INTRODUCTION:

Human health is an important concern for all societies since it contributes to their overall development. Health, nutrition and education are important for the overall development of an individual. Respiratory infections arecommon and spread fast via droplet transmission.¹Transmission of infectious diseases among individuals is frequent and inevitable. Although most such cross-infections are transient and not serious, they may have concentric circles of repercussions for other people. Actions that can help control the spread of such infections are therefore, important to the health of individuals. Outbreak of acute infections caused by viruses, bacteria, parasites, and protozoa has been documented among individuals.²

A study on Dynamics of infectious disease transmission by inhalable respiratory droplets by Nikolas IStilianakis and Yannis Drossinos envisages transmission of respiratory infectious diseases in humans, for instance influenza, occurs by several modes. Infectious pathogens will gain their transferable capability through respiratory droplets which provide a vector of transmission and that may contribute to different transmission modes. In order to assess their relevance in the infectious processan epidemiological model incorporating the dynamics of inhalable respiratory droplets is developed. Inhalable respiratory droplets were divided into respirable dropletsand inspirable droplets, with diameter in the rangeof, droplet diameter less than 10 µm and 10–100 µm respectively: both droplet classes may be inhaled or settle. Physical properties like size determine the droplet dynamics, whereas population dynamics is determined by, other parameters, the pathogen infectivity and the host contact rate. The analysis includes three model influenza epidemic scenarios, mediated by different airborne or settled droplet classes. The scenarios are distinguished by the characteristicbreathing at contact and with hand-to-face contact. The inspirable droplets, be the airborne or settled, characterize short-term epidemics with high attack rates these scenarios suggest that airborne transmission, mediated by respirable droplets, provides the dominant transmission mode in middle and long-term epidemics. The model neglects the close-contact transmission through droplet sprays (direct projection onto facial mucous membranes), retaining close-contact transmission through inspirable droplets³.

In infectious disease, these droplets, which may contain millions of bacteria and viruses, can be a source of infection to others. A healthy susceptible person acquire infection through the droplets that he is likely to inhale some of them. Diseases transmitted by droplet spread include many respiratory infections, eruptive fever, many infections of the nervous system, common cold, diphtheria, whooping cough, tuberculosis, meningococcal meningitis, etc. The potential for droplet spread is increased in conditions of close proximity, overcrowding and lack of ventilation⁴.

To tell about how people are infected and what can be done to prevent the infections. According to answers from many disciplines such as Microbiology, epidemiology, medicine, engineering and physics, there are many pathways for infection to spread, and among the most significant from the epidemiological point of view is air-borne transport. Microorganism can become air-borne when droplets are generated during speech, coughing, sneezing, vomiting. An essential element in understanding the epidemiology of infectious diseases is their mode of transmission. For some infectious diseases, the routes of transmission are multiple and their relative importance and dynamics are neither well described nor well understood. The identification of the dominant transmission mode is important because efficient and effective control strategies depend on it. It is a common knowledge that respiratory activities such as coughing, sneezing produce droplets of saliva and other secretions from the respiratory tract. These droplets may carry micro-organisms and constitute a medium for the transmission of infectious disease. Larger droplets may rapidly settle out of the air and thus contribute to disease transmission only for individual near to each other⁵.

A study published by American Hospital Association, Room Ventilation and Airborne Disease Transmission: review explores the role that ventilation, assessed by air changes per hour plays in infection transmission and disease control. It was found that Airborne Infectious Diseases (2009) note the dilution effect that Automated Clearing House has on infectious disease transmission by the American Society of Heating, Refrigerating and Air-Conditioning Engineers Position Document on. According to Wells-Riley equationit supports the premise that increasing the volume of “clean” air dilutes the room air and thus exposes people in the room to fewer potentially infectious particles. Automated Clearing House is the only variable in the Wells-Riley equation that can be quantified by direct measurement.⁶

The characteristics of Respiratory droplets are key to determine the droplet-borne pathogen transmission, which provide scientific basis for formulating the disease prevention from droplet transmission and control measures. There are important areas, which still need to be focused on respiratory infection of risk assessment in different spaces, such as in hospital, kindergarten, nursing home, community and other the places with high density of people. If thresholds of respiratory disease breaking out for occupants can be obtained, we can use experiment or simulationmethods to predict droplet-borne pathogen spread, and take effective measures to ensure public environmentsecurity.⁷

OBJECTIVES:

The objectives of the study are:

· To assess the knowledge regarding droplet infection among residents in selected community areas at Kollam.

