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“A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING PROGRAMME ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION AMONG MOTHERS OF UNDER-FIVE CHILDREN IN SELECTED RURAL AREA OF BANGALORE”
M.Sc. Nursing Dissertation Protocol Submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
By
Ms. JEBA MALAR. B
M.Sc Nursing 1st Year
2010-2012
Under the Guidance of
HOD, Department of Child Health Nursing
Nightingale College of Nursing
Guruvanna Devara Mutt,
Near Binnyston Garden,
Magadi Road,Bangalore-560023
1
Rajiv Gandhi University of Health Sciences, KarnatakaCurriculum Development Cell
CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Registration No. : Name of the Candidate : Ms. JEBA MALAR. BAddress : Guruvanna Devara Mutt, Near Binnyston, Bangalore - 23Name of the Institution : Nightingale College Of Nursing, BangaloreCourse of Study and Subject : MSc Nursing Paediatric nursingDate of Adimission to Course : 20/05/2010
Title of the Topic
: A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING PROGRAMME ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION AMONG MOTHERS OF UNDER-FIVE CHILDREN IN SELECTED RURAL AREA AT BANGALORE
Brief resume of the intended work : Attached
Signature of the Student :
Guide Name : Mrs. Jeya VanithaRemarks of the Guide : The Study is suitable and feasibleSignature of the Guide :
Co-Guide Name : Signature of the Co-Guide :
HOD Name : Mrs. Jeya VanithaSignature of the HOD :
Principal Name : Principal Mobile No. : Principal E-mail ID : Remarks of the Principal :
Principal Signature :
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
2
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1: NAME OF THE CANDIDATE AND
ADDRESS
MS. JEBA MALAR. B,
NIGHTINGALE COLLEGE OF
NURSING,GURUVANNA DEVARAMUTT,
NEAR BINNYSTON GARDEN,MAGADI ROAD,
BANGALORE.
2: NAME OF THE INSTITUTION NIGHTINGALE COLLEGE OF
NURSING,GURUVANNA
DEVARAMUTT,NEAR BINNYSTON GARDEN,
MAGADI ROAD,BANGALORE.
3: COURSE OF STUDY AND SUBJECT M. SC. NURSING
CHILD HEALTH NURSING
4: DATE OF ADMISSION TO THE
COURSE
15-09 2010
5:
TITLE OF THE STUDY:
. A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING PROGRAMME
ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION AMONG MOTHERS OF
UNDER-FIVE CHILDREN IN SELECTED AREA OF BANGALORE
3
6:
BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“PREVENTION IS BETTER THAN CURE”
Children are the future pillars of a nation. Today’s children are
tomorrow’s citizen and leaders. Child health care is the most crucial factor to determine
growth of the child especially in the first five years of life.1 They are vulnerable to disease,
death and disability owing to their age, sex, place of living, socio economic class and host of
other variables. Certain specific biological and psychological needs must be met to ensure the
survival and healthy development of the child and future adult.2
Dengue fever is an acute febrile disease caused by infection of dengue
virus transmitted by the female aedes mosquito and it is called breakbone fever or dandy
fever.3 This virus affecting humans today and its incidence is increased dramatically in the
fast fifty years. Due in part to population growth and uncontrol urbanization in tropical and
subtropical countries, breeding sites for the mosquitoes that transmit dengue virus have
proliferated and successful vector control has proven problematic.4
In infants and young children, dengue present as a mild fever with
rash. Older children have the classical symptoms of high fever, severe headache, pain behind
the ear, pain in the joints, muscles and rash. Dengue hemorrhagic fever is characterized by
high fever, bleeding and liver enlargement. It requires urgent hospitalization as it may even
lead to death.5
The preventive method dengue fever is controlling the mosquito
