RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTSFOR

DISSERTATION

1. NAME OF THE

CANDIDATE AND

ADDRESS

MR. RAFIK R.

1 s t YEAR, M.SC.NURSING.

E.T.C.M. COLLEGE OF NURSING,

E.T.C.M. Hospital , Post Box No. 4,

Kolar – 563 101

2. NAME OF THE

INSTITUTION E.T.C.M. COLLEGE OF NURSING,

KOLAR

3. COURSE OF

STUDY AND

SUBJECT

MASTER DEGREE OF NURSING.

MEDICAL SURGICAL NURSING.

4. DATE OF

ADMISSION TO

COURSE

   

01-06-2009

5. TITLE OF THE

TOPIC

“A study to evaluate the effectiveness of

structured teaching programme on dietary

management and compliance to drug therapy

among TB patients in a selected hospital at

Bangalore.”

 

BRIEF RESUME OF THE INTENDED WORK

6. INTRODUCTION

Communicable diseases are the major health problem of the

country. Some of them appear in epidemic form and some in endemic

form. Communicable diseases are caused by specific infective agent,

transmitting the infection from a reservoir to susceptible host 1 .So one

among them is tuberculosis which was first formally described by Greek

physician Hippocrates around 460 B.C.E. He called i t phthisis , which is

the Greek word for consumption; because it described the way the disease

consumed its victims. Consumption was the most widespread disease of

the t ime, and most of i ts victims died. The word consumption was used to

describe the disease until 1882, til l the tuberculosis bacteria were

identified as the cause of the disease. 1

Tuberculosis is a chronic infectious disease and one of the

major cause of illness and death in the underdeveloped countries as well

as the deprived sections of the developed countries. Malnutrition resulting

from poverty and ignorance combined with unhygienic living conditions

and poor ventilation makes and individual susceptible to the infection.

Tuberculosis is an infectious diseases caused by mycobacterium

tuberculosis. 2 It usually involves the lungs but i t also occurs in the

larynx, kidney, bones, adrenal glands, lymph nodes and meanings

tuberculosis kills more people world wide than any other infectious

diseases. It estimated that between 19% and 43% of the Worlds

populations is infected with M.tuberculosis 4 . The WHO estimated at more

than 8 mill ion new cases of TB occur each year. And approximately 3

million people die from the disease. 3

According to WHO, India is number one in terms of

tuberculosis (TB) prevalence and it is an alarming health problem of the

public. The global body in its latest report said that 299 Indians in every

100,000 population are infected with TB and the mortality rate is 28 per

100,000. Of all new cases in India, 1.2 percent is infected with HIV.

While 2.8 percent of the new cases have been diagnosed with multi-drug

resistant TB (MDR-TB), 17 percent of patients who have availed treatment

at some point have developed drug resistance. The global health watchdog

said the pace of TB control and diagnosis has slowed down across the

world including India the report said there were 9.2 million new cases of

TB during 2006, of which 700,000 cases are found among people with

HIV/AIDS up from 22,000 in 2002. Worldwide there are 500,000 cases of

MDR-TB and an estimated 1.5 million people died from the disease in

2006. Another 200,000 people with HIV died from HIV-associated TB,

WHO said. “The Revised National TB Control Programme (RNTCP) of

India has begun to operate in parts of the country that are particularly

challenging,” WHO said in its report. “The introduction of MDR TB

treatment as part of routine programme activities will succeed only if the

planned sub-national reference laboratories function properly and if a

reliable supply of high quality second-line drugs is available,” the global

health watchdog cautioned. 4

On the occasion of the World TB Day 2009 comes some relief

in a developing country such as India where the rate of cure is said to

have doubled and 85 per cent of the global and national target achieved.

The detection rate is almost 70 per cent (72 per cent in 2004 and 66 per

cent in 2005) while the fatality rate has reduced to 4 per cent from 29 per

cent in NSP (new sputum positive) cases. Deaths due to TB have come

down from 5, 00,000 to less than 3, 70,000.

Over six million patients have been init iated on DOT

(Directly Observed Treatment) and over 10 lakh lives have been saved.

These figures display early signs of a good beginning of the decline of TB

incidence and prevalence as a direct impact of Revised National

Tuberculosis Control Programme (RNTCP) being implemented by the

Government, according to C.C. Kardiguddi, District Tuberculosis Officer

and he said TB remains a major public health problem in India with

approximately 18 lakh people developing TB and about four lakh

succumbing to the disease.