· To find out the association between demographic variables and knowledge regarding droplet infection among residents in selected community areas at Kollam.

· To develop and distribute pamphlets regarding droplet infection among residents in selected community areas at Kollam.

REVIEW OF LITERATURE:

1. Literature related to prevalence and transmission of droplet infections:

In a Cross-sectional study regarding Tuberculosis Screening at 2 San Diego High Schools with High-Risk Populations done by Alice L. Pong, MD Bronwen, J. Anders, MD et all to determine the prevalence of TB infection and disease in a high-risk population of high school students through school-based screening. Participants of the study were students attending 2 San Diego high schools with high percentages of non–US-born students. Results shows that a total of 744 students at high school 1 and 860 students at high school 2 participated. 95 students of high school 1 and 207 students of high school 2, respectively, had positive tuberculin skin test results. One student had a chest radiograph that showed active tuberculosis. Smear for acid fast bacilli and culture had negative results. Finally conclude that non-US born students more likely to have positive tuberculin skin test than US born⁸.

A retrospective descriptive study on Epidemiological and clinical profile of influenza A (H1N1) 2009 virus infections during 2015 epidemic in Rajasthan by Bharti Malhotra, Ruchi Singh, Pratibha Sharma, Deepa Meena et all and a record-based analysis of suspected and confirmed cases of pandemic influenza A 2009 virus infection in Rajasthan, India, from January to March 2015 was performed. Testing was done as per the Centers for Disease Control guidelines at nine laboratories approved by the Government of Rajasthan. Data were analyzed in terms of demographic characteristics, clinical presentation and outcome. Results shows that Among 18,187 tested cases, 6203 were positive. Death occurred in 378 cases, with six per cent case fatality rate. Maximum number of cases 2801 and deaths 101 were from Jaipur zone. The highest number of cases, 47.60 per cent and deaths, 52.11 per cent were in the age group of 26-50 year, 52.64 per cent of deaths occurred in females. The highest number 63.5% of deaths was from urban areas. Associated risk factors were observed in 59.44 per cent of the death cases, pregnancy being the predominant predisposing factor. In 61.92 per cent of patients, death occurred within three days of hospitalization.H1N1 epidemic caused high morbidity and mortality in early 2015, particularly in the younger and middle-aged population and pregnant women in Rajasthan State of India⁹.

Background & objectives:

Methods:

Results:

Interpretation & conclusions:

Keywords:

In a prospective descriptive study conducted in Chandigarh India to find the prevalence of tuberculosis infection among children in household contact with adults having pulmonary tuberculosis, and identify the risk factors. Children who were in household contact with 200 adults with pulmonary TB underwent tuberculin skin testing. Transverse in duration of greater than 10mm was defined positive tuberculin test suggestive of tubercular infection. Infected children underwent chest radiography, analysis of gastric lavage fluid or induced sputum. Tuberculin test was positive in 95 of 281 contacts (33.8%), of which 65 were contacts of sputum positive patients, while 30 were contacts of sputum negative patients. 9 children were diagnosed of tuberculosis based on clinical features or recovery of acid fastbacilli; 7 were in contact with sputum positive adults. Finally conclude that prevalence of TB infection and clinical disease among children in household contact with adult patients is higher than in the general population, and risk is increased by contact with sputum positive adults¹⁰.

