Proforma for Registration of Subjects Fordissertation

“THE EFFECTIVENESS OF STP ON PREVENTION OF IRON DEFFICIENCY ANAEMIA AMONGPRIMIGRAVIDAMOTHERS IN ANC CLINIC AT SELECTED HOSPITAL AT BELLARY.”

PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION

MRS.OJAS OMKAR SAMANT

INDIAN COLLEGE OF NURSING, BELLARY

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGLORE, KARNATAKA.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION

BRIEF RESUME OF THE INTENDED WORK

6.INTRODUCTION

“HEALTHY MOTHERS AND CHILDREN”

Theme of World Health Organisation day2005

Anaemia is aice berg disease commonly seen in pregnant women, children, adolescent and old age.Anaemia is the commonest haematological disorder that may occur in pregnancy .According to the standard laid down by World Health Organisation, anaemia in pregnancy is when the haemoglobin concentration in the peripheral blood is 11gm per100ml orless. During pregnancy plasma volume expands maximum around 32 weeks of gestation resulting in haemoglobin dilution for this reason, haemoglobin level below 10 gm/dl at any time during pregnancy is considered anaemia is stated by World Health Organisation1913.haemoglobinlevel at or below 9gm/dl requires detailed investigation and appropriate treatment. Adopting this lower level, the incidence of anaemia in pregnancy ranges widely from 40-80 % in the tropics compared to 10-20% in the developed countries.1

Among different types of anaemia iron deficiency anaemia is the most common nutritional disorder in the world as per World health organisation 2002.According to national family health survey 1998, the prevalence of anaemia in India is reported that in urban and ruralis 50% and 60% respectively. 2

In the tropics, majority of cases with iron deficiency anaemia in pregnancy have a low socioeconomic status and insanitary condition. If detected early and proper treatment is instituted anaemia improves promptly. On rare occasion it may remain refractory till pregnancy is over, when rapid improvement occurs. At times, there is a tendency for anaemia to reoccur in subsequent pregnancy. In fact anaemia either directly or indirectly contribute about 20% a maternal death in 30 world countries .The most common causes of anaemia are poor nutrition, deficiencies of iron and other micronutrients, malaria, hookworm disease, and schistosomiasis,human immune deficiency virus infection and haemoglobin pathies are additional factors.3

Anaemia is one of the most prevalent nutritional deficiency problems affecting pregnant women. The high prevalence of iron and other micronutrient efficiencies among women during pregnancy in developing countries is of concern and maternal anaemia is still a cause of considerable perinatal morbidity and mortality.4

6.1 NEED FOR THE STUDY

Anaemia is a major factor in women’s health, especially reproductive health in developing countries. Severe anaemia during pregnancy is an important contributor to maternal mortality ,as well as to the low birth weight which is in turn an important risk factor for infant mortality . Even moderate anaemia makes women less able to work and care for their children. The causes of anaemia are multi-factorial, including diet, infection and genetics, and for some of the commonest causes of anaemia there is good evidence of the effectiveness of simple interventions for example, iron supplementation,long-lasting insecticide nets and intermittent preventive treatment for malaria.Hookworm infection has long been recognized among the major causes of anaemia in poor communities , but understanding of the benefits of the management of hookworm infection in pregnancy has lagged behind the other major causes of maternal anaemia.5

In India Anaemia is more common, up to 88% of pregnant and 74% of non-pregnant women are affected. Throughout Africa, about 50% of pregnant and 40% of non-pregnant women are anaemic. West Africa is the most affected, and southern Africa the least. In Latin America and the Caribbean, prevalences of anaemia in pregnant and non-pregnant women are about 40% and 30% respectively. The highest levels are in the Caribbean, reaching 60% in pregnant women on some islands6.

