ANEESH.G1STYEAR MSc NURSINGMEDICAL SURGICAL NURSING2010-2012SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES

AND RESEARCH CENTRE, B.H.ROAD, TUMKUR-572102

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA ,BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

MR.ANEESH.GI YEAR M.SC.NURSINGSHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD, TUMKUR-572 102.

2 NAME OF THE INSTITUTION

SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD, TUMKUR.-572 102.

3 COURSE OF STUDY AND SUBJECT

MASTER OF SCIENCE IN NURSINGMEDICAL SURGICAL NURSING

4 DATE OF ADMISSION 10.06.2010

5 STATEMENT OF THE PROBLEM

‘A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING DENGUE FEVER AMONG CLIENTS ATTENDING OPD IN SELECTED HOSPITALS AT TUMKUR WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET’

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6.0 BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION“Those who would benefit most from a service are least likely to obtain it”

- K.Park, 2009

Health is a fundamental human right. It is central to the concept of quality of

life. Health and its maintenance is a major social investment and is World-wide social

goal. Health is multidimensional. This health may be assessed by such indicators as

death rate, infant mortality rate and expectation of life. Ideally, each piece of

information should be individually useful and when combined should permit a more

complete health profile of individuals and communities.1

At the time of the establishment of the World Health Organization (WHO), in

1948, Health was defined as being, "A state of complete physical, mental, and social

well-being and not merely the absence of disease or infirmity”. Health is not

perceived the same way by all members of the community. In fact, all communities

have their concept of health, as part of culture.2

Public health is "The science and art of preventing disease, prolonging life and

promoting health through the organized efforts and informed choices of society,

organizations, public and private, communities and individuals" (Winslow, 1920). It

is concerned with threats to the overall health of a community based on population

health analysis.5 Unlike clinical professionals, public health is more focused on entire

populations rather than on individuals. Its aim is preventing from happening or re-

occurring health problems by implementing educational programs, developing

policies, administering services and conducting.3

2

The great positive impact of public health programs is widely admitted.

Because of the health policies and the actions public health professionals develop, the

20th century has registered a decrease of the mortality rates

in infants and children and a constant increase in life expectancy.4 Health in a broad

sense of the word does not merely mean the absence of disease or provision of

diagnostic, curative and preventive services. The state of positive health implies the

notion of “Perfect functioning” of the body and mind. Hence overall health is

achieved through a combination of physical, mental, and social well-being, which,

together is commonly referred to as the Health Triangle.5Nowadys so many diseases

are attacking the people. In that an important one is Dengue fever.

Dengue fever, commonly known as “break bone fever” for its classic

symptoms of severe joint and muscle pain and high fever, once mostly occurred in

tropical and subtropical zones. But during the last 20 years, dengue fever and its

more severe form, dengue hemorrhagic fever (DHF), have been spreading

worldwide. Factors contributing to the spread include increasing international travel,

migration, urbanization, and perhaps even global warming, among others. Although

most U.S. cases have occurred in travelers’ returning from abroad, the risk of

infection is increasing for people living along the U.S.–Mexico border and in other

parts of the southern United States6.

The first isolation of dengue virus was reported from India in 1964,and

Dengue virus serotype 3 in 1968.Ever since, intermittent reports of Dengue and its

sequel have come from various parts of the country. These includes reports from

Ludhiana, Delhi, Lucknow, Calcutta, Chennai, Mangalore, Assam, Nagaland and

Vellore7.

3

Dengue fever and DHF are caused by four serotypes of dengue viruses from

the genus Flavivirus. As one review noted, “the clinical spectrum can vary from

asymptomatic to more severe infections with bleeding and shock.” The hemorrhagic

form involves plasma leakage, as evidenced by elevated hematocrit levels, pleural

effusion, and ascites; this can progress to severe hypovolemic shock and even death.

