RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (in block letters) / MS. SARA MARY JYRWAI YEAR M. Sc. NURSING
MASOOD COLLEGE OF NURSING
BIKARNAKATTA, MANGALORE
2. / Name of the Institution / MASOOD COLLEGE OF NURSING
BIKARNAKATTA, MANGALORE
3. / Course of Study and Subject / M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / Date of Admission to the Course / 30.6.2008
5. / Title of the study
A STUDY TO ASSESS THE KNOWLEDGE AND RISK FACTORS OF ANAEMIA AMONG THE ANTENATAL MOTHERS ATTENDING ANTENATAL CLINIC, MANGALORE.
6. / Brief resume of the intended work
6.1 Need for the study
Anaemia is a health problem of global dimension particularly in women in the reproductive age group. Anaemia is a significant maternal problem during pregnancy. Pregnancy makes considerable nutritional demands on the mother. As a consequence anaemia is very common. The presence of anaemia in pregnancy increases morbidity and mortality of the mother and foetus.1
National Institute of informatics report, specify that, Africa and South Asia have the highest overall incidence of anaemia followed by Latin America and East Asia. Among all pregnant women, 56% women are anaemic in developing countries compared to 18% in developed countries. The global burden of maternal deaths due to anaemia is over five lakh every year. India accounts for about 1.2 lakh annually, and for over 80% of deaths due to anaemia in South Asia 2.According to National Family Health Survey, India has the highest number of cases of anaemia (56.2%) in the world. In Delhi 43.4% of women between ages of 15-49 years were anaemic. 3 In Andhra Pradesh 72% of married women were anaemic, and Karnataka reported the highest percentage (59.5%) of anaemic pregnant women in the age of 15-49 years which is second ranked after Andhra Pradesh.4
Anaemia in pregnancy is an important public health problem worldwide. Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased due to physiological burden of pregnancy5. Anaemia ranges from mild, moderate to severe and the WHO pegs the haemoglobin level for each of these types of anaemia in pregnancy at 10.0 – 10.9g/d1 (mild anaemia) 7 – 9.9g/dl (moderate anaemia) and < 7g/dl (severe anaemia).6
A study was conducted to determine the prevalence of anaemia in pregnancy in Abeokuta, Nigeria receiving antenatal care in two hospitals and a traditional birth home in order to obtain a broader prevalence data was enrolled in the study at their first antenatal visit. 365 (76.5%) of the women were anaemic at one trimester of pregnancy or another. Anaemia was more prevalent among primigravida (80.6%) than the multigravida (74.55%).211 women( 57.8% )had moderate anaemia, while 147 women had mild anaemia (40.35%), seven women were severely anaemic (1.9%) and all were under 30 years old. However, in all the antenatal centres more women were anaemic in the second trimester of pregnancy. Absence of symptoms of ill health was the major reason for late antenatal booking. Anaemia was higher among unemployed women. Educating women on early antenatal booking is necessary to reduce the problems of anaemia in pregnancy. 7
A large majority of Indian women are illiterate or have little formal education. Informal channels like newspaper, radio, TV, etc. can plan a big role in making them aware about their health. But in India, two fifths of women are not regularly exposed to any mass media.8
The study was conducted to determine consumption patterns, dietary quality, health status of expectant women and to assess their level of awareness of nutritional requirements during pregnancy revealed that although the majority of the respondents (83.3%) had some knowledge on nutrition but all were not applying in their feeding practice because of financial constraints.9
The risk factors of anaemia are dietary habits, faulty absorption mechanism and iron loss, excessive blood loss during menstruation, hook – worm infestation, chronic malaria, and chronic blood loss due to bleeding piles. The other factors are increased demand of iron, diminished intake of iron, socio – economic factors, loss of appetite, excessive vomiting in pregnancy, disturbed metabolism, abnormal demands like multiple pregnancy, teenage pregnancies, maternal illiteracy, malnutrition, unemployment, primigravida and multigravida.10
Maternal nutritional status and haemoglobin levels are well known and considerable risk factors for both mother and baby.11 Maternal anaemia results in 12% to 28% of foetal loss, 30% of perinatal deaths and seven to ten percent of neonatal deaths. Anaemia during the second trimester is associated with preterm birth. Preterm delivery is increased five fold in anaemia. Effect of anaemia is also associated with increased risk of foetal hypoxia, intra uterine growth retardation (IUGR), prematurity and postpartum haemorrhage.12
A descriptive analytical study was preformed to evaluate the knowledge and practice of pregnant women in Fars province about supplements containing iron intake. Data were collected by a questionnaire, including their demographic information and questions about the importance and method of consumption, unused complications and the method of iron table intake, completed by face to face interview using simple non random sampling method in 2997 pregnant women of urban and rural areas. It was found that 75.9% of pregnant women were aware about the reason of iron supplementary use during pregnancy, 86.3% knew the method of administration and 91% used supplements containing iron after fourth month of pregnancy.13
The nurse has a major role in identifying the prevalence of anaemia, knowledge and risk factors of antenatal mothers. From the personal experience of the investigator it was found that there was non adherence with iron and folic acid therapy saying “forgot to take tablets”. It was felt that it may be due to lack of motivation resulting from lack of information or misconception about beneficial effects of iron and folic acid therapy. Hence, the investigator felt a need to study the knowledge and risk factors of anaemia in pregnant women.
