A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON HEPATITIS B VACCINE AMONG

PREGNANT WOMEN ATTENDING IN OPD OF SELECTED

HOSPITAL, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED BY:-

KUM. MADHU MALI.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE AND

ADDRESS

KUM. MADHU MALI

1ST YEAR M.SC. NURSING,

SOFIA COLLEGE OF NURSING,

BANGALORE.

2 NAME OF THE INSTITUTION SOFIA COLLEGE OF NURSING

BANGALORE

3 COURSE OF THE STUDY AND

SUBJECT

1st YEAR M.Sc NURSING

OBG NURSING

4 DATE OF ADMISSION 06/07/2012

5 TITLE OF THE TOPIC A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON HEPATITIS B VACCINE AMONG PREGNANT WOMEN ATTENDING IN OPD OF SELECTED HOSPITAL, BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

"There was never a great man who had not a great mother, it is hardly an exaggeration." Olive Schreiner

Children are innocent, trusting and full of hope. Their childhood should be joyful and

loving. Their lives should mature gradually, as they gain new experiences. Each child is a

unique person, a person whose future will be affected for better or worse by the influences that

mould his or her life during the early years. One child will grow up to become a joy to God and

parents and a blessing to others. Another will grow up and become a menace to society. Many

others will live out their lives in fairly good ways. The future of any society depends on its

children. Parents are laying the foundation for their child’s lives. So the parents have a very

key role and opportunity to help promote the health of the children. Children who receive their

immunizations on time are healthier children.

At birth, infants have protection against certain diseases because antibodies have passed

through the placenta from the mother to the unborn child. After birth, breastfed babies get the

continued benefits of additional antibodies in breast milk. But in both cases, the protection is

temporary. Immunization (vaccination) is a way of creating immunity to certain diseases by

using small amounts of a killed or weakened microorganism that causes the particular disease.

Microorganisms can be viruses, such as the measles virus, or they can be bacteria, such as

pneumococcus. Vaccines stimulate the immune system to react as if there were a real infection;

it fends off the "infection" and remembers the organism so that it can fight it quickly should it

enter the body later.1

Some parents may hesitate to have their kids vaccinated because they're worried that

the children will have serious reactions or may get the illness the vaccine is supposed to

prevent. Because the components of vaccines are weakened or killed and in some cases, only

parts of the microorganism are used they're unlikely to cause any serious illness. Some

vaccines may cause mild reactions, such as soreness where the shot was given or fever, but

serious reactions are rare. Hepatitis B virus (HBV) affects the liver. Those who are infected can

become lifelong carriers of the virus and may develop long-term problems such as cirrhosis

(liver disease) or cancer of the liver.1

The hepatitis B vaccine usually creates long-term immunity. Infants who receive the

HBV series should be protected from hepatitis B infection not only throughout their childhood

but also into the adult years. Eliminating the risk of infection also decreases risk for cirrhosis of

the liver, chronic liver disease, and liver cancer. Young adults and adolescents should also

receive the vaccine if they did not as infants.1

Hepatitis B is also a liver disease (the word “hepatitis” comes from the Greek words for

“liver” and “inflammation”). It is caused by the hepatitis B virus. It is spread through contact

with the blood, or other body fluids, of an infected person. Adolescents and adults can be

infected through sharing drug needles or through unprotected sex, and health-care and public

safety workers are often exposed to blood in the course of their jobs. Pregnant women can

infect their newborn babies. People infected with hepatitis B might not feel sick, or might

suffer loss of appetite or tiredness, muscle or stomach pains, diarrhea or vomiting, or yellow

skin or eyes (jaundice). People usually recover from hepatitis after several weeks, but others

become “chronically infected.” They might not feel sick themselves, but they continue to carry

the virus and can infect other people. A baby who is born to a chronically infected mother has

70%–90% chance of being infected at birth. Many people who are chronically infected will

suffer from serious problems such as cirrhosis (scarring of the liver) or liver cancer. More than

a million people in the United States are chronically infected with hepatitis B. In 1996 an

estimated 200,000 people became infected, and 4,000 to 5,000 people die each year from

hepatitis B.2

Anyone can get hepatitis B, but infants and young children are most at risk. Younger

children also have a greater risk of becoming chronic carriers. For example, infants infected

within the first six months of life have an 80 to 90 percent carrier risk, compared to a 10

percent carrier risk in adults. The best way to prevent hepatitis B is through immunization with

the hepatitis B vaccine. When administered properly the vaccine is about 95 percent effective

against hepatitis B disease. The vaccine can be given safely to infants, children, and adults.