The virus is transmitted by the bite of an infected female Aedes mosquito. The species

most often implicated is Aedes aegypti (known as the yellow fever mosquito), a

diurnally active mosquito that prefers feeding on humans. Infected mosquitoes suffer

no pathogenic effects. The cycle of transmission begins when a mosquito feeds from a

human whose blood contains dengue virus. The virus infects the epithelial cells of the

mosquito’s midgut, then “escapes” into the insect’s body cavity and travels to the

salivary gland. The disease is transmitted through the mosquito’s saliva during

subsequent biting. The risk of DHF appears higher in patients who acquire a second

dengue infection than in those experiencing a first, third, or fourth dengue infection.

Because increasing global tourism and migration have disseminated the four serotypes

worldwide, the risk of a second infection has also risen8.

According to the Centers for Disease Control and Prevention (CDC),

dengue fever “has become the most common arboviral [arthropod-borne] disease

of humans.” The WHO reports that it’s currently endemic in at least 100 countries,

putting some2.5 billion people (40% of the world’s population) at risk. The CDC

reports estimates of more than 100 million cases annually. Countries reporting recent

outbreaks include India, Singapore, and Thailand in Southeast Asia; Puerto Rico in

the Caribbean; and Honduras, Nicaragua, Costa Rica, Paraguay, and Brazil in Central

and South America.9

4

Dengue has an incubation period of between three and 14 days. Most cases

present within four to seven days. Patients may report flulike symptoms: sudden

fever, arthralgia, headache, eye pain, and myalgia. Other common symptoms include

“nausea, vomiting, and a maculopapular rash, which appears three to five days after

onset of fever.” About1% of those infected develop the hemorrhagic form. An abrupt

fever is often the first sign, along with other classic dengue symptoms such as

headache and joint and muscle pain. After four to five days, the fever drops, but

instead of improving the patient deteriorates. Symptoms may include rapid pulse,

clammy skin, lethargy, and restlessness. Thrombocytopenia, hemorrhagic tendencies

(such as that evidenced by hematuria or hematemesis), plasma leakage, or a

combination of these will be present. Blood vessels leak, losing fluid into the body

cavity as the patient’s hematocrit (proportion of blood cells) rises and blood pressure

drops. Hypovolemic shock and death can occur within four to six hours if the patient

is not treated.

The CDC advises that dengue should be suspected in all patients “who

have fever and a history of travel to a tropical area within two weeks of onset of

symptoms.” Commercial serologic tests can aid in diagnosis. No vaccine currently

exists. Although research is under way, an effective vaccine isn’t expected to be

available for several years. British researchers recently announced that they’ve

succeeded in genetically modifying male Aedes aegypti mosquitoes so the offspring

die prematurely, which could help to control disease spread10.

People are now demanding a better quality of life. Therefore governments all

over the World are increasingly concerned about improving the quality of life of their

people by reducing morbidity and mortality, providing primary health care and

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enhancing physical, mental and social well being. It is conceded that a rise in the

standard of living of the people is not enough to achieve satisfaction or happiness.

Improvement of quality of life must also be added and this means increased emphasis

on societal policy reformulation of societal goals to make life more livable for all

those who survive.11

6.2 NEED FOR THE STUDY

Dengue/Dengue Hemorrhagic Fever (DHF) is an emergent disease in India.

It is endemic in some parts of country and contributes annual outbreaks of dengue/

DHF. Dengue virus infection is endemic in and around Delhi with peak incidence

between September and November. In the year 2003, (from 1 June to 9 November),

2185 laboratory confirmed cases of dengue fever had been reported in Delhi and

surrounding areas. The present descriptive study was done with the aim of assessing

knowledge and attitude regarding Dengue fever among general population attending a

hospital outpatient department12.

The World health Organization (WHO) declares dengue and dengue

hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no

documented evidence exists in India which reveals the awareness and practices of the

country's adult population regarding dengue fever, its spread, symptoms, prevention,

treatment etc.

Dengue virus is now believed to be the most common arthropod-borne disease

in the world. Dengue is a mosquito-borne infection that had become a major public

health concern. The four dengue viruses (DEN-1 through DEN-4) are immuno-

logically related, but do not provide cross-protective immunity against each other.

