RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DESSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE KNOWLEDGE OF ADULTS REGARDING SWINE FLU AND ITS PREVENTION IN SELECTED URBAN AREA OF BENGALURU SOUTH WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET’’.

SUBMITTED BY,

Mr. AJI MATHEW

1 YEAR MSc NURSING

ROYAL COLLEGE OF NURSING

UTTARAHALLY

BANGALORE 61

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DESSERTATION

| | |

|Name of the candidate and address |AJI MATHEW |

| |1Yr MSc NURSING |

| |ROYAL COLLEGE OF NURSING |

| |7TH MAIN ,1ST BLOCK,UTTARAHALLY |

| |BANGALORE |

|Name of the institution |ROYAL COLLEGE OF NURSING |

|Course of study and subject |1Year MSc Nursing |

| |Community health nursing |

|Date of admission to course |31/10/2010 |

|Title of the Topic; |

|“A study to assess the knowledge of adults regarding swine flu and its prevention in selected urban area of Bengaluru south with a view to|

|develop an information booklet ’’. |

|Brief resume of the intended work |

|6.1 Need for the study Enclosed |

|6.2 Review of literature Enclosed |

|6.3 Objectives of study Enclosed |

|6.4 Operational definitions Enclosed |

|6.5 Hypothesis of the study Enclosed |

|6.6 Assumptions Enclosed |

|6.7 Delimitations of the study Enclosed |

|6.8 Pilot study Enclosed |

|6.9 Variables Enclosed |

|Material and Method |

|7.1 Source of data-Data will be collected from adults at selected urban area of Bengaluru |

|7.6 Method of collection of data-Structured questionnaire |

|7.11 Does the study require any investigation or intervention to the patients or other human being or animal? Yes |

|7.12 Has ethical clearance has been obtained from your institution? Yes |

|List of References Enclosed |

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

| | | | |

| | | |MR. AJI MATHEW |

| |1.NAME AND ADDRESS OF THE CANDIDATE | |FIRST YEAR M.SC. NURSING, |

| | | | |

| | | | |

| |2. NAME OF THE INSTITUTION | | |

| | | |: ROYAL COLLEGE OF NURSING |

| | | |7TH MAIN ,1ST BLOCK,UTTARAHALLY |

| | | |BANGALORE |

| | | | |

| |3.COURSE OF STUDY AND SUBJECT | |IST YEAR M.SC. NURSING, |

| | | |COMMUNITY HEALTH NURSING. |

| |4.DATE OF ADMISSION | | |

| |5. TITLE OF THE TOPIC | | |

| | | | |

| | | | |

| | | |: 31/10/2010 |

| | | | |

| | | |: “A study to assess the knowledge of |

| | | |Adults regarding swine flu and its |

| | | |prevention in selected urban area of |

| | | |Bengaluru south with a view to |

| | | |Develop an information booklet” |

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“The ultimate measure of a man is not where he stands in moment of comfort and convenience but where he stands at time of challenges and controversy.”

- Martin Luther King (Jr)

Swine flu: another pandemic knocking at the door?

An infectious disease is a clinically evident illness resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa; multi cellular parasites.

Swine flu is an infection by any one of several types of swine influenza virus. The H1N1 viral strain implicated in the 2009 flu pandemic among humans often is called "swine flu”.

Influenza A virus strains are categorized according to two proteins found on the surface of the virus: hemaglutinin (H) and neuraminidase (N).Modes of transmission include airborne and fomites. Incubation period ranges from 1-7 days. Symptoms include fever, cough, sore throat runny nose body ache, head ache, chills and fatigue. Diarrhea and vomiting have also been detected.

The ongoing H1N1 virus pandemic is expected to affect large portion of the general population; it mainly affects older children and youths. Early identification and prompt treatment with antiviral drugs in high risk individuals with severe infection is advised to prevent worsening of the disease and death.

The WHO 2009 worldwide figures for H1N1 have at least brought out one consensus among experts-the youth is more affected by it.41.6% of the people who tested positive for H1N1 in India are from metros and are youths. Of the deaths in Bengaluru from swine flu, mostly are from the late 20s.

The outbreak of pandemic swine flu took thousands of lives in the year 2009.As a part of health care provider it is our role that plays a major role in the awareness of swine flu and its prevention among youths.

