RUHS COLLEGE OF NURSING SCIENCES JAIPUR

(RAJASTHAN)

PEROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

SUBMITTED BY

MR. ANIL KUMAR SHARMA

PREVIOUS YEAR M.Sc. NURSING

SPECIALITY COMMITY HEALTH NURSING

BATCH -2018-19

RUHS COLLAGE OF NURSING SCIENCES PRATAP

NAGAR JAIPUR, (RAJ.)
 RUHS COLLEGE OF NURSING SCIENCES, JAIPUR

Performa For Registration of Subject For dissertation

1. Name of candidate Mr. ANIL KUMAR SHARMA

2. Name of the Institution RUHS College Nursing Sciences,

Pratap Nagar, Jaipur,(Raj.)

3. Course of study & specialty Master of Science in Community Health

Nursing

4. BATCH 2018-19

5. TITLE OF TOPIC “A STUDY TO ASSESS KNOWLEDGE

AND PRACTICE REGARDING
PREVENTIVE MEASURES OF WATER
BORNE DISEASES AT LOCAL LEVEL
AMONG ADULTS AT SELECTED
AREA OFJAIPUR”
6.0 BRIEF INTERODUCTION OF THE INTENDED WORK

6.1 BACKGROUND OFSTUDY:-

“Prevention is better than cure”.

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.
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, apart of culture. A disease is an
abnormal condition affecting the body often organism. It is often construction
medical condition associated with specific symptoms and signs. It may be caused
by external factors, such as infectious disease, or it may be caused by internal
dysfunctions, such as autoimmune diseases. In humans, "disease" is often used
more broadly to refer to any condition that causes pain, dysfunction, distress, social
problems, or death to the person afflicted or similar problems contact with the
person in this broader sense, It sometime includes injuries, disabilities, disorders,
syndromes, infections, isolated symptoms, deviant behavior, and atypical
variations of structure and function, while in other contexts and for other purposes
these may be considered distinguishable categories. Diseases usually affect people
not only physically, but also emotionally, as contracting and living with many
diseases can alter one's perspective on life, and their personality.
In certain cases, infectious diseases may be asymptomatic for much or even
their entire course in a given host. In the latter case, the disease may only be
defined as a "disease" (which by definition means an illness) in hosts who
secondarily become ill after contact with an asymptomatic carrier. An infection is
not synonymous with an infectious disease, as some infections do not cause illness
in a host.
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. 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.
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.
Environment implies all the external factors-living and non-living, material
and non- material which surround man. Environmental Science is the broad study
of all the things that make up the environment. These fields include both living
organisms, such as plants, animals, and humans, as well as non-living
environmental components, such as water, earth, and the atmosphere. The major
challenges for environmental science today is climate change, water resources,
food resources, plant and animal extinction, pollution. Out of these, climate change
may directly affect human health through increase in average temperature. Extreme
temperatures can lead directly to loss of life, while climate-related disturbances in
ecological systems, such as changes in the range of infective parasites can
indirectly impact the incidence of serious infectious diseases. Climate change may
increase the risk of some infectious diseases, particularly those diseases that appear
in warm areas and are spread by bacteria and other insects and called as Water born
diseases.
A Water-borne disease is one in which the pathogenic micro-organism is
transmitted from an infected individual to another individual by an arthropod or
other agent, sometimes with Other animals serving as intermediary hosts. Nearly
half of the world's population is infected by vector-borne diseases, resulting in high
morbidity and mortality. These "water - borne" diseases include Typhoid, cholera,
diarrhoea, hepatitis A, E. coli. Typhoid continues to be an important Water borne
disease with an annual morbidity of 4 to 5 million cases. Filaria is another
 important arthropod-born disease with an estimated 236 million people living in
filaria endemic areas. About 5 million people are estimated to be living in areas
where guinea worm disease is endemic, Typhoid, cholera, diarrhoea, hepatitis A, E.
coli is also among the important arthropod borne virus diseases in India.

6.2 NEED OF RESEARCH STUDY:-

Anuja Jaiswal, (Jul 28, 2013),RAIPUR, Water borne diseases

are on the rise in the state following incessant rain and non-availability of safe potable water
to most households, especially in the rural areas. In the fist six months of 2013 some five
people lost their lives and 50,000 were taken ill due to water borne diseases. The fact remains
that, water borne diseases are a major killer in the state. Still, health department does not have
proper data about people affected by it every year. As a result, government's schemes fail to
reach the affected and thousands, particularly those in tribal areas and the hinterlands,
continue to suffer.

