Rajiv Gandhi University of Health Sciences s66

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

Mrs. SHAINI K.V.

First year M.Sc Nursing

Obstetrics and Gynaecological Nursing

Year 2009-2010

SJB COLLEGE OF NURSING

BANGALORE- 560060

1 RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE AND Mrs. SHAINI K.V. ADDRESS I YEAR M.Sc NURSING,

SJB COLLEGE OF NURSING

KENGERI

BANGALORE-60

2 NAME OF THE INSTITUTE SJB COLLEGE OF NURSING

KENGERI,BANGALORE-60

3 COURSE OF THE STUDY AND I YEAR M.Sc NURSING SUBJECT OBSTETRICS AND GYNAECOLOGICAL NURSING.

4 DATE OF ADMISSION 30th OCTOBER 2009

“ A study to assess the knowledge

5 TITLE OF THE STUDY regarding management and prevention of selected complications of pregnancy among expectant mothers attending antenatal clinic at selected PHC, Bangalore, With a view to develop an Information Guide Sheet”

6. BRIEF RESUME OF THE INTENDED STUDY: 2 6.1 NEED FOR THE STUDY:

“Pregnancy is special, let us make it safe.”

WHO 1998.

During pregnancy there is progressive anatomical and physiological changes not only confined to the genital organs but also to all systems of the body. This is principally a phenomenon of maternal adaptations to the increasing demands of the fetus.1

The primary aim of antenatal care is to achieve a healthy baby from the healthy mother at the end of the pregnancy. Ideally this care should begin soon after the conception and continue through out pregnancy. The antenatal care includes the regular and periodic examination and advices regarding diet, hygiene, rest and sleep, bowel, clothing, shoes and belt, dental care, care of the breasts, coitus, travel, smoking and alcohol, immunization and warning signs of pregnancy. Very essential is the early identification of complications. 2

Women in reproductive age group comprise 31.6% of total population in India. Reduction in maternal morality would require intervention to obstetrical services in life threatening situation.3

Poor health status of women in terms of high mortality and morbidity was one of the health priorities in India. India accounts for about one quarter of maternal deaths worldwide, showing an average maternal mortality ratio of 4.07 per 1000 and goals and target for 9th plan is 3 and for National Population policy 2010 is 1 per 1000.2

About 0.9% maternal deaths of total death occurred globally. India stands very high maternal mortality rate in the world having MMR 407 per 1, 00,000 live births (UNICEF 2004). Maternal mortality rate in Karnataka is 228 per 1, 00,000 live births. Karnataka has contributed 12.77% towards national maternal mortality rate, due to Anaemia and other associated dietary deficiency disorders in the year 2005.4

In India more than 1,00,000 women die each year due to pregnancy related cause, large number of home deliveries by un trained person, lack of adequate referral high MMR. Estimated MMR in Karnataka is 195 per 1, 00,000 live birth. The major causes of high 3 MMR were anaemia 19%, toxaemia 8%, bleeding 29%, abortion 9% puerperal sepsis 16%, obstructed labour 10% and other cases 9% Govt of India 2003.2

The hypertension disorders of pregnancy is obstetrical causes results in 13% and anaemia as non obstetrical indirect causes results in 20% of all maternal death. Preeclampsia is a disorder in pregnancy relating to hypertension with protein urea and edema can be detected by measuring blood pressure 140/90 mm Hg, and above, it can lead to eclampsia if untreated. It can be prevented by careful monitoring during pregnancy and treatment with relatively simple anti convulsive drugs in eclampsia.3

Nutritional deficiency during pregnancy has been associated with pregnancy wastage, congenital anomalies, pregnancy induced hypertension, premature rupture of membrane, placement, placental abruption, premature delivery still birth and low birth weight.5

Studies revealed that socioeconomic cultural factors influence dietary inadequacy during pregnancy which is attributed to purchasing power, illiteracy, ignorance regarding nutritive value of readily available cheaper food stuffs, cultural taboos, superstitions, large family etc.5

It was felt that maternal mortality rate and infant mortality rate from anaemia among pregnant women would not diminish until their knowledge, attitudes and practice were understood and brought more into line with the norms of modern obstetric care1

