SYNOPSIS PROFORMA FOR

REGISTERATION OF SUBJECTS FOR

DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME IN RELATION TO IRON AND FOLIC ACID DEFICIENCY AMONG EXPECTANT MOTHERS IN SELECTED P.H.C. AT TUMKUR”.

SUBMITTED BY:

MR. PRAKASH.H

FIRST YEAR M.SC. (NURSING)

(COMMUNITY HEALTH NURSING)

SHRIDEVI COLLEGE OF NURSING

TUMKUR- 06

2008-09

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-II

SYNOPSIS PROFORMA FOR REGISTERATION OF

SUBJECTS FOR DISSERTATION

  1. NAME OF THE CANDIDATE: MR. PRAKASH.H

1ST YEAR M.Sc (NURSING)

SHRIDEVICOLLEGE OF NURSING,

LINGAPURA, SIRA ROAD,

TUMKUR

2. NAME OF THE INSTITUTION :SHRIDEVICOLLEGE OF NURSING,

3. COURSE OF STUDY AND

SUBJECT :1ST YEAR M.Sc (NURSING)

COMMUNITY HEALTH NURSING.

4. DATE OF ADDMISSION

TO COURSE:14-06-2008

5. TITLE OF THE TOPIC:“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME IN RELATION TO IRON AND FOLIC ACID DEFICIENCY AMONG EXPECTANT MOTHERS IN SELECTED P.H.C. AT TUMKUR”.

6. BRIEF RESUME OF INTENTED WORK

INTRODUCTION:

The World Health Organization (WHO) has been concerned with the global problem of nutrional anemia for many years. The first FAO/WHO Joint Committee on Nutrition, meeting held in 1949, discussed the importance of nutrional anemia and recommended that funds should be provided for its study(Mothers care matters, 1999);the first research in nutrional anemia was sponsored in 1955 and the first international meeting was called in 1958. The WHO still has an important role to play in this field, encouraging the development of anemia control programs and providing advice and technical assistance to member countries.1

Anemia is a major cause of maternal death in India. In 1990, 19% of the maternal deaths were due to anemia. Iron deficiency anemia is a significant public health problem in India. National and regional surveys of anemia indicate that the problem could reach as high as 85% in expectant mothers in population groups.2

It has been estimated that iron deficiency costs India about 5% of its gross national product annually. According to a WHO estimation, about 80% of the world’s population likely to be suffering from iron deficiency. Recent analysis highlight the effect of severe anemia in accounting for up to 20% of maternal deaths in developing countries.1

The National Tenth Plan has set the goal of reducing the prevalence of anemia by 25% among pregnant mothers (Government of India.2002). National Programmes and institutional approaches are brought undertaken to achievethis goal. It is recommended that daily supplementation with 4mg of folic acid be started at least one month before conception and continued through the first trimester.3

6.1 NEED FOR THE STUDY:

Anemia affects over 700 millions people of world wide, causing tiredness, poor quality of life and low productivity. For the pregnant woman, anemia can be particularly devastating, if she is severely anemic (<79/dl), it can lead to still birth or low birth weight for the baby and death for the woman. Most of the maternal complications result from a Iron and Folic Acid deficiency.4

Nutritional anemia, due to Iron and Folic Acid deficiency, is directly or indirectly responsible for about 20% of maternal death. Promoting the consumption of Iron and Folic Acid supplements are very essential for expectant mothers during prenatal period.5

In India, Iron and Folic Acid tablets are supplied free to expectant mothers. They do not take them properly, due to lack of knowledge and the idea that if they consume IFA tablets, the color of the stools will be changed as a black and causes diarrhea and their babies will become big and lead to complications during delivery.

Since the investigator had worked in the field of community health nursing, has experienced the following about the knowledge of intake of IFA tablets that is they are not in favor of taking tablets due to their traditional beliefs and taboos, not confident as related to IFA and its uses, forgetfulness and negligence.

For the above reason, the investigator personally felt that there is a need to assess the knowledge of expectant mothers regarding Iron and Folic Acid deficiency during pregnancy and need to take suitable measures to correct or prevent Iron and Folic Acid deficiency by providing Structured Teaching Programme.

6.2 REVIEW OF LITERATURE:

A purpose of review of literature is to obtain comprehensive knowledge base and in department of information previous studies.

