Snakebite Mortality in India: A Nationally Representative ...



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1) Name of the candidate and address : Esther K.C

I year M.Sc Nursing

Mallige Institute of Nursing

Sector-II, HMT Post, Bangalore-13

2) Name of the Institution : Mallige Institute of Nursing

Sector-II HMT Post, Bangalore-13

3) Course of study and Subject : I year M.Sc Nursing

Child Health Nursing

4) Date of Admission to Course : 15-6-2011

5) Title of the Topic : “A study to evaluate the effectiveness of structured teaching programme on knowledge regarding first aid measures for selected animal bites among high school students at selected schools, Bangalore”.

6. BRIEF RESUME OF THE INTENDED STUDY

6.1 NEED FOR STUDY

"Strength does not come from physical capacity. It comes from an indomitable will”

Mahatma Gandhi

“First aid is an important responsibility of all the persons, because there is very limited access to fully fledged hospitals and dispensaries in remote areas” Carotta M Reinke

First aid is an immediate and temporary care given to a victim of an accident or sudden illness before the services of a physician is obtained1. This timely assistance, comprising of simple medical techniques, is most critical to the victims and is, often, life saving. The need for first aid comes in conditions such as drowning, burns, electric shock, poisoning, nose bleed, choking, fall, bites and sting.

Animal bites and scratches, even when they are minor, can become infected and spread bacteria to other parts of the body. Whether the bite is from a family pet or an animal in the wild, scratches and bites can carry disease. Dog bite is one of the most common childhood accidents causing significant morbidity and mortality in paediatric age group. Children under the age of 6 were more likely to be bitten when a dog felt the kids were threatening to take his food or toys. Older children were bitten when the dog felt the kids were intruding on his territory. Children have a tendency to tug on dogs’ ears, pull on their tails or jump on their backs. Very often, children do not realise that their playful behaviour may elicit an angry or defensive reaction from an otherwise friendly well known pet dog2.

According to World Health Organization [Sept 2011], Rabies occurs in more than 150 countries and territories, 55,000 people die of rabies every year worldwide, 40% of people who are bitten by rabid animals are children under 15 years old. In Asia and Africa, dogs are the main source (99%) of infection in all of the estimated 55,000 human rabies deaths annually. In Africa, 24,000 rabies deaths (about 4/100 000 population at risk) occur annually and in India, the figure is about 20,000 (that is, about 2/100 000 population at risk) 3.

A one year cross sectional study was conducted in Delhi on profile of dog bite. Among 313 cases of dog bite, 69.9% were males, 53.9% of the cases were less than 15 years of age, 82.75% of the victims suffered from class III exposures, 73.80% were bitten by a stray dog and only 31.03% of the victims reported treatment within 24 hours. The study shows that over 50% of the dog bite cases were children, less than 15 years of age4.

According to the civic authorities BBMP the estimated dog population in Bangalore city is around 300,000 of which around 200,000 are stray dogs. The number of stray dog bites was 2,909 and pets bite was 2,422.There are over 25,000 dog bites a year in Bangalore Municipal limits alone and 42% of dog-bite victims are children5.

Rabies is a zoonotic disease, transmitted to human by animal bites mainly dogs. It is invariably fatal if proper treatment is not received after exposure. Rabies virus enters the body through a cut or scratch, or through mucous membranes, and travels to central nervous system. Once the infection is established in the brain, the virus travels down the nerves from the brain and multiplies in different organs. The symptoms of Rabies are fever, headache, malaise, vomiting, pain, itching and tingling at the wound, as the disease progress, patients develop difficulty in swallowing, and they become disoriented while others become paralyzed. Immediate death or coma resulting in death from other complications may occur6.

A one year prospective descriptive study conducted on knowledge, attitude and practice on dog bites, study reports that 84% of the caretakers knew that rabies infection is fatal, 56% were unaware that scratch of dogs are dangerous, 72% were unaware that the dog should be carefully watched for development of symptoms of rabies or death after initiation of post exposure prophylaxis, 84% interviewees practiced incorrect first aid methods. The study concluded that there is a wide gap between the caretaker’s knowledge and the correct knowledge regarding dog bite and its first aid measures7.