The central purpose of antenatal care is to identify high risk cases as early as possible from a large group of antennal mothers and arrange for them skilled care while continuing to provide appropriate care for all mothers. 2

With limited resources when mother has to be made safe is a big challenge to the modern obstetrics. Although many complications are unpredictable most deaths are preventable maternal mortality and morbidity can be reduced through good obstetric services which are fundamental to decrease fatalities from complications.5

In spite of many studies conducted earlier and in spite of many interventions, the maternal mortality and morbidity and perinatal mortality and morbidity rate is still high in India. During investigator’s clinical experience in maternity unit and in the community, 4 investigator has observed that many antenatal mothers attending antenatal clinic have very poor knowledge regarding early identification of complications of pregnancy. Hence considering the above factors investigator felt that assessing knowledge of antenatal mothers and providing relevant information regarding early identification of selected complications of pregnancy could help in reducing the maternal and perinatal mortality rates by preventing obstetrical complications.

6.2 REVIEW OF LITERATURE.

A cross-sectional study conducted on diet quality of pregnant women attending an antenatal clinic in Kenya among 716 pregnant women by estimation of nutrient intake using 24-hour dietary recall method. The result of this study indicate poor-quality micronutrients, nutrition education for dietary diversification and nutrient supplementation should be explored as interventions for improving nutrient intake of pregnant mothers.6

A study conducted on impact of simple health education programme about antenatal care on knowledge, attitude, subjective norms and intention of pregnant women in the University of Alexandria. The randomized post test only control design was used among 200 women attending maternal and child health centres. 100 women represented the intervention group who received a simple health education programme and other 100 women constituted the control group. The mean scores of indirect attitude, subjective norms, intention and practice were highest for the intervention and control groups among those having more than 12 years of education. The mean scores of indirect attitude increased with increasing level of knowledge among both the intervention and control groups. The mean scores of practice were highest among those having positive indirect attitudes among both groups. The mean scores of practice were highest among those having high indirect subjective norm either in both groups.7

A study Conducted on “Factors influencing pregnant women’s perceptions of risk in Canada” to explore the factors that women considers in determining their perceptions of pregnancy risk, the study explained that four major themes emerged that influenced

5 perceptions of risk for both groups-self image, history, healthcare and the unknown. Woman with no complications mentions potential risk that were diffuse & hypothetical.8

A study Conducted regarding “Iron supplementation in pregnancy in Turkey” to assess the importance of iron supplementation during pregnancy. The study revealed that pregnant women are at risk for iron deficiency and iron deficiency anaemia. Routine iron supplementation during pregnancy has been almost universally recommended to prevent maternal anaemia, to improve the maternal iron status in the puerperal even in women who enter pregnancy with adequate iron the iron status of infants. Postpartum routine iron supplementation during pregnancy seems to be a safe strategy to prevent maternal anaemia in developing countries where traditional diet provide in adequate iron.9

A study explained on “Complicated pregnancies: women’s perception of risk” to compare the perception of the risk of the women with complicated and uncomplicated pregnancies and to determine the relationship between bio medical, psychosocial, and demographic risk factors and women’s personal perception of pregnancy risk. Revealed that women with complicated pregnancies perceive there overall risk and risk for specific pregnancy out comes as significantly higher than women with uncomplicated pregnancies. Anxiety, bio medical risk were positively related to perception of risk. Nurse’s assessment of pregnant women should include discussion with her perception of risk.10

A study conducted on “Preeclampsia and its psychosocial sequelae” to describe psychosomatic condition in the setting of preeclampsia. Revealed that during development of the disease, she has to face a role change from a so for normal pregnancy to a high risk situation. This may change also the attitude to the unborn child by herself and her partner, the pre term delivery induced therapeutically together with the succeeding problems for the newborn complete the high psychosocial stress related to the entire situation.11

A study conducted on “Hypertension during pregnancy and infant’s health” to assess the prevalence of on classified hypertension during pregnancy and its consequences on infant’s health and to determine which blood pressure level should define hypertension.