  1. Gillian Lindzon; et al. (2007) conducted a study on Folic Acid fortification during reproduction. The United States mandated the addition of Folic Acid to white flour and select grain products to increase the folate intake of reproductive – aged women. Subsequent to this initiative there has been an increase in blood folate concentrations in Canada and a 50% of reduction in Neural Tube defects. Many countries, including Korea, have not mandated Folic Acid fortification of their food supply. Reasons vary but often include concern over the masking of vitamin B12 deficiency, a belief that folate intakes among women are adequate, low priority relative to other domestic issues, and philosophy that individuals have the right not to consume supplemental Folic Acid if they so choose. Prior to Folic Acidfortification of the food supply in Canada, the folate intakes of women were low, and their blood folate concentrations while not sufficiently low to produce overt sign of folate deficiency (E.g. Anemia) were inconsistent with a level known to reduce the risk of a NTD affected preganancy.6
  1. E.N. Shu and S.O. Ogbodo (2005) conducted study on rule of Ascorbic Acid in the prevention of Iron deficiency anemia in pregnancy. A total of 74 pregnant women aged between 18 -42 years were recruited for the study. Also 20 age matched non- pregnant women who were not in their menstrual periods at the time of study were used as control subjects. Blood sample collected from each subject was analyzed for hematological and biochemical parameters. Results showed that 62(83.8%) of the pregnant women were anemic. Then they came to conclusion that Ascorbic Acid plays an important role in intestinal absorption of Iron, especially in low levels of serum Iron.7
  1. ParulChristian, et al. (2003) conducted a study on effects of alternative maternal micronutrient supplements on low birth weight in south eastern Nepal at rural community. The objective of the study was to assess the impact on birth size and risk of low birth weight of alternative combination of micronutrients given to pregnant women. Double blind cluster randomized controlled trial design was used. The sample size was 4926 pregnant women and 4130 live born infants. 426 communities were randomizedto five regimens in which pregnant women received daily supplements of Folic Acid, Folic Acid Iron, Folic Acid Iron – zinc, or multiple micronutrients all given with vitamin- A, or vitamin –A alone (control).

The result was supplementation with maternal Folic Acid alone had no effect on birth size. None of the supplement combinations reduced the incidence of preterm births. Then they concluded that Antenatal Folic Acid Iron supplements modestlyreduce the risk of low birth weight. Multiple micronutrients confer no additional benefit over Folic- Acid-Iron in reducing this risk.8

  1. RoshnyGeorge., (2001) conducted a study regarding Iron deficiency anemia and it was revealed that the lack of knowledge by the women of reproductive age group. The findings of the study showed that, these women had inadequate knowledge regarding Iron deficiency itself leads to anemia.9
  1. Rasmussen., (2001) conducted an extensive study to identify whether Iron deficiency anemia and anemia from any cause are causally related to low birth weight, pre-term birth or perinatal mortality. Supplementation of anemic or non-anemic pregnant women with Iron and Folic Acid or both does not appear to increase either birth weight or the duration of gestation.10
  1. Van-den-Brock, et al. (2000) conducted a study to determine prevalence of anemia in pregnancy in southern Malawi, and to establish if an
    ‘At risk’ group can be identified for targeted intervention. The design of the study was prospective cross –sectional. This study was conducted in semi –urban hospital and a rural health clinic in southern Malawi. The population pregnant women attending the antenatal clinic for their booking visit. And they concluded that prevalence of anemia in pregnancy in our population is unacceptably high and deserves more attention. Prophylaxis of all women rather than an ‘At risk’ group based on age or gravidity is recommended.11
  1. Nelly Zavaleta, et al.(2000) conducted a study to describe the effect of Iron supplementation on hematologic changes during pregnancy, and the effect on those changes of adding Zinc to the supplements. Pregnant women were enrolled in randomized, double –masked study conducted at a hospital in a shantytown in Lima, Peru. Women were supplemented daily from 10-24 wk gestation to 4 wk postpartum with 60 mg Fe and 250 µg Folic Acid with or without 15 mg Zn. Hemoglobin and ferritin concentration were measured in 645 and 613 women, respectively at enrollment, at 28-30 and 37-38 wk gestation, and in the cord blood of 545 neonates.

