RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA SYNOPSIS REGISTRATION OF SUBJECT FOR DISSERTATION

TITLE

1

NAME OF THE CANDIDATE & ADDRESS

MR. VINAY KUMAR S

1ST YEAT M.SC NURSING STUDENT

NISARGA COLLEGE OF NURSING

#18, KIADB INDUSTRIAL AREA, B.KATIHALLI, HASSAN, KARNATAKA.

2

NAME OF THE INSTITUTION

NISARGA COLLEGE OF NURSING, HASSAN, KARNATAKA.

3

COURSE OF STUDY & SUBJECT

1ST YEAR M.Sc. NURSING,

COMMUNITY HEALTH NURSING

4 DATE OF ADMISSION TO THE COURSE

15-06-2012

5 TITLE OF THE TOPIC “TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME(STP) ON KNOWLEDGE REGARDING PREVENTION AND CONTROL OF BIRD FLU (AVIAN FLU) AMONG POULTRY FARM WORKERS OF SELECTED POULTRY FARMS AT HASSAN”

5.1 STATEMENT OF THE PROBLEM

“AN EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME(STP) ON KNOWLEDGE REGARDING PREVENTION AND CONTROL OF BIRD FLU (AVIAN FLU) AMONG POULTRY FARM WORKERS OF SELECTED POULTRY FARMS AT HASSAN”

2

6. BRIEF RESUME OF THE INTENDED WORK

6.0 INTRODUCTION

“As every man is hunted by his own daemon, vexed by his own disease, this checks all his activity.”

“Health is the level of functional or metabolic efficiency of a living being. In

humans, it is the general condition of a person's mind and body, usually meaning to be

free from illness. Generally, the context in which an individual lives is of great

importance for his health status and quality of life. It is increasingly recognized that

health is maintained and improved not only through the advancement and application of

health science, but also through the efforts and intelligent lifestyle choices of the

individual and society.”1

Infectious diseases, also known as transmissible diseases or communicable

diseases comprise clinically evident illness resulting from the infection, presence and

growth of pathogenic biological agents in an individual host organism. Communicable

disease can occur from human to human and some from animals to human. In recent

years human has been affected from many viral infection which have been taken origin in

animal example swine flu, dog flu, bird flu, able to affect human health. This type of

disease is known as the zoonotic disease. These zoonotic diseases are now emerged as

major health problems in the world. Among them avian flu is one of the major disease

which has drawn attention of many countries by becoming the major reason for death of

millions of bird and thousands of human.2

3

Avian influenza — known informally as avian flu or bird flu — refers to

"influenza caused by viruses adapted to birds." Of the greatest concern is Highly

Pathogenic Avian Influenza (HPAI).3

"Bird flu" is a phrase similar to "swine flu," "dog flu," "horse flu," or "human flu"

in that it refers to an illness caused by any of many different strains of influenza viruses

that have adapted to a specific host. All known viruses that cause influenza in birds

belong to the species influenza A virus. All subtypes (but not all strains of all subtypes)

of influenza A virus are adapted to birds, which is why for many purposes avian flu virus

is the influenza A virus.

There are many subtypes of avian influenza viruses, but only some strains of four

subtypes have been highly pathogenic in humans. These are types H5N1, H7N3, H7N7,

and H9N2.4

The reported symptoms of avian influenza in humans have ranged from typical

influenza-like symptoms which fever, cough, sore throat, and muscle aches, eye

infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and

other severe and life-threatening complications.

Spreading of H5N1 from Asia to Europe is much more likely caused by both legal

and illegal poultry trades than dispersing through wild bird migrations, being that in

recent studies, there were no secondary rises in infection in Asia when wild birds migrate

south again from their breeding grounds. Instead, the infection patterns followed

transportation such as railroads, roads, and country borders, suggesting poultry trade as

being much more likely.

4

Influenza A virus subtype H5N1 is highly infectious and transmission of this virus

has been causing global concern as a potential pandemic threat. It is often referred to

simply as "bird flu" or "avian influenza", even though it is only one subtype of avian

influenza-causing virus.H5N1 has killed millions of poultry in a growing number of

countries throughout Asia, Europe and Africa. Health experts are concerned that the

coexistence of human flu viruses and avian flu viruses (especially H5N1) will provide an

opportunity for genetic material to be exchanged between species-specific viruses,

possibly creating a new virulent influenza strain that is easily transmissible and lethal to

humans.

