“A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING PROGRAMME ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION AMONG MOTHERS OF UNDER-FIVE CHILDREN IN SELECTED RURAL AREA OF BANGALORE”

M.Sc. Nursing Dissertation Protocol Submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

By

Ms. JEBA MALAR. B

M.Sc Nursing 1st Year

2010-2012

Under the Guidance of

HOD, Department of Child Health Nursing

Nightingale College of Nursing

Guruvanna Devara Mutt,

Near Binnyston Garden,

Magadi Road,Bangalore-560023

1

Rajiv Gandhi University of Health Sciences, KarnatakaCurriculum Development Cell

CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Registration No. : Name of the Candidate : Ms. JEBA MALAR. BAddress : Guruvanna Devara Mutt, Near Binnyston, Bangalore - 23Name of the Institution : Nightingale College Of Nursing, BangaloreCourse of Study and Subject : MSc Nursing Paediatric nursingDate of Adimission to Course : 20/05/2010

Title of the Topic

: A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING PROGRAMME ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION AMONG MOTHERS OF UNDER-FIVE CHILDREN IN SELECTED RURAL AREA AT BANGALORE

Brief resume of the intended work : Attached

Signature of the Student :

Guide Name : Mrs. Jeya VanithaRemarks of the Guide : The Study is suitable and feasibleSignature of the Guide :

Co-Guide Name : Signature of the Co-Guide :

HOD Name : Mrs. Jeya VanithaSignature of the HOD :

Principal Name : Principal Mobile No. : Principal E-mail ID : Remarks of the Principal :

Principal Signature :

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

2

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1: NAME OF THE CANDIDATE AND

ADDRESS

MS. JEBA MALAR. B,

NIGHTINGALE COLLEGE OF

NURSING,GURUVANNA DEVARAMUTT,

NEAR BINNYSTON GARDEN,MAGADI ROAD,

BANGALORE.

2: NAME OF THE INSTITUTION NIGHTINGALE COLLEGE OF

NURSING,GURUVANNA

DEVARAMUTT,NEAR BINNYSTON GARDEN,

MAGADI ROAD,BANGALORE.

3: COURSE OF STUDY AND SUBJECT M. SC. NURSING

CHILD HEALTH NURSING

4: DATE OF ADMISSION TO THE

COURSE

15-09 2010

5:

TITLE OF THE STUDY:

. A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING PROGRAMME

ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION AMONG MOTHERS OF

UNDER-FIVE CHILDREN IN SELECTED AREA OF BANGALORE

3

6:

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“PREVENTION IS BETTER THAN CURE”

Children are the future pillars of a nation. Today’s children are

tomorrow’s citizen and leaders. Child health care is the most crucial factor to determine

growth of the child especially in the first five years of life.1 They are vulnerable to disease,

death and disability owing to their age, sex, place of living, socio economic class and host of

other variables. Certain specific biological and psychological needs must be met to ensure the

survival and healthy development of the child and future adult.2

Dengue fever is an acute febrile disease caused by infection of dengue

virus transmitted by the female aedes mosquito and it is called breakbone fever or dandy

fever.3 This virus affecting humans today and its incidence is increased dramatically in the

fast fifty years. Due in part to population growth and uncontrol urbanization in tropical and

subtropical countries, breeding sites for the mosquitoes that transmit dengue virus have

proliferated and successful vector control has proven problematic.4

In infants and young children, dengue present as a mild fever with

rash. Older children have the classical symptoms of high fever, severe headache, pain behind

the ear, pain in the joints, muscles and rash. Dengue hemorrhagic fever is characterized by

high fever, bleeding and liver enlargement. It requires urgent hospitalization as it may even

lead to death.5

The preventive method dengue fever is controlling the mosquito

infestation. The mosquito dengue primarily breeds in man made containers like metal drums,

earthenware jars and other water storage jar. Proper solid waste disposal and improved water

storage practices including covering containers should be encouraged. Insecticides should

used periodically. Wear light-coloured, loose fitting, protective clothing that covers as much