Iron deficiency, and specifically iron deficiency anaemia, remains one of themost severe and important nutritional deficiencies in the world today. Every age group is vulnerable. During pregnancy, iron deficiency is associated with multiple adverse outcomes for both mother and infant, including an increased risk of haemorrhage, sepsis, maternal mortality, perinatal mortality, and low birth weight. It is estimated that nearly all women are to some degree iron deficient, and that more than half of the pregnant women in developing countries suffer from anaemia. Even in industrialized countries, the iron stores of most pregnant women are considered to be deficient. Finally, as much as a 30% impairment of physical work capacity and performance is reported in iron-deficient men and women. Iron deficiency affects a significant part, and often a majority, of the population in nearly every country in the world. Programmes for the prevention of iron deficiency, particularly iron supplementation for pregnant women, are under way in 90 of 112 countries that reported to World Health Organisation in 1992.7

Iron deficiency in childbearing women increases maternal mortality,prenatal and perinatal infant loss, and prematurity. Forty percent ofall maternal perinatal deaths are linked to anaemia. Favourable pregnancyoutcomes occur 30-45% less often in anaemic mothers, and their infants haveless than one-half of normal iron reserves. Such infants require more iron than is supplied by breast milk, at an earlier age, than do infants of normal birth weight.8

A total amount of about 700-850 mg of iron is needed to meet the iron requirements of a mother and fetus during pregnancy, at delivery, and during the perinatal period. Iron needs during the first trimester are lower than pre-pregnancy needs; they increase the most during the second half of the pregnancy and especially during the last trimester. For unknown reasons, dietary iron absorption in iron-sufficient women is reduced during the first trimester and increased in the second half of pregnancy.The average woman of reproductive-age needs about 350-500 mg additional iron to maintain iron balance during pregnancy. Potentially, this iron could be provided either from the mother’s iron stores or from iron supplements.However, it is not reasonable to expect that this additional iron can come from iron stores, since they very seldom reach this level in women in either developed or developing countries the mean iron content of the body reserves - ferritin and haemosiderin - is often only around 200-250 mg.

Anaemia is one of the leading causes of maternal mortality in developing countries like India and contributes to 20% of maternal deaths. If all maternal deaths are analysed, 64% have associated anaemia irrespective of the primary cause .Commonest cause of anaemia in pregnancy is still iron deficiency alone or in combination with folic acid deficiency. In spite of government of India’s iron supplementation’s programme, prevalence is as high as 62.3%. This could be due to reduced bioavailability of iron because of dietary habits , iron deficiency anaemia antedating pregnancy , lack of iron intake due to lack of antenatal supervision and advice. Preexisting anaemia is due to poor spacing between pregnancies, parasitic infestations such as hookworm etc.In pregnancy, treatment of anaemia includes confirmation of the type of anaemia, ascertaining the aetiology and instituting appropriate therapeutic measures.Management of anaemia complicating pregnancy would depend on severity and gestation at diagnosis. Prevention of anaemia would depend on creating awareness amongst women regarding importance of iron supplementation and achieving an effective programme of screening for anaemia as well as correction at the primary health care facility.9

Anaemia is a major cause for maternal morbidity and mortality in India. if anaemia is diagnosed earlier future complication can be prevented in mothers and child. Always prevention is better than cure. Illiteracy, poverty, negligence and low socioeconomic status need more effort to prevent it but it is better to help the women to understand why anaemia in pregnancy occurs and who to prevented by maintaining personal hygiene and regular follow up to ANC clinic.

6.2 REVIEW OF LITERATURE

A review of literature on the research topics makes the researcher familiar with the existing concition and provides information, which helps to focus on a particular , problem ,lay a foundation upon which to base new knowledge it creates accurate picture of the information found on the subject PolitHungler 2000Review of literature is systematic identification, location, scrutiny and summary of written material that contains information on the research and problem.