First aid for dog bite is to wash the wound with soap and water under pressure from a faucet for at least five minutes, but does not scrub, as this may bruise the tissue. Apply an antiseptic lotion or cream. Watch for signs of infection at the site, such as increased redness or pain, swelling, drainage, or if the person develops a fever. If the bite or scratch is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding. Dry the wound and cover it with a sterile dressing. Some animals need to be captured, confined, and observed. If the animal cannot be found, the victim may need a series of rabies shots7.

Snake bite is a major public health problem throughout the world especially in tropical country like India. Snake venom is probably the oldest known poison to mankind and has been described in oldest medical writing and myths. Snake bite is responsible for 2.85% -5.3% of the mortality of total hospital admission in different state as compared to 20 year in USA. Various studies have shown that 15,000 to 25,000 people die annually in India due to snake envenomation. The age and sex incidence of snake bite is observed in all age groups. The majority is in males aged between 11-50years.The predominance of male victim suggests a special risk of outdoor activity. The incidence of snakebite shows a distinct seasonal pattern closely related to shelter. A large number of bites occur in fields. The frequent site of bite is in lower extremity8.

A study shows that a total of 562 of the 122,848 deaths (0.47% weighted by sampling probability or 0.46% unweighted) were from snakebites. Almost all snakebite deaths (544 or 97%) were in rural areas. More men (330, 59%) than women (232, 41%) died from snakebites (overall ratio of 1.4 to 1). The proportion of all deaths from snakebites was highest at ages 5–14 years9.

An epidemiological study conducted in central Karnataka reports that out of 633 cases of snake bite, seen in a teaching hospital, upto the age of 18 years, over a period of 8 years from 1985 to 1992 constituted the material for the study. Detailed history with special reference to the type of snake, circumstances leading to the bite and clinical consequences were studied and final outcome was noted. Males (n = 433) were bitten more often than females (n = 200). 256(40.4%) cases were in the age range of 11-15 years. The cases were seen during two periods, i.e., Oct, Nov, Dec (n = 210) and Apr, May, June (n = 199). Most (n = 506) were encountered in the lower limbs. 570 (90%) cases were from rural area. The study recommends that the morbidity and mortality can be reduced substantially by increasing and maintaining confidence in good medical care and first aid10.

Nearly 3500 species of snakes exist in the world. India has about 300 varieties of snakes of which 70 are poisonous and of these only 4 varieties of snakes are encountered as the cause of snake bite poisoning. They are Russells viper, Viperidae, Cobras and Pit Vipers. The commonest biting species is viper, cobra and krait in south India11.

The clinical features of snake bite includes pain, weakness, heaviness of eyelids, blurred vision, swelling at the site, appearance of bullae, tingling and numbness of tongue, mouth and drowsiness, vomiting, bleeding, difficulty in speech, breathing or swallowing and paralysis12.

A study reports that snake bite is one of the most neglected public health issues in rural communities. First aid and further management for snake bite remains unsatisfactory. Poorly informed public apply inappropriate first-aid measures and vital time is lost before victim is transported to hospital. It is recommended to initiate appropriate teaching on first aid and management for snake bite to the public13.

First aid for snake bite involves, reassuring the patient arrange transportation to an institution where antivenom is available. Immobilise the bitten limb with a splint. Apply pressure, immobilize with a long crape bandage so as to block lymphatic flow. Transport the patient to a hospital as quickly as possible but avoid exercising the limb14.

The health nurse as a member of school health team can play a variety of role that has a positive impact on patterns of health behaviours established during school years. Providing first aid training to students and teachers is an important role of school health nurse. Nurses can easily interact with students with patience and teach them effectively. Prevention is better than cure and since animal bites are preventable injuries, educating children regarding first aid and preventive measures can help the health team and the public in reducing the number of animal bites15.

Accidents come and go without you knowing when they will occur. They range from the minor up to the very serious ones. There are times when they can even become fatal. First aid training, on the other hand, is one way of combating the heinous effect of animal bite. With the light of the above facts and with personal experience it is possible to avent the situation if we have the knowledge on how to apply first aid, but various studies show that there is inadequate knowledge regarding first-aid among public. Children learn by doing, they interact with each other to learn. They influence adults and they are partners in education. Hence this study is to assess the knowledge of high school students on first-aid techniques for animal bites and to provide structured teaching programme to high school students on first aid measures for animal bite and measure its efficacy.

