew about the disease felt it could

affect human beings. Practices which favour the spread of the virus that were engaged

in by the respondents included using bird droppings as manure (71.9%), and feeding

fish with intestines of killed chicken (66.7%). The study conclude that a low level of

awareness of avian flu among the poultry workers and owners so the massive

education should be embarked upon for groups occupying strategic positions in disease

epidemiology, as well as all stake holders in poultry y farming.17

The above study shows that poultry workers’ have less knowledge on

prevention and control of avian flu. So the nurses play an important role in the

education of poultry workers regarding the importance of strict infection control, the

use of personal protective equipment during the delivery of care, administration of

antiviral drugs, initiation of active case-finding and enhanced surveillance, active

monitoring of contacts for the development of fever and respiratory symptoms,

voluntary home quarantine of asymptomatic case contacts if human-to-human

transmission is occurring. 4

Culturally sensitive and appropriate communication messages should be

formulated about specific risk factors and behaviors and how such risks can be

reduced. Standard prevention and control measures are help to reduce opportunities for

further transmission of H5N1. Hence the investigator feels that it is important to

improve the knowledge level of poultry workers, to prevent the spreading of avian

infection, and self instructional module will be an effective way to impart this

knowledge. So the investigator decide to give a self instructional module on avian flu

6

to the poultry workers which will make them competent and confident to work in

poultry centres.

6.2 REVIEW OF LITERATURE

“Good research does not exist in vacuum” (POLITE, 1995)

Review of literature is a key step in research process. Review of literature

refers to an extensive, exhaustive, systematic examination of publications relevant to

the research project .Review of literature is defined as a “broad comprehensive in

depth, systematical, and critical review of scholarly publications, unpublished

scholarly, print materials audio visual materials and personal communications.1

In the present study, the literatures are reviewed under the following

headings:

6.2.1 Review of literature related to incidence of avian influenza among

poultry workers.

6.2.2 Review of literature related to knowledge of poultry workers on

avian influenza.

6.2.3 Review of literature related to impact of educational programs on

poultry workers.

6.2.4 Review of literature related to effectiveness of self instructional

module.

6.2.1 Review of literature related to incidence of avian flu among poultry

workers.

A cohort study was conducted on Risk of Influenza A (H5N1)

Infection among Poultry Workers, Hong Kong. To evaluate the potential for avian-to-

human transmission of H5N1 among 293 government workers who participated in a

poultry culling operation and among 1525 PWs. The study shows that PWs, ∼10% had

7

anti-H5 antibody. More-intensive poultry exposure, such as butchering and exposure to

ill poultry, was associated with having anti-H5 antibody. The study conclude that

suggest an increased risk for avian influenza infection from occupational exposure.18

Seroepidemological survey was conducted on avian influenza A virus

among poultry workers in Jiangsu, with an aim to understand the real infection rate

and evaluate the potential risk factors for the zoonotic spread of H5N1 viruses to

humans. The result shows that 2.61% for H5N1 antibodies. The poultry number was

found associated with a 2.39-fold significantly increased subclinical infection risk.

Avian-to -human transmission of avian H5N1 virus remained low. The study conclude

that workers associated with raising larger poultry flocks have a higher risk on

seroconversion.19

A matched case control study was conducted on Identification of risk factors

associated with highly pathogenic avian influenza H5N1 virus infection in poultry

farms; in Nigeria, to evaluate risk factors for infection with highly pathogenic H5N1

virus in poultry farms. The result shows that variables for receiving visitors on farm

premises (odds ratio (OR) =8.32; 95% confidence interval (CI) =1.87, 36.97; P<0.01),

purchased live poultry/products (OR=11.91; 95% CI=3.11-45.59; P<0.01), and farm

workers live outside the premises (OR=8.98; 95% CI=1.97, 40.77; P<0.01) were

identified as risk factors for HPAI in poultry farms. The study conclude that improving

farm hygiene and bio security should help reduce the risk for influenza A infection in

poultry farms.20

A study was conducted to identify the risk related to the transmission of

H5N1 subtype avian influenza virus in the environment of poultry markets in China.