The Global mortality rate for humans with H5N1 is 60%. Since the first H5N1

outbreak occurred in 1987, there have been an increasing number of HPAI H5N1 bird-to-

human transmissions, leading to clinically severe and fatal human infections. Because a

significant species barrier exists between birds and humans, though, the virus does not

easily cross over to humans, though some cases of infection are being researched to

discern whether human to human transmission is occurring. More research is necessary to

understand the pathogenesis and epidemiology of the H5N1 virus in humans.5

Although millions of birds have become infected with the virus since its

discovery, 359 humans have died from the H5N1 in twelve countries according to WHO

data as of August 10, 2012.6

In domestic animals Several domestic species have been infected with and shown

symptoms of H5N1 viral infection, including cats, dogs, ferrets, pigs, and birds.

5

Attempts are made in the United States to minimize the presence of HPAI in

poultry thorough routine surveillance of poultry flocks in commercial poultry operations.

Detection of a HPAI virus may result in immediate culling.

In order to prevent disease occurrence in human following measures should be

followed strictly advice to international visitors infection control practices, use of

protective equipments, storage and positioning of the supplies ,hand washing, linen

handling, waste disposal, patient and family education.

6.1 NEED FOR THE STUDY:

Transmission and infection of H5N1 from infected avian sources human

infection in 1997,7 due to the global spread of H5N1 that constitutes a pandemic

threat. Infected birds pass on H5N1 through their saliva, nasal secretions, and feces.

Other birds may pick up the virus through direct contact with these excretions or

when they have contact with surfaces contaminated with this material. Because

migratory birds are among the carriers of the H5N1 virus it may spread to all parts of

the world. Past outbreaks of avian flu have often originated in crowded conditions in

southeast and east Asia, where humans, pigs, and poultry live in close quarters. In

these conditions a virus is more likely to mutate into a form that more easily infects

humans. A few isolated cases of suspected human to human transmission exist,8 with

the latest such case in June 2006 (among members of a family in Sumatra).[ No

pandemic strain of H5N1 has yet been found.9

6

H5N1 vaccines for chickens exist and are sometimes used, although there are

many difficulties, and it's difficult to decide whether it helps more or hurts more. H5N1

pre-pandemic vaccines exist in quantities sufficient to inoculate a few million people 10

and might be useful for priming to "boost the immune response to a different H5N1

vaccine tailor-made years later to thwart an emerging pandemic". H5N1 pandemic

vaccines and technologies to rapidly create them are in the H5N1 clinical trials stage but

cannot be verified as useful until after there exists a pandemic strain. 11

Most human contractions of the avian flu are a result of either handling dead

infected birds or from contact with infected fluids. While most wild birds mainly have

only a mild form of the H5N1 strain, once domesticated birds such as chickens or turkeys

are infected, it could become much more deadly because the birds are often within close

contact of one another. There is currently a large threat of this in Asia with infected

poultry due to low hygiene conditions and close quarters. Although it is easy for humans

to become infected from birds, it's much more difficult to do so from human to human

without close and lasting contact.12

Vietnam is the country worst affected by bird flu, with 42 deaths and 93 cases.

Most of the deaths were recorded between late 2003 and mid-2005.Nearly 50 million

poultry have been culled in attempts to limit the spread of the disease. On January 5

2006, the government said it had completed its programme of vaccinating 150 million

poultry around the country. The country suffered at the beginning of the current outbreak,

with 22 cases and 14 deaths among humans since December 2003.After a lull lasting

nearly a year, authorities confirmed on November 1 2005 that three people had been

infected during the previous month. This coincided with a recurrence of bird flu among

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poultry in six provinces. The latest victim was a five-year-old boy whose death was

confirmed on December 9 2005. The Thai government has announced it will start

producing a generic version of the anti-viral drug Tami flu.12

Thirty people have been infected in recent months. Twenty-three of them have

died. The latest was a 20-month-old girl from Kapuk, West Jakarta, who died on March

23.The authorities have imposed "extraordinary" measures, including the power to force

people suspected of having bird flu into hospital. Most Indonesian households keep

chickens or caged birds as pets. Eleven of the 16 people infected in China have died.