4

of our body as possible. Use an insect repellent on areas of our skin that are exposed and on

our clothing especially around around loose parts such as collars. Repellants containing a

chemical known as DEET(N,N-diethyl metatoluamide)are thought to be most effective and

use plug in devices, which have insecticides in them, to kill mosquitoes, sleep under a

mosquito net to avoid being bitten at night. It is most important to follow these precautions

around dawn and dusk, as is when the aedes mosquito is most active. However it is important

to remember that the aedes mosquito can bte at any time of the day or night, So making sure

you always take the necessary precautions can help to reduce your risk of catching dengue

fever6

6.1 NEED FOR STUDY :

The incidence of dengue fever is increased in the worldwide.They may be

asymptamatic and annually 100 million cases of dengue fever and half a million cases of

dengue haemorrhagic fever occur world wide. 90% of dengue haemorrhagic fever occur

world wide.90% of dengue haemorrhagic fever subjects are children less than 5YEARS of age

.At present dengue is endemic in 112 contries n the world.Early recognition and prompt

treatment are vital if disease related morbidity and mortality are to be limited7 The purpose of

this study was to identify the early indicatives of haemorrhage in severe degue infections.In

2002 may,out of 116 children 24 children had severe haemorage and 92 had no haeorrhage.8

In New delhi, by the year 2006 in early October more than 590 cases of dengue

fever were reported and over 367from neighbouring states who had come to New Delhi for

treatment.

In Rajasthan, by the year 2006 sep 12 th more than 35 children were treated for

dengue fever.

In Uttarpradesh,over 24 suspected cases o te diseases were reported in 2006.

In Andrapradesh,one person succumbed to the disease and atleast 5 were treated

for the dengue feve n 2006

.

In westbengal ,over 30 peole were treated for degue fever in Kolkata,the capitalof

Westbengal for suspected dengue fever.

5

By October 9 , 2006,more than 50 deaths were reported to dengue fever and more

than 3613 patients were treated for this disease9.

The Government of India’s Health department released the statistical data related

to dengue fTever on October 8th 2006. NATIONAL OUTBREAK OF DENGUE FEVER

New Delhi - 886

Gujarat - 424

Rajasthan - 326

West Bengal - 314

Tamil Nadu - 306

Uttar Pradesh - 79

Karnataka - 59

Andhra Pradesh - 9

. On October 13,2006 , 6 persons died due to dengue fever in Delhi.It was the

highest number of deaths reported from Delhi in a day due to this disease.10

Usually in urban areas , having high population densty,poor sanitation and large

number of desert coolers,overhead tanks.discarded buckets,utensils etc,which promotes

mosquito breeding are at high risk.

It can also occur in rural areas where the environment is friendly for mosquito

breeding.Mosquito breeding can occur in containers user for spring warter for cattle

feedingand drinking , discarded tins,tyres,bottlesetc.which are not emptied and cleaned

periodically.

Most dengue control programme conduct surveillance only for the disease and

vectors. However for prevention and control efforts another critical variable is human

behavior as it relates to managemet of vector larval habitats and to disease recognition and

response.Hence there is a need to focus not only knowledge of disease and its control,but

more important on the actual behavior related to source reduction and treatlment seeking.

6

6.2 REVIEW OF LITERATURE

A review of literature is an essential aspect of scientific research . It is a

systematic identification , location and scrutiny summary of written material that contains

information relevent to the problem under study. It helps to identify the similar studies for the

investigator. It enables the researcher to focus on related studies around the world at different

setup. The major goal of review of literature is to develop a strong knowledge base to carry

out research a nonresearch scholarly activity . The following studies are:

Murell.S, Wu Sc Butler M in 2011 A study was conducted on Review of

dengue virus and development of vaccination in children. Dengue viral infection is the most

rapidly spreading vector borne disease , attributed to changing demographics, urbanization,

environment and global travel. It continues to be a threat in over hundred tropical and sub-

tropical countries, affecting pre dominantly children. Dengue also carries the hefty financial

burden on the health care system in affected areas, as those infected seek care for their

symptoms. The search for a suitable vaccine for dengue has been ongoing for the last 60years,

yet any effective treatment or vaccine remains elusive. A vaccine must be protected for all

four sero types of dengue and be cost effective. Many approaches to developing candidate

vaccines have been employed. The candidates include live attenuated tetravalent vaccines,

chimeric tetravalent vaccines based on attenuated dengue virus or yellow fever 17D and

recombinant DNA vaccines based on flavi virus and non flavi virus. The review outlines the

challenges involved in dengue vaccines development and presence current stages of proposed

vaccine candidate development.11

Vesga-Gomez C,Caceres-Manrique Fde M in 2010 A Study was

conducted on evaluating the effectiveness of primary school children play-based education for

improving knowledge about dengue fever prevention,controland practice.The methods which

was carried out in Bucaramanga between july and November 2010.A group of leading

primary school children received play based education about dengue and leadership after they

had been surveyed regarding their knowledge about dengue control practices.Then they

signed commitment to implement action with family and neighbours;they were followed up

for four months and home visits were made to assess commitment and repeat the

survey.Follow up was completed for 89 of the 99 children(90%).There were significant

7

increase in knowledge about dengue as a disease(from 73% to 95.5%) as being very severe

(82% to 96.6%)being transmitted by mosquitoes(82% to 100%)being Caused by virus(1.1%

to19.1%)in recognising larvae(54% to95.5%)and breeding sites (43%to 88%)recognizing

symptoms of fever(67.4%to 97.8%)pain in the bones(21.3%to62.9%)headache( 37.1%to

645%) and bleeding (16.8% to42.7%)in the need for opportune

consultation(77.5%to98.97%)spraying(22.5%to47.2%) and washing out water

tanks(67.5%to89.7%). The children fulfill their commitment and creatively and inventively

engaged in more activities. Play based education was effective in improving knowledge and

practice r egarding dengue fever.12

.

Tsuzuki A,Thiem V D,Suzuki M,Yanai H A in 2010 A Study was conducted on

can daytime use of bed nets not treated with insecticide reduce the risk of dengue hemorrhagic

fever among children in Vietnam? The purpose of this study was to investigate the

prevalence of bed net use and elucidate the effect of daytime bed net use on preventing

dengue hemorrhagic fever (DHF) among children in Vietnam. We conducted a population-

based cross-sectional survey and a matched case-control study in Khanh Hoa Province where

not only some pre-School children but also some school children, who take a nap during lunch

break prior to returning to school, used bed nets during the day. Among 36,901 children 2-10

years of age, most used untreated bed nets during the night (98.3%) compared with 8.4%

during the day. The results of the case-control study, which defined 151 cases who were

hospitalized with DHF in the provincial hospitals and 604 age-matched neighborhood

controls, did not support our hypothesis that children using untreated bed nets during the day

are lesslikely to be hospitalized with DHF (adjusted odds ratio = 0.56, 95% confidence

interval = 0.23-1.39).13

Dellamonica P 2009 A study was conducted on the clinical features of dengue fever.

The onset is abrupt with frontal headache, retro-orbital pain, myalgia joint pain, prostration

and in many cases, a macular rash usually sparing the face and extremities. Hemorrhagic sings

may occur such as petechiae, purpura, epistaxis and bleeding gingivae. Two severe forms of

dengue f eve r, particularly among children below 3 years of ago, include dengue hemorrhagic

fever (DHF) and dengue shock syndrome (DSS) Treatment of dengue fever, whether in its

uncomplicated form or with hemorrhagic manifestation or shock, remains symptomatic. There

is no specific anti viral treatment. A case should be notified to allow health authorities to take

the appropriate measures for vector control.14

8

Nagoya J in 2009 A study was conducted on knowledge, attitude and practice

regarding dengue among people in pakse. Dengue Fever is an acute febrile disease & it is the

second leading cause of death in pakse district. The cross sectional study was designed to

assess the knowledge, attitude and practice of people regarding dengue disease in 9 villages of

the pakse district from July to September 2006. They had a fair knowledge about the vector