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The World Health Organization (WHO) currently estimates that there may be 50

million cases of dengue infection worldwide every year. The health burden of dengue

in South East Asia only is estimated to be 0.42 Disability Adjusted Life Years

(DALYs) per 1,000 population(52% due to premature mortality, 48% due to

morbidity).

Dengue virus infection is a escalating health problem throughout the world

because of increasing mortality and morbidity and is currently endemic in over 100

countries. The rapid geographic expansion of both the virus and the mosquito,

regularity of epidemics, and the increasing occurrence of Dengue Haemorrhagic

Fever (DHF) and Dengue Shock Syndrome (DSS) are the causes for great concern;

particularly for India where an increased frequency of the infection has been observed

in recent years. Despite the increasing incidence of dengue fever in India in recent

years, only few studies were conducted regarding Dengue fever.

Dengue epidemics have been earlier reported from Vellore. The present results

showed an unusual increase in Dengue virus activity (as evidenced by Dengue IgM

positivity) in this region during 2003(similar to that noticed in 1999).Though there

was a decrease in the number of cases with suspected Dengue infection in 2001 and

2002,there was a steady increase in the package of samples positive for Dengue IgM

in these years compared to 2000 providing evidence that there was an overall increase

in Dengue virus activity over these years.13

A cross sectional study was conducted to assess the knowledge and attitude

about dengue and practice of prevention followed by the residents of a rural area and

an urban resettlement colony of East Delhi. A pre-structured and pre-tested format

containing the relevant questions was administered to the subjects. A total of 687

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subjects (334 rural and 353 urban) were interviewed. Nearly four fifth (82.3%)of

these were aware of Dengue. Audiovisual media was the most common source of

information in both the areas. Knowledge about the disease was fair to good. Fever

was the commonest symptom of the disease known to 92% urban and 83% rural

respondents followed by symptoms of bleeding and headache. Mosquito was known

to spread the disease to 71% rural and 89% urban respondents. More than two third

respondents in urban and two fifth in rural areas had used some method of mosquito

control or personal protection dueling the epidemic14.

A study was conducted on knowledge, attitude and practices (KAP) on

Dengue among selected rural communities in the Kuala Kangsar district. The study

population was 1511 by simple random sampling method. The data was collected by

face-to-face interview of the greed of households using a semi-structured

questionnaire and found that the knowledge on Dengue fever of community was

good. Cross tabulations were done between knowledge and practice, knowledge and

attitude, and attitude and practice. There was no significant association seen between

knowledge and practice. However, there was a significant association seen between

knowledge and attitude towards Aedes control (p=0.047).15

Dengue virus is now believed to be the most common arthropod-borne

disease in the world. The world Health Organization (WHO) currently estimated

there might be 50 to 100million cases of Dengue infection worldwide every year.

About 500,000 individuals per year manifest the severe forms, which gave a mortality

rate of about 10 percent. Given the dramatic geographic expansion of epidemic

Dengue fever (DF)and dengue hemorrhagic fever(DHF),the WHO has classified this

disease as a major international public health concern .DHF is more serious and the

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fatality rate is about 5%.children younger than 15 years comprise 90% of DHF

subjects in the world.DHF can affect both adult and children.

The health burden of Dengue in South East Asia only is estimated to be 0.42

Disability Adjusted Life Years (DALYs) per 1,000 population (52%) due to

premature mortality,48% due to morbidity (Shepard et al).The global prevalence of

Dengue has grown dramatically in recent decades. Not only is the number of cases

increasing as the disease is spreading to new areas, but explosive outbreaks are

occurring as its epidemiological pattern is changing (Gubler,1998).In 2003,only eight

countries in South East Asia Region reported Dengue cases. As of 2006,ten out of the

elevencountriesinthe region(Bangladesh,Bhutan,India,Indonesia,Maldivesetc)reported

Dengue cases. In 2006,mostcountries reported

cases(Bangladesh,Bhutan,Indonesia,Thailand,Maldives and Srilanka)where as India.

