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ST.THOMAS COLLEGE OF NURSING, CHETHIPUZHA

CHAPTER-I

INTRODUCTION

“ You can’t do anything about the length of you life. But you can do something about

its width and depth’’ -Even Esar

Science is more advanced today and it mainly focuses on many discoveries

that will increase the life expectancy of human being. People flow with the stream of

modern civilization, but actually they are not realizing that they are loosing their

quality of life. Here comes the importance of this thought.

Each and everyone in a society can play a vital role in improving the width

and depth of life for that they should have adequate knowledge about the life

threatening diseases.

“Swine flu swipes Devastation Across the Nation. It is Now A Pandemic’’.1

Swine flu is an infection caused by a virus, it is so named for the virus essentially

infects pigs. Humans do not normally get swine flu but human infections can result

from contact with infected pig. The virus is contagious and from the year 2008 the

prevalence of H1N1 has been increased. So it is essential to control the spread of the

disease to improve the quality of human life.

BACKGROUND OF THE STUDY

Swine flu (H1N1) according to reports is spreading thick and fast throughout

our country and people are getting panicky about its possible consequences. As in

most cases, ignorance & fear are the root causes of the unwarranted panic among the

public.

In case of swine flu unlike seasonal flu more than half of the hospitalization

and quarter of the deaths from are in young people under the age of 25 2. The vital

statistics shows that three are about 34115 confirmed cases in India and about 1646

deaths are reported .In Kerala there is about 195 cases of swine flu have been

reported. Pre-monsoon showers flowed by the arrival of south west monsoon in June


and July have only hastened the pace of spread of infections in Kerala according to

officials in the state Government.1

NEED FOR THE STUDY

H1N1 fever is the most common cause of increasing morbidity and mortality

rate in our state. Swine flu doesn’t often infect people and the rare human cases that

have occurred in the past have mainly affected people who had direct contact with

pigs. But the current outbreak is different3.

In most cases ignorance and fear are the root causes of the unwarranted panic

among the public. If they have adequate knowledge about its occurrence they can take

measures preventing it. Here poor sanitation, overcrowding, stagnant water etc, act

as a spreading cause f this disease4.

The health of the nation lies in the people of the society. Family is the basic

unit of the society. As housewives are the care taker of the family members she

should have adequate knowledge regarding the early management and preventive

measures of the health problems5. Thus arise a healthy family there by a healthy

nation. So we selected the housewives for our study to assess the knowledge

regarding H1N1.fever.

Be aware; be well informed only we can stop the pandemic from spreading 6

STATEMENT OF THE PROBLEM

“ A descriptive study to assess the knowledge regarding H1N1 fever (swine flu)

among housewives in selected areas of Vazhappally Panchayat’’

OBJECTIVES.

1. To determine the prevalence of swine flu in selected areas of Vazhappally

Panchayat.

2. To determine the knowledge level of housewives regarding the H1N1 fever.

3. To assess the association between knowledge about swine flu and selected

demographic variables.


OPERATIONAL DEFINITIONS

Knowledge: Knowledge refers to awareness of housewives about H1N1 fever (swine

flu)

H1N1 fever: It is a respiratory disease caused by viruses (influenza virus) that infect

the respiratory tract resulting in sudden onset of fever, cough, sore throat.1

Housewives: Women who are taking care of their family.

HYPOTHESIS

H1: There is an association between knowledge regarding H1N1 fever and selected

demographic variables at 0.05 significance level.

DELIMITATIONS

1. The study is limited to a period of 2 weeks.

2. The study was limited to housewives willing to participate.

3. The study was limited to housewives who are able to read and write.


CHAPTER-II

REVIEW OF LITURATURE

Review of literature is an important step in research project. It helps to know

what was previously done, what method has been used by the researchers and how the

result of other research in their area can be combined to develop new knowledge.

Review of literature is a systematic identification, location, scrutiny and

summary of written materials, which contain information on research problem.

Review of literature is a critical summary of research on a topic of interest often

prepared to put a research problem in the context7.

The available literature was divided into the following headings:

1) Review of literature related to incidence and prevelance of H1N1 fever

2) Review of literature related to community attitudes, perception, anxiety and

behaviour pattern towards disease.

3) Review of literature related to risk factors of swine flu fever

4) Review of literature related to epidemiology.

