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Knowledge and protective behaviors of Staff Nurses towards Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal. Ramesh Neupane ( BPH , MPH). Backgrounds.

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Knowledge and protective behaviors of Staff Nurses towards Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

RameshNeupane

(BPH, MPH)


Backgrounds
Backgrounds Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

  • Influenza Pandemic is a global outbreak of a influenza virus and it has a capacity of swift transmission from the airdrops

    (CDC, 2009)

  • World has faced 4 different influenza Pandemics

    1. 1918 Spanish flu - 40 million killed in < 1 year

    2. 1957-1958 Asian Flu - 2 million deaths

    3. 1968 Hong Kong flu - Approximately one million deaths

    4. P.I “A” H1N1, 2009 - 19,000 deaths and 16 million cases

  • There will be little warning between onset of a pandemic and it’s arrival (WHO, 2010)


Rationales of the study
Rationales of the study Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

The influenza attack rate among unprotected Health Care Workers might be approximately 60% higher than that of the general population

Staff Nurses are the first responders who play key players in any response to influenza pandemic, and will be in the front line of exposure to infection

The behaviors and actions of Staff Nurse play a fundamental role in Influenza pandemic’s control and spread

Most risk of transmission of Influenza Pandemic to staff Nurses is during the period of care and examination of patients

(CDC &WHO, 2010)


Influenza burden in nepal
Influenza Burden in Nepal Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Nepal has faced one potential influenza pandemic outbreak in January 2009 (Avian Flu H5N1): No human death cases

Outbreak of Influenza pandemic A H1N1 was in October, 2009 with 172 cases and 4 deaths

Very few study on influenza Pandemic in Nepal and had no study on Knowledge and protective behavior


Research questions
Research questions Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

What is the level of knowledge of staff Nurses towards Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal?

What are the factors influencing the Knowledge and protective behaviors of staff Nurse towards Influenza Pandemic


Objectives Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

General Objective

  • To assess the knowledge and Protective behaviors of staff Nurses towards Pandemic influenza at some Health care facilities of Kathmandu and Chitwan district, Nepal

    Specific Objective

  • To compare the Knowledge and protective behavior of staff nurses towards pandemic Influenza

  • To identify the factors influencing Knowledge and protective behavior of staff nurses towards Pandemic Influenza


Conceptual framework
Conceptual Framework Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

  • Dependent variables

  • Independent variables

  • Protective behavior

  • Hand washing

  • Immunization

  • Personal protective Equip

  • Masks

  • Cloth

  • Surgical

  • N-95

  • Gloves

  • Gown

  • Goggles

  • Face shield

  • General Characteristics

  • Age

  • Working area

  • Working durations

  • Types of hospital

  • Hospitals guideline

  • contact with PI patients

  • Knowledge

  • Sign and symptoms

  • Mode of transmission

  • Prevention 


Research methodology
Research Methodology Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Hos. 1

Kathmandu

Hos. 2

Study population

Systematic RS

Simple RS

Purposive

Hos. 3

Chitwan

Hos. 4

  • Study design : Quantitative cross-sectional, comparative study

  • Study population : Staff Nurse

  • Study area :Hospitals of Kathmandu and Chitwan District

  • Study period : Feb to March of 2012

  • Sampling technique


Research tools
Research Tools Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

A structured questionnaire

Part 1: General Characteristics

7 questions

Part 2: Knowledge towards IP “A”H1N1

46 questions

Part 3: Protective Behavior towards IP “A”H1N1

44 questions

  • References: (SeldaAslan et al, 25 Aug, 2010and WHO)


Sample calculation cochran
Sample calculation (Cochran) Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Z2 P (1 ─ P)

n = (e) 2

(1.96)2 0.5 (1 ─ 0.05)

n = = 384

(0.05) 2

Where,

n = Sample size.

p = Estimated proportion of the population likely to have knowledge about PI is 50%

e = Desired level of precision.

z= Value from normal distribution associated with 95% confidence interval of 1.96

Taking 10% as the withdraw cases the total sample size 384+38.4(10%) = 423


Data collection process
Data Collection Process Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

1. One data collector was hired for each hospital and

  • 2.Data collector was orientated with objective and methodology before collect the data

Sample size

(424)

Kathmandu (212)

Chitwan (212 )

Teaching Hospital 106

Bharatpur Hospital 106

Teku Hospital 54

Om Hospital

52

Chitwan Medical College

106


Data analysis process
Data analysis process Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Descriptive statistics

Frequency and percentage were used for describing general characteristics, knowledge and protective behavior towards Influenza pandemic by using tables and bar diagrams

Analytical statistics

  • Student’s T-test was used to find the significant difference in the means of knowledge and protective behavior

  • Chi square test was used to calculate the association between dependent variables (protective behavior) and independent variables (general characteristics and level of knowledge)

  • Spearman’s correlation test was used to find the correlation between knowledge and protective behavior.


Validity and reliability
Validity and Reliability Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

  • Questionnaires were verified by highly qualified adviser and 3 concerned public health expertise of Kathmandu and Chitwan

  • The reliability test was done by pre-test among 30 Staff nurses

  • Cronbach alpha coefficient was used for testing reliability of measurement tool (only Knowledge related questionnaire) which gave the result of 0.781


Ethical consideration
Ethical consideration Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

The study was reviewed and approved by Nepal Health Research Council (NHRC), Ministry of Health and Population (MOHP), Nepal

The written and verbal consent was taken from hospitals as well as respondents


Results Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal


Results Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal


Relation between working districts and level of knowledge of pi

Results Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Relation between working districts and Level of Knowledge of PI

Relation between working districts and Protective Behaviorof PI

Relation between working districts and protective Behavior


Finding which achieved objective 1

Results Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Finding which achieved objective 1:

(One sample T test)

  • Compare the knowledge and protective behavior according to district


Association between the formal infection control training with knowledge and protective behavior

Results Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Association between the formal Infection control training with knowledge and protective behavior


Association between the people contacted with pi patients and knowledge and protective behavior

Results Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Association between the people contacted with PI patients and knowledge and protective behavior

  • *Only for those participants who ever contacted with Influenza pandemic patients


Correlation between knowledge and protective score of kathmandu and chitwan district

Results Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Correlation between knowledge and protective score of Kathmandu and Chitwan district


Bivariate analysis objective 2 to identify the factor influencing knowledge and protective behavior
Bivariate analysis: Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, NepalObjective 2: To identify the factor influencing Knowledge and Protective Behavior


Discussions and conclusion
Discussions and Conclusion Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

  • Formal infectious control training was found statistically significant for level of Knowledge but insignificant for protective behavior

  • This study revealed that 16.51% of participants Felt protected from Transmission of PI, while examining Pandemic influenza patients

  • This study found that nurses had high level of knowledge but does not had good protective behavior


Recommendations policy level
Recommendations – Policy level Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal

Nepal government ministry of health and population should provide the necessary equipments to nurses to prevent from the transmission of Influenza pandemic

Need to enhance the level of knowledge of nurses especially focusing on uses of Personal protective equipments

Healthcare Workers should be offered the vaccine against the pandemic influenza strain when the vaccine becomes available


Some pictures
Some pictures Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal


Some pictures1
Some pictures Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal


Thank you
Thank you Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal


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