6.2REVIEW OF LITERATURE

A review of literature enables one to get an insight into the various aspects of the problem under study. It covers promising methodological tools, throws light on ways to improve the efficiency of data collection and suggest how to increase effectiveness of the data analysis and interpretation. Review of literature therefore is an essential step in the development of a research project.

According to a study on Snakebite Mortality in 2011 at India, A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15–29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8–6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500).Snakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India10.

A study was conducted in 2011 on the effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Pre-hospital practices of 72 consecutive snake bite victims at a hospital in north-central Nigeria was included in the study. The primary outcome assessed was death or disability at hospital discharge. Victims were predominantly male farmers, and in 54 cases (75%) the snake was identified as a carpet viper (Echis ocellatus), with the remainder unidentified. Most subjects (58, 81%) attempted at least one first aid measure after the bite, including tourniquet application (53, 74%), application (15, 21%) or ingestion (10, 14%) of traditional concoctions, bite site incision (8, 11%), black stone application (4, 5.6%), and suction (3, 4.2%). The majority (44, 61%) presented late (after 4 hours). Most (53, 74%) had full recovery at hospital discharge. Three deaths (4.2%) and thirteen (18%) disabilities (mainly tissue necrosis) occurred. The use of any first aid was associated with a longer hospital stay than no use (4.6 ± 2.0 days versus 3.6 ± 2.7 days, respectively, P = 0.02). The antivenom requirement was greater in subjects who had used a tourniquet (P = 0.03) and in those who presented late (P = 0.02). Topical application (Odds Ratio 15, 95% CI 1.4-708) or ingestion of traditional concoctions (OR 20, 95% CI 1.4-963) were associated with increased risk of death or disability. Ingestion and application of concoctions were associated with a longer time interval before presentation, a higher cost of hospitalization, and an increased risk of wound infection16.

A cross sectional study was conducted in 2011 at Bangladesh regarding Human rabies among the paediatric population. A total of 70 cases were included in the study, the most common age group were 5 to 10 years of age with 31(44.3%) patients followed by less than 5 years 23(32.9%) and the rest 16(22.9%) were more than 10 years of age. The male female ratio was 3:1. Among the 70 patients 59(84.3%) were from rural areas and only 11(15.7%) were from urban areas.66 (94.3%) patients presented with bleeding from the site of injury and 4(5.7%) were without bleeding. Among the patients 53(75.7%) presented with bite on the limbs followed by bite on the face 8(11.4%), body 5(7.1%) and head 4(5.7%) cases.39 of the cases (55.7%) presented with multiple bites and 31(44.3%) had single bite. More than half that is 37(52.9%) patients presented with severe bite, 31(44.3%) had moderate bite and only 2(2.9 %) patients presented with mild bite. 59(84.3%) patients were unvaccinated whereas 11(15.7%) had history of vaccination after bite. 52 (74.3%) gave the history of bite by stray animal, 10(14.3%) by known rabid animal whereas 8(11.4%) had the history of bite by pet animal. 86 patients(97.1%) had the history of bite by dog whereas 2(2.9%) reported cat bite. The mean ± SD incubation period 45.38±26.91 days and range was 11-150 days. The study concludes that the 5-10 years group children were affected most, bites were mostly by stray animal, most of the children did not get post exposure prophylaxis and incubation period was between 11 to 150 days17.

A study was conducted in 2011 on Effectiveness of structured teaching programme on knowledge regarding bronchial asthma and its management among mothers of asthmatic children. The research design for the study was quasi experimental one group pretest post test design. A structured knowledge questionnaire was used to collect the data from the mothers before and after the administration of the structured teaching program on knowledge regarding bronchial asthma and its management among mothers of asthmatic children. The findings reveals that, in the pretest 36(60%) had moderate knowledge and 24(40%) had inadequate knowledge regarding Bronchial Asthma and its management. After administering STP, the findings reveal that in post test majority of them 56(93.33%) had adequate knowledge, 4(6.67%) had moderate knowledge and none of them had inadequate knowledge. Study attempted to assess the effectiveness of Structured Teaching Programme on Knowledge Regarding Bronchial asthma and its management among mothers of asthmatic children found that the developed STP was effective18.