In Newdelhi,the number of cases reached 1,081 in October 2010 with 67 more

patients testing positive for the vector born disease. The figure was 86 and 22 in the

same periods in 2008 and 2007 respectively.

In Karnataka,1,895 blood samples had been examined and 857 cases had

been confirmed as Dengue. Dengue is claimed 59 lives in Karnataka till July. In this

Tumkur district has the more prevalence of this disease.30%cases of the cases from

the Karnataka is from Tumkur District only.

In the light of above, the investigator found it desirable to evaluate the

knowledge and attitude of OPD clients about Dengue fever. The investigator’s

decision for selecting the topic on Dengue fever for the study grew out of his clinical

experience during his study period with clients who had limited awareness regarding

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the origin, treatment, prevention and control measures of Dengue fever .There for it

is very clear that the clients must need to update their knowledge regarding Dengue

fever.

An information booklet is one of the effective teaching strategy which

consists of figures which will help to draw the attention of the clients. The contents of

this Information Booklet depends on the results of the study. Information Booklet is

not only effective for clients , it can be used by any person in the community.

6.3 REVIEW OF LITERATURE

“Diagnosis is not the end, but the beginning of practice “

- Martin.H.Fischer

Review of literature is a key step in research process. Review of literature is

defined as a broad, comprehensive study in depth, systematic and critical review of

scholarly publications, unpublished materials, audiovisual materials and personal

communications.

A cross sectional study was conducted to assess the level of knowledge,

attitudes and practices regarding dengue fever in people (N=447) visiting tertiary care

hospitals in Karachi, Pakistan. Through convenience sampling, a pre-tested and

structured questionnaire was administered through a face-to-face unprompted

interview. The investigators got the result as, about 89.9% of individuals interviewed

had heard of dengue fever. Sufficient knowledge about dengue was found to be in

38.5% of the samples. Literate individuals were relatively more well-informed about

dengue fever as compared to the illiterate people. Use of anti-mosquito spray was the

most prevalent (48.1%) preventive measure. Television was considered as the most

important and useful source of information on the disease. The investigators

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concluded the study as adult population of Karachi has adequate knowledge related to

the disease 'dengue' on isolated aspects, but the overall prevalence of 'sufficient

knowledge' based on investigators criteria was poor16.

A cross sectional study was conducted on knowledge, attitudes and practices

regarding dengue fever among adults of highland low socioeconomic groups in

Pakistan. A sample size of 440 adults (aged 18 years and above) were interviewed

using a pre-tested questionnaire regarding their knowledge, attitude and practices

about dengue fever. A composite scoring system, based on the answers given in the

questionnaire, was used to establish the level of awareness in the population. The

division of the higher and lower socio-economic groups was based on their income

and locality; both these variables were determined as a part of our survey. About

thirty five percent of the samples had adequate knowledge about dengue fever and its

vector. Study concluded as Knowledge of dengue is inadequate in the low

socioeconomic class. Better preventive practices against the vector are prevalent in

the high socioeconomic group. Hence, a greater focus should be accorded to the low

socioeconomic areas in future health campaigns17.

A community survey study was conducted on knowledge, attitudes and

practice regarding Dengue in two neighborhoods in Bucaramanga, Colombia, to

identify knowledge, attitudes and practice regarding dengue control for guiding

prevention and control measures.643 of the 780 households (82.4%) responded to the

survey. Most people responding (518) were female (80.6%), average age being 39.6

(16.8 standard deviation (SD)), average schooling lasted 6.2 years (3.5 SD) and

average household size was 5 people per house. Study concluded as Knowledge about

dengue was sketchy. Attitudes were favorable regarding dengue control but

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preventative practice was inadequate. The community must be educated and

empowered to ensure their active participation in prevention and control programme.18

A study conducted regarding knowledge and practice of household mosquito

breeding control measures between a dengue hotspot and non-hotspot in Singapore to

compare the knowledge and practices of household mosquito-breeding control

measures between a dengue hotspot (HS) and a non-hotspot (NHS). Eight hundred

households were randomly sampled from HS and NHS areas, and a National

Environment Agency (NEA) questionnaire was administered to heads of the

households. Interviewers were blinded to the dengue status of households. The

samples included subjects aged above 16years, who were communicative and

currently living in the household. The investigators got the result as, the overall

response rate was 59.0% (n = 472).NHS residents were less knowledgeable in 6 out of