infestation. The mosquito dengue primarily breeds in man made containers like metal drums,
earthenware jars and other water storage jar. Proper solid waste disposal and improved water
storage practices including covering containers should be encouraged. Insecticides should
used periodically. Wear light-coloured, loose fitting, protective clothing that covers as much
4
of our body as possible. Use an insect repellent on areas of our skin that are exposed and on
our clothing especially around around loose parts such as collars. Repellants containing a
chemical known as DEET(N,N-diethyl metatoluamide)are thought to be most effective and
use plug in devices, which have insecticides in them, to kill mosquitoes, sleep under a
mosquito net to avoid being bitten at night. It is most important to follow these precautions
around dawn and dusk, as is when the aedes mosquito is most active. However it is important
to remember that the aedes mosquito can bte at any time of the day or night, So making sure
you always take the necessary precautions can help to reduce your risk of catching dengue
fever6
6.1 NEED FOR STUDY :
The incidence of dengue fever is increased in the worldwide.They may be
asymptamatic and annually 100 million cases of dengue fever and half a million cases of
dengue haemorrhagic fever occur world wide. 90% of dengue haemorrhagic fever occur
world wide.90% of dengue haemorrhagic fever subjects are children less than 5YEARS of age
.At present dengue is endemic in 112 contries n the world.Early recognition and prompt
treatment are vital if disease related morbidity and mortality are to be limited7 The purpose of
this study was to identify the early indicatives of haemorrhage in severe degue infections.In
2002 may,out of 116 children 24 children had severe haemorage and 92 had no haeorrhage.8
In New delhi, by the year 2006 in early October more than 590 cases of dengue
fever were reported and over 367from neighbouring states who had come to New Delhi for
treatment.
In Rajasthan, by the year 2006 sep 12 th more than 35 children were treated for
dengue fever.
In Uttarpradesh,over 24 suspected cases o te diseases were reported in 2006.
In Andrapradesh,one person succumbed to the disease and atleast 5 were treated
for the dengue feve n 2006
.
In westbengal ,over 30 peole were treated for degue fever in Kolkata,the capitalof
Westbengal for suspected dengue fever.
5
By October 9 , 2006,more than 50 deaths were reported to dengue fever and more
than 3613 patients were treated for this disease9.
The Government of India’s Health department released the statistical data related
to dengue fTever on October 8th 2006. NATIONAL OUTBREAK OF DENGUE FEVER
New Delhi - 886
Gujarat - 424
Rajasthan - 326
West Bengal - 314
Tamil Nadu - 306
Uttar Pradesh - 79
Karnataka - 59
Andhra Pradesh - 9
. On October 13,2006 , 6 persons died due to dengue fever in Delhi.It was the
highest number of deaths reported from Delhi in a day due to this disease.10
Usually in urban areas , having high population densty,poor sanitation and large
number of desert coolers,overhead tanks.discarded buckets,utensils etc,which promotes
mosquito breeding are at high risk.
It can also occur in rural areas where the environment is friendly for mosquito
breeding.Mosquito breeding can occur in containers user for spring warter for cattle
feedingand drinking , discarded tins,tyres,bottlesetc.which are not emptied and cleaned
periodically.
Most dengue control programme conduct surveillance only for the disease and
vectors. However for prevention and control efforts another critical variable is human
behavior as it relates to managemet of vector larval habitats and to disease recognition and
response.Hence there is a need to focus not only knowledge of disease and its control,but
more important on the actual behavior related to source reduction and treatlment seeking.