Even pregnant women can be safely given these shots if their risk factors warrant it. Hepatitis

B shots are very safe and side effects are rare.3

Hepatitis B is one of the major diseases of mankind and is a serious global public health

problem. It is the parent’s responsibility to keep their children up-to-date with immunizations.

The World Health Organization recommends that all infants, no matter where they live, should

be vaccinated against hepatitis B. When a mother feels that she and her baby have been treated

well, and when she knows when to return for the next immunization, she will be more likely to

bring her children for the full course of immunization.3

6.2 NEED FOR THE STUDY

“To nourish children and raise them against odds is any time, any place, more valuable

than to fix bolts in cars or design nuclear weapons." -- Marilyn French

Vaccinations are some of the most important tools available for preventing disease.

Vaccinations not only protect children from developing a potentially serious disease but also

protect the community by reducing the spread of infectious disease. Parents to make sure their

children are protected. They have the most important role to look after and nurture the child.

They have the responsibility to protect the child from hazardous diseases like hepatitis B and

provide a maximum health to them.4

Hepatitis B is 100 times more infectious than the AIDS virus, yet it can be prevented

with a safe and effective vaccine. For the 400 million people worldwide who are already

chronically infected with hepatitis B, the vaccine is of no use.2 billion people have been

infected (1 out of 3 people). 400 million people are chronically infected. 10-30 million will

become infected each year. An estimated 1 million people die each year from hepatitis B and

its complications. Approximately 2 people die each minute from hepatitis B.4

12 million Americans have been infected (1 out of 20 people). More than one million

people are chronically infected. Up to 100,000 new people will become infected each year.

5,000 people will die each year from hepatitis B and its complications. Approximately 1 health

care worker dies each day from hepatitis B.4

According to Blood Safety Surveillance and Health Care Acquired Infections Division,

Health Canada 78% of all cases of hepatitis B occur in Asia. According to the world health

report, WHO, 2004 about 37,000 deaths from Hepatitis B in South East Asia 2002.5

Similar studies were also conducted by other workers. Sobeslavsky et al estimated a

prevalence of 0% in 0-4 years, 2% in 5-9 years and 6.8% in 10-14 years age group. 6 A

population based study in Chennai revealed a higher prevalence of 12.5% in children less than

one year, 9.4% in 1-5 years, 6.3% in 6-10 years and 7.8% in 11-15 years age group.7 A similar

prevalence was noted by Panda et al from Delhi who identified 12.2% HBsAg positivity in 1-5

years and 10% in 6-15 years age group. These studies highlight the fact that the prevalence

varies in different regions in India and the overall positivity ranges from 1.3-12.7%. 8

A study conducted on vaccinates or not to vaccinate that is the question: why are some

mothers opposed to giving their infants hepatitis B vaccine? Objective of the study was to

identify the characteristics of mothers who prevent their newborn babies from receiving the

hepatitis B vaccine. Method of the study was the Women who gave birth and prevented the

administration of routine hepatitis B vaccine to their newborn infants (study group) were

compared to women who complied with vaccination (control group). During their hospital

stay, both groups were asked to answer a questionnaire constructed to evaluate relevant

demographic data, knowledge and attitudes liable to differ between the two groups. On the

basis of the answers to the questionnaire, the Comply group was further subdivided into two

groups: those with knowledge and those lacking knowledge (determined by subjective

evaluation). This subdivision showed that the differences between the study Group and the

control group exist, even though knowledge was controlled for. The study concludes that the

Mothers prevent administration of the hepatitis B vaccine to their newly born children based

upon their overall approach, and not due to ignorance. In order to overcome this harmful trend,

the medical community must supply counter information that encourages vaccinations.9

A study conducted on Mothers and vaccination, knowledge, attitudes, and behaviour in

