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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING
KNOWLEDGE ON RESPIRATORY PROBLEMS (BAGASSOSIS) AND ITS PREVENTION AMONG THE WORKERS OF GYANBA SUGARS AND DEVELOPERS
LIMITED, DODDABATHI, DAVANGERE”
Mr. BASAVARAJ S.S. FIRST YEAR M.Sc. NURSING,
COMMUNITY HEALTH NURSING
BAPUJI COLLEGE OF NURSING DAVANGERE – 577 004.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA, INDIA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE AND
ADDRESS (IN BLOCK LETTERS)
Mr. BASAVARAJ S.S.
FIRST YEAR M.Sc. NURSING,
BAPUJI COLLEGE OF NURSING,
DAVANGERE – 4,
KARNATAKA.
2. NAME OF THE INSTITUTION BAPUJI COLLEGE OF NURSING,
DAVANGERE - 4.
3. COURSE OF STUDY AND
SUBJECT
FIRST YEAR M.Sc. NURSING,
COMMUNITY HEALTH NURSING.
4. DATE OF ADMISSION TO
COURSE
7th July 2010
5. TITLE OF THE TOPIC “A STUDY TO EVALUATE THE
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME
REGARDING KNOWLEDGE ON
RESPIRATORY PROBLEMS
(BAGASSOSIS) AND ITS PREVENTION
AMONG THE WORKERS OF GYANBA
SUGARS AND DEVELOPERS
LIMITED, DODDABATHI,
DAVANGERE”
1
6. BRIEF RESUME OF THE INTENDED WORK :
6.0 Introduction :
“Work is not a curse, it is the prerogative of intelligence, the only means of
manhood and the measure of civilization”.
Health is the precious possession of all human beings as it is an asset for an
individual and community as well. According to Dunn, “Health is defined as a dynamic
state of wellness which exists on a continuum and ranges from a high level of wellness
to high level of illness”.1
Historically the term health is derived from an old English word ‘Health’
meaning the condition of being ‘safe and sound’ or ‘whole’. To a lay person, health is
freedom from pain, illness and disabilities. Even in present time, many people still
believe in the same concept of health. There is change in this belief in the developed
world and also in the developed areas of developing countries because of research and
life experiences.1
The health problems of India may be conveniently grouped as : Communicable
disease problems, Nutritional problems, Environmental sanitation problems, Medical
care problems and Population problems.2
Among communicable diseases, most of the diseases are related to respiratory
tract as each day our lungs are directly exposed to more than 7000 liters of air, which
contain varying amount of inorganic and organic particles as well as potentially lethal
bacteria and viruses. Airway pathology changes have been recorded with industrial dust
and fumes. Dust, the tiny particles dispersed in air due to mechanical disintegration of
rocks, mineral and other materials by impulsive forces such as drilling, blasting,
crushing, grinding, milling, sawing and polishing or to the agitation or breaking down of
organic materials such as sugar cane fiber (bagasse), cotton fibers, pollens and fungal
spores.