2. Literature related to knowledge regarding droplet infections:

In a descriptive study conducted in Greece to assess the level of awareness of avian influenza among Greek students between 8 to 15 years of age concerning methods of transmission, symptoms and preventive measures. In total, 2805 Greek students participated in the study. Approximately 90% of the students reported knowing what 'bird flu' is, and 25% wrongly answered that there had been at least one human infection from avian influenza in Greece. Nearly half the students (46.2%) reported that an effective vaccine exists against avian influenza, and almost all the study participants (95.7%) believed that they should not touch an ill or dead bird. The findings revealed that the level of information about avian influenza among Greek students was found to be satisfactory, if not ideal. These findings, along with the potential for a future avian influenza pandemic, highlight the need for intensified health education programmes in Greek schools, in order to deal with this serious public health problem¹¹.

In a cross-sectional study conducted in Angolela in Ethiopia to evaluate knowledge attitude and practice among primary school. 669 students were interviewed. Data consists of hygiene, hand washing practices, knowledge about sanitation, personal hygiene characteristics, and presence of parasitic infection. It was found that 52% of students were having adequate knowledge of hygiene. Most students reported hand washing before meals (99.0%), 36.2% reported using soap.76.7% students reported washing hands after defecation was important, 14.8% reported actually following this practice. Students with adequate knowledge of proper hygiene were more likely to have clean clothes and to have a lower risk of parasitic infection¹².

A study was conducted to assess the knowledge and concerns about avian influenza among secondary school students in Saudi Arabia during 2006. A stratified random sample of 514 students from 6 secondary schools was given a self-administered multiple-choice questionnaire. Knowledge scores were significantly related to socioeconomic indicators. Approximately 70% of the participants reported that media (TV and/or radio) was the source of their information. Overall, 65.4% of the participants said they expected there to be cases of avian influenza in Saudi Arabia this year. Females were more concerned than males (70.9% versus 58.9%). Finally, the researcher concludes that effective school health education programmes should be implemented in order to prepare the community to deal with this important threat¹³.

In a cross-sectional study conducted in South Korea during the current influenza A, H1N1 pandemic to determine the knowledge, attitude and preventive measures among 2,333 school children and their 2,089 parents. It was found that in terms of knowledge, 97.9% of participants reported they knew of Novel Influenza A, and 80.2% reported mass media such TV and radio to be their primary source of knowledge. For attitude, 39.4% reported considering Novel Influenza A to be a very serious social problem, and 9.6% of participants showed seriously concern about the possibility of infection. As for preventive behavior, since the public announcement of the Novel Influenza A pandemic, 82.5% of the participants had increased their frequency of hand washing. 90.4% reported that the pandemic has changed their life patterns these findings indicate that children are well aware of H1N1¹⁴.

MATERIALS AND METHOD:

Methods:

A quantitave approach is used in that the research design is adopted for the study is survey design. The setting will be pallithottam community area situated at kollam. The populations in the study include residents in selected villages at kollam. Convenience sampling used in this study.

Tools/Instruments:

The instruments used for the present study are demographic proforma and structured questionnaire which were validated by the experts.

Data collection:

Data will be collected after obtaining prior administrative permission and informed consent from residents. The tools for data collection procedure are demographic proforma including age, type of family, education, religion, monthly income, nutritional status and family history of respiratory infections.

The data collection was conducted on 18/12/2018 The convenience sampling was used to select the samples. Setting for the study is the Pallithottam areas at kollam. Initially, the structured questionnaire was given to 30 samples. The data collected by using a structured questionnaire on the knowledge regarding droplet infection among residents. The data collected after obtaining administrative approval and permission from the Community area. Consent were taken from the samples before conducting the study. After conducting the test the researchers were given pamphlets regarding droplet infection on 20/12/2018 and the knowledge were analyzed.

Data analysis:

The researcher will analyse the data by using descriptive and inferential statistics based on the objectives and hypothesis of the study.To compute the data, a master data sheet was prepared by the investigator.