6.1 NEED FOR THE STUDY

“The history of the human species, it has been said, is the history of infectious disease”. Over the centuries, humans have been exposed to a vast amount and array of contagious conditions, including the Black Death and other forms of plague, typhoid fever, cholera, malaria, influenza, and the acquired immunodeficiency syndrome, or AIDS. Only in the past few hundred years have scientists begun to have any sort of accurate idea concerning the origin of such diseases, through the action of micro organisms and other parasites.1

The H1N1 form of swine flu is one of the descendants of the Spanish flu that caused a devastating pandemic in humans during 1918 -1919. It would have been persisting in pigs and was then circulated into humans during the 20th century, contributing to the normal seasonal epidemics of influenza. In the year 2009 H1N1 has rapidly became a serious threat worldwide. The pandemic calls for urgent preparedness to mitigate its impact as much as possible.2

As of 22 November 2009, worldwide more than 207 countries and overseas territories or communities have reported Over 482300 laboratory confirmed cases of pandemic H1N1 including over 7826 deaths. In India the swine flu death has reached over 561 and total number of affected cases is over 1174863.

Maharashtra which continuous to have the highest number of death from swine flu pandemic, has a death toll that has gone up to220, the highest number of death is from Pune. According to health officials of Karnataka total number of positive cases is 793. The death toll due to the H1N1 virus in the state reached 69, While 16 were from Bengaluru.4 The WHO has raised pandemic alert to the highest level which is 6.5

The advent of a new H1N1 many countries have begun mass immunization programme. The government of India went on high alert mode in preparation for the possibility of the deadly swine flu and has already stored 1 million oseltamivir tablets as a preventive measure during community outbreak of H1N1.6

Sebastain M R, Lodha R, Kabra S K, department of pediatrics, all India institute of medical science, New Delhi described that the currently circulating strain of swine origin influenza virus of the H1N1 strain has undergone triple reassortment and contains genes from the avian, swine and human virus. It is transmitted by droplet or fomites. Common clinical symptoms are indistinguishable by any viral respiratory illness, and include fever cough sore throat and mayalgia preventive measures include social distancing practicing respiratory etiquette, hand hygiene and use of chemo prophylaxis and antiviral drugs.7

Chathurvedi.S of department of community medicine, University College of medical science, Delhi says that non-pharmaceutical intervention would be the only preventive modality available in large part of the world.8

Since swine flu first emerged in April 2009, it has sparked panic. It took the HINI virus only nine weeks to spread across continents from Mexico. The WHO 2009 figures of H1N1 across the world have brought out that youth is more affected by it and 41.6% of the people tested positive for H1N1 flu in India are from urban area. It is observed that youths are at a risk of getting the disease because they travel and socialize more than other age group.9

So the investigator rightly felt that the Adults in this area should be adequately informed about swine flu and its prevention. Keeping the above fact in mind, the investigator is making an attempt to assess the knowledge of youths regarding swine flu and its prevention and based on their knowledge scores the information booklet is prepared and provided to the participants of the study in selected urban areas of Bengaluru south.

6.2 REVIEW OF LITERATURE

Vidushi M, Shiv Sajan S (2010) conducted a study on knowledge, attitude and practices regarding swine flu among pediatricians of Chandigarh. A questionnaire based survey related to Novel H1N1swine origin influenza virus (S-OIV, swine flu) was administered to 134 pediatricians of Chandigarh city, to assess their knowledge, attitudes and practices. Only 52% was aware that swine flu predominantly occurs in young healthy individuals. 90% were familiar with clinical symptoms and 70% with incubation period. Current WHO phase-6 of pandemic alert was known to a few. Regarding management practices, only 33% knew that Oseltamivir and Zanamivir. Hand washing and special masks were suggested as best methods of prevention for the physicians. They concluded that it needed to scale up the efforts to spread awareness about swine flu. 10

