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Ramesh Neupane ( BPH , MPH)

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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 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

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

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

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

slide6

Objectives

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
  • 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

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

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)

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

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

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
  • 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

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

relation between working districts and level of knowledge of pi

Results

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

Finding which achieved objective 1:

(One sample T test)

  • Compare the knowledge and protective behavior according to district
association between the people contacted with pi patients and knowledge and protective behavior

Results

Association between the people contacted with PI patients and knowledge and protective behavior
  • *Only for those participants who ever contacted with Influenza pandemic patients
bivariate analysis objective 2 to identify the factor influencing knowledge and protective behavior
Bivariate analysis: Objective 2: To identify the factor influencing Knowledge and Protective Behavior
discussions and conclusion
Discussions and Conclusion
  • 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

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

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