2
6.1 Need for the study :
In India, the studies revealed that 40-59% of workers in different occupational
work environments suffered from one or more respiratory ailments. As much as 36-40%
of the workers reported work-related symptoms which is close to similar data from
western countries.3
An epidemiological survey was carried during 1999 around Delhi in India on
respiratory diseases among agricultural industry workers, such as bakeries, poultry
farms, granaries, and a sugar refinery by using a medical questionnaire on various
respiratory symptoms. The questionnaire was filled up by two doctoral students during
personal visits to these work environments. The survey revealed that 40-59% of workers
in different occupational work environments suffered from one or more respiratory
ailments. A higher incidence of respiratory disorders was recorded in workers of sugar
refinery and poultry farms. Older workers suffered more than the young ones. Family
history of atopy was found to have least effect on the incidence of cough, breathlessness
and rhinitis in the workers.3
Another survey conducted in China, between 2004-2005 on mortality proportion
of respiratory diseases revealed, deaths from chronic obstructive pulmonary disease
accounted for 81.49% of total respiratory death cases, infectious respiratory cases
12.27% and asthma cases 2.43%.4
According to one of the article, survey conducted on respiratory diseases,
morbidity and mortality among adults at Federal Medical Centre in Nigeria between
November of 2006 and October of 2008 showed, respiratory diseases were predominant
in the 25-44 year age (37.2%). Pulmonary Tuberculosis was the leading cause of
morbidity (in 42.1%) followed by asthma (in 17.5%) and pneumonia (in 15.3%).5
A comparative study was carried in Louisiana in 1986 on 284 persons who had
died by lung cancer over five years with 284 control cases. The researchers concluded
that, persons employed in sugar cane industry had 2.3 times more risk than workers
employed in other industries of contracting lung cancer due to inhalation of bagasse.6
3
The disease bagassosis, an acute respiratory disease that primarily affects workers
who handle bales of “bagasse” or dried sugar cane fiber was first recognized in
Louisiana in 1937. It was first reported in India by Ganguli and Pal in the year 1955 in a
cardboard manufacturing firm in Kolkata.7&1
However, the results of previous studies are inconsistent, particularly in
respiratory problems (bagassosis) and its prevention among sugar cane industry.
Several sugar cane industries are located near by Davangere and so far no studies
were undertaken to examine the effects of baggsse dust on respiratory problems in these
workers.
This study is undertaken to evaluate the pulmonary function of workers exposed
to bagasse dust in sugar cane industry and to teach them the protective measures to keep
up their health.
6.2 Review Of Literature :
Reviews of literature in this study have been organised into,
1) Literature related to structured teaching programme, in industries.
2) Literature related to respiratory problem (bagassosis).
1) Literature related to structured teaching programme :
A study was conducted in 1990 in Botswana revealed, progress in bringing health
care to the workplace lags considerably behind progress in bringing health care to where
people live. The study remarked that, the family nurse practitioner can provide useful
preventive and curative services to people in their places of work. It emphasized on
integration of occupational health services within community health programme. Family
nurse practitioner works included health assessment, the provision of health education
and counseling. When a survey of the health status of industrial workers in Gaborone,
the capital of Botswana, was undertaken 166 types of health problems were detected
among 1007 workers. Hence the National Manpower Development plan adviced
additional 20 family nurse practitioners should be trained per year to minimize health
problems in industries.8
4
2) Literature related to respiratory problem (bagassosis) :
A study was carried on environmental and respiratory health assessment of
workers chronically exposed to bagasse in Egyptian particle-board industry and sugar
industry, during 1998. The study comprised 102 workers employed for durations
ranging from 1 to 35 years in various department, located at Kom-Ombo in upper Egypt.
The workers were subjected to a questionnaire comprising full personal, present, past
and family and occupational histories, full clinical examination, chest x-ray and full
immunological assay. Respiratory symptoms affected more than ¾ of the examined
workers. Clinically 32 workers (31%) had chronic obstructive pulmonary disease while
chronic hypersensitivity pneumonitis affected 13 workers (13%). They concluded that
restrictive defects ranked second, affecting about 19.6% of the workers.9
A study was carried on allergic alveolitis among 20 workers who handled bagasse
in a sugar refinery during 1998 at eastern Poland. The microbiological analysis of the
samples of plant materials or bagasse reported by the patients as causing symptoms has
been carried out, followed by allergological tests. On the basis of the clinical picture, the
bronchoalveolar lavage and allergological tests, the diagnosis of the chronic form of the
disease was stated in 14 patients and an acute form in 6 patients. Also, the numbers of
eosinophils and neutrophils were significantly high in these workers.10
A study was conducted in year 1996 on specific sensitization and respiratory
effects associated with the inhalation of sugar cane dust were evaluated in a group of 51
workers exposed to bagasse. A questionnaire interview, lung function test, serum
precipitin tests for Thermoactinomyces sacchari and Thermoactiomyces vulgaris, and
immunoglobulin E tests for specific environmental allergens were performed for each
worker. Twenty-one workers reported at least one respiratory symptom and 16 reported
possible symptoms of bagassosis. Six workers demonstrated acute symptoms, 1 had
chronic symptoms, and 9 had the reacutized form of the disease. A higher proportion of
precipitin response to Thermoactinomyces sacchari and Thermoactinomyces vulgaris
was found in workers reporting symptoms suggestive of acute bagassosis. A possible
restrictive ventilatory pattern was observed in 8 subjects and a mild airway obstruction
in 1 subject. Study concluded by stating priority must be given to surveillance and
exposure prevention programme for workers employed in sugar cane industry and
processing.11
5
A study was conducted in 1992 by 185 doctors from 185 hospitals on
occupational health practices in Australian raw sugar mills by using a questionnaire.
