Rajiv Gandhi University of Health Sciences Karnatka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATKA

BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6.BRIEF RESUME OF INTANDED WORK:

6.1INTRODUCTION:

“When it's time to change, you have to rearrange.”1

Adolescent girls are the future mothers. Going through the adolescent puberty can be challenging times for any girls. Although it may occur at different ages for different girls, adolescent girlhood is always a critical time of identity formation and a period of transition from childhood to womanhood. In most societies, menarche is an indication of a girls’ developing sexuality.

According toWHO as individuals between the ages of 10 and 19 years, adolescents make up approximately 20% of the world’s population. UNFPA’s State of World Population (2005) estimates that there are 1.2 billion adolescents between 10-19 years of age today.

Puberty isthe physical and biochemical changes associated with maturation of the hypothalamic/pituitary/gonadal axis, which lead to the development of secondary sex characteristics and reproductive organs.

As the girl matures and enters puberty, the pituitary gland releases hormones that stimulate the ovaries to produce other hormones called estrogen and progesterone. These hormones have many effects on a girl's body, including physical maturation, growth, and emotions. These changes may lead to emotionally upset and stress to the girls if they are not having appropriate knowledge and practices durining this time.

Menarche or menstruation is a major stage of puberty in girls, it is one of the many physical signs that a girl going through to become a women. Like lot of the other changes associated with puberty, menstruation can be confusing for many girls. Some girls can't wait to start their periods, whereas others may feel afraid or anxious. Many girls don't have a complete understanding of a woman's reproductive system or what actually happens during the menstrual cycle, making the process seem even more mysterious.

Myths and taboos about menstruating women such as the need to abstain during sex or being forbidden to prepare food, while not having disappeared entirely, have generally diminished in western settings. This likely serves to reinforce misunderstandings about natural bodily processes, and to perpetuate the stigma that is attached to menstruating women and girls. Girls explain that menstruation is a taboo subject even within their own families, describing a ‘culture of silence’ with regard to their menstruation. They feel unable to discuss physiological changes during puberty including menstrual issues with their mothers and certainly not with their fathers. Not being able to talk about their experience and having limited information means that these issues becomes something shameful and something to hide, and is consequently ignored in families, schools and communities.2

For girls in many developing countries like India, puberty, and especially the onset of menstruation, poses particular challenges. In social contexts where these issues are not openly discussed or where there is stigma and/or taboos surrounding puberty and menstruation, girls may have very little understanding of what is happening to them and their bodies. A lack of adequate sourse of information, sanitary materials and private facilities makes it even more difficult for girls to have positive attitudes towards their bodies.

Adolescent girls are not having appropriate knowledge and healthy practices regarding their bodily changes including risk for unwanted pregnancies and sexually transmitted infections. Education may improve knowledge and practices among preadolescent girls before attaining puberty thus increasing their awareness of risks and enabling them to protect themselves accordingly.

There is a need to be sensitive to the environment in which it is given, and to the sensibilities of female students who – at least initially – may feel shy and embarrassed to talk about menstruation and pubertal changes at school. Strategies to address this include, for example, dividing girls and boys into separate discussions, and provide them appropriate knowledge and healthy practices regarding attaining puberty.

6.2 NEED FOR THE STUDY

Puberty is the time of change for every adolescent girl. Due to lack of providence of knowledge regarding puberty the adolescent girls go through the physiological and emotional stresses and malpractices. In Indian society most of the girls do not get adequate knowledge about their own body, s physiological changes and about menstruation. If we are providing accurate knowledge and addressing healthy practices to the pre-adolescent girls it will be helpful for the them at the time ofattaining puberty.

On the other side we should be aware enough to provide the early information to the growing girls. It is very important that, not only mother and family but entire society including health team members should an active part to give adequate information about physical and emotional changes occurring in the girls at the time of attaining puberty. This is important to prevent malpractices due to misinformation.

These days due to many factors like food pattern the girls are attaining puberty early then actual age. The mothers or family some times not even can prepaired their girls to face onset of attaining puberty. This affects the lack of providence of knowledge on accurate time regarding her physiological maturation and onset of menarche further that leads to misunderstanding of the need of the teenage girl.

According the survey being conducted by the Federation of Obstetrics’ and Gynaecologists’ Society of India (FOGSI).7 Sep 2006,the age of attaining sexual maturity among girls in urban India has dropped to 11 from 13. The reverse is true in rural India, where girls are reaching puberty even later than 13.So far we had accepted the global average (around 13 years). More than 80% of the girls in cities are reaching puberty around age 11, indicates the survey that is being carried out in 100 centres — both urban and rural across four regions. So the investigator feels the need to provide knowledge and practices to the pre-adolescent girls before attaining puberty .3

In developing countries especially in India teenage prengnancies are become more common. Indian culture of early marriage of girls is also making this matter more critical. There are including lots of other reasons of teenage pregnancies in India most common are emotional imbalance or inadequate knowledge, premarital sexual activity, early marriage, that need to pay adequate attention to provide appropriate knowledge at preadolescent period regarding physiological process of maturation.