Balkhy HH, Abolfotouh MA, Al-Hathlool RH, Al-Jumah MA (2010) conducted a study on knowledge, attitudes, and practices related to the swine influenza pandemic among the Saudi public. A cross-sectional study of 1,548 adult subjects recruited from various shopping malls in Riyadh and Jeddah was conducted. All of the subjects were interviewed using a questionnaire that tested their knowledge, attitudes, and use of precautionary measures in relation to the H1N1 influenza pandemic. Results shown that More than half (54.3%) of the participants showed high concern, 43.7 % showed a low level of knowledge, and 60.8% had taken minimal or no precautionary measures. They concluded that high concern did not translate into a higher compliance with precautionary recommendations, possibly due to the low level of knowledge about the disease among the public. Frequent communication between physicians and the public is recommended to help dispel myths about the disease and to spread better information about the role that the public can play in limiting the spread of the disease. 11

Kamate SK, Agrawal A, Chaudhary H, Singh K, Mishra P, Asawa K (2009) conducted a study on public knowledge, attitude and behavioral changes in an Indian population during the Influenza A (H1N1) outbreak. A cross-sectional questionnaire survey was conducted in Udaipur (Rajasthan, India) among 791 individuals (57% males and 43% females) from 23 July to 27 August 2009. Results showed that Of 791 respondents, 83.1% had heard about H1N1, but 47.4% felt that they did not have enough information about the pandemic. Only 34.5% felt that their health would be seriously affected if they contracted H1N1. Over half of the respondents (59.6%) had no idea about the duration of the pandemic. Knowledge differed significantly according to gender, age groups, and educational status as well as working status. They concluded that in spite of having acceptable knowledge and attitude, behavioral response to Influenza-A (H1N1) was poor. Therefore, increased efforts should be made by the government to understand what factors are associated with adaptive behavioral changes among the general public. 12

Anand K, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. (2009) conducted a study on critically ill patients with 2009 H1N1Infection in Canada which described characteristics, treatment, and outcomes of critically ill patients in Canada with H1N1 infection. A prospective observational study of 168 critically ill patients with H1N1 infection in 38 adult and pediatrics intensive care units were done. Results showed critical illness occurred in 215 patients with confirmed, probable, or suspected community-acquired 2009 influenza A (H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A (H1N1), the mean age was 32.3 (21.4) years, They concluded that Critical illness due to H1N1 in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multi system organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies.13

Seale H, McLaws ML, Heywood AE, Ward KF, Lowbridge CP, Van D, et al. (2009) conducted a study on the community's attitude towards swine flu and pandemic influenza. It was a Cross-sectional survey of Sydney residents during WHO Phase 5 of H1N1. Members of the public were approached in shopping and pedestrian malls in seven areas of Sydney. Results showed that out of 620 respondents, 596 (96%) were aware of pandemic (H1N1) in 2009, but 44% (273/620) felt they did not have enough information about the situation. More than a third 38%; (235/620) ranked their risk of catching influenza during a pandemic as low. They concluded that emphasizing the efficacy of recommended actions like hand hygiene, risks from the disease and the possible duration of the outbreak may help to promote compliance with official advice.14

Rubin GJ, Amlot R, Page L, Wessely S (2009) conducted study on Public perceptions, anxiety, and behavior change in relation to the swine flu outbreak. A cross sectional telephone survey was performed. The participants were 997 adults aged 18 or more who had heard of swine flu and spoke English. Results showed that 37.8% of participants reported performing any recommended behavior change 4.9% had carried out any avoidance behavior. The results support efforts to inform the public about specific actions that can reduce the risks from swine flu and to communicate about the government's plans and resources. Additional research is required into differing reactions to the outbreak among ethnic groups.15

Crum- Cianflone NF, Blair PJ, Faix D, Arnold J, Echols S, Sherman SS, et al. (2009) conducted a study on clinical and epidemiologic characteristics of an outbreak of H1N1 among United States military beneficiaries. Epidemiologic evaluation of H1N1 virus infections diagnosed in San Diego County among 96,258 local US military beneficiaries. 761 patients presented with influenza-like illness and underwent real-time reverse transcriptase polymerase chain reaction (rRT-PCR) testing. Of these patients, 97 had confirmed H1N1 virus infection, with an incidence rate of 101 cases per 100,000 persons. The median age of H1N1 patients with H1N1 virus infection was 21 years. Fever was a universal symptom in patients with H1N1 virus infection; other symptoms included cough, mayalgia or arthralgia, and sore throat. They concluded that the outbreak primarily affected adolescents and young adults and resulted in a febrile illness without sequelae.16