6
6.2 REVIEW OF LITERATURE
A review of literature is an essential aspect of scientific research . It is a
systematic identification , location and scrutiny summary of written material that contains
information relevent to the problem under study. It helps to identify the similar studies for the
investigator. It enables the researcher to focus on related studies around the world at different
setup. The major goal of review of literature is to develop a strong knowledge base to carry
out research a nonresearch scholarly activity . The following studies are:
Murell.S, Wu Sc Butler M in 2011 A study was conducted on Review of
dengue virus and development of vaccination in children. Dengue viral infection is the most
rapidly spreading vector borne disease , attributed to changing demographics, urbanization,
environment and global travel. It continues to be a threat in over hundred tropical and sub-
tropical countries, affecting pre dominantly children. Dengue also carries the hefty financial
burden on the health care system in affected areas, as those infected seek care for their
symptoms. The search for a suitable vaccine for dengue has been ongoing for the last 60years,
yet any effective treatment or vaccine remains elusive. A vaccine must be protected for all
four sero types of dengue and be cost effective. Many approaches to developing candidate
vaccines have been employed. The candidates include live attenuated tetravalent vaccines,
chimeric tetravalent vaccines based on attenuated dengue virus or yellow fever 17D and
recombinant DNA vaccines based on flavi virus and non flavi virus. The review outlines the
challenges involved in dengue vaccines development and presence current stages of proposed
vaccine candidate development.11
Vesga-Gomez C,Caceres-Manrique Fde M in 2010 A Study was
conducted on evaluating the effectiveness of primary school children play-based education for
improving knowledge about dengue fever prevention,controland practice.The methods which
was carried out in Bucaramanga between july and November 2010.A group of leading
primary school children received play based education about dengue and leadership after they
had been surveyed regarding their knowledge about dengue control practices.Then they
signed commitment to implement action with family and neighbours;they were followed up
for four months and home visits were made to assess commitment and repeat the
survey.Follow up was completed for 89 of the 99 children(90%).There were significant
7
increase in knowledge about dengue as a disease(from 73% to 95.5%) as being very severe
(82% to 96.6%)being transmitted by mosquitoes(82% to 100%)being Caused by virus(1.1%
to19.1%)in recognising larvae(54% to95.5%)and breeding sites (43%to 88%)recognizing
symptoms of fever(67.4%to 97.8%)pain in the bones(21.3%to62.9%)headache( 37.1%to
645%) and bleeding (16.8% to42.7%)in the need for opportune
consultation(77.5%to98.97%)spraying(22.5%to47.2%) and washing out water
tanks(67.5%to89.7%). The children fulfill their commitment and creatively and inventively
engaged in more activities. Play based education was effective in improving knowledge and
practice r egarding dengue fever.12
.
Tsuzuki A,Thiem V D,Suzuki M,Yanai H A in 2010 A Study was conducted on
can daytime use of bed nets not treated with insecticide reduce the risk of dengue hemorrhagic
fever among children in Vietnam? The purpose of this study was to investigate the
prevalence of bed net use and elucidate the effect of daytime bed net use on preventing
dengue hemorrhagic fever (DHF) among children in Vietnam. We conducted a population-
based cross-sectional survey and a matched case-control study in Khanh Hoa Province where
not only some pre-School children but also some school children, who take a nap during lunch
break prior to returning to school, used bed nets during the day. Among 36,901 children 2-10
years of age, most used untreated bed nets during the night (98.3%) compared with 8.4%
during the day. The results of the case-control study, which defined 151 cases who were
hospitalized with DHF in the provincial hospitals and 604 age-matched neighborhood
controls, did not support our hypothesis that children using untreated bed nets during the day
are lesslikely to be hospitalized with DHF (adjusted odds ratio = 0.56, 95% confidence
interval = 0.23-1.39).13
Dellamonica P 2009 A study was conducted on the clinical features of dengue fever.
