RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / ELANGBAM SUNITA DEVINAVANEETHAM COLLEGE OF NURSING.
NO. 132/1, 5TH CROSS, HORAMAVU, BANASAWADI, BANGALORE – 43.
2. / NAME OF THE INSTITUTION / NAVANEETHAM COLLEGE OF NURSING, BANGALORE – 43.
3. / COURSE OF STUDY AND SUBJECT / 1 YEAR M.SC NURSING
OBSTETRICAL AND GYNAECOLOGICAL NURSING.
4. / DATE OF ADMISSION TO THE COURSE / 28/06/2008.
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING THE UTILIZATION OF MCH SERVICES AMONG ANTENATAL MOTHERS IN SELECTED HOSPITAL, BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India and the National Population Policy-2000 reiterates the government’s commitment to the safe motherhood program within the wider context of reproductive health.1
Maternal mortality is on an average 18 times higher in developed countries compared to developing countries. 2
In addition to the number of deaths each year, over 50 million women suffer from maternal morbidity due to acute complications from pregnancy.3
Maternal mortality and morbidity continue to be high despite the existence of national programs for improving maternal and child health in India. This could be related to several factors, an important one being non-utilization or under-utilization of maternal health-care services, especially amongst the rural poor and urban slum population due to either lack of awareness or access to health-care services. Understanding of the knowledge and practices of the community regarding maternity care during pregnancy, delivery and postnatal period is required for program implementation. Therefore, the present study was carried out to evaluate the socio-demographic correlates and barriers of maternal health-care utilization amongst married women aged 15-45 years living in a slum in Delhi.3
Antenatal care services either by visiting a health center where such services are available or from health workers during their domiciliary visits. The former gives an idea about the voluntary utilization of the services by women while the latter is related to the quality aspect of the services. One of the most important components of antenatal care is to offer information and advice to women about pregnancy related complications and possible curative measures for early detection and management of complications. Antenatal care can also play a critical role in preparing a woman and her family for birth by establishing confidence between the woman and her health care provider and by individualizing promotional health messages. Further antenatal visits may raise awareness about the need for care during delivery or give women and their families a familiarity with health facilities that enables them to seek help more efficiently during a crisis. However, uptake of these services is far from universal even in settings where they are widely available.4
6.1 NEED FOR THE STUDY:
MCH services are a method of delivering the health care to the special group in the population which is vulnerable to disease, disability and death .These groups are Under the age 5 years and women in the reproductive age group (15-44) years. These groups cover 31.6% of total Indian population.5
Compare to the olden days the MCH services developed in vast which encompasses the curative, preventive and social aspects of obstetrics, pediatrics, Family welfare, child health, school health .The recent trends in the MCH services are integration of care, Risk approach, manpower changes and primary health care.5
The MCH services mainly aimed to reduce the maternal mortality rate, perinatal mortality rate and infant mortality rate. Though Government of India taking the so many steps to promote the feasibility of the MCH services. The utilization of these services was low. There are many reasons behind the impact of utilization of the MCH services. One of the main reason was inadequate knowledge of the population about the availability and utility of MCH services.5
The following data shows the poor utility of the MCH services
· More than 60 million women deliver at home without skilled care.6
· About 530,000 women die from pregnancy related complications, with some 68,000 of those deaths resulting from unsafe abortion.7
· About 4 million babies die within the first month of life (the newborn period), and more than 3 million die as stillbirths.8
· Over 10 million children under the age of 5 die.9
· Moreover, nearly all (99 percent) maternal, newborn, and child deaths occur in low- and middle-income countries.9
Given the magnitude of the maternal, newborn, and child mortality burden, no individual government, agency, or organization can address these challenges alone. Many governments and nongovernmental organizations (NGOs) are launching new efforts and refining, refocusing, or scaling up existing programs to meet the Millennium Development Goals (MDGs). To create a more unified voice and facilitate the creation of a continuum of care, three separate newborn, maternal, and child health partnerships—the Healthy Newborn Partnership, the Partnership for Safe Motherhood and Newborn Health, and the Child Survival Partnership— have recently merged to form a global partnership, the Partnership for Maternal, Newborn, and Child Health (PMNCH).Members include multilateral organizations, bilateral organizations.10
Period / Utilized / Not Utilized / TotalAntenatal >3 visits / 258 / (50.6%) / 252 / (49.4%) / 510
Intranatal / 359 / (70.4%) / 151 / (29.6%) / 510
Postnatal / 330 / (64.7%) / 180 / (35.3%) / 510
The above table shows the utility of the MCH services India in 2005.10
A community based cross-sectional study was done by interviewing a sample of 360 women of Anchuri Block in the district of Bankura, West Bengal to know the determinants of utilization and coverage quality of antenatal care services of subcentres using an appropriate scoring system for analysis. The study revealed underutilization of subcentres by the women and also sub-optimal performance of subcentres with regard to coverage quality of ANC services The main reason for under utilization of subcentres was found to be better service provision and easy accessibility of B.S.Medical College Hospital. Multiparous mothers were seen to be at a disadvantage both in terms of utilization of the source of choice as well as in terms of coverage of ANC services by subcentre ANMs.11
The reviews support the improper utilization of the available resources by the community the investigator felt that the effective utilization of MCH services by the community less. Before giving health education it is better to asses the knowledge and attitude of antenatal mothers for the effective utilization of MCH services by the population. So the investigator selected the antenatal mothers knowledge and attitude about the utilization of MCH services in indention to develop the booklet.
