SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MR. MAHANTHESH CHIPPALAKATTI
I YEAR M.Sc. NURSING
COMMUNITY HEALTH NURSING
2012 – 2013
TULZA BHAVANI COLLEGE OF NURSING
HAZRAT JUNEEDI DARGA, GYANG BOWDI,
BIJAPUR-586101
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
NAME OF THE CANDIDATE
AND ADDRESS
MR.MAHANTHESHCHIPPALAKATTI
I YEAR M.Sc. (NURSING),
TULZA BHAVANI COLLEGE OF
NURSING HAZRAT JUNEEDI DARGA,
GYANG BOWDI, BIJAPUR-586101
2.
TULZA BHAVANI COLLEGE OF
NAME OF THE INSTITUTE
NURSING HAZRAT JUNEEDI DARGA,
GYANG BOWDI,
BIJAPUR-586101
3.
COURSE OF THE STUDY AND
SUBJECT
I YEAR M.SC. NURSING,
COMMUNITY HEALTH NURINSG
4.
DATE OF ADMISSION
THE COURSE
TO
16/08/2012
“A STUDY TO ASSESS THE
5.
TITLE OF THE STUDY
KNOWLEDGE AND ATTITUDE
REGARDING LEPTOSPIROSIS AMONG
AGRICULTURE WORKERS IN
SELECTED RURAL AREA AT BIJAPUR
WITH A VIEW TO DEVELOP
INFORMATION BOOKLET”
2
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Healthy citizens are the greatest asset any country can have.”
- Winston S. Churchill
″Health is a stste of completephysical mental and social well being and not merely
an absence of disease or infirmity″.
Agriculture in India has a significant history. Today, India ranks second
worldwide in farm output. Agriculture and allied sectors like forestry and fisheries
accounted for 16.6% of the GDP in 2009, about 50% of the total workforce. The
economic contribution of agriculture to India's GDP is steadily declining with the
country's broad-based economic growth. Still, agriculture is demographically the
broadest economic sector and plays a significant role in the overall socio-economic
fabric of India.1
Agricultural work today is best considered as a spectrum of activities in which,
from the health standpoint, four aspects are of particular importance: activity, scale,
technology and workforce. Agricultural workers frequently lack essential basic services
that are available in other worker communities. Moreover, they are often poorly
represented by government infrastructure and largely omitted in occupational safety and
health legislation. With the expansion of agricultural technology there is growing
concern that agricultural workers will face, in addition to traditional health risks, new
occupational health and safety hazards.
Health and safety legislation usually takes many years to develop and implement.
While efforts are being made in the legislative arena, education and training of
agricultural workers, managers and health officials should also take place. In this
manner, occupational health and safety risks in agriculture can be identified and reduced
in the field, with immediate impact on health and safety of agricultural workers. The
field of occupational health in agriculture is broad and involves many disciplines,
including not only occupational health but also parasitology, toxicology,accident
prevention and primary health care, among others.The purpose of this manuals to
3
provide rural health practitioners and other public health officials with information
relating to the major problems facing agricultural workers in health practice.2
Leptospirosis is a zoonotic disease of animals that can be transmitted to humans.
Leptospira bacteria have been found in dogs, rats, livestock, mice, voles, rabbits,
hedgehogs, skunks, possums, frogs, fish, snakes, and certain birds and insects. Infected
animals will pass the bacteria in their urine for months, or even years leptospirosis is a
zoonotic disease with worldwide distribution. It affects both humans and animals and is
emerging as an important public health problem in many developing countries.
The disease has a cosmopolitan distribution. Epidemiological studies have shown
a clear predominance of this infection in low remuneration professions.5 Transmission of
leptospirosis usually occurs through direct contact with urine, blood and organs from
infected animals. This mode of transmission is common in slaughterhouse workers. The
transmission cycle of the disease involves interaction between one or more animal hosts
harboring leptospires, a favorable environment for its survival and human beings.
The acute, generalized illness mimics other acute febrile illnesses, such as dengue
fever, malaria, or typhus. Common symptoms include headache, fever, chills, myalgia,
nausea, diarrhea, abdominal pain, uveitis, adenopathy, conjunctival suffusion without
purulent discharge, and occasionally, a skin rash. The headache is often severe and
includes retroorbital pain and photophobia. Aseptic meningitis occurs in up to 25% of
cases.1-4 Leptospirosis is an important occupational hazard to butchers, animal handlers,
agriculture manual laborers, sewage workers, forestry workers and other outdoor
workers who work in wet conditions. Leptospirosis is caused by obligate aerobic
spirochete bacteria in the genus Leptospira, which grow optimally at 28°C–30°C.
