A STUDY TO DETERMINE THE EFFECTIVENESS OF CHILD TO CHILD PROGRAMME ON HAZARDS OF PLASTIC WASTE AND

ITS SAFE DISPOSAL AMONG SCHOOL CHILDREN IN A SELECTED SCHOOLS AT BANGALORE.

M.Sc. Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

By

MS ARYA S.S

M.Sc NURSING 1ST YEAR

2011-2013

Under the Guidance of

HOD, Department of Child Health Nursing

K.T.G college of nursing

Hegganahalli Cross

Bangalore

RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES,KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE

AND ADDRESS

MS ARYA S.S

1st YEAR M.Sc NURSING

K.T.G COLLEGE OF NURSING,

BANGALORE

2 NAME OF THE INSTITUTION K.T.G COLLEGE OF NURING GANDHADAKAVALHEGGANAHALLI CROSSVISHWANEEDAM POST, MAGADI ROADBANGALORE-91

3 COURSE OF THE STUDY AND

SUBJECT

M.Sc. NURSING

(CHILD HEALTH NURSING)

4 DATE OF ADMISSION TO

COURSE

15-09-2011

5. TITLE OF THE STUDY

A STUDY TO DETERMINE THE EFFECTIVENESS OF CHILD TO

CHILD PROGRAMME ON HAZARDS OF PLASTIC WASTE AND ITS

SAFE DISPOSAL AMONG SCHOOL CHILDREN IN A SELECTED

SCHOOL AT BANGALORE.

6.0 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

The word “plastic” comes from the Greek word “plastikos”

meaning “to form”. Plastics is any of a group of synthetic or natural organic materials that

may be shaped when soft and then hardened, including many types of resins,

resinoids,polymers, cellulose derivatives, casein materials, and proteins: used in place of other

materials, as glass, wood, and metals, in construction and decoration, for making many

articles, as coatings, and, drawn into filaments, for weaving. 1

As a result of increased production and use of chemicals, a

myriad of chemical hazards are present at homes, schools, play grounds and communities.

Chemical pollutants are released in to the environment by unregulated industries or are

emitted from heavy traffic or toxic waste sites. About 50,000 children aged 0-14 years old die

every year as a result of unintentional poisoning. 1

One among the most hazardous manufacture is the plastic.

Plastic is a group of different chemical substances, which consists of a substance having a

high molecular weight called polymers, that change from the thin consistency of plastic into

solid at the final state. 2

Polymers are large molecules that are built up by repetitive

linking of many smaller units called monomer. 3The most popular plastic polymer is

Polyvinyl Chloride (PVC), when any food material or blood is stored in the PVC plastic

containers; the chemical in it gets dissolved. The released chemical may later cause cancers,

skin diseases and other health hazards. 2

Plastic has become a part of every aspect of human living.

It is made important from birth by its use in the form of catheters, masks, sheets etc till the

grave with its multiple facets of application. It is been used for packaging, carrying, storing

and wearing, that which made the life more risky to its exposure. It has become the health and

environmental hazard. 3

The modern risk extra to basic environmental risks are

unsafe use of dangerous chemicals, inadequate disposal of toxic waste and environmental

hazards, noise, industrial, pollution, unsafe chemicals in toys and household products may

also harm children. Emerging potential environmental threats to pollutants and chemicals and

other hazards and emerging diseases. One among them is the plastic products and its use.4

Segregation of waste at the source is very important. After

segregation the material goes to a small industry for re-cycling. Decomposable and bio-

degradable is segregated from dry waste such as paper and plastic. 4

There is a great need to do more tackle environmental risks

to children’s health. The burden of disease from environmental related diseases is great and

falls disproportionately on children. In September 2002, WHO launched the healthy

environment for children initiative. It is with different groups around the world to turn their

initiative in to vibrant, global alliance which will be capable of mobilizing local support and

intervening to make children’s lives healthier where they live, learn and play. Every child has

the right to grow up in a healthy home, school and health include global climate change,

ozone depletion, contamination of persistent organic community. The future development of

our children and of their world depends on their enjoying good health now. 5

6.1

Children are more vulnerable to the illness. They are also

more capable of preventing them. The long lasting ill effects could be brought down through