India accounts for one fifth of the global incidence rate and

tops the l ist of 22 high TB-burdened countries. Every day, more than

40,000 people get infected by tubercle bacill i, 5,000 develop the disease

and 1,000 die of TB. Globally, the estimated figures show that 18 lakh

people die of TB, a majority of them in developing countries. The annual

incidences of new cases of all forms of TB account for about 88 lakh, 95

per cent of which occur in developing countries 5 .

Many patients with active TB experience severe weight loss

and some show signs of vitamin and mineral deficiencies. It is important

to consume a balanced diet to provide body with the nutrients that needed

to fight tuberculosis. It particularly important to avoid consuming any

alcohol during the entire course of treatment as this could result in

treatment complications and side effects. Weight gain generally improves

during appropriate tuberculosis treatment and appropriate nutri tional

supplementation. However, persons who complete treatment are at risk of

losing weight that was gained.

The ult imate aim of any prescribed medical therapy is to

achieve certain desired outcomes in the patients concerned. These desired

outcomes are part and parcel of the objectives in the management of the

diseases or conditions. However, despite all the best intention and efforts

on the part of the healthcare professionals, those outcomes might not be

achievable if the patients are non-compliant. This shortfall may also have

serious and detrimental effects from the perspective of disease

management. Hence, therapeutic compliance has been a topic of clinical

concern since the 1970s due to the widespread nature of non-compliance

with therapy. Therapeutic compliance not only includes patient

compliance with medication but also with diet, exercise, or life style

changes. In order to evaluate the possible impact of therapeutic non-

compliance on clinical outcomes, numerous studies using various methods

have been conducted in the United States (USA), United Kingdom (UK),

Australia, Canada and other countries to evaluate the rate of therapeutic

compliance in different diseases and different patient populations.

Generally speaking, i t was estimated that the compliance rate of long-term

medication therapies was between 40% and 50%. The rate of compliance

for short-term therapy was much higher at between 70% and 80%, while

the compliance with l ifestyle changes was the lowest at 20%–30%

Furthermore; the rates of non-compliance with different types of treatment

also differ greatly. Estimates showed that almost 50% of the prescription

drugs for the prevention of bronchial asthma were not taken as prescribed.

Patients’ compliance with medication therapy for hypertension was

reported to vary between 50% and 70% In one US study, found that

antihypertensive compliance averaged 49%, and only 23% of the patients

had good compliance levels of 80% or higher. Among adolescent

outpatients with cancer, the rate of compliance with medication was

reported to be 41%, while among teenagers with cancer it was higher at

between 41% and 53%. For the management of diabetes, the rate of

compliance among patients to diet varied from 25% to 65%, and for

insulin administration was about 20% More than 20 studies published in

the past few years found that compliance with oral medication for type 2

diabetes mellitus ranged from 65% to 85%. As previously mentioned, if

the patients do not follow or adhere to the treatment plan faithfully, the

intended beneficial effects of even the most carefully and scientifically-

based treatment plan will not be realized. The above examples illustrate

the extent of the problem of therapeutic non-compliance and why it should

be a concern to all healthcare providers. 6

These can be achieved by creating awareness among the

tuberculosis patients regarding dietary management and compliance to

drug therapy so i t is necessary that nurses as a member of health care team

should take init iative to create awareness among the public.

6.1 NEED FOR STUDY

Tuberculosis is a disease of time. It is a chronic infectious

disease and is one of the major cause of il lness and death in the

underdeveloped countries, as well as the deprived sections of developed

countries . Because of the high mortali ty rates tuberculosis is considered as

a social disease. Being a social and chronic natural disease the

tuberculosis affects the l ife style of the persons suffering from

tuberculosis and also affects his family life style activities like sleeping

pattern, dietary requirements compliance with medicine regime 7 .

According to World Health Organization (WHO) estimates,

each year, eight mill ion people worldwide develop active tuberculosis and

nearly two million die. One in 10 people who are infected with

tuberculosis may develop active TB at some time in their lives. The risk

of developing the active disease is greatest in the first year after

infection, but active disease often does not occur until many years later.

Globally the estimated figures show that 18 lakh people die of

TB, a majority of them in developing countries. The annual incidence of

new cases of all forms of TB accounts for about 88 lakh 95% of which

occur in the developing countries 5 .

