RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

ASHA. S MSc. NURSING I YEAR OBG YEAR 2011-2013.

SRI VENKATESWARA COLLEGE OF NURSING, NO.98, MARUTI INDUSTRIAL ESTATE, 10TH MAINPEENYA 2ND STAGE, BANGALORE- 560058

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESKARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

NAME OF THE CANDIDATE AND ASHA. S ADDRESS

SRI VENKATESWARA COLLEGE OF NURSING, NO.98, MARUTI INDUSTRIAL ESTATE,10TH MAIN 560058 PEENYA 2ND STAGE,BANGALORE-

2. 3.

NAME OF THE INSTITUTION

SRI VENKATESWARA COLLEGE OF NURSING

COURSE OF THE STUDY AND MASTER OF NURSING SUBJECTS OBG

4.

DATE OF ADMISSION TO THE 15/06/2011 COURSE A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED TEACHING 5. TITLE OF THE STUDY KNOWLEDGE AND PROGRAMME REGARDING OF ON CAUSES

PREVENTION

PEURPERIAL

INFECTION AMONG PRIMI MOTHERS

OF SELECTED MATERNITY HOSPITALS AT BENGALURU.

6. BRIEF RESUME OF INTENDED STUDY 6.1 INTRODUCTION

The term puerperal infections refer to a bacterial infection following childbirth. The infection may also be referred to as puerperal or postpartum fever, particularly the uterus and genital tract is the mostly infected site. In some cases infection can spread to other parts of the body [1]. Puerperal infection is the wound infection of genital tract after childbirth or abortion. It is still one of the important causes of maternal mortality and morbidity in India, because the delivery is conducted in unhygienic condition. The hospital deliveries, under hygienic condition, proved to be reducing the mortality and morbidity rate [2]. The centre for disease control defines puerperal infections as any isolation of a microorganism in the endometrium, temperature increase to 38C in the period after a recent delivery, presence of sudden tachycardia, purulent vaginal uterine discharge and abdominal pain accompanied by uterine discharge and abdominal pain accompanied by uterine tenderness Under proper care, the incidence of puerperal fever, following normal vaginal delivery, seldom occurs. Its incidence rises in the following causes. Genital puerperal sepsis is commonest, Extra genital, urinary tract infection, Breast infection and wound infection [2].

The breast infections occur during puerperium. Breast engorgement, cracked and retracted nipple. Puerperal fever caused by genital tract infection is responsible for 25% of maternal mortality in India. It is more common in home deliveries conducted by relatives or untrained Dais. It is one of the common causes of puerperal pyrexia, the incidence being 1-5% of all deliveries. Thromophelibitis is a series of complication in the puerperium, but rare in India. It carries a high risk of embolism, and death. Intracranial haemorrhage thrombosis also occurs rarely. Puerperal infection had been estimated about 1-8% among new mothers in the United states followed by medical treatment. And also, it had been estimated that 2-4% of new mothers who delivered vaginally suffer from some form of puerperal infection, which cause risk in womans life [1]. Death related to puerperal infection is very rare in the industrialized world. It is estimated three in 100,000 births result in maternal death due to infection; however, the death rate in the developing nations may be 100 times higher than the developed countries. Puerperal infection ranges between 3% and 20% with a mean rate of 9% in these rates vary between approximately 1% and 7.2% because of failure in the surveillance system, as well as the inexpressive awareness and involvement of people for a better presentation of reality [3]. India is one of the few countries where maternal mortality rates in rural areas are among the worlds highest, ie 570 per 100,000 women. In rural India mothers who belong to low economic status experience more episodes of illness. This is the situation directly linked to poverty, and the vast majority of poor women caught in this circle are the young mothers in the reproductive age. Nowadays, despite scientific and technological advances in different

knowledge areas, Puerperal infection remains a big problem, due to its prevalence morbidity and even lethality [4]. India has achieved satisfactory enhancement in social indicators such as life expectancy literacy levels. However, women in rural areas are largely affected by infectious diseases, malnutrition and maternal problems which still account for most of the disease burden.The puerperal period is called the sutika-period a term derived from the word prasuta or the mother after delivery. There are different opinions about the duration of this period, which ranges from six weeks to six months and some believe that it lasts until the restoration of menstrual cycle [5].