Teenage pregnancy in developing countries is, at long last, beginning to receive the attention it deserves. Eighteen per cent of births are to teenage women aged between 15 and 19a little more than 34 per cent are under the age of 15 years. Complications from pregnancy and childbirth are the leadingcause of death in young women aged 15 to 19 in developing countries,warned a report published last week. An estimated 70 000 adolescentmothers die each year because they have children before theyare physically ready for parenthood.

As per the 2001 census, Karnataka’s adolescent population (10 – 19 years) constitutes 21percent of the total state population (for India, the corresponding figure is 22 percent). Data from NFHS-2 indicate that nearly half (46.3 per cent) of the women currently aged 20-24 years were married below age 18 in Karnataka.The median age at first marriage is 16.8 years in Karnataka. As high as 60.6 percent of women got married before attaining 18 years in Karnataka.What seems alarming is that 24 % of unmarried girls (aged 13-25) reporting compared to 27 % in their married counter parts. This could indicate that there is significant pre-marital sexual activity among young girls and / or them suffering from unsolved gynecological problems due to the lack of knowledge of physiological process and wrong practices due to emotional imbalances in adolescent period.

Indian culture is considering the full of religious beliefs and superstitions. Today we entered in the 21st centuary with the world but still we are behind the curtain of bias religious beliefs. When investigator go through the review of literature she found sutch type of practices in India are following still very strictially.

A study on, providing for pre-adolescent girls in India- In Insights Education [2004]. Menstruation is considered a polluting factor among Hindus. In many places menstruating girls and women are considered untouchable, girls learn from early adolescence that during their monthly cycle they may not touch anything in the kitchen or visit a temple. As an additional example, it is commonly believed that pickles made by a menstruating girl/woman will rot. Some of such taboos are also prevalent among non-Hindu. Such attitudes and practices are unlikely to create a positive self-image within girls.4

School is the adequate place where we can easily essess the teenage girls population. Those issues not openly discussed by mother or in the family we can easily provide adequate knowledge and healthy practices regarding puberty and other related issues.but when investigator examining the syllabus including in the high schools provided information about animal biology, but not human development or reproduction.

In similar study of providing for pre-adolescent girls in India. In Insights Education (2004). Menstruation is considered a polluting factor among Hindus Findings indicate that in school girls and women teachers were very knowledgeable about the intricate system of taboos and sanctions that pertained to menstruation, but had very little actual knowledge about the biological processes of maturation and normal physiology. This lack of factual information, compounded by the prevalence of myths, means that girls’ practical needs related to managing menstruation are often not appreciated or appropriately addressed, e.g. of the provision of adequate sanitary protection. Young and growing children have poor knowledge and lack of awareness about physical and physiological changes associated with the onset and presence of adolescence. They learn about sexuality and secondary sex characteristics primarily from their peer groups or other, inappropriate sources. Most girls are not informed about menarche and how to manage menstrual bleeding, and adolescents also lack knowledge about reproductive health issues. These situations could largely be remedied by effective implementation of school health programs.4

Another study on puberty rituals, reproductive knowledge and health of adolescent school girls in South India June 2001.found that young girls are generally told nothing about menstruation until their first personal experience of it. The silence surrounding menstruation burdens young girls by keeping them ignorant of this biological function. The events and experiences surrounding menarche can be a significant influence on young girls’ view of themselves, as well as on their understanding of reproductive health issues, and on appropriate behaviour for hygienic management of menstruation.5

A study on Menstruation and body awareness: linking girls’ health with girls’Education Uganda: 2004.investigated thatScience classes at secondary school provided information about animal biology, but not human development or reproduction. Findings indicate that there is no deliberate information on puberty either at schoolor at home. Adolescents learn from their peers, and other inappropriate sourses that result in misinformation and the perpetuation of myths. They concluded that primary school pupils are not given enough accessible and accurate information on the processes of sexual maturation.2

A similar study on the survey of sex education in secondary schools (2000). Horsham, UK. Found that there were serious gaps in even the most basic programs. Topics such as puberty and parts of the body were considered to be comprehensively covered in only 85% of the schools and sexual development, including menstruation, in only 72% of the schools. There is little literature available on the current state of school curricula in terms of the inclusion of topics such as puberty and menstruation. However there are studies on sexuality and sexuality education, which give insights into what children may be learning about their bodies and physical maturation in schools. 6

Nevertheless, puberty and menstruation is still frequently perceived in a negative light, with little research conducted on healthy menstruation in ‘normal’women. Professional journals and popular magazines generally place an emphasis on menstrual pathology, with articles and studies about angry, depressed and unreasonablewomen and girls.

Any programming that seeks to address the knowledge level of girls and boys in school about menstruation – needs to move away from traditional anatomical explanations and towards discussion that encompasses meanings and beliefs.