6.2 Review of literature
A prospective study was conducted on “Severe anaemia during pregnancy in Kisumu District of Kenya: Prevalence and risk factors”, a region characterized by high incidences of maternal and infant mortality, to determine the levels and prevalence of maternal complications. Four health facilities were purposely selected to act as sentinel centres from urban and rural clusters. A total of 1,455 cases were recorded of which 59% experienced obstetric related complications. Of those with complications, 22% were suffering from severe anaemia. The study reveals that anaemia prevalence is determined by maternal and environmental factors. Factors include poor pregnancy care, illness during pregnancy, socio-economic conditions of the mother and the sanitary conditions of the household. Therefore, study suggested that policy measures aimed at managing anaemia should seek to address all these factors.14
A cross – sectional study was conducted in Rufiji rural district, coastal Tanzania. Three hundred and seventy nine pregnant women were enrolled to assess the quality of antenatal care with respect to anaemia, a common health problem in a developing country. The prevalence of anaemia and severe anaemia was 58% and 6.2% respectively, but overall only 4% of the anaemic pregnant women had specific action taken within the antenatal care program. The study suggested that deficiencies in individual counselling need to be addressed before any impact of the antenatal care programme on anaemia15
A study was conducted to determine the prevalence of anaemia among pregnant Nepali women in Kathmandu. The distribution of haemotocrit in 2280 pregnant women attending Patan Hospital, for their first antenatal visit in a 12 period was studied. The prevalence of anaemia and severe anaemia were 62.2% and 3.6% respectively. High prevalence of anaemia was observed among teenagers, farmers, women of short height, the ethnic groups and women married to industrial workers or illiterate men. Also, the risk of anaemia was increased with gestation. Study revealed that more than half of the pregnant women in Nepal are suffering from anaemia.16
A pilot study conducted on fertility pattern in anaemic and non- anaemic pregnant women revealed that 73.80% out of 271 pregnant women were anaemic. In that 200 (73.80%) had haemoglobin level less than 11 gm/dl, 185(42.5%) of the anaemic women were married between 15-19 years of age. The mean age at marriage for the anaemic and non-anaemic women was 20.83 years and 22.05 years respectively. Among the 200 anaemic pregnant women, 98 (49%) had one or more living children (multigravida) and 102 (51%) were primigravid, whereas 71 non-anaemic pregnant women 65 (83.33%) were multigravida and six were primigravida. Thus, the statistically significant difference in the age at marriage between the two groups suggests that early marriage and conception may be related to low haemoglobin levels in pregnancy.17
A study was conducted on community – based study to identify, “Can iron status be improved in each of the three trimesters”? in Vellore District. Iron supplementation and deworming were provided to all pregnant women from the fourth month of their pregnancy. An intensive information, education and communication was carried out with facts on anaemia and diet modification to each pregnant women, using a one to one approach in the community and a group method in the mobile clinics. A significant decrease in the prevalence of anaemia was found from 56% to 25.07% (p<0.001), 73.4% to 49.2% (p<0.001) and 68.8 % – 56.8% (p<0.001) among women in the first, second and third trimesters respectively. In the intervention area significant (p<0.001) increases in the mean haemoglobin of 0.85 g /dl (95% 10.18 – 10.84, 11.09 – 11.63), 0.59 g/dl (95% 9.98 – 10.34, 10.55 – 10.95) and 0.36g/dl (95% 9.93 -10.33, 10.25 – 10.73) were also observed in each of the groups. Study concluded that iron supplementation and deworming is necessary for pregnant women. 18
6.3 Statement of the problem
A study to assess the knowledge and risk factors of anaemia among antenatal mothers attending antenatal clinic, Mangalore.