an awareness and modification of the life style at the early age of their life. Use of plastic

containers, bottles and other items by children has become common. It leads to many risks in

life. However it could be only prevented rather repenting at the following stage. This could be

possible through the education given to them in the school days.5

NEED FOR STUDY In India plastic consumption trebles every decade. The impacts of

plastic can be felt across every stage of life, from fetus to adulthood. No one can ignore the

devastating consequences of plastic. In India polyvinyl chloride is commonly used to prepare

plastic materials. From slippers to the stationary used in schools, buildings and officers are

plastic. The dangers of PVC are pervasive phthalate, one of the plasticizers bond loosely with

polymer chains and can easily leach out, leading to severe consequences such as hormonal

imbalance, systemic disorders, decline in sperm count in men and also causes cancers. 6

The study on seventy one poly vinyl chloride made toys

including five from India showed a high level of phthalates. Even adults are known to be

susceptible to the effects of phthalates, especially pregnant women. It can result immature

babies, birth defects and depressed hormone response.5

Polystyrene, another commonly used polymer in plastic used to

pack food, leaches another toxic chemical namely bisphenol – A, a building block of plastic

which causes hormonal imbalance and different types of cancers. 5

Poly carbonates used for making babies bottles and water bottles

can cause severe systemic disorders in children. Other types of plastics such as poly ethylene

trephthalate (PET) is used in manufacturing cooking oil containers, low density poly ethylene

(LDPE) which is a vital component in plastic bags, poly propylene (PP) used to make caps for

containers all impact public health in various ways. 5

Bisphenol A. (BPA) a chemical in the poly carbonate plastic mimics

the hormone estrogen and causes chromosomal abnormalities 7

Plastics are the culprits in the clogging of our storm water drains,

the slow poisoning of the animals in the zoo and the cows on our streets. It also causes

chemical toxins to the subsoil of our landfills and if burnt it cause atmospheric pollution. For

anybody who cares about the future of our environment, plastic is a powerful adversary.8

Horror stories about recycled syringes, other plastic materials and

quilts packed with used surgical cotton keep pouring out of the dirty backyards of our

hospital. Segregation is the key to this waste management. Plastic bags take one million years

to degenerate. 9

The evidence from literature showed that hazards of plastic use

are highly dangerous to health and environment. Although many planned teaching programme

were developed in India on various topics, the investigator has not come across any studies on

effectiveness of a planned teaching programme on hazards of plastic use. The self-observation

of the investigator regarding the plastic use and disposal, motivated to investigate and teach

school children on hazards of plastic use.8

Health education to school children in their

formative age is the most effective method for protection and promotion of their health.

Health education in school children can be carried out in different ways and settings.

Approaching every individual in the rural area is Herculean task with poor sustainability.

Mass media and other teaching methods have their limitations. Under these circumstances

child- to –child programme offers most cost effective strategy to approach the

communities and families.7

Innovative approaches to education for health are essential to gain the

interest,support,involvement and commitment of students. The communication of health

messages is a central component of the child to child programme.This communication

occurs largely between groups where the message is transferred from a group of children

to group of respondents. This method is less stressful and more effective approach of

health education. children’s especially are vulnerable to this disease condition and through

teaching programme the mortality and morbidity rate can be controlled and prevented to a

great extent. So the investigator is very much interested in doing this topic10

REVIEW OF LITERATURE

INTRODUCTION

Review of literature is a key step in the research process. The typical purpose of

analyzing a review of existing literature is to generate questions and to identify what is known

6.2and what is unknown about the topic. The major goals of review of literature are to develop a

strong knowledge base to carry out research and non research scholalarly activity.

The review has been divided under the following headings:

1) Hazards of plastic use on human health

2) Hazards of plastic use to the environment

3) Food toxicity due to plastic chemicals.