The acute, generalized illness mimics other acute febrile illnesses, such as dengue
fever, malaria, or typhus. Common symptoms include headache, fever, chills, myalgia,
nausea, diarrhea, abdominal pain, uveitis, adenopathy, conjunctival suffusion without
purulent discharge, and occasionally, a skin rash. The headache is often severe and
includes retro orbital pain and photophobia. Aseptic meningitis occurs in up to 25% of
cases. Leptospirosis is an important occupational hazard to butchers, animal handlers,
agriculture manual laborers, sewage workers, forestry workers and other outdoor
workers who work in wet conditions.
4
6.1. NEED FOR THE STUDY
“Wisdom.... comes not from age, but from education and learning.”
— Anton Chekhov
Need for the study means Scientific method which refers to a body of technique for
investigation phenomena acquiring new knowledge, collecting and integrating previous
knowledge to be termed scientific method of enquiry must be based on gathering
Empirical and measurable evidence subject to specific principles of reasoning.3
Special attention is needed for the health problems of agricultural workers, who
constitute some three-quarters of the world’s working population. Agriculture is not a
safe occupation. Agricultural workers face a large number of health problems, many of
which arise from their work. In 1990, the National Safety Council of the United States
estimated that agriculture was the most dangerous occupation, agricultural work
embraces a wide range of activities including animal husbandry; planting and cultivation;
harvesting and storage; transport; maintenance and repair; and construction. Animal
diseases are also an important environmental problem associated with livestock in
agriculture. They are generally transmitted by direct contact with infected animals or
through contaminated food, water, soil or animal excreta. Most workers are not aware of
the proper hygienic and sanitary measures to prevent or control the transmission of these
diseases. Zoonoses are diseases that animals pass to humans. Micro-organisms such as
bacteria, fungi, parasites and viruses can cause illness by infecting the body when they
are breathed in, swallowed, or when they penetrate the skin through small cuts or grazes.
Common zoonoses include from sheep or goats, which produces painful pustules on
hands, arms and the face; leptospirosis from rats (Weil’s disease) and cattle urine, which
causes a feverish illness with headache and can result in meningitis. Early treatment is
vital, ringworm, which is a fungal disease from many types of livestock.2
Leptospirosis, a disease caused by pathogenic spirochetes of the genus Leptospira, is
considered the most common zoonosis in the world and has recently been recognized as
are-emerging infectious disease among animals and humans and has the potential to
become even more prevalent with anticipated global warming.1,2 Since 1970,
occupational exposure accounting for 30-50% of human cases and recreational activities
are recognized as important causes of disease. Reclamation of wastelands, deforestations,
5
drainage congestion, water logging and changes in agricultural technology are also
important factors for its spread in present time. The outbreaks of leptospirosis have been
reported from coastal Gujarat, Maharashtra, Kerala, TamilNadu, Andhra Pradesh,
Karnataka and Andaman periodically.In the last decade, there has been a rapid rise in the
incidence of leptospirosis in north India. In rural areas, high-risk groups are farmers and
animal husbandry staff. In urban India, out breaks are reported during monsoon due to
flooding. The infection is probably transmitted to human when wading through stagnant
rainwater contaminated by infected urine of animals.3
Recently there was outbreak of leptospirosis in Orissa after the super cyclones of
29th October 1999. Later on in the month of August 2000 there were cases of
leptospirosis in Gujarat, Maharastra, Kerala and Andaman and Nicobar 5.
A study was conducted in Jamaica on Leptospirosis disease is endemic with an
annual incidence rate of six per 100 000 population (Brown, unpublished results). In
animals, a dominant feature of leptospirosis is abortion which may lead to infertility.
Often these animals are culled from the herd and sold to unsuspecting persons, including
butchers. Furthermore, it is well known that many animals may have sub-clinical
infections and may be persistent shedders of the organism in their urine. A serological
study on leptospirosis in livestock carried out by Grant and co-workers between 1984
and 1988, revealed that the predominant infecting serovars were Portlandvere, Canicola,
Icterohaemorrhagiae and Jules. They noted that more than 50% of the cattle and more
than 60% of the pigs tested were positive. The study also showed good correlation
among certain occupations: dairy farm workers had the highest positive rate (75%)
followed by cane cutters, butchers and farmers having 60%, 57% and 57%, respectively.