Bhunia R, Ghosh S.(2009),Kolkata, Department of Health and Family Welfare, ,

West Bengal, India, reported an increased number of diarrhoea cases at the end of May 2009.
This study was performed to identify the agent and the source of the outbreak as well as to
propose control measures. Matched case-control study was conducted and rectal swabs and
water specimens were collected. In total, 1076 probable case patients and 14 deaths (attack
rate 44/10 000) were identified. Compared with controls, cases were more likely to drink
non-chlorinated piped water [matched odds ratio (MOR) =16, 95% CI 4.9-51; population
attributable fraction 58%) and were less likely to drink chlorine-treated water (MOR=0. 06,
95% CI 0.02-0.18).

Jha N. Et al. (2006)Sunari, Nepal, conducted a study of knowledge attitude and

practices of mothers regarding home management of acute diarrhea in Sunsari, Nepal.45, 000
school age children die due to diarrhea annually, Home management of diarrhea diseases
programme, which aims to increase the correct use oral rehydration solution by mothers.330
mothers interviewed to know the improvement the child and also preparation and use of
ORS.50% mothers could make ORS properly and gave ORS to their children ideally(after
each stool).interventions such as improving basic sanitation and health care services and,
racing the general nutritional status of the population can only be expected to decrease the
diarrheal diseases morbidity and mortality in long term.

Bhunia R, et.al (2006)Chennai, National Institute of Epidemiology, Indian Council

of Medical Research , Chennai, Tamil Nadu, India. Conducted Outbreaks of cholera are
common in West Bengal. In April 2006, They defined a case of diarrhea as occurrence of >
or =3 loose/watery stools a day among the residents of Garulia since April 2006. Two
hundred and ninety-eight cases of diarrhea were reported to various health care facilities
(attack rate: 3.5/1000, no deaths). The attack rate was highest among children (6.4/1000).
Cases clustered in an area distal to leaking water pipelines. Drinking municipal water
exclusively was significantly associated with the illness (OR 13, 95% CI=6.5-27).

Misra AK, Singh V.(2012),Varansi, conducted a study on mathematical model for

the spread and control of water borne diseases, in Varanasi, India. A non-linear SIRS
mathematical model to explore the dynamics of water borne diseases like cholera is proposed
and analyzed by incorporating delay in using disinfectants to control the disease. It is
assumed that the only way for the spread of infection is ingestion of contaminated water by
susceptible. The analysis shows that under certain conditions, the cholera disease may be
controlled by using disinfectants but a longer delay in their use may destabilize the system.
Numerical simulation is also carried out to confirm the analytical results.

Yoon YK et.al. (2008), Korea, Epidemiological and genetic analysis of a sustained

community-wide outbreak of hepatitis A in the Republic of Korea, 2008: a hospital-based
case-control study, Korea. In the multivariate logistic regression model, the risk factors of
HAV infection adjusted by age were contacts with hepatitis A case (OR 3.98, 95% CI: 1.36-
11.66), residence with child aged <or=5 years (OR 3.43, 95% CI: 1.32-8.87), consuming
uncooked lettuce (OR 3.98, 95% CI: 1.83-8.68) or carrot (OR 2.38, 95% CI: 2.38-5.09),
drinking tap water (OR 3.68, 95% CI: 1.62-8.37) or portable spring water (OR 2.71, 95% CI:
1.11-6.62) supplied by water purifiers, and eating out (OR 3.87, 95% CI: 1.53-9.78).

Kulkarni AP, Powar RM, Mangalkar SM, Kulkarni VA, Nagalgaonkar

RN.(1996), Maharashtra, conducted a study on Epidemiological investigation of an
outbreak of enteric fever in a village in Maharashtra, India. Four hundred fifteen fever cases
occurred in village Katkalamba, in Nanded district, Maharashtra during November-
December, 1995. Explosive nature of the outbreak, non involvement of infants, significantly
higher incidence rate in the age group 1-14 years and clustering of almost all cases in the
users of a particular well indicated it to be a water borne outbreak. Chemical and
microbiological examination of water samples from the suspected wells gave evidence of
faecal contamination of water.

According to WHO 2014, WHO has been testing household water treatment
products against WHO health-based performance criteria through the WHO International
‘Scheme’ to Evaluate Household Water Treatment Technologies. The aim of the scheme is to
ensure that products protect users from the pathogens that cause diarrhoeal disease and to
strengthen policy, regulatory, and monitoring mechanisms at the national level to support
appropriate targeting and consistent and correct use of such products.