8 NEA-recommended anti-mosquito breeding actions. Hotspot residents reported

better practice of only 2 out of 8 NEA-recommended mosquito-breeding control

measures. Study concluded more HS residents were knowledgeable and reported

practicing mosquito-breeding control measures compared to NHS residents. However,

a knowledge-practice gap still existed19.

A cross-sectional study was conducted on knowledge, attitudes, and

practices relating to Dengue fever among females in Jeddah high schools to assess

knowledge, attitudes and practice (KAP) of high school female students, teachers and

supervisors towards Dengue fever (DF), and to determine scoring predictors of high

school students knowledge and practice scores. A multistage, stratified, random

sample method was applied. A total of 2693 students, 356 teachers and 115

supervisors completed confidential self-administered questionnaires. The

investigators got the result as, students obtained the lowest mean knowledge score

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compared to the other two groups. Students having literate mothers (>or=secondary

education), and students' age >or=17 were the predictors of students high knowledge

score. The only predictor of high practice score was obtaining high knowledge score.

Study concluded as KAP towards DF was deficient among target populations,

especially among students. School-based educational campaigns and social

mobilization for raising knowledge and changing it into sound practice is urgently

needed for controlling dengue epidemics in Jeddah20.

A cross-sectional study was conducted to assess the knowledge, attitude,

and practice of people regarding dengue disease in 9 villages of the Pakse

district .Purposive sampling was done to collect data from 230 subjects. They had a

fair knowledge about the vector 163 (70.9%). For 101 (43.9%) respondents, their

main source of information about dengue was their friends or relatives. It was

encouraging that 217 (94.3%) respondents had a positive attitude that DF 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 that there was

some confusion about vaccination and water storage for domestic use. Dengue

awareness activity 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 villagers should be ensured21.

A community survey study was conducted on knowledge regarding

Dengue fever among the Indian population to identify the relationship of this country

with dengue. The study concluded that relationship of this country with dengue has

been long and intense. The first recorded epidemic of clinically dengue-like illness

occurred at Madras in 1780and the dengue virus was isolated for the first time almost

13

simultaneously in Japan and Calcutta in 1943-1944. After the first virologically

proved epidemic of dengue fever along the East Coast of India in 1963-1964, it spread

to all over the country. The first full-blown epidemic of the severe form of the illness,

the dengue hemorrhagic fever/dengue shock syndrome occurred in North India in

1996. Aedes aegypti is the vector for transmission of the disease. Vaccines or antiviral

drugs are not available for dengue viruses; the only effective way to prevent epidemic

dengue fever/dengue hemorrhagic fever (DF/DHF) is to control the mosquito vector,

Aedes aegypti and prevent its bite. This -country has few virus laboratories and some

of them have done excellent work in the area of molecular

epidemiology,immunopathology and vaccine development. Selected work done in this

country on the problems of dengue is presented here22.

A study designed to evaluate the efficacy of a general information booklet in

preparing cancer patients for their first visit to a cancer centre. Patients were randomly

assigned to receive the booklet in one of three ways: (1) by mail in advance of their

appointment (mail group), (2) when they arrived at the centre but before their

interview (before group) and (3) after their interview (control group). The patients'

responses were gathered in a structured interview. Those patients who received the

booklet early felt better informed about available services, their physician's reasons

for referring them to the centre; the mail group felt better informed about their disease

and the treatment options and, in general, felt that the centre had helped them prepare

for their first visit23.

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6.4 STATEMENT OF THE PROBLEM

‘A descriptive study to assess the knowledge and attitude regarding Dengue fever

among clients attending OPD in selected Hospitals at Tumkur with a view to

develop an Information Booklet’

6.5 OBJECTIVES OF THE STUDY

1.To assess the knowledge regarding the Dengue fever among clients attending

OPD in selected Hospitals at Tumkur.