163 (70.9%). For 101 (43.9%) respondents, their main sources of information about dengue

was their friends or relatives. It is encouraging that 217 (94.3) respondents had a positive

attitude that dengue fever can be treated and that 222 (96.5%) knew they should visit a doctor

when they suffer from it. About 196 (85. 2%) people stored water at home but infrequently

changed it. The study indicated that the community was quite familiar with dengue, but there

was some confusion about vaccination and water storage domestic use. Dengue awareness act

should be included at the school and college level. Radio and Television should play an

important role in conveying health information to the public and regular visits of health

personnel to the villages should be ensured.15

Phuanukoonnon S in 2005 A study was conducted on the investigation above the

influence larval control methods (using temphos, keeping and covering container with lids)

water use and weekly cleaning of containers on the presence of Aedes aegypti larvae in water

storage containers in rural & urbal house holds. Cross sectional questionnaire survey and

larval survey covered 966 house holds 5821 containers were inspected. The containers more

frequently infested with larvae were rectangular cement containers storing water for boiling &

flashing toilet. Keeping fish was the most effective method of control. Weekly cleaning of

container was an effective method for larval control most type of containers. A combination

of control methods increase effectiveness.16

Simasathien S in 2005 A study was conducted on Dengue vaccine. Dengue is

an expanding health problem. About two – fifths of the world population are at risk for

acquiring dengue with 50-100 million cases of acute febrile illness yearly including about

5000,000cases of Dengue hemorrhagic syndrome & Dengue shock syndrome. No antiviral

drugs active against the flavivirus exist. Vaccination remains the most hopeful preventive

measure. Dengue vaccine has been in development for more than 30 years, yet none has been

licensed. The fact that enhancing antibody from previous infection and high level of T cell

activation during secondary infection contribute to immunopathology of Dengue Hemorrhagic

9

fever, the vaccine must be able to induce protective response to four dengue serotypes

simultaneously. Inactivated vaccine is safe but needs a repeated booster thus, development is

delayed. Tetravalent live attenuated vaccine and chimeric vaccine using yellow fever or

dengue viruses as a backbone are being carried out in human trials. DNA Vaccine and

Subunit vaccine are being carried out in animal trials.17

Kabilan L in 2004 A study was conducted on serologic survey of people in

Chennai to determine evidence of prior exposure to dengue virus infections. The serum

samples from clinical children were analyzed for dengue virus – specific immunoglobulins M

(IgM) and G (IgG) antibodies. There was an increase in the percentage of children with

monotypic antibody response dengue in the later survey (April 2.2% and September 9.93%)

Dengue virus infection was diagnosed in 74.5% (143/192) of cases. While dengue specific

IgM responses were pre-dominant among infants with dengue fever, IgG and mixed

responses (M & G) were seen in 85% of the children with severe forms of dengue18.

Madeira NG in 2002 May A study was conducted on Education in primary

school as a strategy to control dengue. The proliferation of Aedes aegypti, as species of

mosquito, that is the vector of the dengue pathogen, is being augmented by the population’s

lack of care in allowing formation of larval habitats. One form of controlling dengue is the

distribution of information on the mosquito to improve awareness and to provide the means

necessary for the elimination its reproductive habitats. To evaluate a teaching method

concerning the vector and dengue, students from the 5th years ofprimary education were

compared before and after didactic intervention with a group- of control students. The

students who received intervention were more successful in identifying the stage of the cycle,

biological and morphological.19

6.3 .STATEMENT OF THE PROBLEM

“A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING

PROGRAMME ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION

AMONG MOTHERS OF UNDER-FIVE CHILDREN IN SELECTED RURAL AREA OF

BANGALORE”

6.4. OBJECTIVES OF THE STUDY

10

To assess the knowledge of under five mothers on dengue fever and its prevention.

To evaluate the effectiveness of knowledge of under five mothers after video teaching

programme on dengue fever and its prevention.