WHO works closely with UNICEF in a number of areas concerning water and health,
including on water, sanitation, and hygiene in health care facilities. In 2015 the two agencies
jointly developed WASH FIT (Water and Sanitation for Health Facility Improvement Tool),
an adaptation of the water safety plan approach. WASH FIT aims to guide small, primary
health care facilities in low- and middle-income settings through a continuous cycle of
improvement through assessments, prioritization of risk, and definition of specific, targeted
actions. A 2019 report describes practical steps that countries can take to improve water,
sanitation and hygiene in health care facilities.

According to ICMR report 2006, the researchers attempted to identify the

environmental determinants for the occurrence of diarrhoeal diseases in the coastal areas of
West Bengal, to identify environmental markers for early warning signals for predicting the
occurrence of diarrhoea outbreaks. The Institute is involved in communitybased vaccine trials
against cholera, typhoid, and rotaviral diseases; baseline research to estimate the disease
burden is followed by efficacy determination of the respective vaccines in reducing the
burden of the specific diseases in the community. The important areas where ICMR-NICED
continues to work are in exploring the quality of drinking water, personal hygiene, good
sanitation practices, including safe methods of waste disposal at the household level,
promoting community awareness through education, and holding training camps. ICMR-
NICED is focused on investigating various factors responsible for the transmission of enteric
pathogens and taking appropriate actions to control the diarrhoeal disease burden in the
community.

6.3 REVIEW OF LITERATURE:-

Review of literature is an essential activity of scientific research project; help to

familiarize with the practical issue related to the problem and enable the researcher to avoid
unintentional duplication of studies. The typical purpose for analyzing or reviewing existing
literature is to generate research question to identify conceptual of theoretical tradition within
the bodies of literature. Hence the investigator intending to review the literature available on
water borne diseases by using both research and non-researchmaterials.

A literature review discusses published information in a particular subject area, and

sometimes information in a particular subject area within a certain time period. Literature
reviews provide you with a handy guide to a particular topic. Literature reviews can give you
an overview or act as a stepping stone. Literature is a broad, comprehensive in depth,
systematic and critical review of scholarly publications, unpublished scholarly print material,
audio-visual materials and personal communications. The major goal of literature review is to
develop a strong knowledge base to carry out research. Thus, literature review in many ways,
starting from the selection and formulation of problems, providing conceptual framework for
the study, assess feasibility, providing methodology, for comparison and replication, avoiding
obstacles and making generalization.

The review of available literature was organized under the following heading-

1. Review of literature related to basic water supply problem.

2. Review of literature related to knowledge of water born disease.
3. Review of literature related to practice of water supply.
 Magdalena Berger, Rita Shiau, and June M Weintraub (2013), Mumbai,
conducted a study to review of syndromic surveillance and implication for water borne
disease detection,. This review summarizes the evidence gathered from retrospective,
prospective, and simulation studies to assess the efficacy of syndromic surveillance for
waterborne disease detection. There is little evidence that syndromic surveillance
mitigates the effects of disease outbreaks through earlier detection and response.

Smith G.2013 Jun;5(2):77-84. Epidem, 2013.04.002. Epub 2013, conducted a case

control studies to estimate the force of infection that accounts for primary, sporadic cases
in Food- and water-borne disease. The importance of these risk factors is assessed by
case-control studies, in which the measure of effect (the difference in disease occurrence
between one population and another) is the odds ratio. The paper finishes with a worked
example using one of the most common of all food- and water-borne pathogens,
Toxoplasma gondi.

Anuja Jaiswal, Jul 28, 2013,Raipur, Water borne diseases are on the rise in the state
following incessant rain and non-availability of safe potable water to most households,
especially in the rural areas. In the fist six months of 2013 some five people lost their lives
and 50,000 were taken ill due to water borne diseases. The fact remains that, water borne
diseases are a major killer in the state. Still, health department does not have proper data
about people affected by it every year. As a result, government's schemes fail to reach the
affected and thousands, particularly those in tribal areas and the hinterlands, continue to
suffer.

6.4 STATEMENT OF THEPROBLEM:-

“A STUDY TO ASSESS KNOWLEDGE AND PRACTICE REGARDING

PREVENTIVE MEASURES OF WATER BORNE DISEASES AT LOCAL LEVEL
AMONG ADULTS AT SELECTED AREA OF JAIPUR”

6.5 OBJECTIVES OF THE STUDY:-

➢ To assess the knowledge of adults regarding water borne disease and their

prevention.