There is limited information on the impact of leptospirosis on livestock productivity in
Jamaica. The major objectives of this study were to determine the level of awareness and
to identify possible environmental risk factors associated with leptospirosis among
butchers and agriculture workers. determined the seroprevalence of the Leptospira
organism among cattle and pigs presented for slaughter.
Many studies were conducted on leptospirosis From the research findings investigator
concluded that leptospirosis is more common among agriculture workers in India and it
is a serious public health problem. Hence researcher selected this study to assess the
knowledge and attitude of agriculture workers regarding Leptospirosis.
6
6.2. REVIEW OF LITERATURE
A review of literature is a body of text that aim to review critical point of current
knowledge and methodological approaches on a particular topic. Review of literature is
an important step in the development of a research project. It is a systematic & critical
review of the most important published scholarly literature on particular topic. Since
effective research is based upon past knowledge, this exercise provides useful hypothesis
& suggestions for the significant investigation6.
A study was conducted on A retrospective review of notified human leptospirosis
cases in the Waikato region of New Zealand,
Identify risk factors for human
leptospirosis infection. Waikato leptospirosis notification data for the period 1 January
2004 to 31 December 2010 were analysed to identify any trends in the rates and
distribution of key variables. Annual Waikato leptospirosis notification rates were
consistently higher than national rates. Infection was associated with males (93%) of
working age (97%) who had exposure to animals through their occupation . Those who
work with cattle continue to be at risk of infection from Leptospira. The data suggests
that dry stock cattle farmers are at the highest risk. It is speculated that the immunisation
of all cattle herds may further reduce the incidence of leptospirosis, although more
accurate collection of work exposure data and hence there is further analysis is needed
to determine this7.
A study was performed to asses the frequency of leptospirosis in patients of acute
febrile illness in Uttar Pradesh India. A total of 346 serum samples and an equal number
of urine samples were collected from patients ,January 2001 to December 2001. All sera
and urine samples were tested for the presence of IgM antibody by Leptodipstick test and
by dark-field microscopy (DFM) respectively. The results revealed that IgM antibody
was detected in 25/346 (7%) patients ranging in age from 9-65 years. DFM was positive
in only in one case. MAT was positive in 4/17 cases tested and the prevalent sero-groups
were L. grippotyphosa and L. Pomona in two each. Common presenting features in these
patients were fever (25/25) and jaundice (17/25). H+istory of contact with animal or
water contaminated with animal urine was present in 96% cases. The study revealed that
Leptospirosis is not uncommon in Uttar Pradesh. However larger epidemiological studies
are required to know the actual disease burden8
7
A survey was conducted in Thiland. Among a cohort of persons(n=104) from
one village who participated in pond cleaning activity, 41.3% were scropositive for
immunoglobin, only 39.5% of 43 scropositive person reported multivariable logistic
regression indicates wearing long pant and skrrits protects against infection
(adjusted=0.217), Infected and noninfected pond cleaning participants were evaluated for
risk factors for infection in a nested case-control study. All specimens were tested in the
Thailand Ministry of Health Laboratories by using the Lepto-Dipstick Test (Organon,
Dublin, Ireland), a commercial test kit with sensitivity and specificity exceeding 80%
(21). Blood samples were collected and tested from 104 (45.6%) of 228 pond cleaning
participants for serologic testing. The subset of 104 persons who agreed to participate in
the serosurvey was similar to nonparticipants in the distribution of age (p=0.387) and sex
(p=0.124). In addition, all 228 participants reported farming as their occupation. The
serologic survey population consisted of 55 men and 49 women with a median age of
38.5 years (range 15–65),investigator concluded that educational efforts should enhance
to use protective cloths against infection9.
A study was conducted to identify Seroprevalence of Q fever, brucellosis and
leptospirosis in farmers and agricultural workers in Bari, Southern Italy.The sample of
128 workers exposed to farm animals and 280 healthy blood donors were studied.
Antibodies to C. burnetii, Leptospira and Brucella were determined by indirect immunofluorescence assay, by micro-agglutination test (MAT) and by standard tube
agglutination test, respectively. The subjects exposed to farm animals (73.4 %) were
positive for anti C. burnetii IgG (titer > or = 20) compared to (13.6 %) of control subjects
(p < 0.0001). The seroprevalence was found mainly among the veterinarians (100 %) and
the animal breeding workers (84 %). The study was concluded that further improvements
in the occupational hygiene of the work environment is advisable10.