NEED FOR STUDY

Puerperal infection is a general term used to describe any infection of the genital tract after delivery. Because most pyrexia in the puerperium is caused by pelvic infections, the incidence of fever after childbirth associated with other infections related to childbirth such as mastitis. Puerperal infection may be complicated by pelvic inflammatory disease, bilateral tubal occultation and fertility [6]. The difficulty arises not only because of lack of clarity regarding the definition of a maternal death, but because of the weakness of health information systems and consequent absence of the systematic identification and recording of maternal deaths. In recent years, innovative approaches are used to promote well being. WHO and UNICEF estimated for the year 2000 indicated that most of the total 529,000 maternal deaths globally occur in just 13 countries. By contrast, information on the global burden of non-fetal health outcomes associated

with pregnancy and child bearing remains incomplete and estimated number of maternal deaths in 2000 for the world was 529.000. These deaths were almost equally divided between Africa (251,000) and Asia (253,000) with about 4% (22,000) occurring in latin America and the caribean, and less than 1% (2500) in the most developed regions of the world. In terms of the maternal mortality ratio (MMR), the world figure is estimated to be 400 per 100,000 live births. By region, the (MMR) was highest in Africa (830), followed by Asia (330), oceania (240), latin America and the caribean (190), and the developed countries (20). The country with the highest estimated number of maternal deaths was India (136,000), followed by Nigeria (37,000), Pakistan (26,000), Democratic Republic of cango and Ethiopia (24,000 each), the united Republic of Tanzania 921,000), Afghanistan (20,000) Bangladesh (16,000), Angola, and Kenya (11,000 each), Indonesis and Uganda (10,000 each). These 13 countries account for 67% of all maternal deaths [7]. Maternal mortality rate by healthy region for the period, which varies from 46 to 1821 per 100,000 live births. The total for specific state is about 85 per 100,000 live birth. Based on these results, it seems useful to classify the health regions according to its levels of maternal mortality based on the educational level and occupation to construct the socio-economic status
[8]

. The high percentage of maternal death among non-educated women and house wives,

have low income and at risk of dying for maternal cause has been influenced by their position in society [9]. The estimated incidence of sepsis globally to be 4.4% of live births, giving a total number of puerperal sepsis cases of nearly 6 million and almost 77,000 maternal deaths. The

most significant long-term complication is infertility resulting from tubal occlusion, estimated to affect 450,000women each year [10]. The prevalence of maternal morbidity ranges from 0.07 to 8.23% with the case fatality ratio from 0.02 to 37%. There is a big difference between case-fatality ratio in developing South Africa 1:5; India and Niger 1: 11) and developed countries UK 1: 118; France 1: 222[1]. The predisposing factors leading to the development of sepsis include home birth in unhygienic conditions, low socio economic status, poor nutrition, primiparity and anaemia. The transmissions of infecting organisms are typically categorized into nosocomial, exogenous, and endogenous. Nosocomial infections are acquired in hospitals or other health facilities and may come from the hospital environment or from the patients own flora. Exogenous infections come from external contamination, especially when deliveries take place under unhygienic conditions. Endogenous organisms, consisting of mixed flora colonizing the womans own genital tract, are also a source of infection in puerperal sepsis. Aseptic precautions, advances in investigative tools and the use of antibiotics have played a major role in reducing the incidence of puerperal infections [11]. True mechanism of puerperal fever was not generally understood until the 20th century. In 1879 Louis pasteur showed that streptococcus was present in the blood of women with puerperal fever and so the need for antiseptic techniques was widely accepted, to reduce the rate of death during childbirth [12]. Perineal care: Mild Analgesics are used to relieve discomfort from episiotomy or surgical incision.