Tuberculosis is a major public health problem in India. India

accounts for one-fifth of the global TB incident cases. Each year nearly 2

million people in develop TB of which around 0.87 million are infectious

cases. It is estimated that annually around 3, 30,000 Indians die due to TB

and every day more than 40,000 people get infected by tubercule bacill i,

5000 develop the disease and 1000 die of TB 5 .

The one year census of District Tuberculosis Centre shows

that nearly 4000 people are affected with Tuberculosis in Kolar district.

Among them, 1745 per lakh patients are receiving DOT’S treatment 8 .

Recommendation in tuberculosis there is a considerable

wasting body tissue. Therefore i t is essential to increase protein intake in

the form of cereal and pulse combination include a liberal amount of

calcium in your diet to promote healing of tuberculin lesions. If patient

suffers from hemorrhage high iron supplementation is necessary. The diet

should provide as mush retinol as possible by giving milk, milk product,

eggs and meat. The tuberculosis being an infectious disease results in

increased urinary loss of ascorbic acid. As the recommended in the diet in

the form of guava, amla, orange, lemon and sprouted pulses. 9

Department of Nutrition, School of Public Health and Health

Sciences, University of Massachusetts, Amherst, Massachusetts 01003,

USA conducted a study on vitamin D and tuberculosis. They reported that,

Vitamin D influences the immune response to tuberculosis, and vitamin D

deficiency has been associated with increased tuberculosis risk in

different populations. Genetic variabili ty may influence host

susceptibility to developing active tuberculosis and treatment response.

Studies examining the association between genetic polymorphisms,

particularly the gene coding for the vitamin D receptor (VDR), and TB

susceptibility and treatment response are inconclusive. However,

sufficient evidence is available to warrant larger epidemiologic studies

that should aim to identify possible interactions between VDR

polymorphisms and vitamin D status. 1 0

Compliance to therapy is one of the important factors that

affect the out come of therapy. Compliance can be defined as the extent to

which a patient’s behavior coincides with medical advice. Non-compliance

to self administered multi-drug tuberculosis treatment regimens is

common and most important cause of failure of initial therapy and

relapse.1 Non-compliance may also result in acquired drug resistance2,

requiring more prolong and expensive therapy that is less l ikely to be

successful than the treatment of drug susceptible tuberculosis.1 Studies on

acquired resistance (drug resistance among previously treated cases) from

Gujarat (1980-86) showed an increase resistance to isoniazid and

rifampicin and MDR - TB rates of 30%.3,4,5 The adoption of DOT has

been associated with reduced rate of treatment failure, relapse and drug

resistance.2 Despite the impressive gains in compliance associated with

the use of DOT, non-compliance with DOT also occurs when patients fail

to make themselves available for the administration of drug therapy.

Based on the above review literature and researchers experiences it

is felt that education on dietary management and compliances to drug

therapy for tuberculosis patients is important to develop awareness.

6.2 REVIEW OF LITERATURE

Review of l iterature is the task of reviewing li terature which

involves the identification, selection critical analysis and reporting of

existing information on the topic of interest. it provides the bases to

locate the data, new ideas that need to be included in the present study it

helps the researcher to find the accurate data that could be used for

supporting the present finding and drawing conclusion

This chapter deals with a review of published and

unpublished research studies and related material for the present study the

review helped the researcher to develop on insight into the problem area

and helped to build the foundation of the study

The Review of li terature is presented under the following

broad heading

6.2.1 Studies related to dietary management of tuberculosis.

6.2.2 Studies related to compliance to drug therapy

6.2.3. Studies related to knowledge among TB patients .

6.2.1. REVIEW OF LITERATURE RELATED TO DIETARY

MANAGEMENT OF TUBERCULOSIS.

A randomized controlled trial of nutri tional supplementation

in patients with newly diagnosed tuberculosis and wasting was conducted

in department of infectious disease, Tan Tock Seng hospital in Singapur .

The nutri tional support is often recommended as part of the treatment of

tuberculosis, but it has never been properly tested so the objective of the

study was to assess the effects of early nutri tional intervention on lean

mass and physical function in patients with tuberculosis and wasting .The

Patients who started antituberculous therapy within the previous 2 wk

were randomly assigned to receive standard nutritional counseling

(control group) or nutrit ional counseling to increase their intake through

diet and high-energy supplements (nutrit ional supplement group) for 6 wk.