FINDINGS OF THE STUDY:

Description of sample characteristics

This section describe the percentage wise distribution of demographic variables

Figure 1: Bar diagram showing percentage wise distribution of samples according to their age. (N=30)

The data presented in figur e 1 shows that out of 30 samples, 30% were in the age group of 20 - 30 years, 26.7% in the age group of 31 - 40 years, 26.7% were in the age group of 41 - 50 years and 16.67% were in the age group of 51 - 60 years.

Figure 2: Cylinder diagram showing percentage wise distribution of residents according to their Sex. (N=30)

Figure 2 shows that out of 30 samples, 23.3% were males and 76.7% were females

Figure 3: Pie diagram showing percentage wise distribution of residents according to their education. (N=30)

Figure 3 shows that out of 30 samples, 6.7% are illiterate, 53.3% have primary education and 30% have secondary education.

Figure 4: Bar diagram showing percentage wise distribution of residents according to their family type. (N=30)

Figure 4 shows that out of 30 samples, 50% of peoples belongs to nuclear family and 50% of peoples belongs to joint family.

Figure 5: Pie diagram showing percentage wise distribution of residents according to their occupation. (N=30)

Figure 5 shows that out of 30 samples, 43.3% were unemployed and 56.7 % were employed.

Figure 6: Cylinder diagram showing percentage wise distribution of residents according to their monthly income. (N=30)

Figure 6 shows that out of 30 samples, 73.3 % have income <1000 and 23.3% have the income between 1000-10,000 and 3.3 have income > 10,000.

Figure 7: Cone diagram showing percentage wise distribution of residents according to their food pattern. (N=30)

Figure 7 shows that out of 30 samples, 100% were non vegetarian.

Figure 8: Bardiagram showing percentage wise distribution of residents according to their ventilation. (N=30)

Figure 8 shows that out of 30 samples, 73.3% have adequate type of ventilation in the houses and 26.7% have inadequate type of ventilation in the houses.

Figure 9: Pie diagram showing percentage wise distribution of residents according to their family history of respiratory infection. (N=30)

Figure 9 shows that out of 30 samples, 60% have family history of respiratory infection and 40% have no family history of respiratory infection.

Section 2: Assessing the knowledge regarding droplet infection among residents in selected community areas at Pallithottam, Kollam.

Table 1: Frequency and percentage distribution of knowledge regarding droplet infection among residents. (N = 30)

Score range	Score	Frequency	Percentage
0 – 5	Poor	1	3.33%
6 – 10	Average	9	30%
11 – 15	Good	14	46.67%
16 – 20	Excellent	6	20%

The data presented in table 1 shows that out of 30 samples 3.33% of women’s have poor knowledge, 30 % have average knowledge,46. 7 % have good and 20 % have excellent knowledge.

Section 3: Association between knowledge regarding droplet infections among residents and selected demographic variables.

Table-2. Association between knowledge and selected demographic variables.

Sl No	Variables	Knowledge				df	Chi-square Value
Sl No	Variables	Poor	Average	Good	Excellent	df	Chi-square Value
1.	Age
	20 – 30	0	2	5	2	9	16.71
	31 – 40	0	2	3	3
	41 – 50	0	1	6	1
	51 – 60	1	4	0	0
2.	Sex
	Male	1	3	1	2	3	6.848
	Female	0	5	14	4	3	6.848
3.	Education
	Illiterate	0	1	0	1	6	7.032
	Primary	1	7	7	1
	Secondary	0	2	6	4
	Graduate and above	0	0	0	0
4.	Family
	Nuclear	0	3	8	3	3	2.952
	Joint	1	6	6	2	3	2.952
5.	Occupation
	Employed	0	6	8	3	3	1.784
	Unemployed	1	3	6	3	3	1.784
6.	Family income
	< 1000	1	8	9	4	6	2.961
	1000 – 10,000	0	1	4	2
	>1000	0	0	1	0
7.	Food
	Vegetarian	0	0	0	0		No significance
	Non –vegetarian	1	9	14	6		No significance
8.	Ventilation
	Adequate	1	6	10	5	3	0.901
	Inadequate	0	3	4	1	3	0.901
9.	History of respiratory infection
	Yes	1	5	7	5	3	2.685
	No	0	4	7	1	3	2.685

