A study to assess the effectiveness of structured teaching program on knowledge regarding filariasis among adults in selected villages of Dakshina Kannada district

Lymphatic fi lariasis (LF) is a mosquito-borne parasitic disease that affects an estimated 120 million people world-wide with over 1 billion at risk for infection. LF is considered to be a leading cause of permanent disability world-wide due to the clinical manifestations of the disease.[1] LF has been identifi ed as one of the only six diseases, which could be targeted for elimination/eradication based on the considerations that human beings are the only reservoir of infection. A global effort was established to eliminate LF by 2020 through interruption of transmission by annual mass administrations of anti-parasitic drugs. India is the largest LF endemic country and has targeted elimination by 2015.[2] Transmission control and disability/morbidity management/control are the two pillars of the global elimination strategy, recognizing that episodic acute adeno-lymphangitis attacks are associated with the progression of lymph edema through stages and these are caused by secondary bacterial infections. Information, Education and Communication are an integral and important strategy of the program to create awareness among public, health care providers and policy makers. Since India is the largest fi lariasis endemic country in the world, the prospects of global elimination of fi lariasis will depend on mass drug administration (MDA) and awareness program.[3] Hence, the present study was conducted to assess the impact of structured teaching program on knowledge regarding fi lariasis among adults.


INTRODUCTION
Lymphatic fi lariasis (LF) is a mosquito-borne parasitic disease that affects an estimated 120 million people world-wide with over 1 billion at risk for infection.LF is considered to be a leading cause of permanent disability world-wide due to the clinical manifestations of the disease. [1]LF has been identifi ed as one of the only six diseases, which could be targeted for elimination/eradication based on the considerations that human beings are the only reservoir of infection.A global effort was established to eliminate LF by 2020 through interruption of transmission by annual mass administrations of anti-parasitic drugs.India is the largest LF endemic country and has targeted elimination by 2015. [2]ransmission control and disability/morbidity management/control are the two pillars of the global elimination strategy, recognizing that episodic acute adeno-lymphangitis attacks are associated with the progression of lymph edema through stages and these are caused by secondary bacterial infections.Information, Education and Communication are an integral and important strategy of the program to create awareness among public, health care providers and policy makers.Since India is the largest fi lariasis endemic country in the world, the prospects of global elimination of fi lariasis will depend on mass drug administration (MDA) and awareness program. [3]Hence, the present study was conducted to assess the impact of structured teaching program on knowledge regarding fi lariasis among adults.included.A pre-designed and pre-structured questionnaire was used to collect the pre-test and post-test data.The questionnaire was pre-tested on subsample of 5 adults and modifi ed and necessary changes were made accordingly.The language of the questionnaire was in English and later translated to Kannada and it contained 24 questions, which were based on the knowledge regarding fi lariasis.The questions covered knowledge of adults about causes, signs and symptoms, management and prevention of fi lariasis.The ethics committee of the institute approved the study.Prior to data collection the investigator familiarized with the subjects and explained the purpose of study to them.Confi dentiality was assured to all subjects and informed consent was taken from the subjects.Pre-test was conducted using knowledge questionnaire followed by teaching program was administered by using fl ash cards and discussion with them.After a week post-test data was collected.Results were analyzed statistically using percentage, proportions and Chi-square test was applied.Statistical signifi cance was set at

Description of sample characteristics
As you can be seen in Tables 1 and 2, Figure 1, there was a significant improvement in knowledge about filariasis among adults after structured teaching program (P < 0.0001).In the pretest majority of participants 63.33% had average knowledge and 30% participants had poor knowledge and only 6.67% had good knowledge respectively.Although in the post-test 60% participants had good knowledge and 40% participants had average knowledge.
The data presented in Table 3 shows that the mean post-test knowledge scores of subjects were signifi cantly higher than their mean pre-test knowledge scores and calculated value is t = 8.396, P < 0.05.Hence the research hypothesis was accepted indicating that the planned teaching program had been the effective method in increasing the knowledge of the subjects.
The data presented in Table 4 shows that the maximum number of subjects had poor knowledge in the area of causes (83.33), 50% had average knowledge in the area of signs and symptoms, 66.67% had average knowledge in the area of prevention and 50% had poor knowledge in the area of management of fi alariasis respectively.
The data presented in Table 5 shows that 26.67% of subjects had poor knowledge in the area of causes, 60% had average knowledge in the area of signs and symptoms, 63.33% had average knowledge in the area of prevention and 50% had good knowledge in the area of management of fi alariasis.

DISCUSSION
In the present study, despite of MDA program for the elimination of filariasis, there was inadequate public awareness about filariasis among adults.The study revealed that in the pre-  and symptoms, management and prevention of filariasis.Our findings are also similar to those of several other investigators who have conducted surveys among adults.Though the assessment tool used may be different in different studies, the key core knowledge components might be same in all.A study done by Dorle et al. , [4] assessed the knowledge and perception people about LF in one of the endemic taluks of rural north Karnataka found that Most of the study population (68.99%) was not aware about the mode of spread of LF.Only 31.01%knew that LF spread by mosquito bites.Similarly, A lva et al. , [5] administered a survey to adults in Udupi District of Karnataka identified that majority of 63.2% of the participants have average knowledge, 5.8% good knowledge and 31% have poor knowledge regarding filariasis and MDA.
A study done by Nandha and Krishnamoorthy, [6] assessed impact of an intensive education campaign and evaluated using pre-and post-educational surveys in an intervention and comparison village in Tamil Nadu, South India.Environmental and entomological indicators for breeding sites and mosquito density were examined before and after the intervention.Significant (P < 0.05) increase in knowledge was observed in intervention area with regard to transmission and control of LF.Relative change between intervention and comparison villages before and after intervention was also significant (z5 > 1.96).Multiple mosquito control and personal protection methods were in use during the post-intervention assessment and was evident from the significantly (P < 0.05) higher average score.The findings of the study have implications for nursing practice, nursing education, nursing administration and nursing research.

Limitations
• Adults' attitude and practices were not evaluated.

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The study was confi ned to specifi c geographical area which imposes a limit on generalization.

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The study did not use control group.Hence the results of the study must be generalized with caution as there is threat to internal validity due to history.

Recommendations
• A similar study can be replicated with control group.

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A survey can be conducted to fi nd the incidence and prevalence of fi lariasis.

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A comparative study can be conducted between urban and rural areas.

CONCLUSION
In view of the magnitude of the problem, the prevalence of fi lariasis in developing country is consistently high.The present study revealed inadequacies in the knowledge of fi lariasis amongst adults.This indicates that there is need for health education campaign for the    improvement of knowledge, life-style practices and prevention regarding fi lariasis to the community.

Figure 1 :
Figure 1: Cone diagram showing the percentage distribution of the subjects according to their knowledge level

Table 1 : Frequency and percentage of respondents by personal characteristics
test, majority of participants 63.33% had average knowledge and 30% participants had poor knowledge and only 6.67% had good knowledge.Following the administration of structured teaching program there was an improvement in knowledge of adults (60% participants had good knowledge and 40% participants had average knowledge) in the area of causes, signs International Journal of Medicine and Public Health | Apr-Jun 2014 | Vol 4 | Issue 2

Table 2 : Over all pre-test and post-test knowledge score of respondents (n = 30)
International Journal of Medicine and Public Health | Apr-Jun 2014 | Vol 4 | Issue 2