A descriptive study was conducted to assess the prevalence of brucellosis and
leptospirois in a farming community of Saudi Arabia. Standard agglutination tests of sera
from 21 patients were tested. The results revealed that 8 (38%) were positive with titres
of 160 or over 20 480 and with titre of complement fixation tests ranging from 8 to 64.
Agglutination titres of 20 to 40 were present in only 3 cases. Those patients with positive
agglutination titre of 160 or higher admitted histories of consumption of raw milk. This
8
was study suggested that farm workers and those who drink raw milk are more likely to
contract brucellosis and leptospirosis than are the general population11.
A descriptive study was conducted with a objective of assessing the seroprevalence of leptospirosis among the high-risk groups of Andaman Islands India. A
total of 611 sera samples from different high-risk populations were collected and tested
by microscopic agglutination test (MAT). Genetic characterization of the isolate was
done by randomly amplified polymorphic DNA (RAPD) fingerprinting and serological
characterization was done using monoclonal antibody technique. Antibodies to
leptospires were detected in 322 samples giving an overall seroprevalence of (52.7%).
The seroprevalence was highest among Agriculture workers (62.5%) followed by sewage
workers (39.4%), an animal handler (37.5%), forest workers (27.3%), and butchers
(30.0%). Seroprevalence among control population was 14.7%, which was
comparatively less than that of the high-risk population groups. The study was showed
that people engaged in high-risk activities such as agriculture, sewage cleaning, animal
handling, animal slaughtering and forestry are frequently exposed to leptospirosis, and
hence control strategies targeting these populations could be more effective 12.
A Randomized clinical trials evaluated the use antibiotic prophylaxis against
leptospirosis. This systematic review assessed the current literature for evidence for or
against use of antibiotic prophylaxis against Leptospira infection. Trial results were
analysed to independently determine outcomes, while multiple trial data was pooled
when relevant. Result was shown three trials were included, all of which evaluated
doxycyline use. Trial quality suffered from a lack of intention‐to‐treat analysis and
variability across trials in methodology and targeted outcomes. One trial assessed
post‐exposure prophylaxis in an indigenous population after a flood without apparent
efficacy in reduction of clinical or laboratory identified Leptospira infection. Two trials
assessed pre‐exposure prophylaxis, one among deployed soldiers and another in an
indigenous population. Despite an odds ratio of 0.05 (95% CI 0.01 to 0.36) for
laboratory‐identified infection among deployed soldiers on doxycyline in one of these
two trials, pooled data showed no statistically significant reduction in Leptospira
infection among participants (Odds ratio 0.28 (95% CI 0.01 to 7.48). Minor adverse
events were more common among those on doxycycline with an odds ratio of 11 (95%
CI 2.1 to 60). Study is concluded that regular use of weekly oral doxycycline 200 mg
9
increases the odds for nausea and vomiting with unclear benefit in reducing Leptospira
seroconversion or clinical consequences of infection13.
A Study was conducted on leptospirosis outbreaks in Peddamandem Mandal of
Chittoor district, Andhra Pradesh. An outbreak of leptospirosis in Peddamandem
Mandal, Chittoor district, Andhra Pradesh occurred during Aug to Oct 2005. Out of 86
single human sera samples of suspected cases collected during the investigation, 49
(56.97%) samples from seven villages were found positive for leptospirosis both by
DGM tests and IgM antibodies. Out of total 49 positive cases 16 (47.05%) were male
and 33 (69.46%) female patients. The mean age of the positive cases were (42.7) years.
There were no significant differences in male and female ratio and age groups in affected
population. The higher degree of seropositivity was observed in adult females as they
were mainly engaged in both domestic and peri-domestic works. Geographical clustering
of cases was evident. All the 49 positive cases had fever (100%). Myalgia (42.9%),
stiffness of calf muscles (55.1%) and headache (32.6%) were the other major clinical
features observed. There was only 1 (2.04%) case with conjunctival suffusion. None of
the case presented with jaundice. The contaminated water stagnation due to heavy
rainfall and frequent contact of barefooted villagers with the infected sources registered
higher incidence of leptospirosis. Most of the cases were from the contaminated water
logged areas of the affected villages. In the affected villages none of the individual
occupational category showed a significant association with seropositivity. It indicated
that the transmission was from the common single category source in the villages i.e.
contaminated stagnant water. The villagers living with livestock’s and rodents were
significantly associated with seropositivity14
10
6.3 STATEMENT OF PROBLEM
“A
STUDY
REGARDING
TO
ASSESS
THE
KNOWLEDGE
AND
ATTITUDE
LEPTOSPIROSIS AMONG AGRICULTURE WORKERS IN
SELECTED RURAL AREA AT BIJAPUR WITH A VIEW TO DEVELOP
INFORMATION BOOKLET”.