Breasts care: If breast feeding is not given puerperal mothers may experience fullness of discomfort in breast in any time after delivery of the baby. Wearing a light fitting, supportive bra or breast binder will help. Ice packs may also be applied. It is important not to stimulate or pump nipple. This will only aggravated the problem. The discomfort will go away in approximately 36 hours. Bathing and follow-up care: Mothers are encouraged to take bath on 1st day onwards after delivery of the baby and also instructed to note frequency of urine and burning micturation, bleeding and when they find unusual symptoms they must go for the puerperal follow up after 6 weeks of vaginal delivery. Puerperal period is a crucial period, the infections are more common. It is mainly due to the absences of aseptic precautions during delivery and inadequate knowledge about the puerperal infections among the mothers especially Primi mothers.Based on the clinical experience and the supported literature the researcher had selected this topic, to bring an awareness among puerperal Primi mothers through structured teaching programme in order to promote the health status of mothers against post-natal infections. .

6.3 REVIEW OF LITERATURE.

Literature review is one of the major components of the research process. In this chapter, an attempt has been made to bring out the available literature, which helps in projecting the wide perspectives of the study.
I.

Literature related to Puerperal infection

II. Literature related to Causes of Puerperal infection

Literature related to breast infection Literature related to urinary tract infection Literature related to genital tract infection Literature related to thrombophlebitis Literature related to episiotomy infection Literature related to prevention of puerperal infection

I. Literature related to puerperal infection An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsis . A Retrospective cohort study of data from the washington state birth events record database for 1996. The relative risks for maternal rehospitalization association with cesarean or assisted vaginal delivery compared with spontaneous vaginal delivery. A total of 3149 women (1.2%) were rehospitalized within 60 days of delivery. Women with cesarean delivery (RR, 1.8: 95%) control (1.6-1.9) and assisted vaginal delivery (RR, 1.3: 95%) control (1.2-1.4). Results showed that women with cesarean and assisted vaginal deliveries were at increased risk for rehospitalization. The author concluded that the effective strategies for preventing and controlling peripartum infection should be an obstetrical priority[13].

A randomized controlled trial, among 443 women to assess the effects of high volume saline enemas Vs no enema during labour. Tertiary care referral hospital at the Javeriana University colombia. Results showed that the overall infection rate for newborns was 21% and 18% for women. There was no significant difference in puerperal or neonatal infections rates (Puerperal infection: 14/ 190 (22%)) with enema v 26/182 (14%) without enema. RR 0.66 CI95%: 0.43 to 1.03; neonatal infection 38/191 (20%) with enema V 40/179 (22%) without enema; RR 1.12, 95% CI 95% 0.76 to 1.66), the authors concluded that enemas will improve maternal and neonatal outcomes and provide an overall benefit[14]. An experimental study to verify the occurance of puerperal infection in the delivery and to compare the clinical obstetric characteristics of the women readmitted in the hospital with puerperal infection to those who were not readmitted in the hospital and received assistance in the delivery centre, from 2000 to 2003. The results demonstrated that among the 10,559 deliveries, 0.16% of their presented puerperal infection and the obstetric assistance given in the delivery was related to the puerperal infection, only when considering the duration of the Labour. The author concluded that the obstetric assistance given by this model of care brings benefits to the women[15].
II. Literature related to Causes of puerperal infection

Literature related to Breast infection

A randomized control trait to identify the difference in breast feeding frequency, infant weight gain, maternal anxiety. A total of 4385 women experienced vaginal singleton births during the study interval. A total of 1683 (38.4%) were assigned to the short stay programme.

Data from 259 dyads (88.7%) randomized to the experimental group were available for analysis of more outcomes with 252 (86.3%) providing data on breast feeding frequency. Data from 254 dyads (86.4%) randomized to the control group were available for analysis of 1 or more outcomes with 247 (84.0%) providing data on breast feeding frequency[16]. A randomized controlled trial (RCT). This is carried out in Alazahara Research and development center of clinical studies, to evaluate the effectiveness of a topical preparation of peppermint water in comparison with that of expressed breast milk for the prevention of nipple crack and the effectiveness is comparable with other remedies. The results showed that peppermint water-used group was associated with an increased duration and number of feeds, and less nipple pain compared to expressed breast milk [17]. Literature related to urinary tract infection An experimental study among 301 women to evaluate the incidence of bacteriuria following labour and identify risk factors predisposing to this condition. The study results revealed positive urine cultures were present on admission in 5.4% of women, 12.9% had a positive urine culture at discharge (P< 0.003). Bacteriuria was acquired during labour in 12.7% of patients who had negative cultures on admission. Number of digital vaginal examinations (P=0.04), recurrent bladder catheterization (P=0.05), duration of epidural anaesthesia (P=0.002) and vacuum delivery (P=0.02) correlated significantly with an increased risk for acquiring bacteriuria. The author concluded that labour is a bacteriuric event latrogenic interventions can predispose patient with sterile urine cultures to postpartum bacteria [18].
Literature related to thrombophlebitis