6.4 Objectives of the study
1. Determine the knowledge of antenatal mothers on anaemia attending antenatal clinic
2. Identify the risk factors of anaemia among antenatal mothers attending antenatal clinic.
3. Find the association with the knowledge and selected demographic variables.
4. Find the association between the risk factors of anaemia and selected demographic variables.
6.5 Operational definitions
1. Knowledge
In this study, it refers to the verbal responses given by mothers to the items in the structured interview schedule on anaemia.
2. Risk factors
In this study, risk factors refers to those factors contributing to maternal anaemia such as dietary habits, teenage pregnancy, parity, spacing, excessive vomiting during pregnancy, loss of appetite, excessive blood loss during menstruation, chronic malaria, bleeding piles, under nutrition, lower socio – economic status, illiteracy, unemployment and lack of knowledge.
3. Anaemic mothers
In this study, anaemic mothers refers to antenatal mothers both primigravida and multigravida of first and second trimesters whose haemoglobin of below 10gm% mentioned in the patient’s case report.
6.6 Assumptions
1. The antenatal mothers will have some knowledge regarding anaemia.
2. There are nutritional and systemic factors which contribute to the occurrence of anaemia.
6.7 Delimitations
1. Antenatal mothers of first and second trimesters both primigravida and multigravida attending antenatal clinic.
2. Antenatal mothers with haemoglobin less than or equal to 10gm%
6.8 Projected outcome (Hypothesis)
H1: There will be significant association between the knowledge of antenatal mothers and selected demographic variables.
H2: There will be significant association between the risk factors of the antenatal mothers and selected demographic variables.
7. / Material and Methods
7.1 Source of Data
Antenatal mothers belonging to first and second trimesters with haemoglobin less than or equal to 10gm% attending antenatal clinic , Mangalore.
7.1.1 Research Design
Descriptive survey research design will be used for the present study.
7.1.2 Setting
The study will be conducted in having antenatal clinic at Mangalore.
7.1.3 Population
Antenatal mothers of first and second trimesters both primigravida and multigravida with haemoglobin less than or equal to 10gm% attending antenatal clinic.
7.2 Methods of data collection
7.2.1 Sampling procedure
Sample for the present study will be selected by purposive sampling technique.
7.2.2 Sample size
In this study the sample size will be 60 antenatal mothers belonging to first and second trimesters both primigravida and multigravida with haemoglobin less than or equal to 10 gm% attending antenatal clinic.
7.2.3 Inclusion criteria
1. Antenatal mothers of first and second trimesters both primigravida and multigravida with haemoglobin less than or equal to 10gm% attending antenatal clinic , Mangalore.
2. Antenatal mothers who are willing to participate and available during the period of data collection.
7.2.4 Exclusion criteria
1. Antenatal mothers with both medical and obstetrical complications.
7.2.5 Instruments intended to be used
Tool I: Structured interview schedule will be used, which consists of two sections:
Section A: Demographic proforma.
Section B: A structured knowledge questionnaire will be used to determine the
knowledge of the antenatal mothers regarding anaemia.
Tool II: A checklist will be used to identify the risk factors of anaemia in antenatal mothers.
7.2.6 Data collection Method
Prior to data collection written permission will be obtained from the hospital authority concerned for conducting the study as well as from the sample with assured confidentiality. Knowledge will be assessed by using a structured knowledge questionnaire by interview technique. Risk factors will be identified by the risk factor check list. The total duration of the study will be one month.
7.2.7 Data analysis plan
The data will be analyzed using both descriptive and inferential statistics.