The result was no difference in Iron status were detected by supplement type, but hematologic changes were related to initial hemoglobin status. Then they concluded that these hematologic changes are congruent with the effects of Iron supplementation reported in Placebo – controlled trials and addition of zinc did not significantly affect them.12

  1. Dreyfuss. et al.,(2000) conducted a study and stated that, Malaria is one of the cause of anemia in pregnancy. The study objective was to identify the cause of anemia. 336 pregnant women were assessed. The findings of the study revealed that, 19.8% anemic women had plasmodium parasitaemia.13
  1. Abel. et al.,(1999) reported that their study aimed at reducing the prevalence of Iron and Folic Acid deficiency in pregnancy by using Iron and Folic Acid supplementation and providing information, education and communication. They obtained maternal serum ferritin and Folic Acid level from 471 women. The findings of the study revealed that 39.2% of anemia due to Iron and Folic acid defficiency.14
  1. Thomson., (1997) conducted a study on anemia in pregnant women, in Eastern Caprivi, Namibia describes the prevalence, character and possible etiology of anemia in the study region. A cross- sectional study was designed. It was revealed the effects on hemoglobin concentration of age, trimester, parity, residential area, socio-demographic factors, malaria, Parasites, diet, vitamin deficiencies and mineral supplementation and there was a significant risk of their being Iron deficient.15

STATEMENT OF THE PROBLEM:

“A study to assess the effectiveness of Structured Teaching Programme in relation to Iron and Folic Acid deficiency among expectant mothers in selected PHC at Tumkur”.

6.3. OBJECTIVES OF THE STUDY:

  1. To assess the knowledge of expectant mothers regarding Iron and Folic acid deficiency.
  2. To develop a Structured Teaching Programme to educate the expectant mothers regarding Iron and Folic Acid deficiency.
  3. To evaluate the effectiveness of the teaching programme before and after the test.
  4. To suggest the findings for recommendations in implementation of IFA programmes.

6.4. OPERATIONAL DEFINITIONS:

  1. ASSESSMENT: In this study it refers to organized, systematic and continuous process of collecting data about pre test and post test knowledge from expectant mothers regardingIron and Folic Acid deficiency.
  1. EFFECTIVENESS: It refers to gain in knowledge as determined by significant difference in pre and post test knowledge scores.
  1. STRUCTURED TECHING PROGRAMME : It refers to organized group teaching, based on the objective, criteria check list, literature reviewed and openion from experts.For 45min lecture/discussion method to impart knowledge of expectant mothers regarding IFA deficiency (Various aspects of IFA deficiency, such as meaning, cause, signs and symptoms, effects, its prevention).

4. KNOWLEDGE: It refers to the correct responses of expectant mothers to the items listed in the structured interview schedule regarding meaning, causes, signs and symptoms, effects and prevention of Iron and Folic Acid efficiency.

5.IRON AND FOLIC ACID DEFICIENCY : Iron refers to one of the mineralsFolic Acid refers to one of the water soluble vitamin. Iron and Folic Acid deficiency refers to nutritional disorder caused by deficiency of Iron and Folic Acid.

6. EXPECTANT MOTHERS: It refers to all pregnant mothers who are participating in the pre test, Structured Teaching Programme and post test in selected Primary Health Centre area.

6.5. RESEARCH HYPOTHESES:

H1: There will be a significantdifference between the pre-test knowledge scores and post –test knowledge scores regarding Iron and Folic acid deficiency among expectant mothers.

H2: There will be a significant association between the post test knowledge scores regarding Iron and Folic Acid deficiency with selected demographic variables, such as age, sex, religion, educational status,
occupational status, and the health teaching available in area.

6.6. ASSUMPTIONS:

  1. Knowledge of the expectant mothers on Iron and Folic Acid deficiency will influence the the consumption of IFA during pregnancy.
  2. Structured Teaching Programme will enhance the knowledge of expectant mothers regarding Iron and Folic acid deficiency.
  3. The nurse has an important role in imparting education and assessing the knowledge about Iron and Folic Acid deficiency among the expectant mothers.

6.7.DELIMITATIONS OF THE STUDY:

The study is limited to expectant mothers who will be

belonging to selected Primary Health Centre at Tumkur.

available during the period of data collection from the selected area.

willing to participate in the study.

below 36 wks of pregnancy.

able to understand Kannada.

6.8. PILOT STUDY:

Pilot study will be conducted with 10% of the total samples. The purpose is to find out the feasibility for conducting the main study and modification of tool if needed. The findings of the pilot study will be included in main study.