2.To assess the attitude regarding the Dengue fever among clients attending OPD.

3.To associate the level of knowledge with selected sociodemographic variables

4.To associate the level of attitude with selected sociodemographic variables

5.To develop an Information Booklet regarding Dengue Fever

6.6 .1 OPERATIONAL DEFINITIONS

1. Knowledge-In this study the knowledge refers to the correct responses given by

the clients as it is elicited through self administered knowledge questionnaire.

2. Attitude-It refers to the way of thinking of clients about Dengue fever and it’s

prevention as evidenced from attitude scale.

3. Clients-In this study Clients refer to persons attending OPD in selected Hospitals in

Tumkur.

4. Information Booklet-It refers to the planned self instructional material based on

the results of the study.

6.6.2 ASSUMPTIONS

1. Clients will have limited knowledge on Dengue fever.

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2. The increase in level of knowledge will facilitate for the change of

favorable attitude of the clients regarding dengue fever.

6.6.3 HYPOTHESIS

H1: There is a significant association between the level of knowledge with

selected socio demographic variables.

H2: There is a significant association between the level of attitude with selected

socio demographic variables.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Information provided by clients regarding Dengue fever.

7.2 METHOD OF DATA COLLECTION

7.2.1 Research design

A Research Design selected for this study is “Descriptive Research Design’’, to

assess the knowledge and attitude of clients on Dengue fever.

7.2.2 Settings of the study

Selected hospitals at Tumkur.

7.2.3 Population

Clients who are attending OPD of Hospitals at Tumkur.

7.2.4 Sample

Clients who are attending OPD at selected hospitals, Tumkur.

7.2.5 Sampling technique

The samples will be selected by non probability convenient sampling

technique, as it will be the most suitable one for the present study.

7.2.6 Sample size

Total sample size for the study is 200 clients.

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7.2.7 Sampling criteria

Inclusive criteria

1. Clients who are attending the OPD in selected Hospitals at Tumkur.

2. Clients who are willing to participate in the study.

3.Clients who are available at the time of study.

Exclusive criteria

1.Clents who can’t read and write Kannada.

7.2.8 Tool for data collection

Data will be collected by using self administered knowledge questionnaire.

Section A- Socio- demographic variable.

Section B- Self administered knowledge questionnaire regarding

Dengue Fever

Section C –Attitude scale regarding Dengue fever

7.2.9. Method of data collection

The data will be collected from clients by using Self Administered

Knowledge Questionnaire and attitude scale for knowledge and attitude assessment

respectively.

Written permission will be taken from the concerned Authority.

7.3.0 Data analysis and interpretation

Descriptive statistics

Descriptive statistical techniques such as Mean,Mean deviation.

Inferential statistics

t-test, Chi-square test

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7.4 ETHICAL CLEARANCE :

Does the study require any investigation or interventions to be conducted on

patients?

NO. Informed consent will be taken from the patients.

7.5. Has ethical clearance been obtained from your institution in case of 7.4?

Yes. Ethical clearance will be obtained from the institution.

8. BIBILIOGRAPHIC REFERENCES

1) Suneel Garg, Anita Nath, current status of national rural health mission. Indian

journal of community medicine; 2007. Available from: http//www.India-now.org.

2. Preamble to the Constitution of the World Health Organization as adopted by the

International Health Conference. New York:Constitution of the World Health

Organization-Basic Documents.Forty-fifth ed. October 2006. Available from:

http//www.WHO-now.com

3. Patel Kant, Rushefsky, Mark E , McFarlane.Deborah R et al. The Politics of Public

Health in the United States, M.E. Sharpe; 2005, p. 91. Available from: http//www.

publichealth.org

4.  Health Care UK. National Health Service (NHS). March 11; 2010. Available

from: http//www. communityhealth.com

5. WHO.int, Preamble to the Constitution of the World Health Organization as

adopted by the International Health Conference: New York, June 1947; p.100

Available from: http//www. WHO.com

6.Lifson AR. Mosquitoes. models and dengue: Lancet 1996;347(9010): p 1201-2.