Totally the sample size was 835 cases; suffering from 21 occupational hazards and 20
etiological antigens. A new type of bagassosis was described in it. A measurement was
carried out to determine the role of airborn Thermoactinomces sacchari in causing acute
or chronic bagassosis in any of the work force. Monitoring of total airborn bacteria spore
concentrations was undertaken in and around two cane sugar mills before, during and
after 1992 cane processing season. Viable airborn bacteria counts were also obtained to
confirm the presence of Thermoactinomyces sacchari. Area or zone samples at various
sites around the mills and personal breathing zone samples from selected workers were
obtained. The results showed that the total airborn bacteria spore count was lower than
similar counts reported in other industries such as cotton milling and wood chip
handling.12
Another study was carried in 1992. Workers in developing countries face as
many, if not more, work-related health problems as their counterparts in industrialized
nations. Most of the occupational health problems in the sugar industry which exists in
40 countries, mostly in the Third World are seen. Sugar cane workers have a high level
of occupational accidents and are exposed to the high toxicity of pesticides. They may
also have an increased risk of lung cancer, possibly mesothelioma. This may be related
to the practice of burning foliage at the time of cane-cutting. Bagassosis is also a
problem specific to the industry as it may follow exposure to bagasse. The workers may
also be affected by chronic infections which reduce their productivity. The legal
framework for their protection is often inadequate.13
An epidemiological study and environmental survey of 170 bagasse workers
employed by a raw sugar producing company in Trinidad was carried out during 1989 in
order to assess the prevalence of respiratory symptoms and to determine if exposure to
bagasse was associated with alterations in ventilatory capacity. The epidemiological
survey failed to reveal a significantly increased prevalence of respiratory symptoms in
the more exposed group but showed that the group of Indian workers who were
regularly and continuously exposed to bagasse had a significantly lower ventilatory
capacity than the control group. This diminished ventilatory capacity was demonstrated
despite of negligible dust concentration in the plant. The study concluded by saying the
possibility that persistent exposure to low concentrations of bagasse may be the cause
must be considered.14
6
Another study was conducted in the year 1986, to explore the relation of
bagassosis occurrence and inhalation of dust from dried sugar cane fiber or bagasse.
They found nearly about 41 patients were suffering from bagassosis in U.S.A. They also
concluded that, the existing literature on bagassosis contains only a few incomplete
studies of pulmonary function. The need for complete studies in a significant number of
cases using modern physiological methods is essential in future.15
6.3 Statement of problem :
“A study to evaluate the effectiveness of structured teaching programme
regarding knowledge on respiratory problems (bagassosis) and its prevention among the
workers of Gyanba Sugars and Developers Limited., Doddabathi, Davangere”.
6.4 Objectives of the Study :
1) To assess the knowledge on respiratory tract problems (Bagassosis) and its
prevention among workers at Gyanba Sugars and Developers Limited
Doddabathi through pre-test.
2) To associate the background factors with the knowledge score before Structured
Teaching Programme.
3) To assess the effectiveness of structured teaching programme on prevention of
respiratory tract problems (Bagassosis) through post test knowledge.