Han K, Xiaoping Z, Fan H, Lunguang L, Lijie Z, Huilai M, et al. (2009) conducted a study in 2009 on lack of airborne transmission during outbreak of pandemic (H1N1) 2009 among tour group members in China, .They conducted a retrospective cohort investigation. Secondary cases developed in 9 (30%) tour group members who had talked with the index case-patient .This outbreak was apparently caused by droplet transmission during coughing or talking. Their findings highlight the need to prevent transmission by droplets and fomites during a pandemic.17

La JT, Yeung NC, Choi KC, Cheng MY, Tsui HY, Griffiths S (2009) conducted a population based cross sectional survey study on acceptability of H1N1 vaccination during pandemic phase of influenza H1N1 in Hong Kong. Participants were Random sample of 301 adults was interviewed by telephone .45% of the participants reported that they would be highly likely take up vaccination if it was free. Overall 39% of participants believed that H1N1 vaccination would prevent the virus being contracted. They concluded that the uptake of vaccination against H1N1 by the general population of Hong Kong is unlikely to be high and would be sensitive to personal cost. Evidence about safety and efficacy is critical in determining the prevalence of uptake of vaccination.18

Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, et al. (2009) conducted study on Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Twenty vaccinated, antibody-positive health care workers had their hands contaminated with 1 ml of 10(7) tissue culture infectious dose (50)/0.1 ml live human H1N1 virus before undertaking 1 of 5 hand hygiene protocols, soap and water hand washing, or use of 1 of 3 alcohol-based hand rubs, Results showed that there was an immediate reduction in culture-detectable H1N1 after brief cutaneous air drying. They concluded that hand hygiene with soap water or alcohol-based hand rub is highly effective in reducing H1N1 virus on human hands, appropriate hand hygiene may be an important public health.19

Castro-Jiménez MA, Castillo-pabon JO, Rey-Benito GJ, Pulido-dominguez PA,Borboso-R (2009) conducted an epidemiologic analysis of the laboratory-confirmed cases of H1N1in Colombia, A total of 183 laboratory confirmed cases of H1N1 were reported in Colombia, The infection affected younger age-groups and the symptoms most frequently reported were cough, fever and sore throat. Their findings are consistent with recent reports from other countries initiative to reduce pandemic and avian influenza transmission.20

STATEMENT OF THE PROBLEM

“A study to assess the knowledge of Adults regarding swine flu and its prevention in selected urban area of Bengaluru south with a view to develop an information booklet”

6. 3 OBJECTIVES 0F THE STUDY

➢ To assess the knowledge of adults regarding swine flu and its prevention.

➢ To find the association between the knowledge scores of adults regarding swine flu and its prevention with selected demographic variables.

➢ To develop an information booklet based on their level of knowledge on swine flu and its prevention.

4. HYPOTHESIS

H1 - There is a significant relationship between the knowledge of adults on swine flu and its prevention with selected demographic variables.

5. OPERATIONAL DEFINITION

Assess : Statistical measurement of correct response of the adults to the knowledge items listed in the tool.

Knowledge: Refers to understanding and awareness of adults regarding Swine flu and its cause, signs and symptoms, mode of transmission, diagnostic measures, treatment and its prevention in selected urban areas of Bengaluru south

Adults: Refers to men and women with age between 18- 40 years residing in selected PHC area of Bengaluru south.

Swine flu: Refers to an acute infectious viral disease caused by H1N1 virus.

Prevention: Refers to the precautionary measures taken to avoid the occurrence Swine flu

Information Booklet: Refers to a booklet developed based on their knowledge scores of adults regarding causes, signs & symptoms, mode of transmission, diagnostic measures, treatment and prevention of Swine flu.

Selected urban area: Refers to an area which comes under Bruhath Bengaluru Mahanagara Palike, Bengaluru south.

6.6. Assumption :

1. Adults may not have adequate knowledge regarding swine flu and its prevention.

2. Adults demographic characteristic may have association with their knowledge regarding swine flu and its prevention.

3. Information booklet on swine flu and its prevention may improve their knowledge regarding swine flu and its prevention.