Thromboembolic events are a leading cause of maternal morbidity and mortality. The incidence of pulmonary embolism in pregnancy is between 0.09 and 0.7 per 1000 live births, and the incidence of venous thrombosis in pregnancy ranges from 0.5-3.0 per 1000 live births. The risk of venous thrombosis in women increases 5-fold during pregnancy, with any additional risk factors, this frequency increases further, untreated, as many as 24% of patients, with deep vein thrombosis will develop pulmonary embolism, resulting in approximately 13% mortality. In properly anti coagulated patients with deep vein thrombosis, pulmonary embolism occurs in 4.5% and mortality is reduced to less than 1%. Finally, women with a history of thromboembolic events are at an especially increased risk of recurrence when they become pregnant [19]. Literature related to genital tract infection: The wide-spread application of standard aseptic techniques during vaginal birth or termination of pregnancy. This article identified measure to aid in primary prevention and recognition of obstetric in order to facilitate early diagnosis and treatment[20]. Literature related to episiotomy wound infection A prospective cohort study in the admadu Bello university teaching hospital, Zaria, patients who underwent vaginal deliveries during 12 weeks period were followed up for six weeks in order to determine the distribution and determinants of episiotomy and its complication. The results showed that the episiotomy rate was 35.6% of all vaginal deliveries. Episiotomies were significantly associated with Primi gravidity being performed in 88.5% of all primigravida. The most common puerperal complication of episiotomies was perineal pain with the average of 5.5 days. Other complications included asymmetry (32.9%) infection (23.7%), partial dehiscence (14.5%), skin tages (7.9%), haemorrhage (5.3%) and extension of the incision

(1.3%) the complications were not significantly associated with any potential risk factors. Episiotomy rate was very high among primi gravida. The complication should be reduced by attention and needs to be given to adequate pain relief for all women who have had an episiotomy and the delivery repair interval in this unit should be reduced by provision of material for episiotomy repair in the delivery suite[21]. A prospective cohort study of 210 women, who underwent uncomplicated primiparous child birth, the relative effects of episiotomy, first or second degree perineal tears and delivery without tears are episiotomy on perineal pain and dyspareunia have been investigated. Accounting for the differences in pain level observed. While perineal pain in the first postpartum week is most likely following episiotomy, dyspareunia at 6 months in most frequently found in women having perineal tears. In comparison to the situation before pregnancy, for the total experimental patient population dyspareunia decreased. The study results revealed that decline in dyspareunia is most obvious for women whose perineum remained intact, less obvious for women with an episiotomy & abscent for women with a perineal tear [22]. Literature related to prevention of postnatal infection Importance of hand washing is rountinely acknowledged, a religious application of this practice still does not exist. Discussion in modern medicine on the subject of handwashing always states that, it is the single most important factor in preventing hospital acquired infection, Results showed that article continued the series on infection control and practical procedures by looking at the evidence that supports the above statement and discusses various handwashing methods and how to increase compliance to hand washing in the health care setting [23].

An experimental study among 3262 pregnant determine the effectiveness of an intervention that incorporated education about the six clean, with the use of a clean delivery kit in preventing puerperal sepsis. A total of 3262 pregnant women between the ages of 17 and 45 years were enrolled in the study. The study results revealed that village health workers administered questionnaires to each of the mothers at 5 days postpartum for signs of infection, women who used the kit for delivery puerperal sepsis, the women who did not bath, single use delivery kits [24].

6.4 STATEMENT OF PROBLEM.

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED - TEACHING PROGRAMME ON KNOWLEDGE REGARDING CAUSES AND PREVENTION OF PEURPERIAL INFECTION AMONG PRIMI MOTHERS OF SELECTED

MATERNITY HOSPITALS AT BENGALURU.