Dog bites are an important source of injury in 2009 on US population, especially among children. A study was conducted in 2009 at Philadelphia using a retrospective review on the nature of dog bite injuries treated over a 5-year period at a large tertiary paediatric hospital to identify relevant parameters for public education and injury prevention. The result showed that majority of dog bite injuries (62.8%) were sustained by male children, dog bite injuries were most prevalent during the months of June and July (24.1%); grade school-aged children (6 to 12 years) constituted the majority of victims (51%) followed by preschoolers (2 to 5 years; 24.0%); teenagers (13 to 18 years; 20.5%) and infants (birth to 1 year; 4.5%). Injuries sustained by infants and preschoolers often involved the face (53.5%), whereas older children sustained injuries to the extremities (60.7%). The study concludes that the children under 15 are the main victim for dog bites the study concludes that paediatric dog bites are preventable injuries, yet they persist as a prevalent public health problem, evaluation of data from tertiary paediatric institution identifies predictable pattern of injury with respect to age and gender, animal breed, provocation and seasonality.19.

A study was conducted in 2007 at rural Madi Valley. To lessen the dependency on traditional healing, prominent and famous local healers were invited as guest, encouraged and inspired to participate and ventilate their experiences, activities, faiths on traditional healing of snakebite and other misconceptions on snakes. Results shows that immediately after program, 88% participants (n=165) opted program was the best; 89% developed the ability to apply the recommended first aid. On evaluation after 1 year, 74% participants (n=158) transferred their skill to a total of 2097 locals. But from the systematic sampling (n=360), it was found that 44% locals received the knowledge on snakes and first-aid techniques. Consequently, dependency on traditional healing reduced significantly from 56% to 22% and attracted the people towards invaluable pressure immobilization technique and antivenom therapy significantly. They were well aware to move victim to snakebite treatment center immediately after the first-aid in comfortable means of transport. As a conclusion, students focused education programs for dissemination and empowerment of mass people with the invaluable recommended first-aid skill and preventive measures for snakebite that reduced the dependency on traditional healing and attracted the people towards invaluable pressure immobilization technique significantly20.

A study was conducted in 2006 on epidemiological study of animal bites in India to find the incidence of animal bites, anti-rabies treatment practices, Pet dog population and their care. 21 medical colleges chosen with geoscatter representation conducted the survey during February-August, 2003. The survey was conducted in 18 states, covering a population of 52,731 chosen randomly from 8500 households. The annual incidence of animal bites was high, (1.7%) and it was more in rural areas (1.8%), children (2.6%) and poor/low income group (75%). The main biting animal was dog (91.5%), mostly stray dogs (63%), and followed by cat (4.7%). A high proportion of bite victims did not wash their wounds with soap and water (39.5%), preferred Government hospitals (59.9%) and nerve tissue vaccine (46.9%). The use of rabies immunoglobulin was low (2.1%).). The recourse to indigenous treatment (45.3%) and local application to wound (36.8 %/) was quite prevalent. About 17% of households reported having a pet/domesticated dog and the pet dog: man ratio was 1: 36. Pet dog care/management practices were not satisfactory with a low veterinary consultation (35.5%) and vaccination (32.9%). The situation was slightly better in urban areas. The people also reported the presence (83%) and menace (22.8%) of stray dogs. It is recommended to initiate appropriate community awareness and dog vaccination campaigns and effective stray dog control measures21.

A study conducted on knowledge, attitude and practices about animal bites and rabies in general community at a multicentric study was carried out from April 2001 to September. The study was carried out at six selected centers across the country viz. Delhi, Hyderabad, Raipur, Jamnagar, Coonoor and Rajahmundry. A total of 1129 (male: female: 48.5: 51.5) persons in the age group of 18 to 80 years were interviewed in this study. Of these about 751 of the individuals had attended school at some level and rest were illiterates. 68.7% people had heard about rabies. In 60.7% of cases the community associates rabies with dog bite only. Knowledge about appropriate wound toilet was found to be inadequate. Only 360 (31.9%0/) people felt that washing the wound with soap and water was the best option. Application of indigenous products like chillies (11.4%), turmeric (5.6%), lime (6.8%), kerosene oil (2.3%), herbal paste (4.2%) etc was suggested along with visit to occult medicine practitioner (1.5%) as part of the bite wound management. People were not aware of number of injections needed for treatment of animal bites. Multiple reasons viz negligence and ignorance 354 (31.4%), fear of multiple painful injections 365 (32.3%), expensive treatment 169 (15%) and long course requiring daily visits to anti-rabies clinics 73 (6.5%) were cited as reasons for non-compliance of treatment. KAP study suggests that there is need to create awareness amongst the masses regarding epidemiology of the disease and merits of prompt and appropriate post exposure treatment through enhanced IEC activities22.