Descriptive statistics: the descriptive statistics such as frequencies, percentage, mean, mean percentage, and standard deviation will be used and data will be presented in the form of tables and diagrams.
Inferential statistics: Chi-square test will be used to find the association between demographic variable with knowledge of the antenatal mothers and also risk factors with demographic variables.
7.3 Does the study require any investigations or interventions to be conducted on patients or other human or animals? If so, please describe briefly.
Yes, conducting structured interview for antenatal mothers regarding knowledge and risk factors of anaemia.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance will be obtained from the concerned authority for conducting study as well as from the sample prior to the study.
8. / List of references
1. Perry ES, Lowdermilk DL. Maternity and women’s health. London: Mosby Yearbook; 2004:628-9.
2. Special correspondent. Tamil Nadu/Chennai News: Anaemia continues to affect pregnant women. Available from: URL:http://www.hindu.com/2008/09/06/stories/2008090653641000
3. Sivanandan TV. Karnataka – Gulbarga: Health of children, women, poor in State. The Hindu online edition of India’s National Newspaper Nov 10, 2008.PDA version.
4. Anaemia a huge problem in India: National Survey. Available from: URL:http://socialjustice.ekduniya.net/Infocus/document 2007 05-11-98101.
5. Van den Broek, N. The Cytology of Anaemia in Pregnancy in West Africa Tropical Doctor. 1996;26:5–7.
6. World Health Organization, author. Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care. WHO Publications; 1989 Aug. (1989).
7. Idoure OA, Mafiana CF, Sotiloye D. Anaemia in pregnancy: A survey of pregnant women in Abeokuta, Nigeria. Journal Afr Health Science 2005 Dec;5(4):295-9.
8. Singh Ibohal, Lahiri Ramansu, and Singh Damodar N. Health care information for women and children: a case study of north eastern states. 2000 (140-141)
9. Nti A,C, Lawreh Patience M,Yaa GF. Food consumption patterns, dietary quality and health status of expectant mothers: Case studies in suburban and rural communities in Ghana. International Journal of Consumer Studies 2002 Nov;26(1):7-14.
10. DuttaDC. Textbook of obstetrics. Calcutta: New Central Book Agency (P) Ltd.; 2004:264-5
11. Breymann C. Iron deficiency and anaemia in pregnancy, blood cells, molecules and diseases. 2002;29(3):506-7.
12. Colditz BP, Mackay. Obstetrics and the newborn. 3rd ed. Philadelphia: W. B. Sunders; 1997.
13. Moradi F,Mohammad et al, Knowledge and practice of pregnant women in Fars Province about intake of iron supplements.Origanal report.Depatment of family health,office of Vice Chancellor for Health Affairs,Shiraz University of Medical Sciences,Shiraz,Iran.
14. Kennedy ON. Severe anaemia during pregnancy in Kisumu District of Kenya: prevalence and risk factors. International Journal of Healthcare, Quality Assurance;13(5):230-5.
15. Urassa DP, Carlstedt A, Nystrom L, Massawe SN, Lindmark G. Quality assessment of the antenatal program for anaemia in Rural Tanzania. International Journal for Quality in Health Care 2002;14:441-8(2002).
16. Kavale, G, Rana, G, Lie, R.T; et al, The prevalence of anaemia in pregnant Nepali women. Obstetrics and Gynaecology 2000;79(5):341-9.
17. Karthikeyan S Gurav RV. Fertility pattern in anaemic and non-anaemic pregnant women. Journal of Obstetrics and Gynaecology 2001;67(1):121-7.
18. Rajarathnam AR. Can iron status be improved in each of the three trimesters? European Journal of Clinical Nutrition 2000;54(6);490-3
9. / Signature of the candidate
10. / Remarks of the guide
11. / Name and designation of (in block letters)
11.2 Guide / Mrs. Renjini Devi S
Associate Professor
Masood College of Nursing
Mangalore
11.2 Signature
11.4 Co-guide (if any) / Prof.(Mrs)Veena Gretta Tauro Principal Masood College of Nursing,Mangalore
Signature
12 / 12.1 Head of the department / Mrs. Renjini Devi S
12.2 Signature
13. / 13.1 Remarks of the Chairman and Principal
13.2 Signature
13