REVIEW OF LITERATURE RELATED TO INCIDENCE AND

PREVALENCE OF H1N1 FEVER:

A study on H1N1 virus pandemic of 21st centuary and was conducted in

Canada from 10th December to 29th December.They took 700 samples for this study

using unstructured interview method and reveals that 15% of there total population is

affected with this pandemic of 21st centuary.8

A descriptive study on mortality due to H1N1 fever and influenza conducted

in selected hospitals of South America using structured questionnaire method reveals

that 3646 died out of 36115 confined cases.9

A descriptive study on out-break of H1NI among adult is conducted from 10 th

june to 5th august using structured interview method, and study reveals that H1N1

infection in Indian adult had the features similar to that of seasonal influenza 10.


LITERATURE REVIEW RELATED TO RISK FACTORES FOR

SWINE FLU FEVER

A descriptive study on risk factors of H1N1 fever and causes of mortality in

2007 to 2008 was conducted in selected areas of Mexico using structured questionare.

They took a sample size of 200 by convenience. Study reveals that the major risk

factors are lack of environmental hygiene ,poor health care system, and there is

marked association between cattle rearing as pigs ,incidence and mortality rate .11

LITERATURE REVIEW RELATED TO COMMUNITY

ATTITUDES, PERCEPTION, ANXIETY,AND BEHAVIOUR

PATTERN TOWARDS SWINE FLU.

A study on the community attitudes towards swine flu from May 2nd to29th

May through cross sectional survey in Mexico which reveals that society is very much

conscious about the recent epidemic disease.12

A descriptive study on the public perception, anxiety, and behavioural changes

in relation to swine-flu through cross sectional survey is from 8 February to

28thFebruary on a sample of 300 reveals the high anxiety level of the community13.

LITERATURE REVIEW RELATED TO EPIDEMIOLOGY

A cohort study on hutteric colony in Africa from 12th October to 18th

November on a sample of 60 each reveals that occurance of illness among humans

triggers swine.13

A study on how H1N1virus persist and spread in Switzerland from December 3

to 28 and reveals that poor hygien is a precipitating factor14.


REVIEW OF LITERATURE RELATED TO STUDY OF H1N1

VIRUS

An article on the new H1N1 virus ,which threatens to set off an influenza

pandemic is a mishmash of swine, human and bird flu gones down from two flu

strains that infected pigs. He stated that the disease could potentially spread through

virus shed in faeces. Flu virus are thought to be mainly transmitted through droplet

expelled with an infected person cough .2

LITERATURE REVIEW RELATED TO SYMPTOMATIC

MANAGEMENT OF THE SWINE FLU

An expert’s article on the management of symptoms of swine flu which stated

that swine flu begins with the symptoms of cold, and cough. First of all nose and

throat gets infected at the primary infection stage. He added that the best way to

control virus infection is to remove infection from nasal and throat region 15.

REVIEW OF LITERATURE RELATED TO HERBAL REMEDIES

An article on herbal remedies on swine flu says that shathavari,ashwagantha,

bala, naagbala, madhumalini were used for treatment and preventive purpose of swine

flu. The herbal medicine called pippaly was found to have special therapeutic affinity

to the mucosa of the respiratory tract. It can reduce the inflammation swelling and

excessive secretions in the lungs throat and nose 16.


CHAPTER-III

RESEARCH METHODOLOGY

Research is a an exhaustive intelligent searching for facts and their meaning

or implications with reference to a given problem. The methodology of research

indicate the general pattern to gather empirical data for the problem under

investigation 17.

Research methodology refers to investigation of the ways of obtaining

organizing and analyzing the data 7. Methodology address with the development,

validation and revaluation of research tools or methods.

This chapter discuss the methodology adopted for the study and includes

research approach, design, setting for the study, population, sample, sampling

technique, validity of tool and reliability, data collection procedure and plan for data

analysis.

RESEARCH APPROACH

The approach indicates the basic procedure for data collection. A research

approach may be used for the purpose of developing theory, identifying problems

with current practice, making judgment or doing 7.

The selection of approach depends upon purpose of study. The research approach

adopted for the present study was a quantitative approach.