There have been confirmed outbreaks in seven provinces and regions - Hunan, Anhui,

Guangxi, Liaoning, Jiangxi, Fujian and Sichuan. On November 15 2005, the government

announced plans to vaccinate all 14 billion of China's farm birds after more than a dozen

confirmed outbreaks. Millions of birds had already been culled before the programme

was announced.12

All five people confirmed to have contracted bird flu in Cambodia have

subsequently died. US health officials have expressed concern about the country's

surveillance and Containment capacities should a mutation take place. The US has

offered $2m (£1.14m) to improve the country's response systems. On April 6 2006, Egypt

announced that a 16-year-old girl had died of the H5N1 strain of the virus and an eight-

year-old boy had tested positive. The announcements bring to 11 the number of human

cases in the country, including three people who have died. All of Egypt's fatalities have

been women, the previous two were in their 30s. Two people have been cured of the virus

while six are receiving treatment.12

8

Bird flu influenza recently resurfaced in the government-owned Gandhigram

Poultry Farm in western Tripura after one and a half months, forcing the authorities to

cull thousands of poultry birds, ducks and poultry products in the farm and in the adjacent

four villages in a three-kilometer radius. The authorities in Meghalaya’s East Garo Hills

district had culled 6,538 birds, while 9,157 eggs and more than 800 kg of feed were

destroyed at Williamnagar and adjoining villages late January.13

The disease also erupted in various districts of eastern, western and southern

Assam last year and earlier this year. Tripura had been affected by avian influenza since

in April-May 2008, forcing the authorities to cull over 250,000 poultry birds and ducks

since then.14

Hesaraghatta is in the north-west of Bangalore, around 25km from the city centre.

The drastic step to cull all the infected birds by 25 rapid response teams was taken after

the state-run high security animal disease hospital at Bhopal confirmed that over 3,600

turkeys in the poultry farm died last week of October due to the deadly pathogenic

virus.15

The Karnataka government on Monday said that tests had confirmed that the 206

chicken and 17 ducks that died at the Central Poultry Development Organization at

Hesaraghatta near Bangalore were affected by the highly pathogenic avian influenza

(H5N1) virus. The outbreak has necessitated culling of over 33,000 birds — 19,235

chicken, 13,673 ducks and 369 emus — on the institute's premises and its 1km radius. It

said 52 chicken sheds in the area are being sanitized to prevent any spread of the flu.15

9

A study was conducted in china to evaluate the risk related to the transmission of

H5N1 subtype avian influenza virus in the environment of poultry markets in Changsha.

The characteristics of hamagglutinin (HA) genes of H5N1 AIV in the environment were

analyzed. H5N1 antibody of the occupational exposure groups in the poultry market was

tested and AIV nucleic acid in the poultry market environment monitored.102 blood

samples of the occupational exposure groups were tested for H5N1 antibody with single

radioimmunoassay diffusion hemolysis (SRH).While 160 environment samples (from

sewage, birds stools, feathers and smearing samples of poultry cages) in the poultry

market were also detected for AIV nucleic acid with real-time PCR method.. The results

through H5N1 antibody monitoring program showed that H5N1 antibody positive rates

from workers were 25.5% (26/102), 50.0% (9/18) and 25.4% (17/67) respectively in the

poultry markets of township and inner cities. H5N1 antibody positive rate in the township

poultry markets was higher than in the inner cities poultry markets.16

A study was conducted in Italy to evaluate knowledge, attitudes, and infection

control practices of poultry workers regarding avian influenza. A face to face interview

was carried to collect data. The study sample was a total of 284 poultry workers at 110

poultry farms throughout the Campania region of Italy were recruited into the study from