Body composition was measured by dual-energy X-ray absorptiometry,

and physical function was assessed by maximum grip strength.The result

of this study was patients in the nutrit ional supplement group (n=19) had

a significantly greater increase in body weight (2.57+/- 1.78 compared

with 0.84 +/- 0.89 kg, P = 0.001), total lean mass (1.17 +/- 0.93 compared

with 0.04 +/- 1.26 kg, P = 0.006) than did the control subjects (n = 17) at

week 6. During subsequent follow-up, the increase in body weight

remained greater in the nutritional supplement group, but this increase

was due mainly to a greater gain in fat mass in the nutri tional supplement

group than in the control group. This study concluded that the intervention

to increase nutri tional intake increases lean mass and physical function.

This adjunct to tuberculosis therapy could confer socioeconomic and

survival benefits that deserve investigation in large-scale trials.

Nutritional intervention after the init ial phase of treatment could be less

beneficial because i t mainly increases fat 1 1 .

Tuberculosis is a serious infection affecting mainly the lungs.

It may contribute to nutrit ional deficiencies which in turn may delay

recovery by depressing immune functions. Nutritional supplements might

therefore promote recovery in people being treated for tuberculosis. The

objective was to assess the provision of oral nutri tional supplements to

promote the recovery of people being treated with antituberculous drug

therapy for active tuberculosis. The method of this study was randomized

controlled trials comparing any oral nutrit ion supplement given for at

least four weeks with no nutrit ional intervention. Placebo, or dietary

advice only for people being treated for active tuberculosis the data

collection and analysis of this study was two authors independently

selected trails, extracted, data, and assessed risk bias, we calculated risk

ratio for dichotomous variables. And mean differences for continues

variables, with 95% confidence interval. We pooled data from the similar

interventions and outcome the result was twelve trials (3393 participants)

were included. Five trials had adequate allocation concealment.

Interventions included a high energy supplement, high cholesterol diet,

Vitamin D, Vitamin A, Zinc, arginine, multiple micronutrient

supplements, combined multiple micronutrient supplements and zinc,

combined Vitamin A and zinc and combined vitamin A and selenium. The

following supplements were associated were associated with increased

body weight at follow up: high energy supplements (MD 1.73 kg, 95% Cl

0.81 to 2.65, 34 participants, 1 trial); multiple micronutrients plus

additional zinc (MD 2.37 kg, 95% Cl 2.21 to 2.53; 192 participants, 1

trial); and vitamin A plus zinc (MD 3.10 kg, 95% Cl 0.74 to 5.46; 80

participants, 1 trial). There was no evidence that any supplement affected

the number of deaths or number of participants with sputum test positive

results at the end of treatment 1 2 .

An experimental study was conducted in Instituto Nacional

De enfermedades Respiratorias, Tiapari to determine whether a cholesterol

rich diet could accelerate sputum sterilization in patients with pulmonary

tuberculosis. An 8-week follow-up, randomized, controlled trial carried

out from March 2001 to January 2002. Adult patients with newly

diagnosed pulmonary tuberculosis were hospitalized for 8 weeks and

randomly assigned to receive a cholesterol-rich diet (800 mg/d cholesterol

[experimental group]) or a normal diet (250 mg/d cholesterol [control

group]). All patients received the same four-drug antitubercular regimen

(ie, isoniazid, rifampin, pyrazinamide, and ethambutol). Every week, a

quantitative sputum culture and laboratory tests were done and respiratory

symptoms were recorded. Patients in the experimental group (10 patients)

and the control group (11 subjects) were HIV-negative and harbored

Mycobacterium tuberculosis that was fully sensitive to antitubercular

drugs. Sterilization of the sputum culture was achieved faster in the

experimental group, as demonstrated either by the percentage of negative

culture findings in week 2 (80%; control group, 9%; p = 0.0019) or by the

Gehan-Breslow test for Kaplan-Meier curves (p = 0.0037). Likewise, the

bacillary population decreased faster (p = 0.0002) in the experimental

group. Respiratory symptoms improved in both groups, but sputum

production decreased faster in the experimental group (p < 0.05).