6.5

OBJECTIVES.

To assess the existing knowledge of Primi mothers on causes and prevention of puerperal infection

To assess the effectiveness of structured-teaching programme on causes and prevention of puerperal infection

To associate the pre-test and post test knowledge level with the selected demographic and obstetrical variables.

6.6 REASERCH HYPOTHESIS.

H1: There will be significant association between knowledge regarding causes and prevention of puerperal infection among Primi mothers and selected socio demographic variables. H2: There will be significant increase in level of knowledge on causes and prevention of puerperal infection after a planned teaching programme.

6.7

OPERATIONAL DEFINITION.

Effectiveness: It is the outcome of the structured-teaching programme identified with the help
of structured-interview schedule prepared by the investigator in terms of knowledge of Primi mothers regarding postnatal infection.

Structured teaching: It is a systematically organized, planned teaching programme on

prevention of postnatal infection.

Knowledge: Verbal response given by the Primi mothers regarding causes of puerperal
infection which is measured by the knowledge questionnaire.

Primi mothers: Mothers who had normal delivery with or without episiotomy for the first
time and got admitted in postnatal ward for a period of three days after delivery.

Causes: The factors that produces an effect or result in puerperal infections among Primi
mothers

Prevention: The precautionary measures for a Primi mother from puerperal infections. Puerperal infection: Refers to a group of infection affecting the breast, vagina, cervix
endometrium and urinary tract after the birth of the baby and also it alters the physiological and psychological status of the women.

6.8 ASSUMPTION.

Primi mothers are interested to know about the causes and prevention of postnatal infection and willing to attend the class and mothers have inadequate knowledge regarding causes of puerperal infection.

Primi mothers are in need of proper information regarding causes and prevention of puerperal infection.

DELIMITATION
Only 60 samples are including in this study.

 The study is limited to only assessment of knowledge regarding causes and prevention of

puerperal infection among Primi mothers.

Study is only limited to Primi mothers who were admitted in postnatal ward in KCG

hospital.

7. MATERIALS AND METHODS. 7.1. RESEARCH APPROACH.

The research approach for this study is evaluative approach.

7.1.1. SOURCES OF DATA.

The sources of data are from Primi mothers of selected maternity hospitals at Bengaluru.

7.1.2. RESEARCH DESIGN.

The research design selected for this study is one group pre-test and post-test.

7.1.3. SETTING OF THE STUDY.

The study will be conducted in selected maternity hospitals at Bengaluru.

7.1.4. POPULATION.

The populations of the study are the Primi mothers of selected maternity hospitals at Bengaluru.

7.1.5 SAMPLE.
The samples of the present study are Primi mothers of selected maternity hospitals at Bengaluru.

7.1.6. SAMPLE SIZE.

The sample size for the study is 60 Primi mothers of selected maternity hospitals at Bengaluru.

7.1.7 SAMPLING TECHNIQUE.

Purposive sampling technique will be used for the study to assess the knowledge regarding the causes of puerperal infections among Primi mothers of selected maternity hospitals at Bengaluru.

7.2 METHODS OF DATA COLLECTION.

The methods of data collection are by the structured teaching programme from Primi mothers of selected maternity hospitals at Bengaluru.

7.3 SAMPLING CRITERIA.

7.3.1

INCLUSION CRITERIA.

1. Primi gravida mothers who are willing to participate in the study. 2. Primi gravida mothers who are available during the time of data collection. 3. Primi gravida mothers who can read and write Kannada and English.

EXCLUSION CRITERIA:
1. Primi gravida mothers who undergone LSCS. 2. Primi gravida mothers who are having medical disorders.

7.4 TOOLS FOR DATA COLLECTION.

The tool which is used for the data collection is structured questionnaire.

7.5 DATA COLLECTION PROCEDURE.

Data collection is preceded after getting the permission from concerned authorities. Data will be collected by structured questionnaire. For each sample 15- 20 minutes will be spend for data collection.

7.6 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY?

NO

7.7 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE ABOVE

NOT APPLICABLE 8. LIST OF REFERENCE : JOURNALS.

1. Hamadeh, Ghassan, Dedmonm, Paul and Mozley, D. (1995). Postpartum fever,Journal

of American family physician, 52(2): 531.