To compare pre test and post test knowledge of under five mothers.

To associate the knowledge with selected demographic variables such as

age,education,occupation,religion,type of family,socioeconomic status,health status of

the family.

6.5. HYPOTHESIS:

H1: There will be significant difference in the pre test and post test knowledge level scores of

under five mothers on dengue fever and its prevention.

H2: There will be significant association between the knowledge of under five mothers and

selected demographic variables such as age, education, occupation, religion, type of family,

socioeconomic status and health status of the family.

6.6OPERATIONAL DEFINITIONS

EVALUATE: : Measurement of the knowledge of dengue fever and its prevention among mothers of

under five children.

EFFECTIVENESS:

In this study it refers to producing the desired result of video teaching programme on

dengue fever and its prevention as measured by the instrument and shown by the post

test score.

11

VIDEO TEACHING PROGRAMME:

In this study it refers to the electronic motion picture equipment which scans pictures

from magnetic tape on a compact aids which have the recording of motion pictures

and sound and it includes definition, causes, clinical manifestations, management and

prevention of dengue fever.

KNOWLEDGE It refers to correct response on mothers of under five children to the knowledge items

of the questionnaire of interview schedule regarding dengue fever and its prevention.

.

MOTHERS : In this study the word refers to the mothers who are having under five children.

UNDER FIVE CHILDREN: In this study the term refers to the children between the age of 1-5 years of age.

DENGUE FEVER: Dengue is an acutely infectious mosquito borne viral disease transmitted by certain

species of Aedes mosquito that is culex fatiguns, Aedes aegypti and Aedes albopietus.

The disease is also known as breakbone fever or dandy fever.

6.7 ASSUMPTIONS :

The mother will have inadequate knowledge regarding the dengue fever and its

prevention.

The mother wiil be gaining adequate knowledge regarding the degue fever and its

12

7

prevention in under five children after giving a video teaching programme.

The knowledge on dengue fever and its prevention will help the mother to manage

those symptoms while they handle the under-five children who are prone to get

dengue fever.

6.8 DELIMITATIONS:

The study is delimited to mothers who are:

having under five children

willing to participate in the study

able to speak and write in kannada and English.

6.9 PROJECTED OUTCOME: The study will improve the level of knowledge on dengue fever and its prevention among

mothers of under five children.At the same time,the study will prove the effectiveness of

video teaching programme an hence it will help to bring down the under five morbidity.

MATERIALS AND METHOD:

7.1 SOURCE OF DATA The data will be collected from mothers of under five children in selected rural area at

Bangalore.

7.1.1 RESEARCH DESIGN The research design adopted for this study is quasi experimental study.

RESEARCH APPROACH The research approach is evaluative.

7.1.2 SETTINGS

13

7 The study will be conducted in Mahalakshmi layout at Bangalore, it is 7km away

from the college.

7.1.3 POPULATION : The population selected are mothers of under five children who are residing in rural

area at Bangalore.

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 CRITERIAThe criteria or sample selection are mothers of under five children

who have children aged between 1-5 years.

who are willing to participate in the study.

who can able to speak and understand kannada and english

7.2.4 EXCLUSION CRITERIA

mothers

who are having above 5 years of age.

who are not willing to participate in the study

who cannot able to speak and understand kannada and English

14

7.2.5. INSTRUMENTS INTENDED TO BE USED

who cannot able to speak and understand kannada and English

SELECTION OF TOOLThis consists of 3 parts:

PART 1:The tool consists of demographic variables such as

age,education,occupation,religion,type of family,socioeconomic and health status of the

family.

PART2:Questionnaire will be used to assess the knowledge.30 questions will be used.

PART3:Videoteachingprogrameregardingdefinition,causes,clinical

manifestations,transmission,management and prevention of dengue fever will also be used

SCORING PROCEDURE :

For knowledge assessment,it consists of 30 items of objective type related to

knowledge of dengue fever and its prevention.Each item has 4 options with one most

appropriate answer.Each correct response has ‘one’ score and wrong answer is considered to

be “zero”. Thus there are 30 items with maximum of 30 scores.