The onset is abrupt with frontal headache, retro-orbital pain, myalgia joint pain, prostration
and in many cases, a macular rash usually sparing the face and extremities. Hemorrhagic sings
may occur such as petechiae, purpura, epistaxis and bleeding gingivae. Two severe forms of
dengue f eve r, particularly among children below 3 years of ago, include dengue hemorrhagic
fever (DHF) and dengue shock syndrome (DSS) Treatment of dengue fever, whether in its
uncomplicated form or with hemorrhagic manifestation or shock, remains symptomatic. There
is no specific anti viral treatment. A case should be notified to allow health authorities to take
the appropriate measures for vector control.14
8
Nagoya J in 2009 A study was conducted on knowledge, attitude and practice
regarding dengue among people in pakse. Dengue Fever is an acute febrile disease & it is the
second leading cause of death in pakse district. The cross sectional study was designed to
assess the knowledge, attitude and practice of people regarding dengue disease in 9 villages of
the pakse district from July to September 2006. They had a fair knowledge about the vector
163 (70.9%). For 101 (43.9%) respondents, their main sources of information about dengue
was their friends or relatives. It is encouraging that 217 (94.3) respondents had a positive
attitude that dengue fever can be treated and that 222 (96.5%) knew they should visit a doctor
when they suffer from it. About 196 (85. 2%) people stored water at home but infrequently
changed it. The study indicated that the community was quite familiar with dengue, but there
was some confusion about vaccination and water storage domestic use. Dengue awareness act
should be included at the school and college level. Radio and Television should play an
important role in conveying health information to the public and regular visits of health
personnel to the villages should be ensured.15
Phuanukoonnon S in 2005 A study was conducted on the investigation above the
influence larval control methods (using temphos, keeping and covering container with lids)
water use and weekly cleaning of containers on the presence of Aedes aegypti larvae in water
storage containers in rural & urbal house holds. Cross sectional questionnaire survey and
larval survey covered 966 house holds 5821 containers were inspected. The containers more
frequently infested with larvae were rectangular cement containers storing water for boiling &
flashing toilet. Keeping fish was the most effective method of control. Weekly cleaning of
container was an effective method for larval control most type of containers. A combination
of control methods increase effectiveness.16
Simasathien S in 2005 A study was conducted on Dengue vaccine. Dengue is
an expanding health problem. About two – fifths of the world population are at risk for
acquiring dengue with 50-100 million cases of acute febrile illness yearly including about
5000,000cases of Dengue hemorrhagic syndrome & Dengue shock syndrome. No antiviral
drugs active against the flavivirus exist. Vaccination remains the most hopeful preventive
measure. Dengue vaccine has been in development for more than 30 years, yet none has been
licensed. The fact that enhancing antibody from previous infection and high level of T cell
activation during secondary infection contribute to immunopathology of Dengue Hemorrhagic
9
fever, the vaccine must be able to induce protective response to four dengue serotypes
simultaneously. Inactivated vaccine is safe but needs a repeated booster thus, development is
delayed. Tetravalent live attenuated vaccine and chimeric vaccine using yellow fever or
dengue viruses as a backbone are being carried out in human trials. DNA Vaccine and
Subunit vaccine are being carried out in animal trials.17
Kabilan L in 2004 A study was conducted on serologic survey of people in
Chennai to determine evidence of prior exposure to dengue virus infections. The serum
samples from clinical children were analyzed for dengue virus – specific immunoglobulins M
(IgM) and G (IgG) antibodies. There was an increase in the percentage of children with
monotypic antibody response dengue in the later survey (April 2.2% and September 9.93%)
Dengue virus infection was diagnosed in 74.5% (143/192) of cases. While dengue specific
IgM responses were pre-dominant among infants with dengue fever, IgG and mixed
responses (M & G) were seen in 85% of the children with severe forms of dengue18.
Madeira NG in 2002 May A study was conducted on Education in primary
school as a strategy to control dengue. The proliferation of Aedes aegypti, as species of
mosquito, that is the vector of the dengue pathogen, is being augmented by the population’s
lack of care in allowing formation of larval habitats. One form of controlling dengue is the
distribution of information on the mosquito to improve awareness and to provide the means
necessary for the elimination its reproductive habitats. To evaluate a teaching method
concerning the vector and dengue, students from the 5th years ofprimary education were
compared before and after didactic intervention with a group- of control students. The
students who received intervention were more successful in identifying the stage of the cycle,
biological and morphological.19
6.3 .STATEMENT OF THE PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO TEACHING
PROGRAMME ON KNOWLEDGE OF DENGUE FEVER AND ITS PREVENTION
AMONG MOTHERS OF UNDER-FIVE CHILDREN IN SELECTED RURAL AREA OF
BANGALORE”
6.4. OBJECTIVES OF THE STUDY
10
To assess the knowledge of under five mothers on dengue fever and its prevention.
To evaluate the effectiveness of knowledge of under five mothers after video teaching
programme on dengue fever and its prevention.
To compare pre test and post test knowledge of under five mothers.
To associate the knowledge with selected demographic variables such as
age,education,occupation,religion,type of family,socioeconomic status,health status of
the family.
