RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING

KNOWLEDGE ON RESPIRATORY PROBLEMS (BAGASSOSIS) AND ITS PREVENTION AMONG THE WORKERS OF GYANBA SUGARS AND DEVELOPERS

LIMITED, DODDABATHI, DAVANGERE”

Mr. BASAVARAJ S.S. FIRST YEAR M.Sc. NURSING,

COMMUNITY HEALTH NURSING

BAPUJI COLLEGE OF NURSING DAVANGERE – 577 004.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA, INDIA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND

ADDRESS (IN BLOCK LETTERS)

Mr. BASAVARAJ S.S.

FIRST YEAR M.Sc. NURSING,

BAPUJI COLLEGE OF NURSING,

DAVANGERE – 4,

KARNATAKA.

2. NAME OF THE INSTITUTION BAPUJI COLLEGE OF NURSING,

DAVANGERE - 4.

3. COURSE OF STUDY AND

SUBJECT

FIRST YEAR M.Sc. NURSING,

COMMUNITY HEALTH NURSING.

4. DATE OF ADMISSION TO

COURSE

7th July 2010

5. TITLE OF THE TOPIC “A STUDY TO EVALUATE THE

EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME

REGARDING KNOWLEDGE ON

RESPIRATORY PROBLEMS

(BAGASSOSIS) AND ITS PREVENTION

AMONG THE WORKERS OF GYANBA

SUGARS AND DEVELOPERS

LIMITED, DODDABATHI,

DAVANGERE”

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6. BRIEF RESUME OF THE INTENDED WORK :

6.0 Introduction :

“Work is not a curse, it is the prerogative of intelligence, the only means of

manhood and the measure of civilization”.

Health is the precious possession of all human beings as it is an asset for an

individual and community as well. According to Dunn, “Health is defined as a dynamic

state of wellness which exists on a continuum and ranges from a high level of wellness

to high level of illness”.1

Historically the term health is derived from an old English word ‘Health’

meaning the condition of being ‘safe and sound’ or ‘whole’. To a lay person, health is

freedom from pain, illness and disabilities. Even in present time, many people still

believe in the same concept of health. There is change in this belief in the developed

world and also in the developed areas of developing countries because of research and

life experiences.1

The health problems of India may be conveniently grouped as : Communicable

disease problems, Nutritional problems, Environmental sanitation problems, Medical

care problems and Population problems.2

Among communicable diseases, most of the diseases are related to respiratory

tract as each day our lungs are directly exposed to more than 7000 liters of air, which

contain varying amount of inorganic and organic particles as well as potentially lethal

bacteria and viruses. Airway pathology changes have been recorded with industrial dust

and fumes. Dust, the tiny particles dispersed in air due to mechanical disintegration of

rocks, mineral and other materials by impulsive forces such as drilling, blasting,

crushing, grinding, milling, sawing and polishing or to the agitation or breaking down of

organic materials such as sugar cane fiber (bagasse), cotton fibers, pollens and fungal

spores.

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6.1 Need for the study :

In India, the studies revealed that 40-59% of workers in different occupational

work environments suffered from one or more respiratory ailments. As much as 36-40%

of the workers reported work-related symptoms which is close to similar data from

western countries.3

An epidemiological survey was carried during 1999 around Delhi in India on

respiratory diseases among agricultural industry workers, such as bakeries, poultry

farms, granaries, and a sugar refinery by using a medical questionnaire on various

respiratory symptoms. The questionnaire was filled up by two doctoral students during

personal visits to these work environments. The survey revealed that 40-59% of workers

in different occupational work environments suffered from one or more respiratory

ailments. A higher incidence of respiratory disorders was recorded in workers of sugar

refinery and poultry farms. Older workers suffered more than the young ones. Family

history of atopy was found to have least effect on the incidence of cough, breathlessness

and rhinitis in the workers.3

Another survey conducted in China, between 2004-2005 on mortality proportion

of respiratory diseases revealed, deaths from chronic obstructive pulmonary disease

accounted for 81.49% of total respiratory death cases, infectious respiratory cases