Laboratory test results did not differ between the groups. 1 3

6.2.2. REVIEW OF LITERATURE RELATED TO

COMPLIANCE TO DRUG THERAPY

A cross sectional study was conducted in Anand district ,

Gujarat India on the various aspects of compliance to directly observed

therapy (DOT) for the treatment of tuberculosis. The method of this study

has been carried out in tuberculosis units in Anand district all patients

who are register for DOT treatment during last quarter. The result showed

that the majority of study population (85%) was in age group of 15 - 55

years, which is the productive age. 34 patients, 12.4% of 274 patients had

poor out come, during course of DOT therapy. Fifteen expired and 19

defaulted for therapy. 93% of study population was compliant to the DOT.

The traditional risk factors for noncompliance like socio-demographic

factors, t iming, travel, cost of investigation and cost of therapy and long

waiting period; were not major hurdles for treatment adherence. The

toxicity of drugs was the major reason for defaulting for treatment. The

study revealed that the compliance of DOT was significantly high among

those who have good knowledge about various aspects of disease 1 4 .

A study was conducted in New York State in the department

of social services regarding compliance with tuberculosis treatment

corresponding to the primary drugs for the treatment of TB: isoniazid

(INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (ETH). 1,480

patients received 1 or more TB medications. Fi ndings of the patients

36.5% were identified with one drug (primarily INH), and 63.5% with

multiple TB agents. 69% of the patients had poor, discontinuous TB

therapy. The adjusted odds ratio (OR) for discontinuous care was

significantly lower for patients with a dominant provider of care, and for

patients with multiple TB drugs 1 5 .

6.2.3. REVIEW OF LITERATURE RELATED TO

KNOWLEDGE AMONG TB PATIENTS .

The study was done in Zambia to determine the knowledge

att itude and compliance with TB treatment by PTB patients attending

chest clinic at a tert iary hospital . 104 respondents aged 18 to 66 years

took part in the study. Forty-nine percent were female, 51.9% were

married and 42.3% had primary education only. About half of the

respondents (49%) had no monthly income and majority of those with no

income were female. Two third of the respondents (76%) lived in high-

density areas. Half of the respondents (49%) had average knowledge of

TB treatment. Majority of the respondents (89.4%) had positive attribute

towards TB treatment rating high in all the attitude subscales. 74% in

commitment, 84.6% in challenge and 55.8% in control. Most of the

respondents (80.8%) reported complying with TB treatment regimens.

There was a posit ive relationship between compliance and att itude,

indicating that as the level of attitude increases, compliance level also

increases (r = 0.59, p < 0.001). The results further showed that there was a

significant posit ive correlation between knowledge and atti tude. (r = 0.25,

p = 0.005) 1 6 .

A survey study was done in Taiwan among health workers

enrolled in TB training workshops prior to the execution of the directly

observed treatment, short course (DOTS) program to understand the depth

of knowledge of health workers involved in tuberculosis (TB) control

programs. There was l itt le understanding of the depth of knowledge of

health workers involved in tuberculosis (TB) control programs and even

less was known about health workers attaching stigma to TB patients. The

result of the study was pair comparison of knowledge scores revealed that

all participants made statist ically significant improvements in level of TB

knowledge, except those who had a history of TB (p = 0.331). Pair

comparison of st igmatization scores revealed a reduction in

stigmatization, with the DOTS workers attaching less st igma to TB

patients. After training caregivers, including women (p = 0.012). Public

health workers (p = 0.028), 40-49 year-old subjects (p = 0.035), those

with an education of < 12 years (p = 0.024), those who had been a

volunteer (p = 0.018), and those who had a history of TB and those who

did not (p = 0.034, p = 0.036), were significantly less likely to stigmatize

patients. TB knowledge was not found to be significantly correlated with

stigmatization (pre-test, p = 0.298; post-test, p = 0.821) 1 7 .

STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of structured teaching

programme on dietary management and compliance to drug therapy among

TB patients in a selected hospital at Bangalore.”

6.3. OBJECTIVE OF THE STUDY: 6.3.1 To assess knowledge regarding dietary management and

compliance to Drug therapy among TB patients

6.3.2 Evaluate the effectiveness of structured teaching

programme on dietary Management and compliance to

drug therapy among by co TB patients comparing Posttest

Knowledge scores of experimental and control group.

6.3.3 To determine the association between knowledge scores and

selected Demographic variables.