RESEARCH DESIGN

Research design is the overall plan for addressing a research question,

including specifications for enhancing the studies integrity. It is a blueprint for the

conduct of a study that minimizes control over factors that could interfere with the

study desired outcome 17.The design must be appropriate to test the study hypothesis

or answer the research question.


In the present study a structured questionnaire will be used to collect the data

from the sample.

SETTING FOR THE STUDY

Setting is the physical location and condition in which data collection takes

place in a study 7.

The study was conducted in selected area of Vazhappally Panchayat which

includes Koonamthanam, chethipuzha, Sanketham.

POPULATION

Population is a complete set of individual or object that posses some common

characteristics of interest to the research.13 The population for the present study were

housewives.

SAMPLE AND SAMPLE SIZE

Sample is the subset of population that is selected for a study and members of

a sample are the subject 14The sample will posses all the characteristics of the

population.

In this study the sample is housewives from Chethipuzha, Koonamthanam and

Sanketham and the sample size is 60.

SAMPLING TECHNIQUE

Sampling is a process of selecting a portion of population to represent the

entire population 14

In our study Convenient sampling technique was used.

SAMPLING CRITERIA


Sampling criteria are the characteristics essential for the inclusion of target

population. The sample is selected from accessible population that meats these

sampling criteria. 13

INCLUSION CRITERIA

Housewives who are

In age group of 20-60 Yrs

Willing to participate in study

Accessible to researcher

EXCLUSION CRITERIA

Housewives who are health professionals.

DEVELOPMENT OF THE TOOL

Research instruments or research tool area the dense used to collect data. The

instrument facilitates the observations and measurement of variables. The present

study was aimed to assess the knowledge level of housewives regarding H1N1 fever.

Survey method was used for assessing the knowledge. A structured questionnaire was

prepared after consultation with experts in the field of community medicine.

DESCRIPTION OF TOOL

The structured questionnaire for assessment of knowledge regarding H1N1

fever consists of 2 sections:-

Section A deals with demographic variables such as name, age , religion,

education, income, occupation, family status, socioeconomic condition, mode of

treatment, source of information

Section B consists of 40 multiple choice questions on meaning, causes,

clinical manifestations, management prevention and complications of H1N1 fever.


SCORING

There are 40 questions having 3 options for each question.

Each correct answer was given a score of one make each and wrong answer

given as zero. So the total score of section B is 40. Grading was also done based on

the marks obtained.

The knowledge level was categorized as follows.

<50% - Poor knowledge

50 - 65% - Average knowledge

65 - 80% - Good knowledge

80 - 100% - Excellent.

VALIDITY OF THE TOOL

Validity refers to whether an instrument adequately measure, what is supposed

to measure.14 Content validity is the degree to which the items in an instrument

adequately represent the Universe of content for the concept being measured .

The content validity was verified by 2 expert in filed of medicine (Dr.Jamuna

Varghese medical support of taluk Hospital, dr. Gopakumar ) and also by our research

guide for its adequacy.

Suggestion of experts is incorporated into the tool and was modified before

conducting the pilot study.

RELIABILITY OF THE TOOL

Reliability is the degree of consistency or dependability with which an

instrument measures the target attribute.14 The reliability of the tool was tested by split

half method using Karl Pearson’s correlation coefficient, and Spearman Brown

Prophecy formula. The reliability of the tool was found to be 0.81. This indicates that

tool was reliable.


PILOT STUDY

It is a small variation or trial random in preparation for major study. 14 The

function of the pilot study is to obtain information for improving the project and for

assessing the feasibility. Reliability was confirmed through pilot study.

Pilot study was conducted on 31-07-2010 among 6 hours in Chethipuzha

community (Vakkachanpady). The pilot study was reliable and no problems are arised

during the pilot study.

DATA COLLECTION PROCESS

Data collection is the precise, systematic gathering of information relevant to

the research purpose for the specific objective, question or hypothesis of a study.14

Before the actual collection of data, Permission was obtained from Director

of St.Thomas College of Nursing, Chethipuzha and Principal of ST.THOMAS

COLLEGE OF NURSING, CHETHIPUZHA for going forward with the study. We

also got Permission from Vazhappally Panchayat President Mr. M.C. Antony for

conducting the study in housewives and we given a questionnaire to them and made

them to answer independently in the presence of investigator. This assured that no

discussion was made between the samples during answering the questions. After

specific time questionnaire were collected.