12.27% and asthma cases 2.43%.4

According to one of the article, survey conducted on respiratory diseases,

morbidity and mortality among adults at Federal Medical Centre in Nigeria between

November of 2006 and October of 2008 showed, respiratory diseases were predominant

in the 25-44 year age (37.2%). Pulmonary Tuberculosis was the leading cause of

morbidity (in 42.1%) followed by asthma (in 17.5%) and pneumonia (in 15.3%).5

A comparative study was carried in Louisiana in 1986 on 284 persons who had

died by lung cancer over five years with 284 control cases. The researchers concluded

that, persons employed in sugar cane industry had 2.3 times more risk than workers

employed in other industries of contracting lung cancer due to inhalation of bagasse.6

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The disease bagassosis, an acute respiratory disease that primarily affects workers

who handle bales of “bagasse” or dried sugar cane fiber was first recognized in

Louisiana in 1937. It was first reported in India by Ganguli and Pal in the year 1955 in a

cardboard manufacturing firm in Kolkata.7&1

However, the results of previous studies are inconsistent, particularly in

respiratory problems (bagassosis) and its prevention among sugar cane industry.

Several sugar cane industries are located near by Davangere and so far no studies

were undertaken to examine the effects of baggsse dust on respiratory problems in these

workers.

This study is undertaken to evaluate the pulmonary function of workers exposed

to bagasse dust in sugar cane industry and to teach them the protective measures to keep

up their health.

6.2 Review Of Literature :

Reviews of literature in this study have been organised into,

1) Literature related to structured teaching programme, in industries.

2) Literature related to respiratory problem (bagassosis).

1) Literature related to structured teaching programme :

A study was conducted in 1990 in Botswana revealed, progress in bringing health

care to the workplace lags considerably behind progress in bringing health care to where

people live. The study remarked that, the family nurse practitioner can provide useful

preventive and curative services to people in their places of work. It emphasized on

integration of occupational health services within community health programme. Family

nurse practitioner works included health assessment, the provision of health education

and counseling. When a survey of the health status of industrial workers in Gaborone,

the capital of Botswana, was undertaken 166 types of health problems were detected

among 1007 workers. Hence the National Manpower Development plan adviced

additional 20 family nurse practitioners should be trained per year to minimize health

problems in industries.8

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2) Literature related to respiratory problem (bagassosis) :

A study was carried on environmental and respiratory health assessment of

workers chronically exposed to bagasse in Egyptian particle-board industry and sugar

industry, during 1998. The study comprised 102 workers employed for durations

ranging from 1 to 35 years in various department, located at Kom-Ombo in upper Egypt.

The workers were subjected to a questionnaire comprising full personal, present, past

and family and occupational histories, full clinical examination, chest x-ray and full

immunological assay. Respiratory symptoms affected more than ¾ of the examined

workers. Clinically 32 workers (31%) had chronic obstructive pulmonary disease while

chronic hypersensitivity pneumonitis affected 13 workers (13%). They concluded that

restrictive defects ranked second, affecting about 19.6% of the workers.9

A study was carried on allergic alveolitis among 20 workers who handled bagasse

in a sugar refinery during 1998 at eastern Poland. The microbiological analysis of the

samples of plant materials or bagasse reported by the patients as causing symptoms has

been carried out, followed by allergological tests. On the basis of the clinical picture, the

bronchoalveolar lavage and allergological tests, the diagnosis of the chronic form of the

disease was stated in 14 patients and an acute form in 6 patients. Also, the numbers of

eosinophils and neutrophils were significantly high in these workers.10

A study was conducted in year 1996 on specific sensitization and respiratory

effects associated with the inhalation of sugar cane dust were evaluated in a group of 51

workers exposed to bagasse. A questionnaire interview, lung function test, serum

precipitin tests for Thermoactinomyces sacchari and Thermoactiomyces vulgaris, and