6 The study revealed that a diastolic blood pressure of at least 95mm Hg, was a risk factor for poor pregnancy out come and those women were more likely to experience an adverse pregnancy (8%) out come at birth and at seven days post partum than those whose diastolic blood pressure was lower than 95 mg. Hypertension increased the risk of early neonatal mortality and associated with 10% of low weights and 8% of perinatal death.12

A study conducted on “Maternal and child health services in India with special focus on perinatal services” to evaluate the effectiveness of maternal and child health services. Revealed that India has an excellent infrastructural lay out for the delivery of maternal health services in the community through a network, but the health, pyramid does not function effectively because of limited resources communication delays, a lack of commitments on the part of health professionals a lack of managerial skill, supervision and political will. Under the child survival and safe motherhood programme (CSSM) a massive expansion of maternal and child health services as occurred, the reproductive child health program (RCH) launched in 1997 to improve the survival of both mother and their children.13

STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE KNOWLEDGE REGARDING MANAGEMENT AND PREVENTION OF SELECTED COMPLICATIONS OF PREGNANCY AMONG EXPECTANT MOTHERS ATTENDING ANTENATAL CLINIC AT SELECTED PHC, BANGALORE,WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET”

6.3 OBJECTIVES OF THE STUDY:

1. To assess the knowledge regarding prevention and management of selected complications of pregnancy among expectant mothers attending antenatal clinic.

2. To find the association between knowledge scores and selected demographic variables. 3. To develop and provide an information guide sheet.

6.3.1 HYPOTHESIS:

7 H1- Expectant mothers will have some knowledge about management and prevention of selected complication of pregnancy.

H2- There will be a significant association between knowledge scores of expectant mothers and selected demographic variables.

6.3.2 OPERATIONAL DEFINITIONS:

1. Assess: It refers to the process used to get information from the expectant mothers regarding prevention and management of selected complications of pregnancy.

2. Knowledge: It refers to the level of understanding of expectant mothers regarding prevention and management of selected complications of pregnancy as expressed by their correct responses to the items of the knowledge questionnaire.

3. Prevention: It is an action directed towards the avoidance of selected complication of pregnancy.

4. Expectant mothers: It refers to the pregnant mothers in attending 1st, 2nd, 3rd trimesters and attending antenatal clinic at selected PHC, Bangalore. 5. Antenatal clinic: It refers to the department of PHC devoted to the care of antenatal mothers. 6. PHC: Primary health centre refers to the Government health centre or agency which provides health services to the public in rural areas. 7. Information guide sheet: Refers to the concised, comprehensive information regarding prevention and management of selected complications of pregnancy.

8 7.0 MATERIALS AND METHODS:

7.1 Source of Data : Data will be collected from the expectant mothers attending antenatal clinic at selected PHC, Bangalore.

7.2 Method of Collection of Data : Structured interview schedule 7.2.1 Definition of the Study subject : Expectant mothers attending

Antenatal Clinic at selected PHC, Bangalore.

7.2.2 Inclusion and Exclusion Criteria a) Inclusion Criteria : 1. Expectant mothers who are attending Antenatal clinic at selected PHC, Bangalore.

2. Expectant mothers who are willing to participate in the study.

3. Expectant mothers who are present at the time of data collection. b) Exclusion Criteria : 1. Expectant mothers who are in labour.

2. Expectant mothers who are suffering from illness.

7.2.3 Research Design : Descriptive Research Design

7.2.4 Setting : Antenatal clinic at selected

9 PHC, Bangalore.

7.2.5 Sampling Technique : Purposive sampling technique.

7.2.6 a) Sample Size : The sample of the study consists of 50 Expectant mothers.

b) Duration of the Study : 30 days

7.2.7 Tools of Research : Structured Interview Schedule

Will be constructed by the investigator to collect the data. Tool consists of two parts.

Part I- Demographic data

Part II- Knowledge based questionnaire Regarding management and prevention of selected complications of pregnancy.

7.2.8 Collection of data : The investigator herself collects the data from 50 expectant mothers by using structured interview schedule.