Astudy was conductedon incidence of anemia among pregnant women in Westmoreland found that 37% of antenatal mother who was register in Westmoreland, Jamaica were suffering from anaemia. They have also found that body mass index,mid upper arm circumference , and the number of antenatal care visit showed a statistically significant association with anemia. Based on the result, believe that maintaining a healthy body weight and frequently visiting an ANC, will help to lower the incidence of anaemia among preganant women in Westmoreland.10

A comparetivestudy was conducted on Intestinal helminthinfection and anemia during pregnancy.The sample consisted of 108 pregnant women were followed until 5 to 10 weeks postpartum,during the period of December 2005- November 2006. Haemoglobin and total serum iron concentration were evaluated in venous blood sample and helminths infection were evaluated in stool sample in each trimester using standard method There was a significant association between hookworm infection low iron stores. The study concluded that hookworm infection is a strong predictor of iron status.11

A study wasconducted on Impact of Maternal Iron Deficiency and anaemia on pregnancy and it’s outcomes in a Nigerian population Three hundred and forty nine pregnant women aged 15 to 40 years at gestational age total 25 week were analysed for plasma iron and haemoglobin using flame atomic absorption spectrophotometer and Cyanmethaemoglobin method, respectively. The women were followed –up weekly till delivery after which neonatal anthropometric and other birth outcomes were recorded and the result was anaemia and iron deficiency were recorded in 72.2% and 63.6% of thewomen , respectively with 0.3% sererely anaemic while 38.4% and 33.5% were moderately and mildly anaemic respectively.12

Aqusiexperimental study on Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. The sample consisted of Forty trials involing 12706 pregnant women. Overall,the result showed significant heterogeneity across most prespecified outcomes. Heterogenecity could not be explained by standard sensitivity analyses including quality assessment therefore, all result were analysed assuming random – effects. Very limited information related to clinical maternal and infant outcomes was available in the included trials. The data suggest that daily antenatally and postnatally. It is difficult to quantify this increase due to significant heterogenecity between the studies. Women who receive daily antenatal iron supplementation are less likely to have iron deficiency and irondeficiency anaemia at term.13

Asurveywas conducted to assess the effectiveness of existing antenatalinterventions for anaemia prevention at PHC level, with the addition of a community- based health education on causes and prevention of anaemia in pregnancy. The sample consisted of two maternal child health clinics at primary health centre level in the suburban area of Temeke were selected for the study. The result shows the prevalence of anaemia and severe anaemia in pregnant women were 60% and 3.8%, respectively. Iron deficiency was the main underlying cause in all groups. In the anemicpregnant women, Malaria and other infection were more common, and serum Ferritin therefore underestimates iron deficiency.4

A descriptive study on prepartum anaemia on prevention and treatment .The results shows that requirement for absorbed iron increase during pregnancy from o.8mg per day in the first trimester to 7.5mg/day in the third trimester on the average approximately 4.4mg/day, and dietary measures are inadequate to reduce the frequency of prepartumiron deficiency anaemia .However,iron deficiency anaemia is efficiently prevented by oral supplements in dosesof 30to40 mg ferrous iron taken between meals from early pregnancy to delivery.15

An evaluative studywas conductedon effect ofiron supplementation on the iron status of pregnant women consequences for newborns they studied the effect of iron supplementation on the iron status of mothers and on biochemical iron status and clinical and anthropometric measures in their infants. The prevalence of anemia and iron deficiency decreased markedly during the last trimester of pregnancy in the iron-supplemented group but remained constant in the placebo group. Three months after delivery, the prevalence of anemia was significantly higher in the placebo group. At delivery, there were no differences between the two groups in cord blood iron variables. Three months after delivery, serum ferritin concentrations were significantly higher in infants of women in the iron-supplemented group.Mean length and Apgar scores were significantly higher in infants with mothers in the iron group than in those with mothers in the placebo group.16

A comparative studyon Impact of anaemia prophylaxis inpregnancy on maternal haemoglobin, serum ferritin and birth weight.The sample consisted of 418 pregnant women at 16–24 wk of gestation, from six subcentres of arural block of Varanasi district . Pregnant women from 3 subcentresreceived the supplementation of 60 mg elemental iron as ferrous sulphate combined with 500micrograms folic acid, daily for 100 days study group and 123 of 203 pregnant women fromthe other 3 subcentres without supplementation control group could be evaluated for theirpregnancy outcome. The haemoglobin and serum ferritin levels increased significantly in thestudy group. In the latter, the mean birth weight was 2.88 +/– 0.41 kg with low birth weightincidence of 20.4 per cent as compared to the control figures of 2.59 +/– 0.34 kg and 37.9 percent respectively. The incidence of low birth weight was further reduced to 12.1 per cent if thesupplementation could be started by 16–19 wk of gestation.17

STATEMENT OF THE PROBLEM

“THE EFFECTIVENESS OF STP ON PREVENTION OF IRON DEFFICIENCY ANAEMIA AMONG PRIMIGRAVIDA MOTHERS IN ANC CLINIC AT SELECTED HOSPITAL AT BELLARY.”