immunoglobulin E tests for specific environmental allergens were performed for each

worker. Twenty-one workers reported at least one respiratory symptom and 16 reported

possible symptoms of bagassosis. Six workers demonstrated acute symptoms, 1 had

chronic symptoms, and 9 had the reacutized form of the disease. A higher proportion of

precipitin response to Thermoactinomyces sacchari and Thermoactinomyces vulgaris

was found in workers reporting symptoms suggestive of acute bagassosis. A possible

restrictive ventilatory pattern was observed in 8 subjects and a mild airway obstruction

in 1 subject. Study concluded by stating priority must be given to surveillance and

exposure prevention programme for workers employed in sugar cane industry and

processing.11

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A study was conducted in 1992 by 185 doctors from 185 hospitals on

occupational health practices in Australian raw sugar mills by using a questionnaire.

Totally the sample size was 835 cases; suffering from 21 occupational hazards and 20

etiological antigens. A new type of bagassosis was described in it. A measurement was

carried out to determine the role of airborn Thermoactinomces sacchari in causing acute

or chronic bagassosis in any of the work force. Monitoring of total airborn bacteria spore

concentrations was undertaken in and around two cane sugar mills before, during and

after 1992 cane processing season. Viable airborn bacteria counts were also obtained to

confirm the presence of Thermoactinomyces sacchari. Area or zone samples at various

sites around the mills and personal breathing zone samples from selected workers were

obtained. The results showed that the total airborn bacteria spore count was lower than

similar counts reported in other industries such as cotton milling and wood chip

handling.12

Another study was carried in 1992. Workers in developing countries face as

many, if not more, work-related health problems as their counterparts in industrialized

nations. Most of the occupational health problems in the sugar industry which exists in

40 countries, mostly in the Third World are seen. Sugar cane workers have a high level

of occupational accidents and are exposed to the high toxicity of pesticides. They may

also have an increased risk of lung cancer, possibly mesothelioma. This may be related

to the practice of burning foliage at the time of cane-cutting. Bagassosis is also a

problem specific to the industry as it may follow exposure to bagasse. The workers may

also be affected by chronic infections which reduce their productivity. The legal

framework for their protection is often inadequate.13

An epidemiological study and environmental survey of 170 bagasse workers

employed by a raw sugar producing company in Trinidad was carried out during 1989 in

order to assess the prevalence of respiratory symptoms and to determine if exposure to

bagasse was associated with alterations in ventilatory capacity. The epidemiological

survey failed to reveal a significantly increased prevalence of respiratory symptoms in

the more exposed group but showed that the group of Indian workers who were

regularly and continuously exposed to bagasse had a significantly lower ventilatory

capacity than the control group. This diminished ventilatory capacity was demonstrated

despite of negligible dust concentration in the plant. The study concluded by saying the

possibility that persistent exposure to low concentrations of bagasse may be the cause

must be considered.14

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Another study was conducted in the year 1986, to explore the relation of

bagassosis occurrence and inhalation of dust from dried sugar cane fiber or bagasse.

They found nearly about 41 patients were suffering from bagassosis in U.S.A. They also

concluded that, the existing literature on bagassosis contains only a few incomplete

studies of pulmonary function. The need for complete studies in a significant number of

cases using modern physiological methods is essential in future.15

6.3 Statement of problem :

“A study to evaluate the effectiveness of structured teaching programme

regarding knowledge on respiratory problems (bagassosis) and its prevention among the

workers of Gyanba Sugars and Developers Limited., Doddabathi, Davangere”.

6.4 Objectives of the Study :

1) To assess the knowledge on respiratory tract problems (Bagassosis) and its

prevention among workers at Gyanba Sugars and Developers Limited

Doddabathi through pre-test.

2) To associate the background factors with the knowledge score before Structured

Teaching Programme.

3) To assess the effectiveness of structured teaching programme on prevention of

respiratory tract problems (Bagassosis) through post test knowledge.