December 2005 through March 2006. Result revealed that 62.3% wanted more

information. Improving knowledge of transmission and application of preventive

measures is a useful public health strategy for reducing the effects of avian influenza in

poultry workers. Employers and health professionals should work together to provide

effective and coordinated information to these workers.17

10

Strains of influenza viruses are adapted to multiple species, though may be

preferential towards a particular host. For example, viruses responsible for influenza

pandemics are adapted to both humans and birds. Recent influenza research into the

genes of the Spanish flu virus shows it to have genes adapted to both birds and humans,

with more of its genes from birds than less deadly later pandemic strains.12

While its most highly pathogenic strain (H5N1) had been spreading throughout

Asia since 2003, avian influenza reached Europe in 2005, and the Middle East, as well as

Africa, the following year. On January 22, 2012, China reported its second human death

due to bird flu in a month following other fatalities in Vietnam and Cambodia. So control

of bird flu has got more importance in order to prevent further outbreaks.12

Poultry workers are highly risky population as they work in poultry farms and

they are more susceptible host for bird flu which could be get transferred from the

infected bird. Poultry workers are having knowledge gap regarding H5N1 influenza.

Poultry workers should therefore be informed and educated about pandemics like H5N1

influenza and its prevention. It is necessary for poultry workers to understand the disease

pattern and plan for the all prevention and treatment. It is essential to follow the infection

control measures and detection of disease early. The researcher felt the need of

conducting a study to control, prevent and manage the H5N1 or Avian flu or bird flu by

understanding above incidences. Hence the researcher felt that a planned teaching

programme on bird flu (H5N1 influenza) among poultry farm workers will be helpful to

know about the pandemic and its effective management.

11

6.2 REVIEW OF LITERATURE

A literature review involves systematic identification, location, scrutiny

and summary of written material that contain information on research problems

(Polit and Beck 2003). The review of literature is classified under the following

three headings.

1) Reviews related to general information on bird flu(avian flu )

2) Reviews related prevention and control of bird flu(avian flu)

3) Reviews related to educational intervention

1. SECTION-A: REVIEW RELATED TO GENERAL INFORMATION BIRD

FLU (AVINA FLU)

A study was conducted in West Bengal in India to assess the Socio-Demographic

Variables with Respect to the Knowledge of Bird Flu between a Rural and an Urban

Slum Community. This community based cross-sectional study was undertaken in

December 2009 in the village named Hakimpur, Block Singur, District Hooghly, State

West Bengal of India and in the urban slum of Chetla in the city of Kolkata of India in

the month of April and May 2010.A population 862 of 215 families and in an urban slum

of Chetla lockgate area of service area of Urban Health Centre Kolkata with a population

of 1014 of 250 families has been selected as sample. The Results showed that 45.6%

rural and 55.1% urban slum respondents know what Bird Flu is, 75.3% rural and 58.8%

urban slum respondents know the mode of transmission, 32.6% rural and 31.2% urban

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slum respondents know the procedure of culling. The knowledge of transmission by

Infected Body Fluids among Literate Respondents were significantly high than the

Illiterate Respondents in both the study areas. Study concluded that there is necessary to

make people of both the study areas aware regarding bird flu through proper public

education.18

A descriptive study was carried out in ten Greek prefectures to determine the

information level among students about transmission ways, symptoms and prevention

measures of avian flu. A total of 1400 Greek students participated in the study.

Approximately 75% of the students reported to know what bird flu is and 53% reported

to know that there has been at least one case of avian flu in Greece. More than half

(55.6%) reported that an effective vaccine against avian flu does exist. 47% percent

reported that avian flu can be transmitted from human to human whereas 21.4% believed

that humans can suffer from avian flu. Finally they concluded that the level of

information about avian flu among Greek students was found inadequate, especially

regarding serious aspects of avian flu.19

A study was conducted to assess the KAP relating to avian influenza in urban and

rural areas of China. The method used is used standardized, structured questionnaires

distributed in both an urban area and a rural area. A sample size of 1,750 participants in

Shenzhen was calculated to achieve a point estimation with an a-error of 0.05, based on

an estimated prevalence (about 20%) of chickens purchased live in Hong Kong SAR.

Approximately 75% of participants in both groups requested more information about AI.