4) Effectiveness of planned teaching programme

STUDIES RELATED TO HAZARDS OF PLASTIC USE ON HUMAN HEALTH

A study to find mortality patterns among workers exposed to styrene in

the reinforced plastic boat building industry revealed over all, 860 deaths (Standardized

Mortality Ration (SMR) 1.09, Confidence interval 1.02-1.17). The excess mortality was

accounted for esophageal cancer (n=12, SMR 2.30, CI 1.19-4.02), and prostate cancer (n=24,

SMR 1.71, CI 1.09-2.54 (Accidents (n-94, SMR 1.26, CI 1.02-1.53). Among 2.062 highly

exposed workers, urinary tract cancer (n=6 SMR 3.44, CI 1.31-4.44) rates were elevated and

urinary tract cancer SMR increased with duration of employment.11

A study on storage of serum in plastic and glass containers

may alter the serum concentration of polychlorinated biphenyls (PCBs), which is a plastic

content. The information on storage in glass (n=28) versus plastic containers (n=113) was

analyzed. Results revealed the higher PCB values (0.075 micro g/L Vs 0.45 micro g/z,

p=0.025) in the serum stored in plastic containers. The proportion of PCB detects in both

subsamples did not differ.12

A study was conducted to evaluate of the efficiency of

respiratory protective equipment based on the biological monitoring of styrene (content of

plastic). Five factories including 39 workers were investigated. Three types of respiratory

protective equipment were tested. The 20ppm which is the occupational exposure limit

recommended by the Japan society for occupational health. The result showed a significant

disparity in the efficiency of the respirator p<0.05. The site concentrations exceeded 20ppm at

10 of the 82 sampling points (12.2%) and 22 of the 39 workers (56.4%). depending on the

frequency of cartridge exchange (p<0.05). Overall study finding showed that, inspite of a half-

mask respirator used and its inhalation exchanged cartridge every half a day, the workers were

still exposed to a high styrene concentration inhalation at or over 122ppm. the study revealed

the relation of the plastic content styrene with the occupational health and personal health

when used for medical intervention.13

A cross sectional study was conducted to find the

respiratory effects of occupational poly propylene flack exposure. A total of 60 poly

propylene flocking workers were compared to a control group of 45 subjects. The result on

logistic regression analysis showed higher risk of 3.6 fold for respiratory symptoms in

polypropylene flocking workers when compared to controls. Para meters of the study group,

including percent predicted forced vital capacity ; forced expiratory volume in one second,

forced mid expiratory flow 25-75% and DL, CO, were significantly lower than in controls.

Mutlivariate analysis showed that, being polypropylene flocking worker was a predictive

factor of impairment of pulmonary function. Serum IL -8 and TNF – alpha levels were

increased in the study group compared with the controls. High resolution computed

tomography revealed peribronchial thickening and diffuse ground glass attenuation in some

subjects. The study suggested the presence of subtle or the beginning of interstitial lung

disease in these polypropylene flocking workers. 14

A comparative study on cardio toxic effect of Tinuvin 770 –

A light stabilizer of medical plastics was done in rat model. Tinuvin is a component of many

plastic materials used in medical and food industries. Investigation on cardio toxic effects of

Tinuvin 770 in vivo conducted on wistar rats by injecting intra peritoneally with increasing

doses of tinuvin 770 (1,10,100 mug and 1mg) 15 times during a 5 week period showed focal

myocytolysis and hyper contraction necrosis. Morphological results correspond the

catecholamine induced myocardial damage.15

STUDIES RELATED TO HAZARDS OF PLASTIC USE TO THE ENVIRONMENT

A study was conducted on poly chlorinated biphenyls

(PCBs) in the compost amended soil of a landfill site. The purpose was to determine if any of

the mixture of PCBs, Aroclor 1254 and Aroclor 1260 are retained in the compost amended

soil, despite atmospheric loses possible due to the peak summer (100-1170F). The method was

standardized by taking 10gm of ground soil sample in duplicate and spiked separately with

known concentration of Aroclor 1254 solution prepared in n-hexane. The maximum total

PCBs concentrations on dry wet basis were found as 1.2 ug/g. The distribution of PCBs levels

suggested an airborne mode of transport from the source. These compounds have adverse

effects on the organisms by having deposited at the top of food web including human being. 16

A study was conducted to find heavy metals

contamination in surface and ground water supply of an urbanity. The final water supply of

four treatment plants and lighty tube wells at Delhi were surveyed for cadminn chromium,

copper iron, lead, manganese, nickel, selenium and zinc. On this most of them are plasticizers.

