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“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE OF MOTHERS OF SCHOOL AGE
CHILDREN REGARDING FIRST AID MANAGEMENT OF DOG BITE
IN SELECTED AREA OF RAICHUR”
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
MD. MOHSIN AHMED
NAVODAYA COLLEGE OF NURSING
RAICHUR, DECEMBER-2010
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1. Name of the Candidate :Mr. Md. Mohsin Ahmed M.Sc.Nursing. 1st Year Child Health Nursing Navodaya College Of
Nursing, Raichur
2. Name of the Institute : Navodaya College of Nursing. Raichur.
3. Course of Study and Subject : M.Sc.Nursing. 1st Year Child Health Nursing
4. Date of Admission : 15-06-2010
5. Title of the Topic :
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE OF MOTHERS OF SCHOOL AGE
CHILDREN REGARDING FIRST AID MANAGEMENT OF DOG BITE
IN SELECTED AREA OF RAICHUR”
6. BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study:
“While a dog may be a man’s best friendThat is not always in case of children”
Background
Rabies is a viral zoonosis, an animal disease transmissible to humans, caused by
rhabdoviruses of the genus Lyssavirus. It is almost invariably fatal in humans. Rabies is
widely distributed throughout the world and present in all continents. More than 99. 9 %
of human deaths from rabies reported worldwide result from the bite of a rabid dog. Due
to cleansing of the wound, non administration of immunoglobulin in cases of severe
exposure1
Rabies is one of the oldest recognized diseases affecting humans and one of the most
important zoonotic diseases in India. It has been recognized in India since the Vedic
period (1500–500 BC) and is described in the ancient Indian scripture Atharvaveda,
wherein Yama, the mythical God of Death, has been depicted as attended by 2 dogs as his
constant companions, the emissaries of death. Rabies is endemic in India, a vast country
with a population exceeding 1.02 billion and a land area of 3.2 million km 2. In India,
about 15 million people are bitten by animals, mostly dogs, every year and need post
exposure prophylaxis. Since 1985, India has reported an estimated 25 000–30 000 human
deaths from rabies annually The majority of people who die of rabies are people of poor
or low-income socioeconomic status and school age children2
National Multicentric Rabies Survey, conducted in 2004 by the Association for
Prevention and Control of Rabies in India in collaboration with the World Health
Organization,1 is 20 565 deaths from rabies per year. Most animal bites in India (91.5%)
are by dogs, of which about 60% are strays and 40% pets. The incidence of animal bites
is 17.4 per 1000 population. A person is bitten every 2 seconds, and someone dies from
rabies every 30 minutes. The annual number of person-days lost because of animal bites
is 38 million, and the cost of post-bite treatment is about $25 million2.
Most people received the vaccine at government and municipal anti-rabies clinics.
Each case required a mean of 4.4 visits for treatment, at a cost of Rs 2500/- (for the
vaccine and other medicines) and a loss of 2.2 days of work In the past, a large
proportion of rabies patients did not receive any vaccination, and of those who did, many
did not complete the full course. In the latest survey, in 2004, only 39.5% of bite victims
washed the wounds with soap and water, and about 46.9% received rabies vaccination2
The 2004 survey also revealed that about 60% of infected people resort to
indigenous treatment, with local applications to the wound (36.8%) and indigenous
remedies (45.3%) being . In 21st century thousands of people in India are dying from
rabies, some of the medical professional bodies such as the Indian Academy of Pediatrics
and the Association for the Prevention and Control of Rabies have taken action. They
have collaborated to create awareness, develop strategies suitable to the Indian situation,
popularize the use of intradermal vaccination, with a view to reduce the high cost of
treatment and cooperate with the government to reduce the incidence of death from
rabies, with the ultimate goal of eradicating rabies from the country.3
Public health educational programs are needed to create awareness both in the
medical community and in the public regarding the dangers of inadequately managed
animal bites. The importance of proper wound care, post exposure vaccination with
modern tissue-culture vaccine and the administration of human rabies immune globulin,
The World Health Organization (WHO) in 2003 says that death due to rabid dog bites in
India is increasing every year. About 17,000 people die of rabies in India every year3.
