6. BRIEF RESUME OF THE INTENDED WORK.
INTRODUCTION
“The bearing and training of a child is a women’s wisdom”
- Tenny son
Pregnancy is an amazing journey. Every pregnancy is a unique experience for the women and each pregnancy the women experience will be new and uniquely different. It is a journey of dramatic, physical, psychological and social change of becoming a mother for the newborn child1.
Pregnancy is generally measured by weeks lasting 40 weeks or 266 days from conception. Knowledge about fetal growth and development has generally developed in the last 50 years. In human fetus the introduction of ultra sound and doppler has provided data about growth and development of fetus. More recently the availability of 3D ultra sound and magnetic resonance imaging has made possible the evaluation of growth and development of fetal organs2.
A web survey was done to find out why and how pregnant woman use internet as a health information source and overall affect it had in their decision-making. Data were collected using a valid and reliable web based questionnaire. 613 women from 24 countries participated in this study. The results shoes that 97% of women used google to access large variety of pregnancy related information. 94% of women used the internet to supplement information already provided by health professionals. 83% used it to influence the pregnancy decision- making3.
For many years it was believed that baby in the uterus was completely insulated from outside influences. Scientists now know that this is not true. Environmental influences ranging from radioactivity, stress, drugs, chemicals, hormones and viruses in the blood stream affect prenatal development4.
The family planning association of India advanced to include spacing and limitation of child birth, gives guidance to general marriage problems and helps in training of personnel and research. The maternal and child health2010 objectives are to reduce fetal and infant death, increase proportion of pregnant women who receive early and adequate prenatal care. Increase the proportion of pregnant women who attend a series of prepared child birth classes. Reduce preterm birth, increase abstinence from alcohol, cigarette, and drugs among pregnant women. Increase the percentage of healthy full term infants who are put down to sleep on their back. Increase the proportion of mothers who breast fed their babies5.
6.1) NEED FOR THE STUDY
“Child bearing is glorified in part, because women die for it”
- Andrea Dworkin
Motherhood is the dream of every mother from time of conception till delivery. The growth and development of the fetus takes place in the mother’s uterus without any contribution from the fetus. A little care taken from the moment conception is confirmed will make delivery healthy and safe6.
Maternal Mortality is said to be indicator of social in equality and discrimination against women. In 2002 WHO has launched an initiative to make pregnancy safer by prevention management of unwanted pregnancy, unsafe abortion and skilled care during pregnancy and the child birth7.
Antenatal education received by expectant mother’s results in sustained improvement in knowledge. A study was conducted from March –April 2008, in Vientiane Laos. A structured teaching programme on neonatal care among 101 women. Pre test and post test was conducted. On immediate post test 10% increase in knowledge noted8.
The prevalence of low birth weight is estimated to be 15%world wide with a range of 3.3 -3.8% and occurs mostly in developing countries. According to WHO African regions report, vision 2010 has taken in to account the aspects of nutrition including vitamin A and iodine supplementation, to reduce maternal morbidity and mortality which in turn promotes fetal development9
A study was conducted in Tanzania on effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. Data collected on 512 deliveries took place from October 2004-november 2006 by safe motherhood promoters, also 242 respondents were interviewed on safe motherhood issues. The results shows that deliveries with skilled assistant significantly increased from 34.1%-51.4% [p<0.05], Early antenatal clinic booking rose from 18.7%-37.7% [p<0.001].After 2 years 88% of the safe motherhood providers were still active,79% of pregnant women were visited, further benefits include the enhancement of male involvement in safe motherhood issues. The study has demonstrated the effectiveness of community- based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery10.
According to the researchers clinical and community experience, she found that many of the pregnant women have inadequate knowledge on fetal development. Improved Knowledge of pregnant women on fetal development promotes better practices of healthy behaviors and reduces anxiety. Thus the researcher wish to conduct a study to evaluate the effectiveness of a video assisted teaching on knowledge of fetal development among pregnant women in selected hospitals at Mangalore.
6.2) REVIEW OF LITERATURE
The Literature review is a written summary of the state of that existing knowledge on research problems. The sources selected to obtain more information on the selected topic are Medline, pubmed, internet search & journals.