Italy. The study evaluates knowledge, attitudes, and behaviour of mothers regarding the

immunization of 841 infants. The result of the study shows that only 57.8% of mothers were

aware about all four mandatory vaccinations for infants (poliomyelitis, tetanus, diphtheria,

hepatitis B). So it is essential to provide educational programmes promoting paediatric

immunization, accessibility, and follow-up should be targeted to the entire population

especially parents.10

After reviewing above facts the investigator while working as a staff nurse in paediatric

hospital he came across with many mothers of under five children don’t have adequate

knowledge on hepatitis b vaccine. Many research studies also revealed that importance of

knowledge of parents; especially mothers about hepatitis b vaccine have a major role in

preventing this disease by vaccinate their child. Hence the investigator felt a need to conduct a

study on mothers of under five children to assess the effectiveness of structured teaching

programme regarding hepatitis b; therefore structured teaching programme will enhance the

mothers knowledge.

6.3 REVIEW OF LITERATURE.

Review of related literature is an integral component of any study or research project. It

enhances the depth of the knowledge and inspires a clear insight into the crux of the problem.

Literature review throws light on the studies and their findings reported about the problem

under study.

The review of literature is a broad, comprehensive, in depth, systemic and critical

review of scholarly publications, unpublished scholarly print materials, audio visual materials

and personal communications. Reviewing and evaluating the literature is central to the research

process.11

A study conducted on improved immunization practices reduces childhood hepatitis b

infection in Tonga. The results show that the instituted changes in the delivery of hepatitis B

vaccine have been effective in reducing the transmission of hepatitis B to children. So it is very

essential to give proper education to the parents especially to the mothers regarding hepatitis B

vaccine for the healthy future of child.12

A study conducted regarding Successful promotion of hepatitis B vaccinations among

Vietnamese-American children ages 3 to 18. The objective of the study was to improve the

rates of hepatitis B vaccine coverage among Vietnamese-American children and adolescents

ages 3 to 18. The results of the study shows that only the awareness of parents or care givers of

children regarding hepatitis B vaccine can help them to get a complete course vaccination to

their children.13

An article explains on prevention in liver disease. Prevention has become an important

component of medical therapy for a variety of diseases. Preventive strategies in liver disease

are relatively underdeveloped and have focused mainly on specific complications of chronic

liver disease and vaccination for viral hepatitis. Although public health initiatives designed to

prevent certain forms of liver disease are in place, they seem to be underutilized and their

utility has not been evaluated. This article reviews the available literature regarding prevention

for health care providers, includes a summary of ongoing public health initiatives, and suggests

an approach to prevention in liver disease. It is intended to raise awareness and encourage

implementation of preventive strategies in hepatology.14

An article reviews that hepatitis B virus (HBV) infection is a health problem that

affects numerous infants and children in the United States. Immunization of all newborn

infants and adolescents for hepatitis B virus is a vital step toward eradicating HBV from the

general population. Pediatric nurse practitioners are in a strategic position to provide education

and the carry out immunization efforts that will dramatically decrease the morbidity associated

with hepatitis B virus.15

A survey conducted on Evaluation of the hepatitis B prevention education programme

in Poland. Evaluation of the hepatitis B prevention education programme was performed as a

survey including all the coordinators in 25 regions (211 coordinators; half the country). The

survey showed a connection between the results of the education programme and the incidence

of hepatitis B virus infection. Also indicates that giving education is having the major role in

preventing hepatitis b.16

The hepatitis B prevention education programme conducted in Poland. The main

objective of the hepatitis B prevention education programme in Poland is to promote education

in the school setting. The main aims of the programme include reducing morbidity from HBV

infection by increasing community awareness, facilitating access to vaccination, establishing

local lobbies to support the programme, and encouraging cooperation with vaccine producers.

The programme indicates the importance of educational programme regarding hepatitis b for

the better prevention of this dangerous disease.17

A study conducted on Immunization status of children enrolled in a hospital-based

Medicaid managed care practice: the importance of the timing of vaccine administration.

Objective of the study was to evaluate the immunization status of children enrolled in a

hospital-based Medicaid managed care practice and to assess the impact of the timing of

vaccine administration on measured immunization rates. The result shows that overall

coverage of immunization including hepatitis b remained below 90%. The results implies that

provide education regarding the early administration of vaccines have a major role in

improving vaccination status.18

A study conducted on the relation of parent and provider characteristics to vaccination

status of children in private practices and managed care organizations in Maryland among 466

parents of 2 year old children. The result shows that approximately 70% of the study children

were up-to-date by age 2 years for the full vaccination series, excluding hepatitis B vaccine.