India already has the word's highest number of dog-bites, 17.6 million annually. It
also accounts for 80 percent of the world's rabies cases according to the Association for
Prevention and Control of Rabies in India (APCRI) . In Bangalore, 45 percent of dog-bite
victims are slum children playing on streets in low-income .4
Deaths due to dog bites are few within BBMP (Bahrut Bangalore Mahanagra
Palike) limits, says the report by the Directorate of Health & Family Welfare Services
(communicable diseases department). According to the report, two deaths each were
reported in 2008 and 2009 within BBMP limits. Elsewhere in the state, there were 59
deaths in 2007, 29 in 2008 and 10 in 2009. This is due to lack of awareness about rabies
vaccinations. As per data of RIMS (Raichur Institute of Medical Science).Reported Dog
bite cases from the year January 2009 to December 2009 are 3086 and from the year
January 2010 to November 2010 are 1516. Majority of dog bites cases are found in
children victims are from slums..5
6.2 Review of literature
The review of literature helps to ascertain what is already known in relation to a problem
of interest. It provides a basic for future investigation and justify the need for replication6
A study was conducted in pune, Maharashtra in order to determine the profile
of Management of animal bite cases among rural population in district Pune, three
Primary Health Centers (PHCs) were selected randomly and patients attending with
animal bites during the month of study period were enrolled for the study. The results
reported that all animal bite cases (451) were due to dog bite and 61.4% were reported
to be bitten by pet dogs. Immediate care like washing of wound with soap and water
was practiced by only 23.5%.The study concluded that management of animal bites
cases among rural population needs health education regarding dog bite management
in home.7
A retrospective chart review was conducted by University of Washington School
of medicine, USA to evaluate children less than 16 years of age who had dog bite injuries
that resulted in hospitalization or death to determine the typical characteristics of the
children, the dogs, and the injuries suffered. Three large city hospitals and forty cases
were selected and hospitalization data included total length of stay, need for intensive
care, Injury Severity Score, the nature and extent of the injuries, procedures performed,
complications, and outcome. The results reported that the average hospital stay was 6
days (SD = 5), and 12 (30%) patients required a stay in the intensive care unit. Injuries to
the face, head, and neck area were most common (82%). Major surgical procedures
included craniotomy, exploration of the neck or abdomen, ocular procedures, and repair
of fractures. The study concluded that severe dog bites in children occur most frequently
in those younger than 5 years old and involve the head and neck. Large dogs that are
familiar to the child are usually involved. Young children should be closely supervised
when around any dog.8
A retrospective study was conducted by department of paediatric surgery in South
Africa to perform an analysis of dog bite in community in order to develop preventive
strategies. The results reported that a total of 2025 dog bite injuries were sustained by the
1871 children and majority of injuries (n=1626, 80%) were classified as minor, Children
less than six years of age were more likely to sustain injuries to the head, face or neck
(n=421, 49%), whereas children greater than six years of age more commonly received
injuries to the thigh or leg (n=560, 48%). The most frequent injuries were superficial
lacerations and only 38 (2%) of children required major surgery. The study concluded
that health practitioners should actively contribute to responsible dog ownership and
provide evidence based dog bite preventions.9
A Multicentric study was conducted by National institute of communicable
diseases in Delhi, Hyderabad, Raipur with the objective of assessing of knowledge,
attitude, belief and practices about animal bites and rabies in the general community. A
sample of 1129 persons in the age group of 18 to 80 years were interviewed. Data was
collected by using a interview Performa. The results reported that (68.7%) people had
heard about rabies, (60.7%) of cases associates rabies with dog bite only knowledge
about appropriate wound toilet was found to be inadequate, (31.9%) people felt that
washing the wound with soap and water was the best option , application of indigenous
products like chillies (11.4%), turmeric (5.6%), lime (6.8%), kerosene oil (2.3%), herbal
paste (4.2%) was suggested along with the visit to medicine practioner (1.5%) as part of
the bite wound management. The results also reported that multiple reasons like