➢ To assess the practice of adults regarding water borne disease and their

prevention.

➢ To find out the association between the knowledge of adults on water borne

disease and their prevention with selected demographical variables.

6.6 HYPOTHESIS:-

➢ H1: There will be significant association between knowledge score & selected
 demographical variables.

➢ H2: There will be significant association between practice score & selected

demographical variables.

➢ H01: There will be no significant association between knowledge score &

selected demographical variables.

➢ H02: There will be no significant association between practice score & selected

demographical variables.

6.7 VARIABLES:-

INDEPENDENT VARIABLE:
Knowledge of adults

DEPENDENT VARIABLE:
Dependent variables which includes age, sex, religion, type of family, educational status,
occupation, family income, number of children and source of information.

6.8 OPERATIONALDEFINITION:-

➢ Assess: To measure of the knowledge of adults on water borne diseases by

structure questionnaires.

➢ Knowledge: Refers to the correct response of adult regarding Water borne

disease.

➢ Practice: the customary, habitual, or expected procedure or way of doing of

something.

➢ Adults: An adult is a mature, fully developed person. An adults has reached

the age when they are legally responsible for their actions.

➢ Preventive measures: Intended or used to prevent or hinder; acting as an

obstacle: preventive measures. Carried out to dater expected aggression by

hostile forces. Preventing or slowing the course of an illness or disease;

 prophylactic: preventive medicine; preventive health care.

➢ water borne diseases: diseases which are transmitted through contaminated

water are known as water borne diseases in this study include cholera,

diarrhea, polio, hepatitis and enteric fever etc.

➢ Prevention: It refers to teaching programme to increase knowledge on

prevention water borne diseases.
➢ Local level: The "local level" is a term commonly used to refer municipal
government such as cities, towns and villages. It is called the local level
because it is the lowest and most closely related to the local citizens than is
county, state or federal government.

6.9 ASSUMPTIONS:-

The study is based on the assumption that

➢ Adults may have some knowledge regarding water borne disease and their

prevention.

➢ the knowledge and practice of adults regarding water borne disease and

their prevention.

6.10 DELIMITATIONS:-

• Sample size limited to 60 adults.

• Measurements of scores for knowledge once before and afteronly.

• Limited to the period of data collection (4-6weeks).

6.11 RESEARCH DESIGN:-

A research design selected for the present study was descriptive non experimental.

6.12 SETTING OF THESTUDY:-

It refers to the physical location and conditions in which data collection takes

place in the study.

The study will be conduct at Vatika, Beelwa, Goner.

6.13 TARGETPOPULATION:-
In the present study population consists of Adults who are living in
Vatika, Beelwa, Goner.
6.14 SAMPLE:-
➢ Samples size: Number of the samples size in this study will be 60.
➢ Setting of the study: Selected area at at Vatika, Beelwa, Goner.

6.15 SAMPLING TECHNIQUE:-

The sampling techniques adopted for the study is non probability purposive
sampling techniques.

SAMPLING CRITERIA:

Adults, there are attending PHC -

• Available at the time of data collection.

• Who can read and speak Hindi & English.

• Willing to participate in the study.

EXCLUSION CRITERIA:

Adults,

• Who are not willing to participate.

• Who are not available at the time of data collection.

• Who are non resident of the selected area.

• Who can’t speak or read Hindi & English.

7.2.8 DATA COLLECTION TOOL:

o Section 1: Include 6 items related to the demographic variables of the

 respondents about age, religion, type of family, educational status, occupation

, and number of children.

o Section 2: Consists of 30 multiple choice questions to assess the knowledge

and practice.

7.2.9 DATA ANALYSIS METHOD:

Data analysis will be through descriptive and inferential statistics.

DESCRIPTIVE STATISTICS:

• To describe the demographic data and level of knowledge and practice of the

adults. Percentages were worked out for interpretation.

To compute central tendency and standard deviation for the knowledge among adults.

INFERENTIAL STATISTICS

• Paired Chi-squire test to assess the effectiveness of Information Booklet on Vaccine

Preventable Diseases among mothers of under five children.

7.0 BIBLIOGRAPHY:
1. Amin S E, Haberland N Chong. Programme to Address community health:
Framing to problem no. 14. New York.

2. The Nursing journal of India.Sep 2004.Volxlv.no.9.

3. SpencerA,Rathus,Jeffirey.S.Nenvid,LoisFichner.Humansexualityinworlddiversity.

Library of congress cataloging, 3rded .1997. Pp 381-82.