2. Dawn, C.S. (2004). Text book of obstetrics, neonatology & reproductive & child health

education, 16th edition, published by Smt, Aratidawn. 3. Saude, M.D., Parto & Brasillia, D.F.(2001). Assistencia humanizada a mulher. Pueperal infection. 4. Ramanakumar, A.V.(2004). Reviewing Disease burden of rural indian women 2:1.
5. Ramanakumar, A.V. (2004). Reviewing disease burden of rural Indian women, Journal

of health allied science. 2:1.

6. Chavkin, W. (1993). Questionable category of non-maternal deaths. American journal of

obstetric gyneacology. 168: 1640-1.

7. Fortney, J.A., Smith, J.B., Bere, M. andRavindran, T.K.S. (1999). Reproductive health

matters critical issues, measuring maternal mortality. Journal of Perinatology.76: 1220.

8. Abouzahr, C. (2000). Reproductive health matters critical issues Measuring maternal

mortality. Journal of Perinatology 130-33.

9. Ravindran, S. and Berger, M. (1990). Reproductive health on alters critical issues,

preventing maternal mortality. 10. Koonin. (1985). United status, maternal mortality. 37: 19-29. 11. Maharaj&Dushyant. (2007). Department of obstetrics and gynaecology, willingston school of medicine.
12. Lewis, G., (2003). Reviewing maternal death the make motherhood safe. Journal of

Perinatology. 10: 11-14. 13. Mona Lydon Rochelle, M.P.H., Ph.D, CNM, Victoria, M.P.H., Ph.D, Diane, P., Martin, M.A., Ph.D, Thomas, R., Easteriling, M.D. (2000). Association between method of delivery and maternal Rehospitalization.2411-2416.
14. Luis, Maria & Natalia. (1997). Effects of high volume saline enema Vs no enema during

labour. Journal of Obstetrics and Gynaecology. 18: 45-50.

15. Nilce Xavier de Souza machado (2005). The puerperal infection in a delivery centre,

Journal of Perinatology. 58(11): 55-60.

16. Universidade de Sao Paulo, Ribeiraopreto. (2004). Common problems during lactation

and their management. Journal of Obstetrical &Gynaecology. 55:92-97.

17. Sofira, A.G.K. (2004). A comparison of topical agents to relieve ripple pain and enhance

breast feeding. Journal of Neonatology. 3: 27-30.

18. Tamar Elram. (2002). Labour as a bacteriuric event, assessment and risk factors. Journal

materla. Fetal medicine.

19. Rutherford, S.E., Phelan, J.P. (1986). Thromboembolic disease in pregnancy. Journal of

Perinatology. 13: 719-739. 20. Tarpe, N. (2001). Post pregnancy genital trait and wound infection, midwifery institute of Philadelphia university. 21. Sule St, Shittuso. (2006). Puerpal complications of episiotomies, Ahmadu Bello University Teaching hospital. 61(5): 651-6.
22. Weijmar Schultz, W.C.M., H.B.M., Van Dewiel, R., Heidemann, J.G., Aarnondse, H.J.,

Huisges. (1990). Perineal pain and dyspareunia after uncomplicated Primiparous delivery, journal of psychosomatic obst &gynec. 119-127.
23. Parker, L.J. (1999). Importance of hand washing. British Journal of Nursing. 716-720.

24. Winanis, (2003). Determine the effectiveness of an intervention that incorporated education about six cleans, 80(7): 351-6.

WEBSITES.

www.biomedcentral.com www.wikipediafreeencyclopedia.com www.medicine net.com

www.science direct.com www.pubmed.com www.about.com www.medicine.net www.themerck manual online medical library.com

Signature of the Candidate

10

Remarks of the guide

The topic selected by the researcher will enhance the knowledge regarding causes and prevention of puerperal infection among Primi mothers. Mrs. KAVITHA. D Asst. Professor Department Of OBG Sri Venkateshwara College of Nursing, Bangalore.

11. 11.1

Name and designation of Guide

11.2

Signature

11.3

Head of department

11.4

Signature

12

Remarks of Principal

GOOD

12.1

Signature