6.9. VARIABLES:

Variables are the concepts at various level of abstraction that are entered, manipulated and collected in a study.

  • INDEPENDENT VARIABLE : Structured Teaching Programme.
  • DEPENDENT VARIABLES : Knowledge,, marital status, religion, educational level, occupation, total family income, total family members, gestational period, spacing of pregnancy and source of Health awareness.

7. MATERIAL AND METHOD:

In this study one group pre and post –test design will be used. The study is designed to assess the effectiveness of Structured Teaching Programmein relation to Iron and Folic Acid deficiency among expectant mothers in selected PHC at Tumkur.

7.1. SOURCE OF DATA:

The data will be collected from expectant mothers in selected PHC at Tumkur.

  1. Primary Source – The data will be collected originally from the expectant mothers by the investigators in a selected villages attached to the PHC area f Tumkur.
  2. Secondary Source – The data will be collected from research articles already carried out by other researches.

.

7.1.1. RESEARCH DESIGN:

Qusiexperimental design- one group pre-test and post-test design will be chosen for the study.

7.1.2. RESEARCH APPORACH:

I Phase - The demographic data will be collected from the expectant mothers in
a selected area of PHC at Tumkur.

II Phae – Pre-test questionnaire will be distributed to the expectant mothers or by
interview technique.

III Phase –Implementation of STP

IV Phase –After a week the same questions will be given to assess the post test
knowledge.

7.1.3. RESEARCH SETTING:

A few villages will be selected and expectant mothers will be interviewed
according to the selection of samples.

7.1.4. POPULATION:

The Target population of the study consist of 100 expectant mothers in selected PHC and its subcenters at Tumkur.

7.2. METHOD OF DATA COLLECTION:

The data collection procedure will be carried out for a period of 3 months.

The study will be conducting after obtaining permission from the concerned

authorities.

PART I: It deals with demographic characteristic of samples expectant mothersseeking information such as age, religion, educational level, martial status, occupational status, total family members, total family income, number of pregnancies, gestational period, pregnancy spacing and source of health awareness.

PART II: It deals with multiple choice questions about IFA deficiency such as meaning, causes, signs and symptoms, its effects on Iron and Folic Acid deficiency, and total prevention of Iron and Folic Acid deficiency.

7.2.1. SAMPLING PROCEDURE:

Multistage cluster sampling techniques will be used.

7.2.2.SAMPLE SIZE:

The sample of the study consists of 100 expectant mothers selected form selected PHC at Tumkur.

CRITERIA FOR SAMPLE SELECTION

7.2.3.INCLUSIVE CRITERIA:

All expectant mothers who will be

  1. belonging to selected PrimaryHealthCenterareas at Tumkur.
  2. below 36 wks of pregnancy.
  3. willing to participate in the study.
  4. able to understand Kannada.
  5. present during the period of data collection.

7.2.4.EXCLUSIVE CRITERIA:

Expectant mothers who are

  1. not willing to participate in this study.
  2. not available at the time of data collection.
  3. not able to undertsant Kannada.
  4. not below 36 wks of pregnancy.

7.2.5.INSTRUMENT:

A Structural interview questionnaire study will be used to assess the knowledge of expectant mothers, regarding Iron and Folic Acid deficiency.

7.2.6.DATA ANALYSIS PLAN:

The data will be analysed by using descriptive and inferential analysis

  1. Descriptive Statistics: Frequency, Mean, Mean percentage and Standard Deviation will be used to describe the demographic variables.
  1. Inferential Statistics: Paired ‘t’test to compare the score and chi-square
    testwill be used to find out the association between selected variables.

7.2.7.TIME AND DURATION:

Time and Duration of the study will be according to the research committee.

7.3.DOES THE STUDY REQUIRES ANY INVESTIGATION OR INTERVETION TO BE CONDUCTED ON PATIENT OR OTHER HUMENS OR ANIMALS?

Yes, the study will be conducted on assessment of knowledge on Iron

and Folic Acid deficiency among expectant mothers.

7.4. ETHICAL CLEARANCE:

The pilot study and the main study will be conducted after the approval from the research committee.Permission will be obtained from the concerned authorities of the selected PHC at Tumlur. The purpose of the study will be explained to the study subjects and an informed consent will be obtained from them. Assurance will be given to the study subjects on the confidentiality and anonymity of the data collected from them.