6.4. OPERATIONAL DEFINITIONS:

EVALUATE:To find the value or amount of knowledge about dietary management

and compliance of drug therapy.

STRUCTURE TEACHING PROGRAMME:It refers to organize teaching learning activity to impart knowledge

among TB patients

DIETARY MANAGEMENT :In this study it refers to the instruction for tuberculosis patient

about tuberculosis importance of protein, fats, carbohydrates lipids

diet and weight gain.

COMPLIANCE TO DRUG THERAPY :

In this study it refers to the will ingness and adherence to complete

the course of TB treatment.

TUBERCULOSIS PATIENTS :

The patients who are diagnosed as sputum positive and attending at

the OPD and male and female medical ward in selected hospital at

Bangalore.

6.5. ASSUMPTION: The patients will have some knowledge about dietary management

of tuberculosis

Teaching enhances the knowledge of tuberculosis patients.

The oral responses to the questionnaire would accurately reflect the

actual knowledge of the TB patients regarding dietary management

and compliance to drug therapy.

6.6. HYPOTHESIS: H 1 : There will be a significant statist ical difference between the

posttest knowledge scores of experimental And control group.

H 2 : there will be a significant statistical association between

Knowledge scores and selected demographical variables.

6.7. VARIABLES UNDER THIS STUDY :

Independent variable:

STP regarding Dietary management and compliance to drug therapy.

Dependent Variable:

Knowledge of TB patients regarding dietary management and

compliance to drug therapy.

Extraneous variable:

Selected demographic variables such as age, sex, education income,

occupation, area of residence and course of information.

7.0. MATERIAL AND METHODS:

7.1. SOURCES OF DATA: Data will be collected from the TB patients attending at the OPD

and male and female patients admitted in medical ward in a selected

hospital at Bangalore.

7.2.1. RESEARCH APPROACH :

Evaluation research approach.

7.2.2. RESEARCH DESIGN:True experimental research design with two group pre and posttest.

7.2.3. SETTINGS: The study will be conducted in a selected hospital at Bangalore .

7.2.4. POPULATION: All TB patients who are attending at the OPD and male and female

medical ward in selected hospital at Bangalore.

7.2.5. SAMPLING TECHNIQUE :

Simple Random sampling technique.

7.2.6. SAMPLE SIZE: The sample size consists of 60 TB patients (30 in experimental and

30 in control group)

7.2.7. CRITERIA FOR SELECTION OF SAMPLE: i) Inclusion criteria:

Male and female TB patients.

Those who are willing to participate in the study.

Those who knows Kannada, English and Hindi.

ii) Exclusion criteria:

Those who are absent during data collection.

7.2.8. DATA COLLECTION TOOL:

The researcher will collect through structured interview schedule. It

consists of two parts

PART I:

Sociodemographic data sheet

PART II:

Structured interview schedule regarding dietary management of

tuberculosis and compliance to drug therapy among TB patients.

7.2. METHOD OF DATA COLLECTION: Structured interview schedule will be used to collect data.

The data will be collected in the following stages:

(i) Ethical consideration: The written permission from authorities of

the selected hospital will be obtained prior to data collection.

(ii) The study participant will be selected by using simple random

sampling technique that fulfi lls the inclusion criteria.

(iii) Formal permission will be obtained from study participants after

explaining the objective of study.

(iv) Pretests data will be collected using structured interview

schedule regarding dietary management and compliance to drug

therapy.

(v) Conduct post test after 8 days after the teaching programme

using the same structured interview schedule.

7.2.9. METHOD OF DATA ANALYSIS :

(i) Demographic data will be analyzed using descriptive statistics

frequency distribution and percentage.

(ii) Knowledge of dietary management and compliance to drug

therapy will be analyzed by using descriptive statistics mean and

standard deviation.

(iii) Effective of STP will be analyzed by comparing by posttest

knowledge scores of experimental and control group using ‘t’

test

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION

OR INTERVENTION TO BE CONDUCTED ON

PATIENTS OR OTHER HUMANS OR ANIMALS?

Yes, non-invasive intervention will be done. The TB patients’

knowledge will be assessed using structure interview schedule on dietary

management and compliance to drug therapy among TB patients will be

conducted for the same group.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

INSTITUTION?

1. Permission will be obtained from the authorities of the selected

hospitals.