The results shows that H5N1 antibody positive rates from workers were 25.5%

(26/102), 50.0% (9/18) and 25.4% (17/67) in the poultry markets of township and

inner cities. It concludes that large numbers of H5N1 subtype AIV detected in the

environment of poultry markets and HA genes of H5N1 subtype AIV in the poultry

markets environment carried molecular characteristics of highly pathogenic which

could increase the risk for H5N1 subtype AIV transmission in the environment of

poultry markets.21

A seroepidemological study was conducted on avian influenza H9N2

seroprevalence among poultry workers in Pune, to understand the prevalence of

8

antibodies against AI H9N2.The result shows that were negative by HI assay using ≥40

cut-off antibody titre. Overall 21 subjects were positive for antibodies against AI H9N2

by either HI or MN assays using ≥40 cut-off antibody titre. A total of 4.7% and

3.8% poultry workers were positive for antibodies against AI H9N2 by HI and MN

assay respectively using 40 as cut-off antibody titre. This is the first report of

seroprevalence of antibodies against AI H9N2 among poultry workers in India.22

6.2.2 Review of literature related to knowledge of poultry workers on avian

influenza

A cross-sectional survey was conducted on Knowledge of avian

influenza among poultry workers, China; A 360 poultry workers showed that workers

had inadequate levels of avian influenza risk knowledge, preventive behavior, and

outbreak preparedness. The study concludes that the main barriers to preventive

practices were low perceived benefits and interference with work. Poultry workers

require occupation-specific health promotion.23

A cross-sectional study was conducted on knowledge and practices related

to avian influenza among poultry workers in Nepal. This study aims to explore

the knowledge and practices related to avian influenza among 96 poultry workers. The

result shows that the knowledge about preventive measures was high with regard to

some behaviours (hand washing), but medium to low with regard to others (using

cleaning and disinfecting procedures or protective clothing). The study concludes that

the importance of targeting lack of knowledge as well as structural-material barriers to

successfully build preparedness for a major outbreak situation.24

A cross-sectional epidemiological study was conducted on knowledge and

compliance of poultry workers with preventive measures for avian influenza in

Nigeria. This study was aimed at assessing the knowledge and compliance with

preventive practices for avian influenza infection. The results shows that nearly all

respondents (92.9%) had heard about H5N1, 61.4% correctly defined the infection.

The majority (78.6%) agreed that avian influenza is a serious and preventable disease.

No vaccination of poultry against avian influenza was reported by 98.6%, and wearing

of personal protective equipment was not a routine practice. The study concludes that,

to provide effective and coordinated information

9

to poultry workers about avian influenza and the precautions necessary to avoid

spreading the virus among poultry and to humans.25

6.2.3 Review of literature related to impact of educational programs on poultry

workers

A study was conducted on impact of educational intervention

concerning awareness and behaviours relating to avian influenza in a high-risk

population in Vietnam. The aim of the study was to enhance awareness of H5N1 and

motivate people to access to health care earlier when H5N1 infection is suspected or

likely. A study was conducted in two communities (intervention and control groups). A

knowledge and practice scores were compared between the different time points and

between the groups. The study indicated an increased awareness of H5N1 and

increased reliance on local health care workers. The novel educational program which

was developed for this study impacted awareness of H5N1, and resulted in more

people seeking early access to healthcare, and also resulted in earlier medical

intervention for patients with H5N1 infection.26

An interviewer-administered survey was conducted on

avian influenza risk perception and preventive behaviour among traditional

market workers and shoppers in Taiwan. This study aims to explore risk perception and

other factors associated with hand washing and wearing face masks to prevent AI. A