negligence and ignorance 354 (31.4%), fear of multiple painful injections 365 (32.3%),
expensive treatment 169 (15%), and long course requiring daily visits to anti rabies
clinics 73(6.5%) were cited as reasons for non-compliance of treatment. The study
concluded that there is a need to create awareness amongst the masses regarding
epidemiology of the disease and merits of prompt and appropriate post exposure through
enhanced IEC ( Information and electronic communication) activities.10
A cross sectional study was carried by anti rabies clinic of sasoon hospital pune to
determine the profile of animal bites cases. Data was collected using questionnaire. A
total 250 cases were included in and the male female ratio was 1.98: 1. The results
showed that children in the age group 0-14 years were the victims in 132 (52.8%) cases,
dog bite (94.4% ) cases, cat (2.4%), Jackal (1.2%), mongoose (1.2%), monkey (0.4%)
and horse (0.4%). The report also showed that the wound was washed with soap and
water in only 3.6% of cases. 64.8% of the bites were on the lower extremity and 63.2% of
cases reported within 24 hours of the bite. Of the 247 cases administered Beta Propio
Lactone (BPL) inactivated vaccine only 18.8% did not have any local reaction and 58.3%
had one or more systemic reaction. The study concluded that a three pronged strategy has
been recommended to reduce the burden of morbidity and mortality associated with
rabies.11
An electronic hospital database was conducted to examine the hospital incidence, hospital
charges, and characteristics of dog bite injuries among children by age group and
hospitalization status and who were treated at health care system to guide prevention
programme and policies. Demographics, injury information, hospital admission status,
length of status, hospital charges and payer source of all patients younger than 18 years
who were treated for dog bites from 1999 to 2006 were collected. the results showed that
during 8 years, 1,347 children younger than 18 years were treated for dog bites, the
majority were treated and released from the emergency department (91%), (4.9%)
requiring inpatient admission, the median length of stay was 2 day, victims were
frequently male (56.9%) and <8 years (55.2%). The study concluded that Dog bite visits
comprised 1.5% of all pediatric injuries and majority (91%) of all dog bite visits were
treated and released from the emergency department. and age less than 5 years increased
the odds of being admitted as an inpatient (OR, 3.3).12
A randomized controlled trids was conducted to evaluate the effectiveness of educational
interventions in population under 20 years old for preventing dog bites. The results
reported that the intervention group showed less inappropriate behavior when observed
in the presence of dog after a 30 minute educational intervention and also an increase in
knowledge and in caution after an information programme. The study concluded that
educating children who are less then 10 years old in school settings could improve their
knowledge, attitude and behavior towards dogs and there is a need for high quality
studies that measure dog bite rates as an outcome.13
6.3 Statement of the Problem:
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE OF MOTHERS OF SCHOOL AGE
CHILDREN REGARDING FIRST AID MANAGEMENT OF DOG BITE
IN SELECTED AREA OF RAICHUR”
6.4 Objectives of the study
1 To assess the knowledge of mothers of school age children regarding first aid
management of dog bite
2 To implement structured teaching programme regarding first aid management of
dog bite
3 To determine the effectiveness of structured teaching programme in terms of gain
post test knowledge
4 To find out the Association between knowledge of mothers and school age
children with selected variables (age, parents educational status, occupation,
source of knowledge prior information and first aid management of dog bite
6.5 HYPOTHESIS
H1: There will be a significant Association between pre test and post test knowledge
scores of mothers of school age children regarding first aid management of dog bite
H2: There will be a significant relationship between knowledge of mothers of school age
children with the selected variables (age, parents educational status, source of knowledge,
prior information and first aid management of dog bite
6.6 OPERATIONAL DEFINITIONS
EFFECTIVENESS: it is defined as significant gain in knowledge of mothers of school
age children and first aid management as evidenced by pretest and post test scores
STRUCTURED TEACHING PROGRAMME: It refers to systematically developed
instruction designed for a group of mothers of school age children to provide information
regarding first aid management of dog bite
KNOWLEDGE OF MOTHERS: The level of understanding of mothers of school age
children regarding first aid management of dog bite in selected area of Raichur.