6.5 Operational definitions :

1) Evaluate : It is the organized systematic and continuous process of evaluating

the gain of knowledge after structured teaching programme.

2) Effectiveness : In this study “effectiveness” means improving the knowledge

regarding Bagassosis and its prevention by structured teaching programme which

may result differences between pre and post-test score.

3) Structured teaching programme : It refers to systematically planned teaching

programme designed to provide information regarding Bagossosis and its

prevention to the sugar factory workers.

4) Knowledge : It refers to the correct response of the workers to knowledge items

on prevention of Bagassosis as achieved by knowledge score.

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5) Respiratory problems (Bagassosis) and its prevention : It refers to the

respiratory tract problems (Bagassosis) among the workers who handle Bagasse

and handling it safely to protect themselves.

6) The workers : It refers to the employees who handle the Bagasse and are risk to

develop Bagassosis especially those who are working in crushing unit.

6.6 Hypothesis :

The mean post test scores of subjects exposed to structured teaching programme

will be greater than their mean pre-test scores as measured by structured questionnaire at

0.05 level of significance.

6.7 Assumption :

1) Workers handling Bagasse may deficit of knowledge regarding ill effects or health

hazards of Bagassosis.

2) Structured teaching programme can significantly increase their knowledge level.

6.8 Limitation :

1) The study is limited to only workers of Gyanba Sugars and Developers Limited.,

Doddabathi.

2) The study is limited only to male workers.

Projected outcome : The workers will have enhancement in knowledge regarding

prevention of Bagassosis.

7. MATERIALS AND METHODS :

7.1 Source of Data collection : The data will be collected from workers of Gyanba

Sugars and Developers Limited., Doddabathi, through interview method.

7.1.1 Research design : Quasi experimental design.

7.1.2 Research Setting : The study will be conducted in Gyanba Sugars and Developers

Limited., Doddabathi.

7.1.3 Population : All the workers of Gyanba Sugars and Developers Limited.,

Doddabathi

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7.14 Sample : The workers of Gyanba Sugars and Developers Limited., Doddabathi

especially who handle Bagasse in crushing unit.

7.1.5 Sample size : The total study sample consists of 80 workers.

7.1.6 Sample technique : Simple random sampling technique and lottery method.

7.1.7 Inclusion criteria :

1) The workers in the age group of 20-60 years of age.

2) The workers who are willing to participate in the study.

3) The workers who are able to read and write Kannada.

7.1.8 Exclusion criteria :

1) Those workers who are not willing to participate in the study.

2) Those workers who are not available at the time of data collection.

7.2 Methods of collection of data :

Tool :

Section 1 : Socio-demographic data.

Section 2 : A structured questionnaire will be prepared to assess the knowledge of

workers regarding Bagassosis and prevention through interview.

Variables :

Independent : Structured teaching programme.

Dependent : Background factors regarding Bagassosis and its prevention among

workers.

Data collection Method :

Step 1 : Researcher introduces himself.

Step 2 :Administration of pre-test on knowledge regarding Bagassosis and its

prevention.

Step 3 : Introduces structured teaching programme.

Step 4 : Administration of post-test on knowledge on Bagassosis and prevention.

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Data analysis : The data will be analysed by using appropriate statistical methods and

finding will be presented in forms of figures and tables.

7.3 : Does your study require any investigation or interventions to conduct on

patients or other humans or animals ? If so, please describe briefly.

Yes, structured teaching programme will be administered to workers working near and

handling the Bagasse.

7.4 : Has ethical clearance been obtained from your institution in case of 7.3?

Yes, written permission obtained from Managing Director, Gyanba Sugars and

Developers Limited., Doddabathi.

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8. LIST OF REFERENCES :

1) Gulani KK (edt). Conceptual Aspects of community Health. In :

Community Health Nursing Principles & Practices, Chapter 1, 1st edition, Kumar

Publishers, Delhi, 2005:pg.10-12.

2) Park K. Health care of the community and Occupational Health. In:

Preventive & Social Medicine, Chapter 15 & 21, 19 th edition. Banarsidas Bhanot

Publishers, Jabalpur, 2008:pg.691, 609.