18

17.Hales S et al. Potential effect of population and climate changes on global

distribution of dengue fever: an empirical model:Lancet 2002;360(9336). p830-4.

8.World Health Organization (WHO). 1997. Dengue Haemorrhagic Fever: Diagnosis,

Treatment, Prevention and Control. 2nd edition); Geneva: WHO.

9.Centers for Disease Control and Prevention. Dengue hemorrhagic fever—U.S.–

Mexico border, 2005. MMWR Morb Mortal Wkly Rep 2007;56(31): p 785-9.

10.Shepard DS, Suaya JA , Halstead SB, Nathan MB ,Gubler DJ, Mahoney RT et

al;2004.p 1275-1280.

11. Health. Recreational Values of the Natural Environment in Relation to

Neighborhood Satisfaction, Physical Activity, Obesity and Wellbeing. Retrieved

2010/06/24, Available from: http//www.healthsafety.com

12.Shepard DS, Suaya JA, Halstead SB, Nathan MB, Gubler DJ, Mahoney RT, et al;

2004. P 1275-80.

13.Koenraadt CJ, Tuiten W, Sithiprasasna R, Kijchalao U, Jones JW, Scott TW;

2006. Dengue knowledge and practices and their impact on Aedes aegypti populations

in Kamphaeng Phet, Thailand. Am J Trop Med Hyg: p 692-700.

14.Gupta.P.Kumar,P.Aggarwal et al.Knowledge,Attitude and Practices related to

Dengue in rural and slum areas of Delhi after the Dengue epidemic of 1996.Journal of

communicable diseases.2006.30(2),p:107-112.

15.Hairi.F.Ong,C.H.Suhaimi.A.et al(2003),Knowledge,attitude and practices(KAP)

study on Dengue among selected rural communities in the Kuala Kangsar

District,Asia Pacific Journal of public health.15(1),p:37-43.

16. Kittigul L, Suankeow K, Sujirarat D et al,,Southeast Asian J Trop Med Public

Health. 2003 Jun;34(2):385-92. Dengue hemorrhagic fever: knowledge, attitude and

19

practice in Ang Thong Province, Thailand. Department of Microbiology, Faculty of

Public Health, Mahidol University, Bangkok, Thailand. phlkt@mahidol.ac.th

17. Syed M, Saleem T, Syeda U et al.Department of Community Health Sciences,

The Aga Khan University, Stadium Road, Karachi, Pakistan.

18. Cáceres-Manrique Fde M, Vesga-Gómez C, Perea-Florez X, Ruitort M. Talbot

Y. Departamento de Salud Pública; Universidad Industrial de

Santander:Bucaramanga, Colombia. fmcacer@uis.edu.co

19. J Biosci,Dengue and dengue haemorrhagic fever: Indian Perspective: Nagar

R.Department of Microbiology; CSM Medical University, Lucknow ;2008 Nov;33.p

429-41

20. Al-Bar A, Kordey M et al,Mar 4,Knowledge, attitudes, and practices relating

Dengue fever among females in Jeddah high schools;King AbdulAziz University,

Jeddah, Saudi Arabia. ;2009.nahlakhamis@yahoo.com

21. Nagoya J Med Sci.Knowledge, attitude and practice regarding dengue among

people in Pakse;Laos: Champasack Hospital, Pakse, Laos;2009. P 29-37

22. Ong DQ, Sitaram N, Rajakulendran M, Koh et al ,Department of Community,

Occupational and Family Medicine, Yong Loo Lin School of Medicine, National

University of Singapore, Singapore. daveong85@hotmail.com

23. Shirley Huchiroff, Thomas Snodgrass, Cherryl Wares, Testing the effectiveness of

informational booklet for cancer patients, Tom Baker Cancer Centre; 2008.

9.0 SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

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11. NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3 HEAD OF THE DEPARTMENT

11.4 SIGNATURE

12. REMARKS OF THE PRINCIPAL

12.1 SIGNATURE

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