6.7 Delimitations : This study is delimited to,

1. It is limited to the Adults who are willing to participate in the study.

2. It is limited to Adults who are in the age group of 18years and above

3. The study is further limited to only those Adults who are residing in the Selected PHC area, Bengaluru south

6.8 Pilot Study :

After having obtained formal administrative approval from the Medical Officer of PHC, Participants were informed about the purpose of the study and consent was taken from them. The pilot study will conduct in selected PHC area, Bengaluru south. Data was collected form 10 samples with the help of the structured questionnaire schedule. The pre testing of the structured questionnaire schedule was done to check the clarity of the items, their feasibility, reliability and practicability.

6.9 Variables :

A variable is Any thing that can change or anything that is liable to vary.

Independent Variable-: An independent Variable that stands alive and is not dependent on any other. In this study, the Information booklet has been used as independent variable by the researcher intended to provide information.

Dependent Variable-: The dependent variable is the variable the researcher is interested in understanding, explaining or predicting. In the present study it refers to the Adults knowledge regarding Swine flu and its prevention.

7. MATERIALS AND METHODS

7.1 Source of Data : Data will be collected from adults at selected urban

area of Bengaluru.

7.2 Research Design : Descriptive Research Design.

7.3 Research Approach : In order to accomplish the main objectives

of the study i.e., a Descriptive Research Design

approach was used. A research approach tells the

researcher what data to collect and how to analyze it.

It also suggests possible conclusions to be drawn

from the data.

7.4 Setting : Selected PHC area in Bengaluru.

7.5 Population : Population is the entire aggregation of cases that

meet a designed set of criteria. In the present study

population consists of Adults in selected PHC area.

7.6 Method of Data Collection

Definition of the study subject : Adults at selected urban area of

Bengaluru.

Collection of data : The investigator collects the data from

adults using structured questionnaire

7.7 Sampling Technique : Purposive sampling

(a) Sample Size : 100 Adults

(b) Duration of Study : 4 Weeks.

7.8 Sampling Criteria

Inclusion criteria : Adults willing to participate in the study.

: Adults present at the time of data collection.

Exclusion criteria : Adults affected with swine flu are not included.

: Adults who do not know to read and understand Kannada and English

7.9 Tools of Research : The structured questionnaire schedule will be

constructed in two parts.

Part I - Demographic data

Part II - Structured questionnaire of

knowledge regarding swine flu and its

prevention.

10. Method of data analysis

and presentation a, The investigator will use appropriate Descriptive

and Inferential Statistics such as mean, median,

standard deviation Chi-square, T-test and other

relevant statistical analysis.

b, The data will be presented in the form of tables

diagrams and graphs where ever necessary.

7.11. Does the study require any investigations to the patients or other human beings or animal?

Yes

7.12. Has ethical clearance obtained from your institution?

➢ Yes, ethical clearance has been obtained from the concerned authority.

➢ Informed written consent will be obtained from the participants prior to the study.

➢ Privacy, confidentiality and anonymity will be guarded.

➢ Scientific objectivity of the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCES

1. McGraw-Hill. Infectious disease. Dictionary of Scientific and Technical Terms,

Sci-Tech Dictionary 2003. [Online]. 2003 [cited 2009 Dec 09]; Available from:

URL:

2. Swine influenza history. [Online]. 2009 [cited 2009 Dec 07]; Available from: URL:

3. India’s swine flu deaths reach 561. [Online]. 2009 [cited 2009 Nov 16]; Available from: URL:

4. Karnataka swine flu rises to 69. [Online]. 2009 [cited 2009 Sept 16]; Available from: URL: toll- rises-to-69-22577.html.

5. Archana PB. H1N1 infection in children. Prism’s Nursing Practice. Journal of clinical nursing education, training and career development. 2009 jul-sept; 4(3):80-4.