DOG BITE: A bite caused by dog is called dog bite
FIRST AID: First aid is a procedure done for a dog bitten child prior to the hospital or
anti rabies clinics
In this study first aid refers to immediate measures to prevent dog bite complications.
COMMON SITES OF DOG BITE INJURIES: it refers to dog bite injuries among
school children in this study following common sites
1. Face
2. Neck
3. Scalp
4. Buttocks
5. Scrotum
6. Hands and lower extremities
7 MATERIALS AND METHODS
7.1 SOURCES OF DATA
DESIGN: one group pretest and post test quasi experimental design is adapted for the
present study
O1XO2
SETTING OF THE STUDY: Raichur is one of the backward districts, situated in
northern Karnataka, it as an area of 60square kilometers and it consist of 5 towns and 300
villages total population of Raichur is1669762 with 15 revenue wards and 35 election
wards and ward number 21 is harijan ward and urban community center is selected for
studies, it has area of 796, 86 sectors and population of 19745 out of which 9743 are
males 10002 Are females including children
POPULATION: The population included in this study is mothers of school age children
who are borne for the dog bite, the population of present study comprises of the entire
mothers of school age children
SAMPLE SIZE: The sample size of this study comprises of 30 mothers of school age
children
SAMPLING TECHNIQUE: Sampling refers to the study process of selecting a portion
of the population to represent the entire population. In this study convenient sampling
technique will be used to select the samples.
A house to house survey will be done to identify the families with school age children
from each street
INCLUSIVE CRITERIA
The study includes the mother
Who are?
1 Having school age children
2 Willing to participate in the study
3 Available at the time of data collection
4 Residing in Harijan ward
EXCLUSION CRITERIA
The study excludes the mothers
Who are not?
1 Mentally ill individuals
2 Willing to participate in the study
3 Available at the time of data collection
4 Residing in Harijan ward
SELECTED VARIABLES
DEPENDENT VARIABLES: Knowledge of mothers regarding first aid management
of dog bite in school age children
INDEPENDENT VARIABLES: Structured teaching programme on first aid
management of dog bite in mothers of school age children
EXTRANEOUS VARIABLES:
AGE: Age of the sample is categorized as
a. 18-20 years
b. 21-22 years
c. 23-24 years
d. 25-26 years
e. 26 years and above
RELIGION: Religion of the sample is categorized as
a. Hindu
b. Muslim
c. Christian
d. Others
EDUCATIONAL BACKGROUND
a. Primary education
b. Secondary education
c. Higher education
d. Diploma
e. Graduation
f. Post graduation
OCCUPATION
a. Working women
b. House wife
PREVIOUS KNOWLEDGE
a. Yes
b. No
SOURCE OF KNOWLEDGE
a. Television
b. Radio
c. News paper
d. Magazines
e. Others
7.2 METHOD OF DATA COLLECTION
DATA COLLECTION INSTRUMENTS
A structured interview schedule will be developed and used for collecting the
data. It consists of two parts namely part I and part II. Part I deals with socio –
demographic data and Part II represents the knowledge related items on first aid
management of dog bite for mothers of school age children.
DATA COLLECTION METHOD
After obtaining the prior permission from the significant authorities and consent
from the subjects, the Investigator will assess the knowledge of mothers of school age
children regarding first aid management of dog bite by using a structured interviewing
schedule and then interviewer structured teaching programme. Again the Investigator will
assess the effectiveness of structured teaching programme by post test after a gap of 7
days depending on the convenience of the sample
PLAN FOR DATA ANALYSIS
a) Frequencies and percentage will be used to summarize the sample characteristic
and item analysis
b) Mean, standard deviation and paired t-test will be used to calculate the
effectiveness of structured teaching programme
c) Chi square value will be computed to find out the relationship between knowledge
and selected variables I.e. (age, parents educational status, occupation, sources of
knowledge, prior information of first aid).