A cross sectional study was conducted in 2005 on Knowledge, Attitude, Behavior and Practice Study on Dog-Bites and Its Management in the Context of Prevention of Rabies in a Rural Community of Gujarat. One of their objectives was to ascertain the first aid measures adopted by people after dog bite. A total of 225 families were contacted in nine villages with 25 families per village. Results shows that all of the individuals were aware about rabies and 98.6% knew about its transmission by dog bite. Only 31.1% would like to apply first aid measure and 36.4% will visit to doctor and rest either do nothing or adopt some religious practices to prevent the development of rabies. 86.6% of individuals were aware about anti-rabies vaccine and 24.4% knew that pet dogs need vaccine against rabies23.

An epidemiological study was conducted in 2001 on a community survey of dog bites, anti-rabies treatment, rabies and dog population management in Bangalore city with the aim of knowing the nature and magnitude of the problem of rabies in Bangalore city. The study reports that the disease was enzootic and endemic and the principal reservoir of infection was dog. There was stray dog menace due to ineffective dog control measures. Nearly 30% of animal bite victims did not wash their wounds and about 60% of patients started antirabic vaccine late after 24 hours of bite. The antirabies serum (equine) was not available at all. The victims of hydrophobia were both children (37.5%) and adults (62.5%) and the average incubation period ranged from 35-111 days. Pre-exposure antirabic vaccination was not given to dog catching and dog pound staff. Lastly, there was lack of proper first aid24.

A retrospective study was done of poisonous snakebite in 1995 at Utah to determine the current epidemiology and scope of treatment, reviewing emergency department logs and other sources statewide for a 69-month period. These bites were considered accidental, and all were presumed to be from rattlesnakes. Nearly three fourths of the victims were male, ranging in age from 2 to 56 years (mean, 22 years). Most accidental bites occurred in areas of high human populations, during the summer months, in the afternoon or evening hours, and during recreational activities. Of the 48 bites, 11 (23%) were provoked. Two thirds of bites were on the upper extremities, and a third were on the lower extremities. More than half of the victims had no first-aid treatment recorded25.

An epidemiological and clinical study of snake-bites in childhood at Royal Children's Hospital in 1989 at Herston, reports that there has been major changes in the first-aid management of elapid snake-bites and the introduction of a new venom-detection kit which can identify the genus of medically-important snakes. In the light of these developments, the report a 10-year study that comprised 218 consecutive children who were admitted to hospital in southeast Queensland, after a confirmed or a suspected snake-bite. One-third (34.9%) of victims were preschool children (0-5 years of age) but the highest "at-risk" group comprised prepubescent boys. Of the 218 children who were admitted to hospital, 42% manifested local or systemic symptoms that were consistent with a confirmed snake-bite, irrespective of whether or not the species of snake was venomous. We have found that appropriate first aid was applied in the field in a maximum of 18% of cases26.

6.3 PROBLEM STATEMENT

A Study to evaluate the effectiveness of structured teaching programme on knowledge regarding first-aid measures for selected animal bites among high school students at selected schools, Bangalore.

6.4 OBJECTIVES OF THE STUDY

Assess the knowledge regarding first-aid measures for selected animal bites among high school students by conducting pre-test.

Evaluate the effectiveness of structured teaching programme regarding first-aid measures for selected animal bites among high school students by comparing mean pre-test and post –test knowledge scores.

Find the association between pre-test knowledge scores regarding first-aid measures for selected animal bites with selected socio-demographic variable.

6.4.1 HYPOTHESES

H1 - There will be significant difference in the knowledge level after providing structured teaching programme on first aid measures for selected animal bites among high school students.

H2 - There will be significant relationship between demographic variables and post-test knowledge on first aid measures for selected animal bites among high school students.

6.4.2 RESEARCH VARIABLES

Independent variable

In this study, independent variable refers to structured teaching programme on first-aid measures for selected animal bites.

Dependent variable

In this study, dependent variable refers to knowledge among high school students regarding first aid measures for selected animal bites

6.5 OPERATIONAL DEFINITION

EFFECTIVENESS: Effectiveness refers to the positive changes that structured teaching programme will produce on knowledge regarding first aid measure for selected animal bites among high school students by comparing pre-test and post-test scores

KNOWLEDGE: This refers to the information that the high school students possess regarding first-aid measures for selected animal bites as evidenced by number of correct responses to the items in the structured questionnaire.