Family demographics strongly correlate with vaccination status; however, they are generally

not modifiable. But the only way to improve the vaccination status is by providing education to

the parents.19

An article explains about proposed vaccine information materials for hepatitis B, Haemophilus

influenzae type b (Hib), Varicella (chickenpox), and measles, mumps, rubella (MMR)

vaccines--CDC. Notice with comment period. It also remind that Under the National

Childhood Vaccine Injury Act (42 U.S.C. section 300aa-26), CDC must develop vaccine

information materials that health care providers are required to give to patients/parents prior to

administration of specific vaccines.20

An article explains about the Immunization strategies for the elimination of hepatitis B.

The Centers for Disease Control and Prevention and the American Academy of Pediatrics have

provided new recommendations for a comprehensive strategy to eliminate hepatitis B virus.

The first priority is the prenatal screening of all pregnant women and follow-up vaccination of

all infants. The second is the immunization of at-risk adolescents and adults. Ultimately, it is

hoped that all adolescents will be immunized when feasible and that the incidence of hepatitis

B virus infection will decline. Primary care providers have an important role in the provision of

public education about hepatitis B and in the implementation of this new recommendations.21

A paper explains about Awareness and acceptance of hepatitis B vaccination in

Clementi, Singapore. Hepatitis B Virus infection, a public health problem in Singapore, can be

effectively controlled by vaccination. This paper reports on a study conducted in 1988/89 to

ascertain the awareness and uptake rate of Hepatitis B vaccination. 226 children responded to

the study. The result shows hepatitis B vaccination uptake had increased only up to 48.3%. The

immunization status showed a correlation with the ethnic group, father's occupation and

awareness score of respondents. So it is essential to educate the parents regarding hepatitis b

vaccination to prevent this disease in future.22

A survey conducted on Determinants of vaccination coverage in rural Nigeria. The

objective of this survey was to assess vaccination coverage and its determinants in this rural

community in Nigeria. A cross-sectional survey was conducted in September 2006, which

included the use of interviewer-administered questionnaire to assess knowledge of mothers of

children aged 12-23 months and vaccination coverage. The result shows that two hundred and

ninety-five mothers (87.0%) had only a satisfactory level of knowledge and the vaccination

coverage against all the seven childhood vaccine preventable diseases was only 61.9%.The

study conclude that completeness of vaccination was significantly correlated with knowledge

of mothers on immunization and adequate attention should be given to this if high coverage

levels are to be sustained.23

An article explains about increased seroprevalence of hepatitis B in dental personnel

necessitates awareness of revised pediatric hepatitis B vaccine recommendations. The purpose

of this discussion is twofold: to provide information to assist dental personnel in the decision-

making process regarding vaccination of infants, children, and adolescents in their households;

and to increase knowledge to facilitate educational presentations. Comprehension of these

changes may increase compliance regarding vaccination of children in our household, as well

as enhancing our educational presentations to patients, the community, and professional

societies.24

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of structured teaching programme on hepatitis B

vaccine among pregnant women attending in OPD of selected hospital, Bangalore.

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge of pregnant women regarding hepatitis b vaccine.

2. To evaluate the effectiveness of structured teaching programme regarding hepatitis b

vaccine among pregnant women.

3. To find out the association between knowledge regarding hepatitis b vaccine and

selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

1) Assess: Refers to gather subjective data and objective data. It includes gathering classifying

and analyzing the information about the hepatitis B vaccines.

2) Effectiveness: Refers to differences in the post test knowledge score with that of pre test

knowledge score.

3) Structured Teaching Programme: Refers to systematic by lecture cum discussion method

designed to provide information regarding hepatitis b vaccine, purpose, need and importance,

course of vaccination and available resources. The duration of teaching is 2 hours.

4) Hepatitis B vaccine: refers to vaccine developed for the prevention of hepatitis B virus

infection.

5) pregnant women : refers to women age group between 23 to 45 yrs.