6.5 Operational definitions :
1) Evaluate : It is the organized systematic and continuous process of evaluating
the gain of knowledge after structured teaching programme.
2) Effectiveness : In this study “effectiveness” means improving the knowledge
regarding Bagassosis and its prevention by structured teaching programme which
may result differences between pre and post-test score.
3) Structured teaching programme : It refers to systematically planned teaching
programme designed to provide information regarding Bagossosis and its
prevention to the sugar factory workers.
4) Knowledge : It refers to the correct response of the workers to knowledge items
on prevention of Bagassosis as achieved by knowledge score.
7
5) Respiratory problems (Bagassosis) and its prevention : It refers to the
respiratory tract problems (Bagassosis) among the workers who handle Bagasse
and handling it safely to protect themselves.
6) The workers : It refers to the employees who handle the Bagasse and are risk to
develop Bagassosis especially those who are working in crushing unit.
6.6 Hypothesis :
The mean post test scores of subjects exposed to structured teaching programme
will be greater than their mean pre-test scores as measured by structured questionnaire at
0.05 level of significance.
6.7 Assumption :
1) Workers handling Bagasse may deficit of knowledge regarding ill effects or health
hazards of Bagassosis.
2) Structured teaching programme can significantly increase their knowledge level.
6.8 Limitation :
1) The study is limited to only workers of Gyanba Sugars and Developers Limited.,
Doddabathi.
2) The study is limited only to male workers.
Projected outcome : The workers will have enhancement in knowledge regarding
prevention of Bagassosis.
7. MATERIALS AND METHODS :
7.1 Source of Data collection : The data will be collected from workers of Gyanba
Sugars and Developers Limited., Doddabathi, through interview method.
7.1.1 Research design : Quasi experimental design.
7.1.2 Research Setting : The study will be conducted in Gyanba Sugars and Developers
Limited., Doddabathi.
7.1.3 Population : All the workers of Gyanba Sugars and Developers Limited.,
Doddabathi
8
7.14 Sample : The workers of Gyanba Sugars and Developers Limited., Doddabathi
especially who handle Bagasse in crushing unit.
7.1.5 Sample size : The total study sample consists of 80 workers.
7.1.6 Sample technique : Simple random sampling technique and lottery method.
7.1.7 Inclusion criteria :
1) The workers in the age group of 20-60 years of age.
2) The workers who are willing to participate in the study.
3) The workers who are able to read and write Kannada.
7.1.8 Exclusion criteria :
1) Those workers who are not willing to participate in the study.
2) Those workers who are not available at the time of data collection.
7.2 Methods of collection of data :
Tool :
Section 1 : Socio-demographic data.
Section 2 : A structured questionnaire will be prepared to assess the knowledge of
workers regarding Bagassosis and prevention through interview.
Variables :
Independent : Structured teaching programme.
Dependent : Background factors regarding Bagassosis and its prevention among
workers.
Data collection Method :
Step 1 : Researcher introduces himself.
Step 2 :Administration of pre-test on knowledge regarding Bagassosis and its
prevention.
Step 3 : Introduces structured teaching programme.
Step 4 : Administration of post-test on knowledge on Bagassosis and prevention.
9
Data analysis : The data will be analysed by using appropriate statistical methods and
finding will be presented in forms of figures and tables.
7.3 : Does your study require any investigation or interventions to conduct on
patients or other humans or animals ? If so, please describe briefly.
Yes, structured teaching programme will be administered to workers working near and
handling the Bagasse.
7.4 : Has ethical clearance been obtained from your institution in case of 7.3?
Yes, written permission obtained from Managing Director, Gyanba Sugars and
Developers Limited., Doddabathi.
10
8. LIST OF REFERENCES :
1) Gulani KK (edt). Conceptual Aspects of community Health. In :
Community Health Nursing Principles & Practices, Chapter 1, 1st edition, Kumar
Publishers, Delhi, 2005:pg.10-12.