7.2.9 Method of Data : 1) The investigator will use descriptive Analysis statistical techniques such as mean, median, mode, standard deviation and inferential statistics like Chi-square test and relevant statistical techniques. 2) The analyzed data will be presented in the form of tables, diagrams & graphs.

10 7.3 Does the study require any investigation to be conducted on patients or other human or animals? If so please describe briefly?

Yes, with prior consent the study will be conducted on Expectant mothers who are attending antenatal clinic at selected Primary health centre, Bangalore

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

 Yes, permission will be obtained from the concerned person and authority of the institution before the study.  Privacy, confidentiality and anonymity will be guarded.  Scientific objectivity of the study will be maintained with honesty and impartiality.

11 8. LISTS OF REFERENCES

1. Dutta DC. Text Book of Obstetric. 5thed. Calcutta: New central Book Agency; 2001. p. 100,105-6.

2. Park K. Preventive and social Medicine. 18thed. Jabalpur: Banarsidas Bhanot; 2007. p. 417,438.

3. Soumya Ramrao, Leila Caleb, Me Khan, J.W.Townsend. Safer maternal health in rural Uttar Pradesh, Do primary health services contribute? Health policy and planning. New York, 2001; 16(3):256-63.

4. Dr. Basavanthappa BT. Nursing Research. First edition. New Delhi: Jaypee Brothers publishers; 1998. p. 126-46.

5. Bennet V Ruth, Linda K Brown. Myles Text Book for Midwives. 11th ed. Livingstone publishers; 1989. p. 257,582.

6. Kamau-Mbuthia E, Elmadfa I. Diet quality of pregnant women attending an antenatal clinic in Nakuru, Kenya. Ann Nutr Matab [serial online] 2007 [cited on 2008 Nov 19]; 51(4): 324-330. Available from: URL: http;//www.google.com

7. Fetohy EM. Impact of simple health education programme about antenatal care on knowledge, attitude, subjective norms and intention of pregnant women. J Egypt Public health Assoc (serial online) 2004 (cited on 2008Nov 18); 79(3-4): 283-310. Available from; URL: http;//www.google.com

8. Heaman M, Gupton A, Gregory D. Factor’s influencing pregnant women’s perceptions of risk. MCN American Journal, Canada: 2004; 29(2): 111-6.

9. Mungen E. Iron supplementation in pregnancy. Journal of perinatal Medicine, Turkey, 2003; 31(5): 420-6.

12 10. Gupton A, Halman M, Cheung LW. Complicated and uncomplicated pregnancies women’s perception of risk. Journal of Obst. & Gyn. Neo. Nursing, Canada2001; 30(2):192-201.

11. Cignacco E, Laederach, Hofmann K. Preeclampsia & its psychosocial sequelae. Schweiz Rundsch Med. 1998; 87(33):1019-23.

12. Lang T, Delarecque E, Astagneau P, Le-schampfeleire I, Jeannee F, Salem G. Hypertension during pregnancy & Infants health in Africa Journal of Parinat Med. Paris. 1993; 22 (1):13-24.

13. Singh M, Paul V.K. Maternal and childe Health Services in India with special focus on perinatal services. Journal Of perinatal1997; 17(1):65-9.

13 9 Signature of Candidate

10 Remarks of the Guide The study is feasible and of genuine interest of the student 11 Name & Designation Of 11.1 Guide Mrs. ROSELINE REDDY, M. Sc (N) Professor Department Of Obstetrics and Gynaecological Nursing SJB College Of Nursing, Bangalore-60 11.2 Signature

11.3 Co-Guide Mrs. MANIMOZHI, M.Sc (N) Professor, Department of medical surgical Nursing, SJB College Of Nursing Kengeri , Bangalore-60 11.4 Signature

11.5 Head of the Department Mrs. ROSELINE REDDY, M.Sc (N) Professor Department Of Obstetrics and Gynaecological Nursing SJB College Of Nursing, Bangalore-60 11.6 Signature

12 12.1 Remarks of the Principal The topic for the study is relevant and forwarded for needful action. 12.2 Signature