The sample stored at room temperature and inductively. Coupled plasma atomic emission

spectrometer (ICP-AES) was used for analysis. Result showed high levels of lead, manganese,

cadmium, copper and iron compared to the Indian standard specification of 5mgL-1. Thus

study revealed the chemical toxicity to the water which cause ill effects to human health.17

A study was conducted on a cluster randomized

controlled trial evaluating the effect of hand washing promotion programme in china in

2007.87 schools were selected randomly to usual practices, slandered intervention. in control

schools, childrenexperienced a median 2 episodes of absence per 100 students per week. in

standard intervention schools ,there were a median 1.2 episodes (p=0.08) and 1.9 days

(p=0.14) of absence per 100 students weeks. Children in expanded intervention school

experienced a medium 1.2 episodes (p=0.08) and 1.9 days (p=0.14) of absence per 100

students per week. Children in expanded intervention schools experienced a medium 1.2

episodes (p=0.003) of absence per student weeks. The results showed that provision of a large

scale hand washing programme and soap was associated with significantly reduced

absenteeism.18

STUDIES RELATED TO FOOD TOXICITY DUE TO PLASTIC CHEMICALS

A comparative study of global migration levels of

recycled vs. virgin poly ethylene for packaging and storage of milk was done by using a

sample of virgin and recycled blended polyethylene films. A piece of LDPE (low density

polyethylene) was brought into contact with the stimulating solvent under the specified time

and temperature. At the end of prescribed duration, the contact liquid evaporated and the

residue was weighed for a constant weight. Analysis showed increase value of global

migration with increase percentage of recycled granules and percentage and type of activities

in film at every temperature and time combination with all extractants. The global migration

was determined by extraction method. The extractability (leaching from the LDPE) was

determined by contracting the polyethylene sample with either the food material or a range of

oily, alcoholic and aqueous extractants which stimulate various foods. 19

STUDIES RELATED TO CHILD TO CHILD PROGRAMME

A study was conducted to evaluate the effectiveness of child

to child programme on hazards of plastic waste in a selected school in Bhopal in2006.the

research approach selected was evaluative. The sampling technique was purposive and sample

size was 10 change agents and peer groups. The tool comprised of structured questionnaire.

The pre test knowledge scores range between 29.2 % to 43.3 % and post test knowledge

scores range between 65.3 % to 88.4 %.the gain in knowledge scores range between 25.6% to

4.5 %.the result showed that the post test knowledge was greater than the pre test knowledge

in every section of child to child programme. 20

A study was conducted to evaluate the effectiveness of

child to child programme in Jamaica in 2004 about the concept of Plastic disposal . A child

programme was carried out in fourth and fifth grade students of six schools.423 students and

90mothers and guardians from four of the project school were evaluated and compared with

199 children and 47 parents from 2 control schools. The project children showed higher

knowledge in the topic at the end of the year.21

A study was conducted to assess the impact of child to child

programme on knowledge,attitude,practice regarding plastic waste disposal strategies among

school children in Belgaum district in Karnataka .The subjects included sixth grade students

of primary schools. The study group and the sixth grade students as control group pre tested

pre designed questionnaire was administered to study as the Control group students to know

their knowledge, attitude and practice prior to starting of the programme.Once a week one

hour child to child session were conducted for the study group students. The result of the

study showed that child to child programme had made a significant improvement in the

knowledge, change in attitude and practice of the study group students after the intervention

when compared to control group students. 22

STATEMENT OF PROBLEM:

“A STUDY TO DETERMINE THE EFFECTIVENESS OF CHILD TO CHILD

PROGRAMME ON HAZARDS OF PLASTIC WASTE AND ITS SAFE DISPOSAL

AMONG SCHOOL CHILDREN IN A SELECTED SCHOOL AT BANGALORE “.

6.3

6.4

OBJECTIVES OF THE STUDY

The objectives of the study are:

To assess the existing knowledge of school children regarding hazards of plastic

waste and its safe disposal.

To evaluate the effect of child to child programme on knowledge regarding hazards of

plastic waste and its safe disposal.

To associate the knowledge with selected demographic variables such as age, religion,

education of the parents, type of family, area of residence.