2) Park K. Health care of the community and Occupational Health. In:
Preventive & Social Medicine, Chapter 15 & 21, 19 th edition. Banarsidas Bhanot
Publishers, Jabalpur, 2008:pg.691, 609.
3) Singh AB, Singh A, Pandit T. Respiratory diseases among agricultural
industry workers in India : A cross-sectional epidemiological study. Ann Agric
Environ Med 1999;6:115-126.
4) Xy L, Hu N, Huang ZJ, Jiang Y, Wu F. Mortality and death cause
proportion of respiratory diseases in China, 2004-2005. Am Ind Hyg Assoc J
1996Nov.;57(11):1002-12.
5) Pneumol JB, Paulo S. Respiratory diseases morbidity and mortality
among adults in their work environment. J Bras Pneumol 2009 Aug.;35(8):1806-
1810.
6) Dawson MW, Scott JG, Cox LM. The medical and epidemiologic effects
on workers of the levels of airborne thermoactinomyces spp. Spores present in
Australian raw sugar mills. Am Ind Hyg Assoc J 1996;57(11):1002-1012.
7) Weill H, Buechner HA. Bagassosis : A study of pulmonary function in 20
cases. Br J Ind Med 1985 Oct.;25(4):267-282.
8) Rojas P, Stark R, Tembo P. Nurses bring primary health care to industrial
workers. World Health Forum 1990;11(1):108-13.
9) Elata GAA, Ezzat HEMM, Shalaby AEDO, Kholey BMBE, Emara AM,
Ghaafar S, et al. Environmental, mycological and respiratory health assessment of
workers chronically exposed to bagasse in Egyptian particle-board industry. Int J
Env Health Res 1998;8:315-334.
11
10) Milanowski J, Dutkiewicz J, Potoczna H. Allergic alveolitis among
agricultural workers in eastern Poland : A study of twenty cases. Ann Agric
Environ Med 1998;5:31-43.
11) Romeo L, Molle D, Zanoni G, Peretti A, Marangi G, Conrado LG, et al.
Respiratory health effects and immunological response to thermoactinomyces
among sugar cane workers in Nicaragua. Am Ind Hyg Assoc J 1996
Nov.;57(11):1002-12.
12) Zhonghua Yu, Fang Yi, Xue Za Zhi. 2010 April;44(4):298-302.
13) Phoolchund HN. Aspects of occupational health in the sugar cane
industry. Br J Ind Med 1992;49:499-506.
14) Hearn CED. Bagassosis : An epidemiological, environmental, and
clinical survey. Br J Ind Med 1989;28:152-158.
15) Herbert SJ. Bagassosis : A study of pulmonary function in 20 cases. New
Orleans USA 1986;25(4):285-290.
12
9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
11. NAME & DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
12. 12.1 REMARKS OF PRINCIPAL
12. 2 SIGNATURE
13
ETHICAL COMMITTEE CLEARANCE
1. TITLE OF THE DISSERTATION : “A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON RESPIRATORY PROBLEMS (BAGASSOSIS) AND ITS PREVENTION AMONG THE WORKERS OF GYANBA SUGARS AND DEVELOPERS LIMITED., DODDABATHI, DAVANGERE”
2. NAME OF THE CANDIDATE : Mr. BASAVARAJ S.S.First Year M.Sc. Nursing, Bapuji College of Nursing, Davangere – 4, Karnataka.
3. SUBJECT : COMMUNITY HEALTH NURSING
4. NAME OF THE GUIDE : Mrs. G. THILAGAVATHI M.Sc.(nursing)
Community Health Nursing Dept,Bapuji College of Nursing,Davanagere-4.
5. APPROVED/NOT APPROVED
(If not approved, suggestion)
:
Prof. S.F.BILLALLI,Principal and HOD,Medical Surgical Nursing,Bapuji College of Nursing,Davanagere-4.
Mrs. LEELAVATHI. R.HHead of the Department, Department ofObstetrics and Gynecological Nursing,Bapuji College of Nursing,Davanagere-4.
14