6.5. HYPOTHESIS:
H1: There will be significant difference in the pre test and post test knowledge level scores of
under five mothers on dengue fever and its prevention.
H2: There will be significant association between the knowledge of under five mothers and
selected demographic variables such as age, education, occupation, religion, type of family,
socioeconomic status and health status of the family.
6.6OPERATIONAL DEFINITIONS
EVALUATE: : Measurement of the knowledge of dengue fever and its prevention among mothers of
under five children.
EFFECTIVENESS:
In this study it refers to producing the desired result of video teaching programme on
dengue fever and its prevention as measured by the instrument and shown by the post
test score.
11
VIDEO TEACHING PROGRAMME:
In this study it refers to the electronic motion picture equipment which scans pictures
from magnetic tape on a compact aids which have the recording of motion pictures
and sound and it includes definition, causes, clinical manifestations, management and
prevention of dengue fever.
KNOWLEDGE It refers to correct response on mothers of under five children to the knowledge items
of the questionnaire of interview schedule regarding dengue fever and its prevention.
.
MOTHERS : In this study the word refers to the mothers who are having under five children.
UNDER FIVE CHILDREN: In this study the term refers to the children between the age of 1-5 years of age.
DENGUE FEVER: Dengue is an acutely infectious mosquito borne viral disease transmitted by certain
species of Aedes mosquito that is culex fatiguns, Aedes aegypti and Aedes albopietus.
The disease is also known as breakbone fever or dandy fever.
6.7 ASSUMPTIONS :
The mother will have inadequate knowledge regarding the dengue fever and its
prevention.
The mother wiil be gaining adequate knowledge regarding the degue fever and its
12
7
prevention in under five children after giving a video teaching programme.
The knowledge on dengue fever and its prevention will help the mother to manage
those symptoms while they handle the under-five children who are prone to get
dengue fever.
6.8 DELIMITATIONS:
The study is delimited to mothers who are:
having under five children
willing to participate in the study
able to speak and write in kannada and English.
6.9 PROJECTED OUTCOME: The study will improve the level of knowledge on dengue fever and its prevention among
mothers of under five children.At the same time,the study will prove the effectiveness of
video teaching programme an hence it will help to bring down the under five morbidity.
MATERIALS AND METHOD:
7.1 SOURCE OF DATA The data will be collected from mothers of under five children in selected rural area at
Bangalore.
7.1.1 RESEARCH DESIGN The research design adopted for this study is quasi experimental study.
RESEARCH APPROACH The research approach is evaluative.
7.1.2 SETTINGS
13
7 The study will be conducted in Mahalakshmi layout at Bangalore, it is 7km away
from the college.
7.1.3 POPULATION : The population selected are mothers of under five children who are residing in rural
area at Bangalore.
7.2 METHOD OF DATA COLLECTION:
7.2.1 SAMPLING PROCEDURE
The sampling technique adopted for this study is purposive.
7.2.2 SAMPLE SIZE
The Sample size is 60.
7.2.3 INCLUSION CRITERIAThe criteria or sample selection are mothers of under five children
who have children aged between 1-5 years.
who are willing to participate in the study.
who can able to speak and understand kannada and english
7.2.4 EXCLUSION CRITERIA
mothers
who are having above 5 years of age.
who are not willing to participate in the study
who cannot able to speak and understand kannada and English
14
7.2.5. INSTRUMENTS INTENDED TO BE USED
who cannot able to speak and understand kannada and English
SELECTION OF TOOLThis consists of 3 parts:
PART 1:The tool consists of demographic variables such as
age,education,occupation,religion,type of family,socioeconomic and health status of the
family.
PART2:Questionnaire will be used to assess the knowledge.30 questions will be used.
PART3:Videoteachingprogrameregardingdefinition,causes,clinical
manifestations,transmission,management and prevention of dengue fever will also be used
SCORING PROCEDURE :
For knowledge assessment,it consists of 30 items of objective type related to
knowledge of dengue fever and its prevention.Each item has 4 options with one most
appropriate answer.Each correct response has ‘one’ score and wrong answer is considered to
be “zero”. Thus there are 30 items with maximum of 30 scores.