2. Permission will be obtained from research committee.

3. Informed consent will be obtained from the subject enrolled before the

study.

8. LIST OF REFERENCES

1. Kasturi sunderao an introduction community health nursing 4 t h edit ion

jantath Bi publications pvt. l td. 2004 P 605

2. File:H:\tuberculosis.htm Introduction an Ancient Scourage That Still Kills Today. page no 1.

3. Food Nutrition and diet Therapy KRAUSE and HUNSHER, 5th Edition page no 333.

4. www. thaidian.com/newsreporter/health/India-tops-in-tb-prevalence-drug-resistance-

learning-who_10028836. html3ixzz0ZU6Cfrha

5. Dr kadiguddi. The Hindu : Karnataka / Belgaum News : Deaths due to TB have reduced URL:www.thehindu.com/2009/03/26/stories/ 2009032650490200.htm

6. jing j in, grant Edward skalr, Vernon min sen oh, and shuchuen LI.

Factors affecting therapeutic compliance; department of pharmacy,

national university of Singapure: 2008 Feb: 4 (1) P. 269- 286

7. Park k text book of preventive and social medicine 17 t h edit ion

Jabalpur banarsides. Bhanof. 2002 P138 – 142

8. the report of district tuberculosis centre in the year 2007 – 2008 in

Kolar

9. File:H:\tuberculosis.htm eat to beat illness diet in tuberculosis page No.

1

10. chucano Bedoyap: department of nutri tion school public health

Science University. May 2009 67 (2) 289 -293

11. NI Paton. Randomized controlled trial of nutritional supplementation in patients

with newly diagnosed tuberculosis and wasting: 2004. Available from: URL

www.ncbi.nlm.nih.gov/pubmed/15277171.

12. Abba K, Sudarsanam TD, Grobler L, Volmink J. Nutritional supplements for people

being treated for active tuberculosis. (online).2008 October 08; available from:URL:

www.cochrane.org/reviews/en/ab006086.html

13. C Pérez-Guzmán, et al. A Cholesterol-Rich Diet Accelerates Bacteriologic

Sterilization in Pulmonary Tuberculosis.[online]. 2005 available from;

URL:www.chestjournal.org/content/127/2/643.abstract:

14. N. Pandit, S.K. Choudhary. A Study of Treatment Compliance in Directly Observed

Therapy for Tuberculosis. Indian Journal of Community Medicine 2006 , October-

December 31(4). Available from URL:medind.nic.in/iaj/t06/i4/iajt06i4p241.pdf

15. Cosler LE, Markson LE, Fanning TR, Turner BJ. Compliance with tuberculosis

treatment in a symptomatic HIV cohort.[online]. 1996 available from;

URL:gateway.nlm.nih.gov/MeetingAbstracts/102222174.html

16. Mweemba P, Haruzivishe C, Siziya S,et al. Knowledge, Attitude and Compliance

with Tuberculosis Treatment, Lusaka, Zambia. Medical Journal of Zambia. 2008;

35(4).12 available from URL:https://bora.uib.no/bitstream/ 1956/3476/1/

TBcomplaince PMPJ.pdf

17 P. Wu, P. Chou, N. Chang, et al. Assessment of Changes in Knowledge and

Stigmatization Following Tuberculosis Training Workshops in Taiwan. Journal of the

Formosan Medical Association.2009108 (5).377-385.available from URL:

linkinghub.elsevier.com/retrieve/pii/S0929664609600814

9. SIGNATURE OF THE

CANDIDATE

10. REMARKS OF THE

GUIDE

“The topic which is selected by the

candidate is relevant and appropriate to

increase the knowledge of tuberculosis

patients for their early recovery.

11. NAME AND

DESIGNATION OF

11. 1 GUIDE

MS. BEENA MARREL. M

Associate Professor

11.2 SIGNATURE OF

THE GUIDE

11.3 NAME OF THE

CO – GUIDE

11.4. SIGNATURE OF

THE CO – GUIDE

11.5 HEAD OF

DEPARTMENT MS. BEENA MARREL. M

11.6 SIGNATURE OF

THE HOD

12. 12.1 REMARKS OF THE

PRINCIPAL

“The topic selected is relevant as it

enhances the knowledge tuberculosis

patients regarding dietary management and

compliance to drug therapy.”

12.2 SIGNATURE OF

THE PRINCIPAL