6.6. HYPOTHESIS

H1: There will be significant difference between the pre and post test knowledge score on

hepatitis B vaccine in relation to structured to programme among the pregnant women.

H2: There will be significant association between the pre and post test knowledge score on and

hepatitis b vaccine in relation to structured to programme among the pregnant women and

demographic variable.

6.7. ASSUMPTION

1. There will be no significant different between the pretest and post test knowledge of the

hepatitis B vaccine in relation to structured teaching programme among pregnant

women.

2. There will be no significant association between the mean difference into knowledge of

hepatitis B vaccine and selected demographic variables.

6.8 DELIMITATION

The data collection period is limited to 6 weeks

Assessment of knowledge is measured by one observation only

Teaching strategy is delimited to lecture method only

6.9. VARIABLE

Dependent variable of this study is knowledge of pregnant women regarding Hepatitis b

vaccine.

Independent variables of this study are structured teaching program on Hepatitis B vaccine

Demographic variables of this study are

Age

education

occupation

religion

Family income

Type of family

Source of information

7. MATERIALS AND METHODS

The study is designed to determine the effectiveness of structured teaching programme on

hepatitis B vaccine among the pregnant women in OPD of selected hospital, Bangalore.

7.1. SOURCE OF DATA

Data will be collected from pregnant women who are coming in OPD of selected hospital,

Bangalore.

7.1.1. Research design

Research design adopted for the present study is quasi experimental, one group pre test- post test design

7.1.2. Research approach

The research approach used in this study is Evaluative approach

7.1.3. Setting of the study

OPD of selected hospital, Bangalore.

7.1.4. Population

Pregnant women in selected hospital, Bangalore,

7.1.5. Sample size

The proposed sample size of the study is 40 pregnant women.

7.1.6. Sampling technique

Sampling technique using in this study is purposive sampling.

SAMPLING CRITERIA

7.1.7. Inclusion criteria

1. Who are willing to participate in this study.

2. Who can read and understand Kannada or English.

7.1.8. Exclusion criteria

1. Women who are not pregnant.

2. Pregnant women who are absent at the time of data collection.

7.2. METHOD OF DATA COLLECTION

7.2.1. Tool for data collection

Self administered questionnaire

7.2.2. Method of data Collection

Method used is structured questionnaire.

7.2.3. Plan for data analysis

The data will be collected with the prescribed time period for 6 weeks

7.2.4.Procedure for data collection

Permission will be obtained from higher authorities.

Purpose of the study will be explained to the respondents.

Pre test will be conducted using structured knowledge questionnaire. Subsequently

planned teaching programme will be given on the day. On the seventh day post test

will be conducted. Proposed data collection period will be 30 days.

7.2.5. Data analysis Method

descriptive statistics

The data analysis through descriptive and inferential statistics

Frequency, mean, mean percentage, and standard deviation of described demographic

variables.

Inferential statisticsPaired t test to compare pre and post test knowledge score.

Chi square test will be used

7.2.6. Projected outcome

The structured teaching programme will enhance pregnant women’s

knowledgeregarding hepatitis b vaccine.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED

ON THE PATIENT OR OTHER HUMAN BEINGS

No

7.4. ETHICAL CLEARANCE

The main study will be conducted after approval of the research committee.

Permission will be obtained from the concern head of the institution. The purpose and after

details of the study will be explained to the study subjects and as informed concerned will

be obtained from them. Assurance will be given to the study subject on the confidentiality of

the data selected from them.

Information consent will be taken from nurses who are willing to participate in the study

8 . BIBLIOGRAPHY

1. Larissa Hirsch.Your child’s immunization.Available from URL:

http://kidshealth.org/parent/infections/immunizations/vaccine.html#

2. Parents' Guide to Childhood Immunization. Hepatitis B.Available from URL:

www.cdc.gov/vaccines/vpd-vac/hepb/.../pg_why_vacc_hepb.pdf

3. Siri Wood, Heidi Lasher, and Scott Wittet.Immunizing children against hepatitis

B.A training module for vaccinators. Available from

URL:http://74.125.153.132/search?q=cache:OwyOQ_zXSYEJ:www.path.org

4. Hepatitis B foundation. What is hepatitis B. October 21, 2009.Availabie from URL:

http://www.hepb.org/hepb/statistics.htm

5. WrongDiagnosis.Statistics about Hepatitis B.Available from URL:

http://www.wrongdiagnosis.com/h/hepatitis_b/stats.htm

6. Sobeslavsky O. Prevalence markers of HBV infection in various countries: a WHO

collaborative study. Bull WHO 1980;58:621-8.  