LITERATURE RELATED TO
1. Fetal development
2. Importance of antenatal education
3. Effectiveness of video assisted teaching
LITERATURE RELATED TO FETAL DEVELOPMENT
A study was done on maternal indicators and obstetric outcome in the north Indian population. The objective of the study was to determine the effects of various maternal indicators on pregnancy outcome in north Indian women. A prospective study of all consecutive women with singleton pregnancy who were registered in the first 2 months of pregnancy and delivered in the hospital. Maternal indicators such as age, height, pregnancy weight, body mass index, hemoglobin and parity were correlated with pregnancy outcome. The result shows that a total of 2027were analyzed, maternal height, weight, BMI, and parity had a positive correlation with birth weight of the newborn. [r=0.081, p value<0.001, r=0.148, p value=<0.001, r=0.121, p=<0.001, and r=0.099, p=<0.001 respectively] . The rate of preterm delivery was significantly higher in women with hemoglobin <7g% and women with parity>3. The chance of caesarian section increased significantly with increase in maternal height, weight and BMI. The study suggests that a pre pregnancy weight of more than 40 kg, BMI of more than 19.8 and hemoglobin of 7g% or more favor good obstetric out come11.
A study was done on consanguinity and its effect on fetal growth and development, in Davengare, India . A total of 3700 consecutive live and stillbirths took place at three hospitals between November 1985 and March 1987. They were examined within 24 hours of Birth for evidence of congenital malformations, and their growth parameters such as weight /length /head circumference were assessed by standard anthropometricTechniques.5 Mothers were questioned about their obstetric history, parental consanguinity, and socioeconomic class. Social class was graded according to the classification of Prosad. The results shows that the total incidence of congenital malformations39 1/1000 births with a significantly higher incidence among the consanguineous group (8-01%)as compared with the non-consanguineous group(2-42%) (p<0-001.The incidence of malformations was higher in the uncle-niece mating (9-34%) as compared with the first cousin marriages (6-18%) (p<0-001). The study, in conjunction with certain other studies, shows that consanguinity has in all Probability, a deleterious effect on fetal growth and Increases the risk of congenital malformations and fetal loss12.
LITERATURE RELATED TO ANTENATAL EDUCATION
A Study was done on Antenatal Care and pregnancy outcome in Ghana, the importance of women’s education. The antenatal characteristics of 503 pregnant women attending maternal and child health clinics in Accra were studied to ascertain the influence of antenatal care on pregnancy outcome. Gestation age of first antenatal care attendance, duration of nutrients supplementation during pregnancy, infant birth weight and education in relation to seeking early antenatal care were studied. Sub samples of 128 were selected for a longitudinal study which assessed the monthly Hemoglobin concentration of pregnant woman. Results shows that level of education of the pregnant women was important in seeking early antenatal care. The average birth weight of infants delivered by the 503 pregnant women was 3.02 kg and the prevalence of low birth weight was 8.3%. Pregnant women who sought antenatal care before the end of the 3rd of month delivered infants whose birth weights were significantly better compared to those who sought care later. (3.08 vs 2.85 respectively, P<0.0001). Those who received antenatal care before the end of the 3rd month had on average 3.2 times (95% CI: 1.9-5.2, P<0.0001) better chance of giving birth to a normal weight infant. Pregnant women who received antenatal care and were on multivitamin and minerals supplements for more than 5 months had infants who weighed better than those who received care for lesser duration. Early antenatal care was associated with significant improvement in hemoglobin concentration (r=0.35, P<0.0001, n=128). It was concluded that early antenatal care is crucial to favourable outcome of pregnancy in this population13.
A descriptive study was done on socio economic and medical determinants of low birth weight in Iran. The main aim of the study was to describe socioeconomic and medical factors related to low birth weight in the context of free and universal access to primary health care. Data about socio economic, reproductive and prenatal condition of 4510 live singleton births from June to October 2004 were gathered using a standard questionnaire, by interview and record review. The effect of these conditions on birth weight was studied using a logistic regression model. The results shows that of 4510 newborns, 305[6.8%] were low birth weight, among this 159 preterm and 146 term newborns. Mothers with a primary and secondary education [odds ratio,OR6.83,95% confidence interval,2.35-7.34and OR4.81,,95%CI,1.95-6.37 respectively with a birth interval of 1year or less and height less than 155cm[OR`1.82,95%CI,1.12-3.31]were most likely to have low birth weight infants. The study suggests that policy makers should place more emphasis on education as it imparts knowledge and thus influences dietary habits, and birth spacing behavior14.