HYPOTHESIS

The hypothesis will be tested at 0.05 level of significance.

H 1: There will be significant difference in the pre test and post test knowledge

scores of school children receiving child to child programme..

H 2: There will be significant association between knowledge of school children

and selected demographic variables such as age,religion,education.

Of the parents, type of family, area of residence.

OPERATIONAL DEFINITIONS:

DETERMINE In this study it refers to firmly decide on the effect of child to child programme

6.5

6.6

on hazards of plastic waste and its safe disposal as measured by the semi –structured

questionnaire and expressed as the post test scores of the experimental group.

EFFECTIVENESS In this study it refers to producing the desired or intended result of child to child

programme on hazards of plastic waste and its safe disposal as measured by the instrument

and shown by the post test scores of the experimental group.

CHILD TO CHILD PROGRAMME

It is an approach of health education in which a group of students are selected

according to their academic abilities, interest in participating group activities and their

communication abilities as reported by their teacher and giving health education to

these selected students regarding hazards of plastic waste and its safe disposal and these

students educate other students of the school.

KNOWLEDGE

In this study it refers to the correct responses of the students to the knowledge

part of the questionnaire of the interview schedule and expressed as knowledge scores

SCHOOL CHILDREN

Those children between 11-13 years of age, studying in 7 th standard of a selected

School.

HAZARDS

It refers to the ill effects caused by plastic on the environment and health of human

6.7

beings, in terms of physical and emotional capabilities.

DISPOSAL

It refers to safe methods of getting rid of plastic wastes.

ASSUMPTIONS

Adequate information about hazards of plastic waste and its safe disposal can be

provided through child to child programme.

Knowledge level of the students will be improved.

They will follow good plastic waste disposal strategies.

DELIMITATIONS:

The study is delimited :

To children’s

who knows kannada or English

Children between the age group of 11 to 13 years.

PROJECTED OUTCOME: The present study will help the rural school children to understand about the

6.8

6.9

7.0

hazards of plastic waste and its safe disposal

MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from school children who are studying in 7 th grade.

7.1.1 RESEARCH DESIGN

The research design adopted for this study is pre experimental study. One group pre

test and post test control group.

RESEARCH APPROACH

The research approach is evaluative.

7.1.2 SETTING:

The study will be conducted in S.V sunrise school Bangalore. It is 10 km away from

the College.

7.1.3 POPULATION

The population selected are school children who are studying in 7 th grade.

7.2 METHOD OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE

The Sampling Technique adopted for this study is purposive.

7.2.2 SAMPLE SIZE

The sample size is 60.

7.2.3 INCLUSION CRITERIA

The criteria for sample selection are mothers of under five who

Students of 7 th grade both boys and girls.

willing to participate in the study

students who are present on the day data collection.

7.2.4 EXCLUSION CRITERIA

Children who are studying in other grades.

7.2.5 INSTRUMENT INTENDED TO BE USED

SELECTION OF TOOL

This consist of three parts :

PART 1 :consist of demographic variables such as age,religion,education of the parents,

type of family, area of residence.

PART 2:Questionnaire will be used to assess the knowledge.25 Questions will be used.

SCORING PROCEDURE

For knowledge assessment

For Answers. If answer is yes 1

If answer is no 0

SCORING INTERPRETATION Good :- 75-100%

Average :- 50-75%

Poor :- Below 50%

7.2.6 DATA COLLECTION METHOD

Prior permission will be obtained from the principal of the school before conducting the study.

Self administered questionnaire will be distributed to the children and responses will be

collected . Data will be collected from 2 to 3 samples per day. The duration will be 4 weeks.

7.2.7 PILOT STUDY

6 samples will be selected and a study will be conducted to find out the feasibility.

7.2.8 DATA ANALYSIS PLAN

The data obtained from will be analyzed in view of the objectives of the study using

analytical and inferential statistics.

The plan of data analysis is as follows:-

Frequencies and percentage of distribution will be used to analyze the demographic

data.

Mean, Median and Mode , Standard Deviation is used for accessing the knowledge

score

DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS?

- No-

HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

7.3

7.4

YES, Ethical clearance will be been obtained from the research committee of

K.T.G college of nursing.