6.4
OBJECTIVES OF THE STUDY

To assess the knowledge regarding leptospirosis among agriculture workers in
selected rural areas

To assess the attitude regarding leptospirosis
among agriculture workers in
selected rural areas

To find out the correlation between knowledge and attitude regading domestic
violence among agriculture workers in selected area at bijapur

To determine association between knowledge and attitude regarding leptospirosis
in selected rural areas at bijapur
6.5 OPERATIONAL DEFINITIONS
1. Assess: It refers to the process of critical analysis and valuation of the knowledge
and attitude of the agriculture workers regarding leptospirosis.
2. Knowledge: It refers to acquisition of information of fact about leptospirosis among
agriculture workers
3. Attitude: It refers to the expressions or feelings of agriculture workers towards
leptospirosis, which will be measured by an attitude scale.
4. Information Booklet : It refers to organized group of information booklet to impart
knowledge on causes, symptoms investigations, management, complications, and
prevention of leptospirosis to agriculture workers.
5. Leptospirosis: It refers to an infectious disease cause by leptospira and transmitted
to humans from domestic animals characterized by jaundice and fever.
6. Agriculture workers: It refers to a person employed on a farm whose work is
directly related to primary production of certain agricultural products, age group
under 20 to 50 years.
11
6.6 ASSUMPTIONS
1
The agriculture workers may have in adequate knowledge regarding
leptospirosis
2
Agriculture workers may have favorable attitude towards control and prevention
of leptospirosis.
3
6.7
Information booklet helps to collect data.
HYPOTHESIS
H1: There will be significant relationship between knowledge and attitude
regarding leptospirosis among agriculture workers
H2: There will be significant association between level of knowledge and attitude
regarding leptospirosis with their sociodemographic variables.
6.8 DELIMITATIONS
Study is limited to agriculture workers who understand Kannada in selected rural
areas at Bijapur.
MATERIALS AND METHODS
:
7.1 Sources of data collection
:
Data will be collected from agriculture
workers who understand Kannada in
selected rural areas at Bijapur.
7.1.1 Research design
:
Correlative descriptive research design will
be used
7.1.2 Research approach
:
Descriptive exploratory research approach
will be used for the study
7.1.3 Setting of the study
:
Study will be conducted in Selected Rural
areas, Bijapur.
7.1.4 Population
:
Population under the study includes
agriculture workers those who understands
Kannada.
12
7.1.5 Variables
:
Independent variable
:
Information booklet
Dependent variable
:
knowledge and attitude
Socio Demographic variable
:
Age, Gender, education, religion and
family income, type of family
source of information etc .
7.2 METHODS OF DATA COLLECTION:
7.2.1 Sampling procedure
:
Purposive sampling technique
7.2.2.1 Sample size
:
sample size will be 100 agriculture
workers in selected rural areas at
Bijapur
7.2.3 Inclusion Criteria
:
1. Agriculture workers who can
understand Kannada.
2. Agriculture
workers
who
are
willing to participate in the study
under 20 to 50 years.
3. Agriculture workers who are
available at the time of data
collection.
7.2.4 Exclusion Criteria
:
1. Agriculture workers
who are
less than 20 and more than 50
years.
2. Agriculture workers who are not
available at the time of data
collection.
13
7.2.5 INSTRUMENTS USED
Part A
:
:
Proforma for collecting sociodemographic
data.
Part B
:
self structured interview schedule.
Part C
:
Modified 3 point Likert scale to assess the
attitude.
2.6 DATA COLLECTION METHOD:
1. Permission
will be obtained from
concerned authority.
2. Purpose of conducting study will be
explained to the subjects.
3. Informed consent will be obtained from
the subject.
4. Data would be collected using

Interview schedule

Attitude scale
7.2.7 METHOD OF DATA ANALYSIS :

Descriptive analysis- Performa will be
analyzed using frequency , percentage,
knowledge and attitude score will be
analyzed by Mean, Median, Mode,
Standard deviation and Range.

Interfrential intervention – Correlation
between knowledge and attitude will be
analyzed
using
Karl
Pearson’s
coefficient and correlation. Reliability of
the tool will be established by using
Brown prophecy formula and Karl
Pearson’s correlation method
14
7.3
DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATION
OR
INTERVENTION TO BE CONDUCTED ON THE PATIENT OR HUMAN
BEINGS
Yes,
The study requires preparing and providing information booklet on
knowledge and attitude regarding laptospirosis.