LITERATURE RELATED TO VIDEO ASSISTED TEACHING
A study was done on evaluating the benefits of a patient information video during the informed consent process. The aim of the study was to evaluate the effectiveness of a patient information video during the informed consent process of a perinatal trial. 90 women between 19-33 weeks of gestation were randomized to receive information through a video or to receive written information only .Participants completed a questionnaire immediately after entry and 2-4 weeks later assessing knowledge of, feelings about the worth of ,and willingness for future participation in the perinatal trial. when initially asked , more women who watched the video thought they would consent to the study [c2=6.3,df=1, p=0.01] No difference in knowledge about the perinatal trial were found initially but 2-4 weeks later more knowledge had been retained by women who had watched the video [c2=6.7, df=1, p=0.001] The study suggests that a patient information video combined with an information sheet may results in greater participation in a research trial and may increases women’s knowledge15.
6.3) STATEMENT OF THE PROBLEM
A study to evaluate the effectiveness of a video assisted teaching programme on knowledge of fetal development, among pregnant women in a selected hospitals at Mangalore.
6.4) OBJECTIVES
1) To assess the knowledge of pregnant women on fetal development.
2) To develop and administer video assisted teaching programme on fetal development among pregnant women in a selected hospitals at Mangalore.
3) To evaluate the effectiveness of the video assisted teaching programme on fetal development among pregnant women in a selected hospitals at Mangalore.
4) To find out the difference between experiment and control group knowledge score.
5) To find out the association between level of knowledge with demographic variables such as age, education, occupation , type of family , parity , place of living (urban/ rural) etc
6.5) OPERATIONAL DEFINITIONS
1) Evaluate: In this study it refers to measuring the worth of the study.
2) Effectiveness: In this study effectiveness refers to the extent to which the video assisted teaching helped the pregnant women to gain knowledge on fetal development.
3) Video Assisted Teaching Programme: In this study it refers to showing ultra sound pictures on a large screen .regarding fetal development.
4) Knowledge : In this study knowledge refers to the correct responses given by pregnant women to the questionnaire
5) Fetal development: In this study it refers to growth of baby in the uterus.
6) Pregnant Women: Women who carries offspring in her Womb.
6.6) ASSUMPTION
The Study assumes that:
· Pregnant Women may have inadequate knowledge on fetal development
· Knowledge of pregnant women on fetal development will improve fetal maternal attachment.
· Video assisted Teaching will improve knowledge of pregnant women on fetal
development.
· The increased knowledge will help the pregnant women to follow health behavior practice.
· The increased knowledge of pregnant women will help to reduce stress and anxiety which promotes health and well being of the fetus.
6.7) DELIMITATION
· The study will be limited to Pregnant Women admitted in a selected hospitals at Mangalore.
6.8) HYPOTHESIS
H1® Mean post test knowledge score on fetal development among Pregnant Women will be significantly higher than the mean pre-test knowledge score.
H2® There will be a significant difference between control group and experimental group post test knowledge score.
H3® There will be a significant association between level of knowledge of pregnant women on fetal development and their selected demographic variables such as age, education, occupation, type of family, parity urban or rural living area.
7. MATERIALS AND METHODS
7.1) SOURCE OF DATA:
Pregnant Women admitted in selected hospitals at Mangalore.
7.1.1) RESEARCH DESIGN
True experimental design- pretest post test control design
01 / X / 0203 / 04
Experimental Group – R .
Control group – R.
Key:
R® Randomization
01® Conduct Pretest to experimental group on knowledge of fetal development.
X® Video assisted teaching on fetal development to experimental group on the same day of Pre test.
02® Conduct post test on experimental group on 3rd day.
03® Administration of Pretest to control group.