352 traditional market workers and shoppers are included. The result shows that

knowledge about the fatality rate of AI (4.18), knowing of severe cases of (2.13), being

informed of local AI outbreaks (2.24), and living in north-eastern Taiwan (6.01. The

study concludes that specific information concerning AI risk perception was associated

with the recommended AI preventive behaviour. These results also have practical

implications for prevention and policy-making to more effectively promote the

recommended AI preventive behaviour in the public.27

6.2.4 Review of literature related to effectiveness of self instructional module

A study to develop a self instructional module based on the learning

needs of the Anganwadi workers regarding malnutrition among children below six

years of age, Davangere. An iterative design used to develop a self-instructional

module, to assess the learning needs of Anganwadi workers. The results shows that

mean percentage for the area ‘management of malnutrition’ was 41.0% in pre-test

10

which increased to 99.0% in post-test and mean percentage of the area ‘assessment of

malnutrition’ was 68.0% in pre-test whereas it was 100.0% in post-test. The study

concludes that the effectiveness of self instructional module.28

A study was conducted on effectiveness Of Self Instructional Module

on prevention and control measures of malaria, for families in a selected rural

community at Mangalore. A one group pre-test post-test design with pre-experimental

approach was adopted to evaluate the “Effectiveness of self instructional module and

determine the existing knowledge of family members. The results shows that mean

percentage of knowledge of families was 59.16 per cent with mean of 18.34 and SD of

± 4.59, which increased to 94.96 per cent with mean of 29.44 and SD of ± 2.06 in the

post- test. The study concludes that the Self Instructional Module is very effective in

improving the knowledge of family members.29

STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL

MODULE ON KNOWLEDGE REGARDING PREVENTION AND CONTROL OF

AVIAN INFLUENZA A (H5N1) AMONG WORKERS IN POULTRY CENTRES IN

SELECTED AREAS AT BANGALORE.

11

6.3 OBJECTIVES OF STUDY

• To assess the pre test knowledge regarding prevention and control of Avian

Influenza A (H5N1) among workers in poultry centers in selected areas.

• To evaluate the effectiveness of self instruction module in terms of gain in post

test score on knowledge regarding prevention and control of Avian Influenza A

(H5N1) among workers in poultry centers in selected areas.

• To determine the association between the pre-test knowledge regarding

prevention and control of Avian Influenza A (H5N1) with selected demographic

variables.

6.4 HYPOTHESIS

• H1: There will be significant difference between the mean pre test and post test

score of workers in poultry centers on knowledge regarding prevention and

control of avian influenza.

• H2: There will be significant association between pre test level of knowledge

and selected demographics variables of workers in poultry centers.

6.5 OPERATIONAL DEFINITIONS OF THE TERMS

• Assess: Assess means an act to measure the level of knowledge before and

after the self instructional module.

• Effectiveness: In this study it refers to the outcome of self instructional module

measured in terms of increase knowledge regarding prevention and control of

avian influenza.

• Self instructional module: In this study, it refers to systematically prepared

self explanatory information which are designed to increase the knowledge

regarding prevention and control of avian influenza.

• Knowledge: In this study, it refers to the process of acquiring information

regarding prevention and control of avian influenza.

12

• Avian influenza A: Influenza A virus subtype H5N1, also known as "bird

flu", A(H5N1) or simply H5N1, is a subtype of the influenza A which can

cause illness in humans and many other animal species.

• Poultry: In this study, it refers to a domesticated flesh of chickens, turkeys,

ducks or geese raised for food.

• Poultry workers: In this study, it refers to the people working in the poultry

centers who sell poultry products such as chickens, turkeys, and ducks.

6.6 VARIABLES UNDER STUDY

• Independent Variable: - In this study the independent variable is Self

Instructional Module on prevention and control of avian influenza A.

• Dependent Variables: - In this the dependent variable is gain in knowledge of

workers in poultry centers regarding prevention and control of avian influenza

A.

6.7ASSUMPTIONS

The study assumes that;

• The poultry workers may have inadequate knowledge prevention and control of

avian influenza.

• Self instructional module is an acceptable method to improve the knowledge of

workers in poultry centers regarding knowledge of prevention and control of

avian influenza.

• Poultry workers will be willing to participate in the study actively.