6.3 OBJECTIVES OF THE STUDY

1. To assess the knowledge on preventionof iron deficiency anaemia among primigravida mothers .
2. To developand administer STP on prevention of iron deficiency anaemiaa among primigravida mothers .
3. To compare the knowledge on iron deficiency anaemia of pre-test and post-test score among primigravida mothers .
4. To determine the association between post-test knowledge with selected demographic variables .

6.4 OPERATIONAL DEFINITIONS :

1. EFFECTIVENESS : It refers to extend the structured teaching programmedhas achived the desired effect in improving knowledge of primigravida mothers on prevention of iron deficiency anaemia.

1. STRCTURED TEACHING PROGEAMME: It refers to the system of planned instruction designed to impart information in order to bring about a desired change in knowledge of primigravida mothers regarding iron deficiency anaemia.

1. PREVENTION : In this study prevention of iron deficiency anaemia refers to measures taken by the women on factors that place her at high risk for the development of iron deficiency anaemia

1. IRON DEFFECIENCY ANAEMIA:Iron is a metallic element, present in the body in small quantities & essential to life .A deficiency may produce anaemia

1. PRIMIGRAVIDA MOTHER : A women who is pregnant for the first time.

1. ANTENATAL : A medical examination during pregnancy.

1. CLINIC : A facility, often associated with a hospital or medical school, that is devoted to the diagnosis and care of out patients.

ASSUMPTION :

1. Primigravida mothers have inadequate knowledge on prevention of iron deficiency anaemia .
2. Structured teaching programmed may improve the knowledgeamong primigravida mothers.
3. There will be significant increase in the post –test knowledge level on prevention of iron deficiency anaemia among primigravida mothers.
4. There will be significant association between knowledge and selected demographic variables.

6.5 HYPOTHESIS:

H0- Therewill be no ignificant difference between pre and post knowledge of primigravida mother on prevention of iron deficiency anaemia .

H1 -There will be a significant difference between pre and post -test knowledge score among primigravida mothers on prevention of iron deficiency anaemia.

H2- There will be a significant association between post test knowledge score of primigravida mothers regarding prevention of iron deficiency anaemia with selected demographic variable.

7.6RESEARCH VARIABLES

DEPENDENT VARIABLES –

Knowledge of primigravida mothers on prevention of iron deficiency anaemia .

INDEPENDENT VARIABLES - Structured teaching programme on prevention of iron deficiency anaemia .

EXTRANEOUS VARIABLES - In the study, extraneous variables refers to the variables such as age, education , occupation , income ,type of family , habits , and residence etc .

7. MATERIALS AND METHODS

7.1 SOURSE OF DATA:

Primigravida mothers are visiting to ANC clinic at VIMS and S.R. hospitalat , Bellary.

7.2 METHOD OF DATA COLLECTION:

7.2.1 Research approach–

Quasi Experimentalresearch approach

7.2 .2 Research design:

In the study investigator is using quasi-experimental is one group pre test-post test design.

7.2.3 Research setting:

Study will be conducted in ANC clinic at VIMS and SR hospital at ,Bellary.

7.2.4 Sampling criteria :

Inclusive criteria :

• The study is limited to the selected primigravida mothers only.
• Primigravida mothers who are willing to participate in the study.
• Primigravida who can write, read &communicate in kananda, English .

Exclusive criteria :

• Who are not co operating the study.
• Who are not available during the study .
• Primigravida mothers with complications or seriously ill.

7.2.5 Sample :

The population included in the present study is primigravida mothers in ANC clinic of VIMS and SRhospitalat ,Bellary .

7.2.6 Sample size:

In this study total sample is 50 ANC primigravida mothers.