Consent will be taken from the authority and permission will be taken from the

study subjects before the collection of data.

LIST OF REFERENCES

1 ) Elias, Hans-Georg ” An Introduction to Plastics”4th edition. Wiley & Weinheim

Publishers; (2003);pno 121.

2 ) Andrady, Anthony.” Plastics and the Environment” 6th edition . John Wiley & Sons;

2003); pno 222

3) Callan, Scott and Thomas.”Environmental Economics and Management ” Environmental

8.0Health Journal ; (2006) June4 (2):59.

4 )Dr.Veena SR .“Handling Hospital waste Health action “ The Indian Journal on

Medicine :2003 ;December; 16 (12): 19-21.

5) Susan Norwood.” Environmental Health Hazards and Children” The Environmental Health

Journal :2006 ;Feb. 5(25):25-29.

6 ) Richardson. E,et al.” Environment and Health”.Archives of Environmental Health

Journal :2001;May;56(3):264-70.

7) Dave G,Etal.”Environmental Health Hazards”. Science Total Environmental Journal .:

2011; August;409(18):9-24.

8 ) Gregory MR.” Effects of Plastic Burning on Environment ”. Biological Science Journal.:

2009 ; July;364(1526):2013-25.

9) Dr. Veena SR Handling Hospital waste. Health action 2003 December; 16 (12): 19-21.

10)Kalpana Sunder “Plastics a Menace”. The Indian Journal On Environmental

Health.:2009;Jan 37(3): 119-137.

11) Ruder AM. Ward EM, Dongm, Okum AH, Davis-King K. Mortality patterns among

workers exposed to styrene in the reinforced plastic boat building industry. Amj Ind Med 2004

Feb; 45 (2) 165-76.

12) Karmaus W, Rie bow jf. Storage of Serum in Plastic and Glass Containers may alter the

serum concentration of polychlorinated biphenyls. Environment Health Prospect 2004 May;

112 (b): 643-647.

13) Nakayama S, Nishide T, Horike T, Kishi Moto T, Kiras. Evaluation of the efficiency of

respiratory protective equipment based on the biological monitoring of styrene in fibre glass

reinforced plastic industries. Journal of Occupational health 2004 March; 46 (2) : 132-140.

14) Atis S, Tutluoglu B, Levent E, OZturk C, Tunacl A, Sachin K, et al. The respiratory

effects of occupational poly propylene flock exposure. Eur Respir J. 2005 Jan; 25 (1) : 110-

117.

15) Sotonyi, Peter Merkely, Bela, llubay, Marta, et al. Comparative Study on Cardiotoxic

effect of Tinuvin 770 : A light stabilizer of medical plastics in Rat Model. Toxicological

Sciences, 2004 Feb; 77 (2) : 368 – 374.

16) Thacker NP, Titus A, Pande SP. Poly chlorinated biphenyls in compost amended soil of a

land fill site. Indian Journal of Environmental Health 2002 Jan; 44 (1) : 19-23.

17) Dixit RC, Verma SR, Nitnaware V, Thacker NP. Heavy Metals contamination in surface

and ground water supply of an urban city. Indian Journal of Environmental Health 2003 April;

45 (2) : 107-112.

18) Chen X, Xi F, Geng Y,”potential environmental gains from recycling waste plastics”.

Waste Management journal: 2011; January; 31(1):168-79.

19) Upender MK, Srivastava, Sing P. Chopras. Comparative Studies of Global Migration

levels of recycled Vs. Virgin polyethylene for packaging and storage of milk. Indian Journal

of Environmental Health 2003 April; 45 (2) : 101-106.

20) Thaneja .r “use of ctc to evaluate knowledge regarding plastic disposal in selected

schools”. the Indian journal of holistic nursing 2006 14(2):12-14.

21) Jennifer knight,grantham “the effectiveness of ctc programme” the American journal of

Pediatrics;2002,6:66-68.

22) Walvekar p.r,naik v.a,wantamutte a.s.”impact of child to child programme on

knowledge,attitude and practice regarding hazards of plastic among rural school

children”.theIndian journal of public health;2006 february 31(2):45

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3CO-GUIDE

11.4SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THE PRINCIPAL

12.2 SIGNATURE