6.2 REVIEW OF LITERATURE:
The review of literature will discussed based on the following headings
1. Studies related to the availability of the MCH services.
2. Studies related to the Knowledge of utilization of MCH services among the Antenatal mothers.
1. Studies related to the utilization of MCH services.
The Cross sectional study conducted to examine the factors influencing the utilization of health services in antenatal, intranatal and postnatal period. This design study in 27 urban slums of Davangere city. The results show that only 35.9% of the women had utilized all the three services i.e., antenatal, intranatal and postnatal completely. The percentage of deliveries conducted by the trained attendants was 70.4% and 64.7% of the women had received at least one postnatal visit. The socio-demographic factors like literacy status, occupation, type of family, parity and an unwanted pregnancy were found to influence the pattern of utilisation.12
The present study is an analysis of a clinic-based early intervention programme for high-risk babies in a developing society in Goa, India. A sample of 152 neonates and their parents were offered an early intervention programme and followed up until their first birthday. The primary outcome under study was the uptake of the programme. Various socio-demographic, programmatic and infant-related variables that could affect compliance were examined. Compliance with the intervention programme was only moderate, with 59.2% of infants brought for three or more sessions. Higher maternal educational levels and proximity of the place of residence of the family to the early intervention clinic were significantly associated with better compliance. Early intervention programmes that go into homes have a greater chance of reaching high-risk infants, compared with those provided at a distant centre. Better-educated mothers are more likely to be convinced about the benefits of such inputs. The authors conclude with recommendations for future practice and research.13
The study conducted to assess the perceived health problems and help seeking behaviour and utilization pattern of adolescent health clinics. This method is. a pre-tested, semi-structured questionnaire was administered to 360 school going adolescents who were selected by stratified random sampling from two sectors of Chandigarh where services were being provided by a school-based and dispensary-based adolescent health clinics this result is (81%) of the adolescents reported having some health problem during last three months prior to the survey; predominant (60%) problems were psychological and behavioral in nature. To resolve these problems boys consulted mainly friends/peers (48%) while girls consulted their mothers (63%). Compared to the dispensary-based adolescent health clinic, utilization was significantly higher in a school-based clinic where proportion of psychological or behavioral problems reported was also significantly higher (p<0.01). Adolescents have greater counseling needs for psychosocial problems than for medical problems. School based adolescent health clinic was utilized more often than the dispensary-based clinic particularly for psychosocial problems14
A study to assess their reproductive health problems and help seeking behaviour among 300 urban school going adolescents between 11-14 years were chosen at random and assessed using four tools namely, self administered questionnaire: provision of adolescent friendly services; medical screening and focus group discussions . This result shows that the 72% girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behaviour. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys. This study shows that to increase help seeking behavior of adolescents, apart from health and life skill education, their medical screening with a focus on reproductive health by trained physicians, parental involvement, supported by adolescent friendly centers (AFC) for counseling, referral and follow up are essential.15
2. Studies related to the Knowledge of utilization of MCH services among the general Antenatal mothers.
A quasi-experimental study design included one intervention district and one comparison district of rural Uttar Pradesh. A household survey conducted between January and June 2003 established baseline rates of programme coverage, maternal and newborn care practices, and health care utilization during 2001-02. An endline household survey was conducted after 30 months of programme implementation between January and March 2006 to measure the same indicators during 2004-05. The changes in the indicators from baseline to endline in the intervention and comparison districts were calculated by socio-economic quintiles, and concentration indices were constructed to measure the equity of programme indicators. The equity of programme coverage and antenatal and newborn care practices improved from baseline to endline in the intervention district while showing little change in the comparison district. Equity in health care utilization for mothers and newborns also showed some improvements in the intervention district, but notable socio-economic differentials remained, with the poor demonstrating less ability to access health services.16
The study conducted about the Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.A range of electronic databases was searched for studies conducted inTwenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Only one study examined the effect of the quality of antenatal services on utilization. The study concluded that the qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.17
After decades of neglect, the founding of the Utilization of MCH services Initiative in 1987 promised action on this problem. A dozen years later, there is no evidence that maternal mortality has declined. A major reason for this disappointing record is that the initiative lacks a clear, concise, feasible strategy. Poor utilization of the MCH services and lack of Knowledge about utilization of MCH services in the Community. The mostly the reproductive problems focused to the women’s and not to the unmarried girls. There is lack of primordial prevention in the reproductive health care in India. One of the reproductive health problems was nutritional anemia.18
In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery. A majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery. As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.19