Table 2: The association was computed by using chi square test. In demographic variable such as age the calculated value is 16.71 which is greater than tabulated value 0.9115, sex the calculated value is 6.848 and the tabulated value is 0.8790, education the calculated value is 7.032 which is greater than tabulated value 0.8880, family the calculated value is 2.952 which is greater than 0.8790, occupation the calculate4d value is 1.784 and the tabulated value is 0.8790, regarding family income the calculated value is 2.961 which is greater than tabulated value 0.888, ventilation the calculated value is 0.901 which is greater than tabulated value 0.8790, regarding the history of respiratory infections the calculated value 2.685which is greater than tabulated value 0.8790. It was inferred that the present study showed significant association between knowledge and demographic variables like age, sex, education, type of family, occupation, monthly income, ventilation, history of respiratory infections with knowledge (calculated value greater than tabulated value at 0.05 level of significance). So, there was significant association between demographic variables and knowledge at 0.05 level of significance regarding droplet infection.

CONCLUSION:

The present study aimed to assess the knowledge regarding droplet infections among residents in selected community areas at Kollam. The study result showed that majority of the residents has good knowledge (46.67%) regarding droplet infections. Chi square calculations shows that the knowledge had association between demographic variables like age, sex, education, type of family, occupation, monthly income, Food habits, ventilation and history of respiratory tract infections at 0.05 level of significance.

RECOMMENDATIONS:

Based upon the study findings, the following recommendations were made for the future study:

· A similar study can be replicated in a large sample to generalize the findings.

· A quasi experimental study can be conducted to assess the effectiveness of structured teaching programme on the level of knowledge regarding droplet infections among residents.

· A quantitative study can be conducted to assess the knowledge of resident’s regarding preventive aspects of airborne infections.

REFERENCES:

1. Position Paper National focus group on Health and Physical Education, 1st edition May 2006. Available at www.ncert.nic.in/new-ncert/ncert/.../health-prelims-final.pdf. Pg no.1-2

2. Building characteristics and the spread of infectious diseases. Available at www.nap.edu/openbook.php?record-id=11756

3. K. Park, Textbook of Preventive and Social Medicine, 21st edition, MS BanarasidasBhanot. Jabalpur pg no. 92.

4. Morawska L. Droplet fate in indoor environments or can we prevent the spread of infection? Indoor Air 2006 October;16(5) : 335-347.

5. Rao S. Papineni and Frank S. Rosenthal. The size distribution of droplets in the exhaled breadth of healthy human subjects. Journal of Aerosol Medicine volume 10 No.2,1997.

6. Nicki L. Potts, Barbara L Mandleco. Pediatric Nursing Caring for Children and their Families 2nd edition, 2007.

7. Infection control guidelines for early learning and childcare. Available at www.gov.mb.ca/fs/childcare/pubs/.../infection-control.pdf.

8. https://www.ncbi.nlm.nih.gov/pubmed/9667535.

9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433285.

10. https://academic.oup.com/tropej/article-pdf/56/5/291/4606169/fmqosi..

11. https://www.researchgate.net/.../6220916

12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075961/

13. https://www.researchgate.net/.../knowledge

14. In Han song, Hanna Lee, Sewon Kwon, Junghee Wang, Hye-Jin Lim, Ahyoung Song. Influenza A(H1N1) 2009-Related Knowledge, Attitude and Preventive behavior among Korean Children, American Public Health Association Nov 1, 2011.

Received on 08.01.2020 Modified on 05.02.2020

Int. J. Nur. Edu. and Research. 2020; 8(2):249-255.

DOI: 10.5958/2454-2660.2020.00054.X