TIME DURATION OF THE STUDY

We started our research work on 26-07-10. The pilot study was conducted in

Chethipuzha on 31-08-10 & 04-08-10. Duration of the study was 2 weeks that is from

26-07-10 to 07-08-10


PLAN FOR DATA ANALYSIS

Data will be analyzed using descriptive statistics that is to describe and

synthesize data. Frequency and percentage distribution table was used to assess the

level of knowledge and its association with demographic variables.

Inferential statistics was also used and data will be presented in the form of

tables and figures. Association will be analysed using chi-square test.

SUMMARY

This chapter dealt with research approach research design, setting of the

study, population, sample and sample size, sampling technique, Piolt study, data

collection process and plan for data analysis.


CHAPTER-IV

ANALYSIS AND INTERPRETATION

“Analysis is the process of organizing and synthesizing data so as to answer

research questions and test hypothesis”.14

Analysis enters into a research in one form or another from the very beginning.

Research mainly consists in general of two steps: The gathering of data and analysis

of this data. But no amount of analysis can validly extract from the data factors that

are not available.

Analysis of the data means studying the collected material in order to

determine the facts or meaning. It involves breaking down complex factors into

simple parts and managing them in order for the solid purpose of information. When

a researcher selects a problem and begins planning his study he at once think about

the analysis of the total problems in order to formulate a hypothesis that allows him to

start work on the problem stated. First he will engage in determining the factors

required for the study. The final analysis must be calculated in detail when places are

therefore gathering data.16

Statistical analysis helps researchers make sense of quantitative information.

Without statistic, quantitative data would be a chaotic mass of numbers. Statistical

procedures enable researches to Summarise, Organize evaluate Interpret and

Communicate numeric informations.17

The data analysis was organized and done under the following headings.

Section A : Distribution of sample according to demographic variables.

Section B: Assessment of knowledge

Section C: Association between knowledge and demographic variables.


SECTION I.

ASSESSMENT OF DEMOGRAPHIC VARIABLES

1. AGE OF THE HOUSE WIVES.

Table 1: Table showing distribution of sample according the age.

N=60Age Frequency Percentage

20-30 4 6.67 %

30-40 19 31.67 %

40-50 17 28.33 %

50-60 20 33.33%

In the study 33.33% samples are under the age group 50-60 yrs, 31.4% under 30-40

Yrs, 28.33 % under the age group of 40-50 and 6.6% come under the age group of 20-

30.


2. RELIGION

Table.2: Table showing distribution of sample according the religion.

N=60Religion Frequency Percentage

Hindu 9 15%

Christian 49 81.6%

Muslim 2 3.33%

In this study, 81.66% sample come under Christian Religion 15% are included

in Hindu and 3.33% under Muslim.


3. EDUCATION

Table 3: Table showing distribution os sample according to education.

N=60Education Frequency Percentage

>S.S.L.C 6 10%

S.S.L.C 35 58.33%

> Degree 19 31.66%

In this study 58.33% sample were educated upto SSLC 31.66% have them or the

degree and 10% have less than SSLC.


4. MONTHLY INCOME

DISTRIBUTION OF SAMPLE ACCORDING THE MONTHLY

INCOME.

Table

N.60

Monthly Income Frequency Percentage

500-1000 12 20%

1001-2000 7 1167%

2001-3000 18 30%

>3000 23 38.33%

Monthly Income in Rs. Of the sample have family income between 2001-3000

monthly, 20% have the Income between 500-1000, 10.33% have income more than

3000 and 11.66% have income between 1001-2000.


4. OCCUPATION

DISTRIBUTION OF SAMPLE ACCORDING TO

OCCUPATION.

Occupation Frequency Percentage

Yes 10 16.64%

No 50 83.33%

In this study 83.33% of sample having occupation and 16.66% have no occupation.


5. WATER SUPPLY

DISTRIBUTION OF SAMPLE ACCORDING TO WATER SUPPLY.

Table No.

N.60

Water Supply Frequency Percentage

Well 52 36.67%

Public Well 2 3.33%

Public Tap 6 10%

Bore Well 0 0%

In this study 86.66% of sample have well for water supply 10% took water

from public Tap and 3.33% water from public well


6. CATTLES

DISTRIBUTION OF SAMPLE ACCORDING TO THE CATTLE REARING.