3) Singh AB, Singh A, Pandit T. Respiratory diseases among agricultural

industry workers in India : A cross-sectional epidemiological study. Ann Agric

Environ Med 1999;6:115-126.

4) Xy L, Hu N, Huang ZJ, Jiang Y, Wu F. Mortality and death cause

proportion of respiratory diseases in China, 2004-2005. Am Ind Hyg Assoc J

1996Nov.;57(11):1002-12.

5) Pneumol JB, Paulo S. Respiratory diseases morbidity and mortality

among adults in their work environment. J Bras Pneumol 2009 Aug.;35(8):1806-

1810.

6) Dawson MW, Scott JG, Cox LM. The medical and epidemiologic effects

on workers of the levels of airborne thermoactinomyces spp. Spores present in

Australian raw sugar mills. Am Ind Hyg Assoc J 1996;57(11):1002-1012.

7) Weill H, Buechner HA. Bagassosis : A study of pulmonary function in 20

cases. Br J Ind Med 1985 Oct.;25(4):267-282.

8) Rojas P, Stark R, Tembo P. Nurses bring primary health care to industrial

workers. World Health Forum 1990;11(1):108-13.

9) Elata GAA, Ezzat HEMM, Shalaby AEDO, Kholey BMBE, Emara AM,

Ghaafar S, et al. Environmental, mycological and respiratory health assessment of

workers chronically exposed to bagasse in Egyptian particle-board industry. Int J

Env Health Res 1998;8:315-334.

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10) Milanowski J, Dutkiewicz J, Potoczna H. Allergic alveolitis among

agricultural workers in eastern Poland : A study of twenty cases. Ann Agric

Environ Med 1998;5:31-43.

11) Romeo L, Molle D, Zanoni G, Peretti A, Marangi G, Conrado LG, et al.

Respiratory health effects and immunological response to thermoactinomyces

among sugar cane workers in Nicaragua. Am Ind Hyg Assoc J 1996

Nov.;57(11):1002-12.

12) Zhonghua Yu, Fang Yi, Xue Za Zhi. 2010 April;44(4):298-302.

13) Phoolchund HN. Aspects of occupational health in the sugar cane

industry. Br J Ind Med 1992;49:499-506.

14) Hearn CED. Bagassosis : An epidemiological, environmental, and

clinical survey. Br J Ind Med 1989;28:152-158.

15) Herbert SJ. Bagassosis : A study of pulmonary function in 20 cases. New

Orleans USA 1986;25(4):285-290.

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9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME & DESIGNATION OF (IN BLOCK LETTERS)

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE (IF ANY)

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12. 12.1 REMARKS OF PRINCIPAL

12. 2 SIGNATURE

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ETHICAL COMMITTEE CLEARANCE

1. TITLE OF THE DISSERTATION : “A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON RESPIRATORY PROBLEMS (BAGASSOSIS) AND ITS PREVENTION AMONG THE WORKERS OF GYANBA SUGARS AND DEVELOPERS LIMITED., DODDABATHI, DAVANGERE”

2. NAME OF THE CANDIDATE : Mr. BASAVARAJ S.S.First Year M.Sc. Nursing, Bapuji College of Nursing, Davangere – 4, Karnataka.

3. SUBJECT : COMMUNITY HEALTH NURSING

4. NAME OF THE GUIDE : Mrs. G. THILAGAVATHI M.Sc.(nursing)

Community Health Nursing Dept,Bapuji College of Nursing,Davanagere-4.

5. APPROVED/NOT APPROVED

(If not approved, suggestion)

:

Prof. S.F.BILLALLI,Principal and HOD,Medical Surgical Nursing,Bapuji College of Nursing,Davanagere-4.

Mrs. LEELAVATHI. R.HHead of the Department, Department ofObstetrics and Gynecological Nursing,Bapuji College of Nursing,Davanagere-4.

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