STRUCTURED TEACHING PROGRAMME: It refers to a planned programme to impart knowledge using relevant teaching methods and appropriate AV Aids regarding first aid for selected animal bites.

FIRST AID MEASURES: It refers to the provision of care to be initiated immediately after an exposure to animal bites.

ANIMAL BITE: It refers to a physical damage caused to a victim by an attack from an animal. In this study it refers to a dog bite and snake bite.

HIGH SCHOOL STUDENTS: It refers to students studying in 8th and 9th classes in selected schools, Bangalore.

7. MATERIAL AND METHOD

7.1 SOURCE OF DATA

The data will be collected from students studying in high school students in a selected school.

7.2 METHOD OF DATA COLLECTION

7.2.1 Inclusion criteria and exclusion criteria

Inclusion criteria

High school students studying in 8th and 9th standard.

Students who are willing to participate in the study.

Students who are present at the time of data collection.

Exclusion criteria.

Students who are not interested to participate in the study.

Students who are absent at the time of data collection.

7.2.2 Research Design

Quasi experimental, one group pretest- posttest design.

7.2.3 Setting

Selected schools in Bangalore.

7.2.4 Sampling technique

Non probability sampling: purposive sampling

7.2.5 Sample size

80 numbers.

7.2.6 Tools of research

The data will be collected using structured self administered questionnaire which consists of two parts

Part A: Items of demographic variables like sex, socio-economic status, previous knowledge.

Part B: Structured questionnaire for assessing knowledge among high school students regarding first aid measures for selected animal bites

7.2.7 Data collection   .

The data will be collected by the researcher from high school students at selected schools in Bangalore. A Pre-test will be conducted by using a self administered structured questionnaire regarding first aid measures for selected animal bites. Immediately Structured teaching programme will be conducted on the topic first-aid measures for selected animal bites. After 7 days post-test will be conducted using the same questionnaire among the same group to assess the effectiveness of structured teaching programme.

• The period of data collection will be for 4 weeks.

7.2.8 Method of Data analysis and presentation

Data analysis will be done through necessary descriptive and inferential statistics.

Descriptive statistics: The investigation will use descriptive statistical techniques like mean, median, mode, percentile and standard deviation for data analysis. The analyzed data will be presented in the form of tables, diagram and graphs based on the findings.

Inferential Statistics: Test of significance such as t-test and chi-square will be used depending on the results obtained.

7.3 Does the study require any investigation or interventions to be conducted on patients or other human or animals?

No, only a structured questionnaire will be used to assess the knowledge of high school children regarding first aid for animal bite. No other invasive physical or laboratory test will be conducted on samples.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, Administrative permission and ethical clearance with regard to the study will be obtained from the institution and samples prior to conducting the study.

8. LIST OF REFERENCES

1. K Maloti Devi. Effectiveness of planned teaching programme on knowledge regarding first aid in selected conditions among primary school teachers working in schools, Bangalore. 2006

2. K.M. Kale, S.K. Wadhva, N.R. Aswar, N.D. Vasudeo. Dog Bites in ChildrenVol. 31, No. 1;(2006-01 - 2006-03)

3. WHO. Rabies information: 2010 September. Available from:

4. Anita Khokhar, G.S. Meena, Malti Mehra. Profile of Dog Bite cases attending M.C.D. Alipur, Delhi: All Medical Journals Issues Contents Editorial Board:2003dec. Available from:

5. B K Lakshmikantha. Pets as dangerous as stray dogs. Bangalore mirror. 2010 Mar 30. Available from :index.aspx?Page=article...10.

6. Charles Patrick Davis.Article on Rabies. November 28, 2011

7. Dr. B. Sreelatha, Dr. P. Ramkumar, Dr. J. Ganesh, Dr. P. Ambikapathy,Dr. Kamalarathinam, Dr. Aravind, et al. Knowledge, attitude and practice study on dog bites, rabies infection and its vaccination among caretakers of children; ix national conference of pediatric infectious diseases. 2006 Oct:

8. Nayak KC, Sain AK, Sharada DP, Mishra SN.Profile of Cardiac complication of snakebite. Indian Heart Journal.1990; 142:185-188.