7.4
HAS
ETHICAL
CLEARANCE
BEEN
OBTAINED
FROM
INSTITUTION IN CASE OF 7.3?
Yes,
Ethical clearance will be obtained from the institutions ethical.
15
YOUR
7.5 LIST OF REFERENCES
1. ″Agriculture - Wikipedia, the free encyclopedia″,
2012 Jul 29, available from
www.ikipedia.org/wiki/Agriculture, retrieved 20th December 2012.
2. ″WHO Regional Publications, Eastern Mediterranean Series 25,health workers in
agriculture applications-2003, available from
http://
www.emro.who.int/ dsaf/,
retrieved on 20th December 2012.
3. 3″Introduction to Leptospirosis″ ,available from Trupti H Trivedi, Sandhya A
Kamath JAPI• -june 2010 • available from www.japi.org.,retrievedon
25th
December 2012.
4. Suresh sharma, ″The text book of nursing research and statistic″, 2nd edition 2011
,70-72p .
5. Park K,″ Preventive and social medicine″.,Banarasidas Publications, new Delhi,17th
edition, 232p.
6. 6.Bylan A.,″the nurse information giving .nursing times″ 1982,78,1523,available
from www.pubmed.com,retrieved on26th December 2012.
7. Cowie G , Bell A,″ A retrospective review of notified human leptospirosis cases in
the Waikato region″ -2012 Jul 29 ,available from http:// www.nzdoctor.co.nz/un
,retrieved on 26th December 2012.
8. 8.Manocha H, Ghoshal U, Singh SK, Kishore J, Ayyagari,″ A.Frequency of
leptospirosis in patients of acute febrile illness in Uttar Pradesh India- 2004″Aug
available
from
http://www.plosntds.org/article/info:doi/10.1371/journal.
pntd
.00005,retrieved on 20th November 2012.
9. 9..Phraisuwan P, Spotts Whitney E, Tharmaphornpilas.P, et.all, ″Skin Wounds and
Control Strategies- 1999 ″,available from http://wwwnc.cdc.gov/eid/article/8/12/020180_article.htm, on 25th November 2012.
10. Monno R, Fumarola L, Trerotoli P, Cavone D, ″ Seroprevalence of Q fever,
brucellosis and leptospirosis in farmers and agricultural workers in Bari, Southern
Italy. Ann Agric Environ Med.-2009 Dce″, available from http:// www.google.com
,retrieved on 27th December 2012.
11. Talukder MA, Abomelha MS, Higham RH, ″Brucellosis in a farming community in
Saudi Arabia″ -1984, available from www.pubmed.com,retrieved on28th December
2012.
16
12. Sharma S, Vijayachari P, Sugunan AP,″ Seroprevalence of leptospirosis among
high-risk population of Andaman Islands, India″,2006 Feb, available from
www.pubmed.com,retrieved on30th December 2012.
13. REF First published: July 8,-2009,″This version published: 2009; Review content
assessed
as
up-to-date:
February
17,
2009.
Editorial
Group:
Cochrane
Hepato‐Biliary Group″, from www.pubmed.com,retrieved on28th December 2012.
14. Sohan L, Shyamal B, Kumar TS, Malini M, Ravi K, ″Studies on leptospirosis
outbreaks in Peddamandem Mandal of Chittoor district, Andhra Pradesh India-2008
Jun, available from www.pubmed.com,retrieved on5th December 2012.
17
7.6 SIGNATURE OF THE CANDIDATE :
7.7 REMARKS OF THE GUIDE
:
7.8 NAME AND DESIGNATION OF
7.9 GUIDE
:
MR.SATEESH SINDHE,
ASSO.PROFESSOR,
HOD, DEPT OF COMMUNITY
HEALTH NURSING,
TULZA BHAVANI COLLEGE OF
NURSING, BIJAPUR.
8. SIGNATURE
:
8.1 CO-GUIDE (IF ANY)
:
8.2 SIGNATURE
:
8.3 HEAD OF THE DEPARTMENT
:
MR.SATEESH SINDHE,
ASSO.PROFESSOR,
HOD, DEPT OF COMMUNITY
HEALTH NURSING,
TULZA BHAVANI COLLEGE OF
NURSING, BIJAPUR.
8.4 SIGNATURE
:
8.5 REMARKS OF THE PRINCIPAL
:
8.6 SIGNATURE
:
18