SCORING INTERPRETATION :

LEVEL OF KNOWLEDGE RANGE

15

EXCELLENT

26 -- 30

GOOD 21 -- 25

AVERAGE 16 -- 20

POOR 0 – 15

7.2.6. DATA COLLECTION METHOD :

The mothers of under five children in the selected rural area will be

selected for the study using non-probability purposive sampling.Formal administrative

permission will be obtained from the concerned panchayat president.The data will be

collected from 60 mothers of under five children after obtaining their consent.The procedure

will be explained to them and confidentiality will be assured.Data will be collected from 8-10

samples per day.The duration will be 4 week.

7.2.7. DATA ANALYSIS PLAN

The plan of data analysis are :

The data obtained will be analysed in view of the objectives of the study.

Mean,Median,Mode and Standard deviation is used for assessing knowledge

scores.

The effectiveness of pre-test and postest knowledge scores will be analyzed

by paired ‘t’ test

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION ?

16

Yes, ethical clearance will be been obtained from the research committee of Nightingale

College of Nursing.Consent will be taken from concerned authority and permission will be

taken from the study subjects before the collection of data .

REFERENCES :1. Ukoko. Childrens health tomorrows wealth . Indians Journal of Paediatrics. 1997;54:33-

342. K. Park, Text book of Preventive and social Medicine, 18th edition,banarsidas, Bhanaot

publishers,2005,Jabalpur, pp no. 385, 391, 474-476.3. www.denguefeversymptoms.org 4. Annu Rev microbilal.Global spread and persistence of dengue. 2008;pp no;62, 71-925. Donalisio M R, Alves M J, Visockas A. A survey of knowledge and attitudes in a

population about dengue transmittion- region of Campinas, SaoPaulo,Brazil,19986. www.bupa.co.uk individuals/heath information directory/d/dengue-fever7. http:/www.ncbi.nlmnih.gov/pubmed 188135328. http://www.thehinde.com/2005/09/01/dengue cases/2005090113560300.htm 9. Indian Journal of Community Medicine.2010,July;35(3) pp no 386-390.10. Indian journal of Community Medicine. 2011, feb 32(3), pp no 284-29011. MurellS, Wusc Bulter M, Biotch nol adv .2011march-april; 29(2):239-24712. Vesga Gomez C,Cacerer Monrique fde M, Re V, Salud PUblca, 2010,aug;12(4);558-6913. Tsuzuki A ,Thiem VD, Suzuki M,Yanai H.AM J Trop Med Hyg.2010 Jan;82[6]:pp

no:1157-914. Dellamonica P, arch Pediatrics; Dengue Fever; Clinical features, article in French; 2009,

17

8.

Oct;16 supp 2;S80-415. Navoya j, Med sci. knowledge, attitude and practice regarding dengue fever;2009,

Feb;71(1-2):29-3716. Phuanukoonnon S muller I, Bryan J H, Effectiveness of dengue control practices in

household water cntaners; Trop Med Int Health. 2005; Aug;108(8);755-6317. Simasthean S,Watanaveeradej V J Med Assoc Thai. Dengue Vaccine;2005 nov;88 Suppl

3:5 363-7718. Kabilan L, Velayutham T, Sundaram B, Natarajan A, et al. field and laboratory-based

active dengue surveillance in Chennai, Tamil Nadu; dengue epidemic 2004 nov;32(7)-391-6

19. Madeira N G,Macharelli C A,Pedras J F,Rev Soc Bras Med TROP.Educatio in primary school as a strategy to control dengue.2002 may-june;35(3):221-6

9.SIGNATURE OF THE CANDIDATE

10.REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

18

.11.6 SIGNATURE

1212.1 REMARKSOF THE

PRINCIPAL

12.2 SIGNATURE

9.SIGNATURE OF THE CANDIDATE

10.REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

19

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

1212.1 REMARKSOF THE

PRINCIPAL

12.2 SIGNATURE

20