9. Bijayeeni Mohapatra,David A. Warrell, Wilson Suraweera, Prakash Bhatia, Neeraj Dhingra et al. Snakebite Mortality in India: A Nationally Representative Mortality Survey. 2011 February 15.

10. Kulkarni ML,Anees S. Snake venom poisoning: experience with 633 cases.1994 Oct:31(10):1239-43

11. Virmani SK, Dutt OP.A profile of snake bite in Jammu region.J.Indian.Med.Assoc 1987: 85:132-134.

12. David A Warrell.Hunter’s Tropical Medicine and emerging infections disease.8th edition.USA.Saunders WB Company:2000

13. Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake bite in South Asia: a review2010 Jan 26: 4(1):e603.

14. Pradeep Bambery.API Textbook of medicine.7th edition. Mumbai API 2003.

15. American Nurses Association: National Council of State Boards of Nursing. [2006]. Joint statement on delegation: Available from

16. Michael GC, Thacher TD, Shehu MI. The effect of pre-hospital care for venomous snake bite On outcome in Nigeria2011 Feb: 105(2):95-101.

17. Dey AC, Shahidullah M, Hossain MA, Mannan MA, Mitra U. Human rabies among the paediatric population in Bangladesh. 2011 Apr: 20(2):245-51

18. Prashanth P V. Effectiveness of structured teaching programme on knowledge regarding bronchial asthma and its management among mothers of asthmatic children. International journal of Nursing Education.2011.Vol.3 (1).74-77.

19. Kaye AE, Belz JM, Kirschner RE. Pediatric dog bite injuries: a 5-year review of the experience at the Children's Hospital of Philadelphia. Philadelphia: 2009 Aug: 124(2):551-8.

20. Deb Prasad Pandey. Snake bite first-aid education and its impact in rural Madi Valley.Nepal2007.

21. Sudarshan MK,Mahendra, BJMadhusudana, SNAshwoath Narayana . An epidemiological study of animal bites in India: results of a WHO sponsored national multi-centric rabies survey. Association for Prevention and Control of Rabies in India (APCRI)2006 Mar:38(1):32-9

22. Ichhpujani RL, Chhabra M, Mittal V, Bhattacharya D, Singh J, Lal S. Knowledge, attitude and practices about animal bites and rabies in general community-a multi-centric study. WHO Collaborating Centre for Rabies Epidemiology. National Institute of Communicable Diseases. 2006.Dec:38(4):355-61

23. U. S. Singh, S.K. Choudhary. Knowledge, Attitude, Behaviour and Practice Study on Dog-Bites and Its Management in the Context of Prevention of Rabies in a Rural Community of Gujarat. Indian journal of community medicine: 2005. Volume 30, Issue 3 [p. 81-83].

24. Sudarshan MK, Mahendra BJ, Narayan DH. A community survey of dog bites, anti-rabies treatment, rabies and dog population management in Bangalore city. Dept. of Community Medicine and Anti-Rabies Clinic, Kempegowda Institute of Medical Sciences.2001 Dec: 33(4):245-51.

25. Plowman DM, Reynolds TL, Joyce SM. Poisonous snakebite in Utah. West J Med. 1995 Dec:163(6):547-51

26. Jamieson R, Pearn J. An epidemiological and clinical study of snake-bites in childhood

Royal Children's Hospital.1989 Jun 19:150(12):698-702.

9. Signature of the candidate :

10. Remarks of the guide : This topic is appropriate as it empowers the high school student’s knowledge regarding first aid measures for selected animal bites, since students are quick learners and co partner in educating the adults.

11. Name and Designation of :

11.1. Guide : Mrs. Mariam Jaisy G

Assoc. Professor

Mallige Institute of Nursing,

Sector-II, HMT Post, Bangalore-13.

11.2 Signature :

11.3 Co-guide : Mrs. S. Padmavathi

Professor & Principal,

Mallige Institute of Nursing,

Sector-II, HMT Post, Bangalore-13.

11.4 Signature :

11.5 Head of the Department : Mrs.Mariam Jaisy G

Assoc. Professor

Mallige Institute of Nursing,

Sector-II, HMT Post, Bangalore-13.

11.6 Signature :

12. Remarks of the Chairman/Principal : This topic is appropriate as it enriches the knowledge of high school students regarding first aid measures for selected animal bites.

12.1 Signature : [pic][pic][pic]

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