The investigator out of her own experience found that many times the preadolescent girls are not aware or having less knowledge and practices regarding puberty. The present study aims to fill the above knowledge and practices gaps by examining expectations of menarche and their influencing factors among premenarcheal teenage girls. Thus the investigator felt that planned teaching program would increase the knowledge and practices towards puberty.

6.3 STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE EFFECTIVENESS OF A PLANNED TEACHING PROGRAMME (PTP) ON KNOWLEDGE AND PRACTICES REGARDING ATTAINING PUBERTY AMOUNG PRE-ADOLESCENT GIRLS AGE BETWEEN 10-12 YEARS IN SELECTED SCOOL AT HASSAN.”

6.4 OBJECTIVES OF THE STUDY:

To identify the level of knowledge and practices regarding attaining of puberty among pre-adolescent girls in selected high scools at Hassan.

 To provide planned teaching programme regarding attaining of puberty among pre-adolescent girls in selected high school at Hassn.

* To determine the effectiveness of planned teaching program regarding attaining of puberty amoung pre-adolescent girls in selected high schools of Hassan

To associate the posttest knowledge and practice score among pre-adolescent girls regarding attaining of puberty with selected demographic variables.

6.5 Hypothesis

H1-There will be a significant difference between the pre and posttest knowledge score of experimental group regarding attaining puberty among pre-adolescent girls.

6.6 OPERATIONAL DEFINITIONS:

1.ASSES:

It is the statistical measurement on knowledge and pracice score of pre-adolescent girls.

2.Effectiveness:

It is the statistical measurement of difference between pre test and post test knowledge scores.

3.Knowledge:

It refers to the response of pre-adolescent girls to the knowledge items in close-ended questionnaire regarding attaining puberty.

4.Practice:

It refers to response of pre-adolescent girls to the practice items in closed ended questionnaire regarding attaining puberty.

5.Planned teaching program:

It refers to the systematically organized instructions and discussion of knowledge and practices regarding attaining puberty among the pre-adolescent girls.

6.Preadolescent:

Gilrls age between 10-12 years who have not attained puberty in selected high school at Hassan.

7.Puberty:

The physical and biochemical changes associated with maturation of /pituitary/donadal axis witch lead to the development of secondary sex characteristics and reproductive functions in female.

6.7 ASSUMPTION:

Preadolescent girls will be having less knowledge and malpractices regarding puberty.

The preadolescent girls knowledge and practice will be improve after giving planned teaching programme.

The difference between pre and posttest will show the effectiveness of planned teaching programme.

Demographic factors will have the influence on knowledge and practices scores of both experimental and control group.

6.8 DELIMITATIONS:

The sample size is limited to 40 preadolescent girls age between 10to 12 years of age.

Prescribed data collection is only 4-6 weeks.

6.9 SIGNIFICANCE OF THE STUDY:

The study implies the importance of knowledge and practices regarding attaining puberty among pre-adolescent girls.

6.10.CONCEPTUAL FRAMEWORK:

It is based on Roy’s adaption theory.

6.11.Review of literature

Survey of literature provides valuable help in the development of knowledge of research project. A reviewed literature is an essential aspect of scientific research. One of the major functions of review of literature is to ascertain what is already known in to which a research problem will fit. 7

The investigator to gain insight in to the selected problem will do an extencive review of literature and it is presented under following headings.

1.Studies related to knowledge and practices regarding menarche

2.Studies related to knowledge and practices about menstruation.

3.Studies related to knowledge and practices about reproductive health.

1.STUDIES RELATED TO KNOWLEDGE, AND PRACTICES REGARDING MENARCHE

A study on questionnaire survey of knowledge, attitudes and beliefs towards menstruation was made in 22 schools in Gujrat, India [2006] .Of 900 schoolgirls aged 11-17 years, only 38.5% felt comfortable about menarche and only 31.0% believed that menstruation was a normal physiological process. Many (37.2%) had not been informed about menarche before its onset and 48.2% felt they were not mentally prepared. The major sources of information were the mother (60.7%) or an elder sister (15.8%); teachers and others relatives played a small role. In this area of India, many families continue the custom of celebrating the first menarche and observing social restrictions. The finding shows that the knowledge regarding preparation for puberty and menstruation is not provided to the girls. 8

Another study on preparing girls for menarche in India, [2003].The findings of this study have implications for nursing education, practice, administration and research. There is a need for the health personnel to take active part in preparing the pre-adolescent girls for menarche. Health education programmes on menstrual hygiene for adolescent girls help in maintaining healthy practices during menstruation. Studies show that the failure to adequately educate girls about their own anatomy and physiology has serious implications. These responses also support the need for the menstrual education as a long term, continuous process, beginning well before menarche. If the girls are prepared even before menarche, they will develop a positive attitude to cope up with physical and psychological changes. Further, this will enable them to develop a healthy attitude towards menstruation and thus adopt hygienic practices during menstruation.9