The preferred source of information for both groups was television.. Almost half of the

participants in both groups had continued to eat poultry after being informed about the

13

disease. This study concludes that a high degree of awareness of human AI in both urban

and rural populations, and could provide scientific support to assist the Chinese

government in developing strategies and health-education campaigns to prevent AI

infection among the general population.20

A study was conducted in Thailand to assess poultry handling practices during

avian influenza outbreak. The survey method used to conduct study in resident of rural

Thailand regarding avian influenza KAP. To detect a change of >15% between results

before and after the education campaign, Researcher sampled 200 persons. From a list of

villages and their populations, researcher selected 5 by using a probability proportional to

size. Result revealed that knowledge and attitudes about how to protect oneself from

diseases from poultry changed significantly after the respondent heard about avian

influenza .The percentage of adults who thought touching sick or dead poultry with their

bare hands was safe decreased from 40% to 14% (p<0.01) and from 23% to 5% for

children in their household (p<0.01). This study suggests that public campaigns can be

effective at educating rural populations. Renewed efforts are needed to find practical

solutions that will induce behavioral change.21

A study was conducted in Tafi,Saudi Arabia on Knowledge and concern about

avian influenza among secondary school students knowledge and concerns about avian

influenza among secondary school students in Taif, Saudi Arabia. A stratified random

sample of 514 students from 6 secondary schools was given a self-administered multiple-

choice questionnaire. Result revealed that Knowledge scores were significantly related to

socioeconomic indicators. Approximately 70% of the participants reported that media

14

(TV and/or radio) was the source of their information. Overall, 65.4% of the participants

said they expected there to be cases of avian influenza in Saudi Arabia this year. Females

were more concerned than males (70.9% versus 58.9%). This study concludes that

Effective school health education programmes should be implemented in order to prepare

the community to deal with this important threat.22

A study conducted to determine factors associated with knowledge and

anticipated attitudes to a foreseen avian influenza outbreak in a high-risk population from

a Turkish remote region. A random, cross-sectional face-to-face survey of 1,046 Turkish

adults. The proportion of participants concerned about contracting the virus was

significantly lower amongst the less educated and rural located respondents. Significantly

more rural than urban located participants declared not complying with quarantine

policies and not handing out their poultry in case of an influenza outbreak. Factors

associated with protective behaviours were higher level of education, urban location, not

performing backyard farming of poultry, and preferring ready-to-eat products.

Preparedness against bird flu endemic in remote regions could be hindered by factors,

such as low levels of education and economic dependence on small-scale backyard

farming. The baseline data collected in this survey will be useful in monitoring changes

over time in the population's perceptions of threat, and its attitude towards compliance

with specific public health recommendations.23

A descriptive survey was conducted in Italy regarding knowledge, attitude and

practices towards avian influenza in an adult population. A random sample of 1020 adults

received a questionnaire about socio-demographic characteristics, knowledge of

15

transmission and prevention, behaviours regarding use of preventive measures and food

handling practices and sources of information about avian influenza. Finally, they

concluded that respondents demonstrated no detailed understanding of avian influenza

and were at greater perceived risk, and a lower compliance with precautions. Behaviours

and health educational strategies are strongly needed.24

A cross-sectional questionnaire-based study on ‘awareness of bird flu amongst

young college students was conducted at Karachi in Pakistan. A total of 220 students

participated. About 211 (96%) students said that they had heard about bird flu but only 86

(39%) correctly identified it as a disease of both birds and humans. 70% of the

participants said that virus causes it and the most common source of knowledge was TV

(70%) followed by newspaper (51%). Flu-like symptoms were identified by 77 (35%);

160 (73%) considered birds-to-human as the most likely route of transmission. 133 (70%)

replied that a vaccine is not available; 80 (41%) said that there is a treatment for the

disease. About 143 (73%) thought that it is life-threatening. According to 105 (48%) the

suitable preventive measure to be taken by the government would be to kill susceptible

chickens. The awareness regarding bird flu was quite low among poultry farm workers.