7.3 PROJECTED OUTCOME
The result of the study throws light on effectiveness of structured teaching programme
On knowledge of mothers on first aid management of dog bite in school age children,
there by help the future researcher to adopt modified strategies to enhance the knowledge
of mothers
7.4 Does the study require any investigation or intervention to be conducted on
patients or other human or animals? If so please describe briefly
Since it is one group pre test and post test experimental design, the study requires
intervention. The investigator will assess the knowledge of mother regarding dog bite and
first aid management in school age children and administer structured teaching
programme and again test the knowledge of mothers to assess the effectiveness of
structured teaching programme.
7.5 Has ethical clearness been obtained from your institution?
Permission will obtained from institutional ethical committee Navodaya College
of Nursing
Permission will be obtained from municipal health officer and ward counselor
Consent will be obtained from all the participants.
8. References:
1. J Travel Med, Meslin FX. Rabies as a traveler’s risk, especially in high-endemicity areas. Department of communicable diseases, world health organization, Switzerland.2005 April; 12 Suppl 1:S30-40.
2. Rozario Menezes, MD Chief medical officer (retired), Mormugao port authority; consultant, pediatrics, vasco da Gama, India. RABIES IN INDIA. CMAJ,2008 February 26;178(5):564-566
3. M J.Prabhu. Rabid dog bite cases on the rise. The Hindu Online edition of Indian’s National Newspaper , Sunday, May 02, 2004
4. Keya Acharya. IT hub can handle gigabytes, Not dog bites, The Hindu group, Bangalore, Jan 17, 2007(IPS)
5. B.K Lakshminath. Pet as dangerous as strays. Bangalore Mirror Newspaper. March 30, 2010.
6. Talbot. Nursing Research. 2nd edition. Philadelphia : W.B. Saunders Company; 1995.
7. Sharma Al, Bhuyar PA, Bhawalkar JS, Pawar SN. Profile of management of animal bite cases among rural population in district pune, Maharashtra. Indian J Public Health 51(1): 62-3. 2007.
8. Brogan TV, Bratton SL, Dowd MD, Hegenbarth MA.Severe dog bite in children, University of Washington School of medicine, seattle, USA. Pediatrics. 1995 Nov; 96(5Pt 1):947-50.
9. Van As AB, Du Toit N, Nyakaza P, Millar ALW. Review of dog bites in small children, Department of paediatric surgery, university of Cape Town; Child safe South Africa. March 04, 1991 to October 25, 2004.
10. Ichhpujani RL, Chhabra M, Mittal V, Bhattacharya D, Singh J, Lal S. Knowledge, attitude and practices about animal bites and rabies in general
community—a multi centric study. J Commun Dis 38(4):355-61. 2006.
11. Shetty RA, Chaturvedi S, Singh Z. Profile of animal bite cases in pune. J Commun Dis 37(1):66-72. 2005.
12. Daniels DM,Ritzi RB,Analysis of non fatal dog bites in children in children Trauma 66(3 Suppl):S17-22.
13. Duperrex O, Black hall K, Burri M,Jeannot E. 2009, Education of children
and adolescents for the prevention of dog bites injuries,Cochrane Data
baseS Syst Rev(2):CD 004726
9. Signature of the Candidate :
10. Remarks of the Guide :
11. Name and Designation of :
11.1 Guide : Mrs. Shameem gulnaz unissa
Associate Professor
HOD. Of Child Health Nursing
Navodaya college of Nursing, Raichur
11.2 Signature :
11.3 Co-Guide :
11.4 Signature :
11.5 Head of the Department : Mrs. Shameem gulnaz unissa
Associate Professor
HOD. Of Child Health Nursing
Navodaya college of Nursing, Raichur
11.6 Signature
12 Remarks of the Chairman & : Principal
12.1 Signature :