6. Swine flu: India on high alert plans to stockpile 15 billion oseltamivir pills. [Online]. 2009 [cited 2009 Oct 18]; Available from: URL: stockpile-15-billion-oseltamivir-pills/.html

7. Sebastain MR, Lodha R, Kabra SK. Swine origin influenza (swine flu). Indian J Pediatrics [serial online] 2009 Aug [cited 2009 Oct 28]; 76(8): 833-41.Available from: URL:

8. Chathurvedi S. Pandemic influenza; imminent threat, preparedness and the divided globe. Indian Pediatrics [Online]. 2009 [cited 2009 Nov 5]; 46(2): 115-21. Available from:

URL:

9. Youth more at risk of swine flu: WHO [Online]. 2009 [cited 2009 Aug 18]; Available from: URL:

10. Vidushi M, Shiv Sajan S. Knowledge, attitude and practices regarding novel

H1N1 (swine) flu among pediatricians of Chandigarh. Indian pediatrics

[serial online] 2010 January 17 [cited 2010 Jun 7]; 47:101-2. Available from:

URL:

11. Balkhy HH, Abolfotouh MA, Al-Hathlool RH, Al-Jumah MA. Knowledge, attitudes, and practices related to the swine influenza pandemic among the Saudi public. BMC Infect Dis [serial online] 2010 Feb [cited 2010 Jun 7]; 28(10):42. Available from: URL: /20187976

12. Kamate SK, Agrawal A, Chaudhary H, Singh K, Mishra P, Asawa K. Public knowledge, attitude and behavioral changes in an Indian population during the Influenza A (H1N1) outbreak. J Infect Dev Ctries. [serial online] 2009 Nov 30 [cited 2010 Jun 2]; 4(1):7-14. Available from:

URL:

13. Anand K, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J. et al. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA [serial online] 2009 Nov 4 [cited 2009 Nov 23]; 302(17):1872-9. Available from: URL:

14. Seale H, McLaws ML, Heywood AE, Ward KF, Lowbridge CP, Van D. et al. The community attitude towards swine flu and pandemic influenza. Med J Aust [serial online] 2009 Sep [cited 2009 Nov 28]; 191(5):267-9. Available from: URL:

15. Rubin G J, Richard A, Lisa P W. Public perception, anxiety, and behavioral change in relation to the swine flu outbreak: a cross- sectional telephone survey. BMJ [serial online] 2009 Jul [cited 2009 Nov 22]; 2(339):2651. Available from: URL:

16. Crum- Cianflone NF, Blair PJ, Faix D, Arnold J, Echols S, Sherman SS et al. Clinical and epidemiological characteristics of an outbreak of an outbreak of novel H1N1(swine origin) influenza a virus among unite states military beneficiaries. Clin Infect Dis Dis [serial online] 2009 Dec [cited 2009 Dec 13]; 49(12):1801-10. Available from: URL:

17. Han K, Xiaoping Z, Fan H, Lunguang L, Lijie Z, Huilai M et al. Lack of airborne transmission during outbreak of pandemic(H1N1) 2009 among tour group members, China. Emerg Infect Dis [serial online] 2009 Oct [cited 2009 Nov 9]; 15(10):1578-81. Available from:

URL:

18. La JT, Yeung NC, Choi KC, Cheng MY, Tsui HY, Griffiths S. Acceptability of A/HINI vaccination during pandemic phase of influenza A/H1N1 in Hong Kong; population based cross sectional survey.BMJ [serial online] 2009 Oct

[cited 2009 nov12]; 27(339): 4164. Available from:

URL:

19. Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, Mastorakos T. et al. Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis [serial online] 2009 Feb [cited 2009 Nov12]; 48(3): 285-9. Available from: URL:

20. Castro-Jimenez MA, Castillo-pabon JO, Rey-Benito GJ, Pulido-dominguez PA, Borboso-R. Epidemiologic analysis of the laboratory-confirmed cases of Influenza A (H1N1) in Colombia. Euro Surveillance [serial online] 2009 Jul [cited 2009 Nov10]; 14(30):19284. Available from: URL:

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|9. |SIGNATURE OF CANDIDATE | |

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|10. |REMARKS OF THE GUIDE | |

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|11.1 |NAME AND DESIGNATION OF GUIDE | |

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|11.2 |SIGNATURE | |

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|11.3 |CO-GUIDE (IF ANY) | |

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|11.4 |SIGNATURE | |

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|11.5 |HEAD OF THE DEPARTMENT | |

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|11.6 |SIGNATURE | |

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|12.1 |REMARKS OF THE | |

| |PRINCIPAL | |

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|12.2 |SIGNATURE | |

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