As bird flu is a worldwide public health problem it was suggested that increasing the

awareness regarding it would be a solution to avoid its spread and complications.25

2. SECTION B: Reviews related Prevention and control of bird flu (avian flu)

A study was conducted to evaluate Knowledge, Attitudes, and Practices of US

Travelers to Asia Regarding Seasonal Influenza and H5N1 Avian Influenza Prevention

Measures. The survey was conducted from June through September 2008 among

16

travelers to Asia at the departure lounges of four international airports in the United

States. A sample of 1,024 travelers to Asia was chosen to achieve sufficient power to

estimate the KAP of travelers regarding influenza prevention measures, with a precision

of 40% ± 3% and 95% level of confidence. This study revealed that a sample of 1,024

travelers to Asia was chosen to achieve sufficient power to estimate the KAP of travelers

regarding influenza prevention measures, with a precision of 40% ± 3% and 95% level of

confidence. This study concludes that tailored communication messages regarding

influenza prevention measures should be developed to reach high-risk travelers,

especially FB travelers and younger travelers who are traveling for longer time periods.

This study concludes that Clinicians should ensure that all patients receive influenza

vaccine prior to travel.26

A study was conducted in Nigeria to assess the knowledge of, attitudes to, and

compliance with preventive practices for avian influenza infection among poultry

workers. A cross-sectional epidemiological study design was conducted using a semi-

structured questionnaire administered at interview to obtain information. A total of 140

poultry workers from 25 poultry farms were interviewed. Their average age was 29.9+/-

9.6 years, and the median duration of work activity was 3 years (range 1 to 21 years).

Result revealed that 61.4% correctly defined the infection as a viral infection that occurs

in all species of birds. Knowledge of transmission and preventive practices for the

infection was varied and incomplete among respondents. The majority (78.6%) agreed

that avian influenza is a serious and preventable disease; however, the perceived risk of

infection was moderate. No vaccination of poultry against avian influenza was reported

by 98.6% of respondents, and wearing of personal protective equipment was not a routine

17

practice. There is a need to provide effective and coordinated information to poultry

workers about avian influenza and the precautions necessary to avoid spreading the virus

among poultry and to humans.27

A study was conducted in Bahetim district, Qalubeya Governorate to assess the

rural community knowledge, attitudes, and practice (KAP) related to AI prevention and

control. A household survey, using an interviewing questionnaire and observational

checklist, .399 participants were observed out of which 41.1% were dealing with poultry,

of them 26% were raising poultry at their home. Results shows that score level, 55.7% of

the respondents had fair knowledge level, 67.5% had positive attitude towards prevention

and control of AI and 38.1% had fair practice level. Younger persons, those who had

completed secondary or higher level of education, those living in nuclear family had

moderate knowledge and attitudes towards AI prevention and control (p < 0.05), while

age, sex, and education level did not affect their healthy behavior and sanitary practices.

This study concludes that level of community knowledge and practices about AI disease

was moderate, but their attitudes were positive. Therefore, designing and implementing

health educational programs about AI to improve the community practices should have

the priority to encourage people to take a more active role.28

A cross-sectional survey was conducted to assess the willingness of Hong Kong

healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert

levels during the year 2009. Surveys were conducted at 31 hospital departments of

internal medicine, paediatrics, and emergency medicine under the Hong Kong Hospital

Authority from January to March 2009 and in May 2009. 2255 healthcare workers

18

completed the questionnaires in the two studies. They were doctors, nurses, or allied

health professionals working in the public hospital. Result revealed that out of 2255

health workers 28.4% showed the willingness to accept pre-pandemic H5N1 vaccine in

the first survey. The willingness to accept pre-pandemic H1N1 vaccine was 47.9%

among healthcare workers when the WHO alert level was at Phase 5. More than half of

the respondents thought nurses should be the first priority group to receive the vaccines.