SCORING INTERPRETATION :
LEVEL OF KNOWLEDGE RANGE
15
EXCELLENT
26 -- 30
GOOD 21 -- 25
AVERAGE 16 -- 20
POOR 0 – 15
7.2.6. DATA COLLECTION METHOD :
The mothers of under five children in the selected rural area will be
selected for the study using non-probability purposive sampling.Formal administrative
permission will be obtained from the concerned panchayat president.The data will be
collected from 60 mothers of under five children after obtaining their consent.The procedure
will be explained to them and confidentiality will be assured.Data will be collected from 8-10
samples per day.The duration will be 4 week.
7.2.7. DATA ANALYSIS PLAN
The plan of data analysis are :
The data obtained will be analysed in view of the objectives of the study.
Mean,Median,Mode and Standard deviation is used for assessing knowledge
scores.
The effectiveness of pre-test and postest knowledge scores will be analyzed
by paired ‘t’ test
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION ?
16
Yes, ethical clearance will be been obtained from the research committee of Nightingale
College of Nursing.Consent will be taken from concerned authority and permission will be
taken from the study subjects before the collection of data .
REFERENCES :1. Ukoko. Childrens health tomorrows wealth . Indians Journal of Paediatrics. 1997;54:33-
342. K. Park, Text book of Preventive and social Medicine, 18th edition,banarsidas, Bhanaot
publishers,2005,Jabalpur, pp no. 385, 391, 474-476.3. www.denguefeversymptoms.org 4. Annu Rev microbilal.Global spread and persistence of dengue. 2008;pp no;62, 71-925. Donalisio M R, Alves M J, Visockas A. A survey of knowledge and attitudes in a
population about dengue transmittion- region of Campinas, SaoPaulo,Brazil,19986. www.bupa.co.uk individuals/heath information directory/d/dengue-fever7. http:/www.ncbi.nlmnih.gov/pubmed 188135328. http://www.thehinde.com/2005/09/01/dengue cases/2005090113560300.htm 9. Indian Journal of Community Medicine.2010,July;35(3) pp no 386-390.10. Indian journal of Community Medicine. 2011, feb 32(3), pp no 284-29011. MurellS, Wusc Bulter M, Biotch nol adv .2011march-april; 29(2):239-24712. Vesga Gomez C,Cacerer Monrique fde M, Re V, Salud PUblca, 2010,aug;12(4);558-6913. Tsuzuki A ,Thiem VD, Suzuki M,Yanai H.AM J Trop Med Hyg.2010 Jan;82[6]:pp
no:1157-914. Dellamonica P, arch Pediatrics; Dengue Fever; Clinical features, article in French; 2009,
17
8.
Oct;16 supp 2;S80-415. Navoya j, Med sci. knowledge, attitude and practice regarding dengue fever;2009,
Feb;71(1-2):29-3716. Phuanukoonnon S muller I, Bryan J H, Effectiveness of dengue control practices in
household water cntaners; Trop Med Int Health. 2005; Aug;108(8);755-6317. Simasthean S,Watanaveeradej V J Med Assoc Thai. Dengue Vaccine;2005 nov;88 Suppl
3:5 363-7718. Kabilan L, Velayutham T, Sundaram B, Natarajan A, et al. field and laboratory-based
active dengue surveillance in Chennai, Tamil Nadu; dengue epidemic 2004 nov;32(7)-391-6
19. Madeira N G,Macharelli C A,Pedras J F,Rev Soc Bras Med TROP.Educatio in primary school as a strategy to control dengue.2002 may-june;35(3):221-6
9.SIGNATURE OF THE CANDIDATE
10.REMARKS OF THE GUIDE
11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
18
.11.6 SIGNATURE
1212.1 REMARKSOF THE
PRINCIPAL
12.2 SIGNATURE
9.SIGNATURE OF THE CANDIDATE
10.REMARKS OF THE GUIDE
11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
19
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
1212.1 REMARKSOF THE
PRINCIPAL
12.2 SIGNATURE
20