Table No. N.60

Cattle rearing Frequency Distribution

Yes 4 6.67%

No 56 93.33%


7. WASTE DISPOSAL.

DISTRIBUTION OF SAMPLE ACCORDING TO THE TYPE OF WASTE

DISPOSAL.

Table No.

N.60

Waste disposal Frequency Percentage

Pit 16 26.67%

Compost 4 6.67%

Others 40 66.7%

The findings reveals that 26.66% uses pit for the waste disposal, 6.66% uses

Compost & Mas of usese about 66.66% other technique for the waste disposal.


9. PREVALENCE

DISTRIBUTION OF SAMPLE ACCORDING TO PREVALENCE

Table No.

N.60

Frequency Percentage

Yes 0 0%

No 60 100%

There is no Prevalence of H1N1 fever in the specified areas of Vazhappally

Panchayat.


10. TREATMENT

DISTRIBUTION OF SAMPLE ACCORDING TO TREATMENT

Table No

No.60

Method of treatment Frequency Percentgae

Ayurveda 2 3.33%

Allopathy 56 93.67%

Homeopathy 2 3.33%

Others 0 0%

The reveals that 93.66% of the sample use allopathy for their treatment

3.33% of the sample use Ayurveda and Homeopathy treatment.


11.SOURCE OF HEALTH INFORMATION

DISTRIBUTION OF SAMPLE ACCORDING TO SOURCE OF

INFORMATION

Table No.

N.60

Source of Information Frequency Information

Television 26 43.33%

PHC 9 15%

Newspapers & Magazines 25 41.67%

Internet 0 0%

In this study 43.33% of samples are getting information from television, 41.66%

are from newspapers and magazines 15% are from PHC and study revealed that

no housewife’s are depending on internet as a source of information


SECTION-2

ASSESSMENT OF KNOWLEDGE

Table 2 a

N.60

Grading Number of Housewife’s Percentage

Poor 10 25%

Average 32 77.5%

Good 15 37.5%

Excellent 4 10%

35-50 poor knowledge

50-65 Average knowledge

65-80 Good Knowledge

80-95 Excellent

Finding reveals that only 10% have excellent knowledge, 37.5% good

knowledge, 77.5% have average knowledge and the remaining 25% have poor

knowledge.


SECTION-3

ASSESSMENT OF ASSOCIATION BETWEEN

KNOWLEDGE AND DEMOGRAPHIC VARIABLES.

Table: 3a

N.60

Variable CHI-SQUARE Significance

Age 7.8274 Not Significant

Education 3.8442 Not Significant

Monthly Income 29.71 Significant at 0.05

Religion 17.540 Significant at 0.05

Occupation 99.345 Significant at 0.05

Source of Information 4.4415 Not Significant

Level of significance at 0.05 level


SUMMARY AND CONCLUSIONS.

INTRODUCTION.

This chapter deals with the following headings.

Summary of the entire study

Conclusion of the topic

Limitations of the study

Suggestions and recommendations for improving the study and nsg implications.

SUMMARY

Swine flu is spreading thick and fast throughout the world. The virus spreads

through the air and the infection normally begins with the respiratory organs. The

major cause of this fast spreading is lack of awareness about its among the

community. As a care giver in the 1st part of community ie. Family, housewife’s

can play a major role in its prevention.

The study reveals assessment of knowledge level in housewife’s about H1N1

fever in specified areas of Vazhappally Panchayat.

The objectives of the study were:-

o To assess the prevalence of swine flu in selected areas of Vazhappally

Panchayat

o To assess the knowledge about the H1Ni fever among housewives

o To assess the association between knowledge about swine flu and selected

demographic variables.

Research approach selected for the study was descriptive method. The tool for

the study was a structured questionnaire. Pilot study was conducted in

Chethipuzha community on 31-7-2010 by randomly selecting 6 samples from the

area. Based on pilot study the mainstudy was conducted in Konnamthanam,


Sanketham, Vakkachanpadi and in Chethipuzha Community. It was comnducted

on 60 samples by random selection.

The study took 2 weeks to complete. The major findings of the study were

presented under 3 sections.

Section 1 : Distribution of sample according to demographic variables.

Section 2 : Assessment of Knowledge

Section 3 : Association between knowledge and demographic variables.