Finally the researcher concluded that the willingness to accept pre-pandemic influenza

vaccination was low, and no significant effect was observed with the change in WHO

alert level.29

3. SECTON- C: Reviews related to Educational intervention

A study was conducted in Laos to evaluate paradoxical risk perception and

behaviours related to avian flu outbreak and education campaign. The study method was

used 2-stage cross-sectional randomized survey and interviewed 1098 households using

a pre-tested questionnaire in five provinces representative of the Southern to Northern

strata of Laos. The sample included 988 people with a 5% precision with a=0.05 and 90%

power. To account for incomplete or missing data, an additional 10% of people were

included, for a total sample size of 1086 then rounded up to 1100. Of the 1098

participants, 303 (27.6%) received training on HPAI. The level of awareness was similar

to that in 2006. The study result shows that the urban population considered risk to be

decreased, yet unsafe behaviour persisted or increased. This contrasted with an increase

in awareness and safe behaviour practices in rural areas. The study reported a paradoxical

19

relationship between unsafe behaviour and risk perception in urban areas, as well as

exposure to HPAI training and message misinterpretation. This study concludes that

future educational campaigns need to be tailored to specific target populations and

farming styles, for example, small holder farms as compared to commercial farms.30

A study was conducted in Vietnam to assess Impact of Educational Intervention

Concerning awareness and behaviors relating to avian influenza (h5n1) in a high-risk

population. A total of 600 participants were randomly selected from four villages in the

Yen Son commune (intervention group) and four villages in the Ninh Hoa commune (the

control group). The sample size was chosen so that it could detect an effect of 0.25 with a

power of 0.8 even after substantial dropout. The knowledge, attitude and practice (KAP)

surveys were conducted in December 2009 as a pre-educational intervention survey

(KAP 1) and 3 months after the educational intervention for the intervention group in

March 2010 as a post-educational intervention survey (KAP 2). KAP 1 and KAP 2 for the

control group were conducted at the same time point as the KAPs for the intervention

group. Result revealed that having a higher education level was strongly correlated with

the largest difference in the attitude-practice score. The score of the intervention group

differed by 8.69 points from that of the control group. This study concludes that

educational intervention needs to be continuously conducted to eventually change

behavior related to avian influenza (H5N1) infection. 31

20

STATEMENT OF THE PROBLEM

“An experimental study to evaluate the effectiveness of structured teaching

programme (STP) on knowledge regarding prevention and control of Bird flu

(Avian flu) among poultry farm workers of selected poultry farms at Hassan”

6.3. OBJECTIVES OF THE STUDY

1. To assess the knowledge of poultry farm workers regarding prevention and

control of Bird flu before administration of STP

2. To assess the knowledge of poultry farm workers regarding prevention and

control of bird flu after administration of STP

3. To evaluate the effectiveness of the structured teaching programme by comparing

the pre test and post test knowledge scores of poultry farm workers regarding

prevention and control of bird flu

4. To find out the association between the selected socio demographic variables of

poultry farm workers and gained knowledge scores regarding prevention and

control of bird flu

6.4. HYPOTHESIS

H1: There will be a significant difference between the pre test and post test

knowledge scores of poultry farm workers regarding prevention and control of bird

flu

21

H2: There will be a significant association between the selected socio demographic

variables of poultry farm workers and gained knowledge scores regarding prevention

and control of bird flu.

6.5. ASSUMPTIONS

1. Poultry farm workers will be having less knowledge regarding prevention and

control of bird flu.

2. Administration of STP on prevention and control of bird flu will promote the

knowledge of poultry farm workers regarding prevention and control of bird

flu.

6.6. OPERATIONAL DEFINITIONS

• Experimental study : It is a systematic study and scientific approach to

research in which researcher manipulates one or more variables and

controls and measures and controls and measures any change in other

variables.

• Evaluate: It refers to a systematic determination of a subject merit worth

and significance using criteria grounded by set of standards.

• Structured teaching program (STP):

It refers to systematically developed health education design for parents to

provide information and knowledge regarding control and prevention of

bird flu to poultry farm workers.

22

• Knowledge : It refers to the understanding and awareness of poultry

farm workers regarding prevention and control of bird flu

• Poultry farm workers: It refers to persons who are working in poultry

farms at Hassan.

• Avian flu (bird flu): A viral infection caused by H5N1 virus which

occurs in birds and can be transferred to human via birds

• Prevention and control of bird flu: It refers to restoring the life of

Poultry workers, by providing information regarding protective and

control measures to be maintained and followed.