7. Jayaram S. Prevalence of HBV markers in different age groups in Madras. Ph.D.

thesis on "Prevention and control of Hepatitis B in Tamil Nadu". University of

Madras 1992.  

8. Kant L, Hall AJ. Epidemiology of Childhood Hepatitis B in India: Vaccination

related issues. Indian J Pediatr 1995;62:635-53.  

9. Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate--

that is the question: why are some mothers opposed to giving their infants hepatitis

B vaccine? Vaccine. 2005 Mar 14;V.23(16),P.1941-8.

10. Angelillo IF, Ricciardi G, Rossi P et all. Mothers and vaccination: knowledge,

attitudes, and behaviour in Italy. Bull World Health Organ. 1999; V.77 (3), P.224-9.

11. Basavanthappa B.T. Nursing Research. New Delhi: Jaypee brothers Publications;

1998.P.98-100.

12. Danielsson N, Fakakovikaetau T, Szegedi E. Improved immunization practices

reduce childhood hepatitis B infection in Tonga. Vaccine. 2009 Jul 16; V.27 (33),

P.4462-7.

13. McPhee SJ, Nguyen T, Euler GL et all. Successful promotion of hepatitis B

vaccinations among Vietnamese-American children ages 3 to 18: results of a

controlled trial. Pediatrics. 2003 Jun;V.111(6), P.1278-88.

14. Arguedas MR, Fallon MB. Prevention in liver disease. Am J Med Sci. 2001

Feb;V.321(2),P.145-51.

15. Ott MJ, Aruda M. Hepatitis B vaccine. J Pediatr Health Care. 1999 Sep-

Oct;V.13(5),P.211-6

16. Przewlocka T. Evaluation of the hepatitis B prevention education programme in

Poland. Vaccine. 2000 Feb 18;V.18(1),P.46-8.

17. Osińska H. The hepatitis B prevention education programme in Poland. Vaccine.

2000 Feb 18;V.18(1),P.S44-5.

18. Vivier PM, Alario AJ, Simon P. Immunization status of children enrolled in a

hospital-based medicaid managed care practice: the importance of the timing of

vaccine administration. Pediatr Infect Dis J. 1999 Sep;V.18(9),P.783-8.

19. Hughart N, Strobino D, Holt E et all. The relation of parent and provider

characteristics to vaccination status of children in private practices and managed care

organizations in Maryland. Med Care. 1999 Jan;V.37(1),P.44-55.

20. Proposed vaccine information materials for hepatitis B, Haemophilus influenzae type

b (Hib), Varicella (chickenpox), and measles, mumps, rubella (MMR) vaccines--

CDC. Notice with comment period. Fed Regist. 1998 Sep 3;V.63(171),P.47026-31.

21. Reece SM. Immunization strategies for the elimination of hepatitis B. Nurse Pract.

1993 Feb;V.18(2),P.42-5.

22. Fong NP, Basir H, Seow A. Awareness and acceptance of hepatitis B vaccination in

Clementi, Singapore. Ann Acad Med Singapore. 1990 Nov;V.19(6),P.788-92.

23. Odusanya OO, Alufohai EF, Meurice FP et all. Determinants of vaccination

coverage in rural Nigeria. BMC Public Health. 2008 Nov 5;V.8,P.381.

24. Wisnom CJ, Lee RJ. Increased seroprevalence of hepatitis B in dental personnel

necessitates awareness of revised pediatric hepatitis B vaccine recommendations. J

Public Health Dent. 1993;V.53(4),P.231-4.

9 Signature of candidate

10 Remarks of the guide

It is a feasible Study.

11 Name and designation of (in block letters

11.1 Guide

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

MRS.KASTHURI G.ASSOCIATE PROFESSOR

12 12.1 Head of the Department

12.2 Signature

MRS. KASTHURI G.

13 13.1 Remarks of the Chairman or

Principal

13.2 Signature