SECTION 1:-

1) Age:- Among the 60 samples 6.6% were in 20-30 yrs,, 31.4% are 30-40 yrs,

23.33% are included in 40-50 yrs and 33.33% are in between 50-60 yrs.

2) Religion:- 81.66% of samples are Christians 15% are Hindus and 3.33% are

Muslims.

3) Education:- About 10% are educated <SSLC 58.33% are and 31.66% in

were collegiate.

4) Monthly Income:- About 20% have 500-1000, 11.66% have 1000-2000. 30%

have 2001-3000 and 13.33% have a monthly income of more than 3000.

5) Occupation- From the 620 samples 50% are employed and the remaining have

no any job.

6) Water Supply: Source of watersupply for 86.66% are from well, 33.33% are

from public well, 10% are using public tap and no one from bore well.

7) Cattle rearing:- In the study only 6.66% have cattle rearing and the remaining

have no such activities.

8) Waste disposal:- Waste disposal of 26.66% are through pit, 6.66% are by

other methods.

9) Incidence of H1N1 :- There is no prevalence of H1N1, in the selected samples.


10) Type of Treatment:- The 3 types of treatment for majority of the are allopathy

(93.66%), 3.33% are following Ayurvedic and Homeopathy respectively.

11) Source of Information: Source of Information of 43.33% samples was TV,

41.66% are newspaper, 15% are from PHC and no one using internet.

SECTION 2:-

The present study revealed that among the 60 samples, only 10% have

excellent knowledge 31.5% have good knowledge 11.5% have average knowledge

and 25% have poor knowledge.

SECTION 3:-

There is a significant association between knowledge and 3 of the selected 6

variables namely income, occupations Religion.

CONCLUSIONS

From the findings of the study it can be concluded that among 60 Samples

10% have excellent knowledge, 37.5% have good knowledge, 77.5% have average

knowledge and 25% have poor knowledge. That is majority of housewives have only

moderate relationshio between knowledge and 3 of the selected variables namely,

income, Religion and occupation

IMPLICATIONS.

Investigators study can be applied in various nsg aspects . It can be divided to:-

Nursing Service

Nursing Education

Nursing Administration

Nursing Research


Nursing profession is a service to the people. Nursing services can be provided

by helping the people to maintain their health, or by imparting knowledge regarding

various aspects through health education.

As in most cases, ignorance and fear are the roof causes of the unwarranted

panic among the public.

Nurses can import knowledge regarding the causes, symptoms and preventive

measures among the housewives through heath education.

Nurses can conduct awareness programmes at community level.

NURSING ADMINISTRATION:-

Based on the study result nurses can increase the service by improving the

administration study (help in improving) the nsg administration at community.

Community health nurse, or junior public health nurse can plan various in

service education programme for the community people, especially housewives for

improving their knowledge and education to the students.

NURSING EDUCATION:-

Nursing educatiojn plays an important rote in preparing nurses for ensuring

the well being of the people.

Nurses should have through knowledge regarding the emergence of new

diseases as H1N1 fever and about cts early detection, treatment and preventive

measures

Nursing educators can update their knowledge and also search for

advancement made for the prevention and management of H1N1 fever.

Nursing students can organize health education programme for housewives at

community level

Nursing students can conduct seminars, symposium or other health education

programmes the ill effects of H1N1 fever and its preventive measures.


NURSING RESEARCH:-

Study opens the wide doors towards

Some interventional studies can be done on the effectiveness of health

education regarding the H1N1 fever

Studies can be conducted regarding the influence of hygienicmeasures in

preventing H1N1 fever.

Develop strategies for educating the housewives about the H1N1 fever.

Studies can be conducted bout the effectiveness of vaccination to prevent H1N1

fever.

RECOMMENDATIONS:-

Studies can be conducted on a large scale.

Health education programmes can be conducted in the community to make

them aware about the disease.

A comparative study between urbah and rural population can be done

regarding the knowledge of H1N1 fever.

An experimental study can be conducted offer the implementation of

interventions as health education to assess the knowledge. Can assess the

practice attitude of community.

LIMITATIONS OF THE STUDY :-

o Study is limited to 60 sample

o Study is limited to selected areas of Vazhappally panchayat

o No educational programmes or materials are given



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