6.7. SAMPLING CRITERIA

Inclusion criteria

Poultry workers who are

• Present in the selected poultry farms at Hassan

• Willing to participate in the study

• Able to read and write kannada

Exclusion criteria

Poultry workers who are

• Not willing to participate in the study

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• Not present in the selected poultry at Hassan

• Unable to understand kannada

6.8. LIMITATIONS OF THE STUDY

The study is limited to

• the poultry farm workers of selected poultry farms at Hassan

• the study period is limited to 4-6 weeks of duration.

• sample size is limited to 60 poultry farm workers

• the study is limited to pre experimental design.

6.9. SIGNIFICANCE OF THE STUDY

This study will

1. promote the knowledge of poultry farm workers regarding prevention

and control of bird flu

2. Helps the poultry workers in future to manage the bird flu outbreaks in a

effective manner.

6.10. CONCEPTUAL FRAME WORK

This study is based on “general system theory”( modified Ludwig von

Bertalanffy General system Theory 1968)

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7. MATERIAL AND METHODS OF STUDY

7.1 SOURCE OF DATA

Data will be collected from the poultry workers in the selected poultry farms at

Hassan, Karnataka.

7.2 METHODS OF COLLECTION OF DATA

7.2.1 RESEARCH DESIGN

Pre experimental single group pre test post test design.

Schematic plan of the study

GROUP PRE TEST INTERVENTION POST TEST

E O1 X O2

key words

E- Experimental Group (60 Poultry farm workers)

01- Observation of knowledge of Poultry farm workers before STP.

X- Planned teaching programme on prevention and control of avian flu (bird

flu).

02 - Observation of knowledge of poultry farm workers after STP.

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7.2.2 RESEARCH SETTING

The study will be conducted in selected poultry farms at Hassan District.

7.2.3 POPULATION

o Target population: All the poultry farm workers in poultry farms at

Hassan District.

o Accessible population: The poultry farm workers in poultry farms at

Hassan District.

7.2.4 SAMPLE

All the poultry farm workers of selected poultry farms who fulfils the inclusion

criteria are the samples of the study.

7.2.5 SAMPLE SIZE

Sample comprised of 60 poultry farm workers in poultry farms at Hassan,

Karnataka.

7.2.6 SAMPLING TECHNIQUE

Non Probability Convenient sampling technique will be used.

7.2.7 COLLECTIONS OF DATA

Data will be collected from poultry farm workers in poultry farms at Hassan,

Karnataka.

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7.2.8 SELECTION OF TOOL

Part A- Socio demographic profile.

Part B- Collection of data is done by using semi structured knowledge

questionnaire interview regarding prevention and control of avian flu (bird flu).

7.2.9 RESEARCH APPROACH: Evaluative approach.

7.3 VARIABLES

Independent variable: STP on Prevention and control of bird flu.

Dependent variables: Knowledge of poultry farm workers.

Extraneous variables: Age, Religion, gender, income, nature of work, Educational

status, Type of Family, poultry farm condition, Previous knowledge regarding prevention

and control of bird flu accidental hazards in children, Source of health information.

7.4. PLAN FOR DATA ANALYSIS

• Descriptive statistics: -The descriptive statistical analysis includes frequencies,

percentages, mean, and Standard deviation for poultry farms workers regarding the

prevention and control of bird flu.

• Inferential statistics: - Difference in knowledge score will be analyzed by using

independent student paired t-test and an association between demographical variables of

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poultry farm workers and level of knowledge regarding prevention and control of bird flu

will be analyzed using Pearson’s chi-square test.

7.5 PILOT STUDY

The pilot study is planned with 10% of the total sample size which will be

conducted in selected poultry farms at Hassan and that will be excluded in the main

study.

7.6. ETHICAL CONSIDERATION

DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CARRIED OUT

ON PATIENTS OR OTHER HUMANS?

Yes, study will be conducted on poultry farm workers in poultry farm and

consent has been obtained.

HAS ETHICAL CLEARENCE HAS BEEN OBTAINED FROM YOUR

INSTITUTION?

Yes, permission will be obtained from the research committee of the Nisarga college of

Nursing, Hassan.

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