4. Dangal G. An update on water born disease. The internet journal of

Gynaecology and obstetrics.2005.vol5.

5. L. Garzaro. Human Reproduction: Vol. 17, No. 11, 2986-2994, November2008.

6. Bhatia BD, Chandra R. dengue prevention-an unprepared child. India

maternal child Health (1228700) [cited 2009Ags] ;4 (3): 6-7-70. Available

from: URLhttp://www.adolespublished.com

7. Rao R, Lena A, Nair NS, Kamath V, Kamath A. Indian Journal of

MedicalScience2010. Vol 62 (11)439-443.

8. VijayalakshmiN,DamodarR.Workshoponpreventionofchildmarriage.2010.

Available from http://www.socialwelfare.bih.nic.in/DOC/Sw-Bestpractice.

9. Prabhu R. Fight Against water born disease. 2009. Available from

http://www.jeywin.com/blog/fight-against-child-marriage-in-India.

Dr. Darshan K. Narang, Dr. Ranjana Vaishnav. Determinants and PsychoSocial

Consequences of Teenage Pregnancy,2011. Available from
"www.academia.edu/8133632/Psycho-social_consequences_of_WATERborndisease"
Community level prevention health Journal. 2001;11(7):22-24. Available from:

http://www.unicef-iedc.org/publication/pdf/digest.

10. Wikipedia, the free encyclopedia [Internet].Teenage Pregnancy.

Inc;c2007.[cited.2010 Jul 5]. Available

fromhttp://en.wikipedia.org/wiki/teenag-pregnancy.
11. Emily S, Susan R J, .Shagon SM, Jean W A. Maternal child nursing 3rd ed.

El sevier publication. Canada.2009;581-583.

12. Sahana B. India: Bengal record highest dengue cases. 2008. Available

fromhttp://southasia.oneworld.net/todaysheadlines/India-bengal-regards-

higest-teen-pregnancy-cases.

13. Sunil M, Deepti A. Adolescent Health Determinant for water born and child

Health outcome among the urban poor. India Pediatric journal of Indian

academy. 2004;10(3): 137-140.

14. Park.K.Park’sTextbookofpreventiveandsocialmedicine17thedition.Jabalpur

(India). M/S BanarsidasBhanot Publishers:2002.p.329-331.

15. Herrman J.W. The voice of teen mother: The experience of repeat pregnancy.

Journal of Maternal Child Nursing.2006; 31(4):243-249.

16. Bonsu LK. How Contraception nurses can improve teenage sexual health.

Nursing Times 2005; 101(7):34-36.

17. Kafle PP, Pakuryal KN, Regmi RR, Luintel S. Health problems and social

consequences in teenage pregnancy. Nepal Medical College Journal. 2010;

12(1):225-228.

18. Banerjee B, Pandey GK, Dutt D, Sengupta B, Mondal M, Deh S. Teenage

pregnancy: A socially inflicted health hazard. Indian Journal of Community

Medicine. 2009; 34(3): 227-231.

19. Chahande MS, Jadhao AR, Wadhva SK, Ughade S. Study of some

epidemiological factors in teenage pregnancy. Indian Journal of Community

Medicine. 2000; 27(3): 280- 285.

20. WereM.Determinentsofteenagepregnancies.TheCasofBusiaDistrictinKenya.
 Economic Human Biology 2007;5 (2), 322-339.

21. Choe M K, Thapas M V. Early Marriage and Early Motherhood in Nepal.

Journal of Biosocial.2005;37(2):143-162.

22. Choe M K, Thapas M V. Early Marriage and Early Motherhood in Nepal.

Journal of Biosocial.2005;37(2):143-162.

23. Shrestha.S.Socio-CulturalfactorsinfluencingadolescentpregnancyinruralNepal.

Journal of Adolescent Medical Health.2002;14 (2): 101-119.

24. Skinner SR, Smith J, Gerwick J, Hendricks J, Tyfe S, Kedali G. Pregnancy

and protection: perceptions attitude and experience of Australian female

adolescent. Women Birth. 2009; 22(2):20-56.

25. Rahman MM, Kabir M. Do adolescent support early marriage in Bangladesh?

Evidence from shortly. JNMA Journal of Nepal Medical Association. 2010;

44 (159):73-78.

26. Rahman MM, Kabir M, Shahidullah M. filariya morbidity and health care

seeking behavior. Journal of Agub Medical Collge Abbottabad 2009; 16

(2):9-14.