6.8 DELIMATIONS

The study is limited to:

• Poultry workers in selected poultry centers at Bangalore.

• Those who are willing to participate in this study.

• Poultry workers who are available during the time of data collections.

13

• Poultry workers who knows Kannada.

• Poultry workers who knows to read and write.

• The study is limited to the workers between the age group of 25-45 years in

selected areas, Bangalore

• Study period is limited to 6-8 weeks.

• Sample size is limited to 60.

7 MATERIALS AND METHOD

7.1SOURCES OF DATA:

The data will be collected from the poultry workers of selected workers in

poultry centre’s at Bangalore.

7.2METHOD OF DATA COLLECTION:

The investigator collects data from poultry workers in selected poultry centres

at Bangalore. Prior to data collection written permission will be obtained from selected

concerned subjects and authority of organization to conduct the study. The investigator

introduces herself to subject and notifies about her aims, objectives and steps of study

and takes written consent from the sample. The investigator will collect the data in

following three phases.

Phase-one: Assess the pre test knowledge of poultry workers regarding prevention and

control of Avian Influenza A (H5N1) by using structured knowledge questionnaire.

Phase-two: Administer self instructional module to poultry workers regarding

prevention and control of avian influenza.

Phase-three: Assess their post test knowledge by using same structured knowledge

questionnaire.

7.2.1. Research approach:

Evaluative approach.

14

7.2.2 Research design:

The research design adopted for the study is pre-experimental, one group pre test

and post test design.

The symbolic representation of design is;

Group Pre-test Intervention Post-test

Single groupO1 X O2

O1:-Assessing the pre-test knowledge regarding prevention and control of avian

influenza A.

X: - Administering the self instructional module regarding prevention and control

of avian influenza A.

O2:- Assessing the post test knowledge regarding prevention and control of avian

influenza A after one week of providing the self instructional module.

7.2.3 Research settings:

The study will be conducted in selected poultry centers, Bangalore.

7.2.4 Population:

The population of the study comprises of workers in selected poultry centres,

Bangalore.

7.2.5 Sample size:

Sample size of the study is 60.

7.2.6 Sampling technique:

Purposive sampling techniques.

7.2.7 Sampling criteria:

Inclusion criteria:

15

• Poultry workers in selected poultry centers at Bangalore.

• The workers between the age group of 30-50 years in selected areas.

• Those who are willing to participate in this study.

• Poultry workers who are available during the time of data collections.

• Poultry workers who knows to read and write in Kannada.

Exclusion criteria for sampling:

• The subject who are absent during the course of study.

• Workers who are not co-operative to provide data.

7.2.8 Tool for data collection: Structured questionnaire consists of two parts,

• Part I: Proforma of socio demographic variables.

• Part II: Multiple choice questions regarding the knowledge on prevention and

control of avian influenza.

7.2.9 Plan for data analysis:

• Descriptive statistics: The descriptive statistics use to explain the frequency,

mean, percentage and standard deviation.

• Inferential statistics: The chi-square test is planned to associate the socio

demographic variables with level of knowledge and paired t-test will be used to

compare the pre test and post test knowledge.

7.3Does the study require any investigations or interventions to be conducted on

patients or other humans or animals? If so, please describe briefly.

Yes, a self instructional module will be given for the sample as intervention.

7.4 Has ethical clearance been obtained from your institution in case of?

Yes, consent will be obtained from concerned subjects and authority of

organization. Scientific objectivity of the study will be maintained with honesty and

impartiality.

16

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9 Signature of the candidate

10 Remarks of the guide

11 Name and designation of(in block letters)

11.1 Guide MRS.P. NEELAVATHI

PROFESSOR

MEDICAL SURGICAL NURSING

11.2 Signature

11.3 Co-guide(if any) MRS. GLADISH GEORGE

ASSISTANT PROFESSOR

MEDICAL SURGICAL NURSING

11.4 Signature

11.5 Head of the department MRS. GLADISH GEORGE

11.6 Signature

20

12 12.1 Remarks of the principal

12.2 Signature

21