“A STUDY TO ASSESS THE EFFECTIVENESS OF INDIVIDUAL

TEACHING PROGRAMME ON KNOWLEDGE REGARDING

ANTENATAL DIET AMONG MULTIGRAVIDA MOTHERS

WITH IRON DEFICIENCY ANAEMIA ATTENDING

ANTENATAL OPD IN SELECTED MATERNITY HOSPITALS,

AT BIJAPUR”.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

MISS. SUDHA Y. TALIKOTI

OBSTETRICS AND GYNAECOLOGICAL NURSING,

FIRST YEAR M.Sc. NURSING

YEAR 2011 -2013

B.L.D.E.A’S SHRI B. M. PATIL

INSTITUTE OF NURSING SCIENCES,

SOLAPUR ROAD, BIJAPUR – 586 103

0

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS

MISS. SUDHA Y.TALIKOTI.

I YEAR M.Sc. NURSING

SHRI B. M. PATIL INSTITUTE OF

NURSING SCIENCES, BIJAPUR-586 103

2 NAME OF THE

INSTITUTION

SHRI B. M. PATIL INSTITUTE OF

NURSING SCIENCES, BIJAPUR -586 103

3 COURSE OF THE STUDY

AND SUBJECT

I YEAR M. Sc. NURSING

OBSTETRICS AND GYNAECOLOGICAL

NURSING

4 DATE OF ADMISSION TO

THE COURSE

22.07.2011

5 TITLE OF THE STUDY

“A STUDY TO ASSESS THE EFFECTIVENESS OF INDIVIDUAL

TEACHING PROGRAMME ON KNOWLEDGE REGARDING ANTENATAL

DIET AMONG MULTIGRAVIDA MOTHERS WITH IRON DEFICIENCY

ANAEMIA ATTENDING ANTENATAL OPD IN SELECTED MATERNITY

HOSPITALS, AT BIJAPUR”.

2

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Pregnancy is special, let us make it safe.”

Pregnancy is not just a matter of waiting to give birth but a joyful and a

fulfilling period in a woman’s life. It can also be one of the experiences of misery and

suffering when complications or adverse circumstances compromise the pregnancy,

causing ill health or even death.1

Anaemia is the term that indicates a low red cell count and a below normal

haemoglobin or haematocrit level. A reduction in the concentration of haemoglobin in

the blood stream to a level below 11gm/dl for pregnant women.1 Among different

types of anaemia iron deficiency anaemia is the most common nutritional disorder

(66-80%), in the world as per WHO (2002).2 Iron deficiency continues to be the

leading single nutrional deficiency in the world, despite considerable efforts over the

past 3 decades to decrease its prevalence.3

The high frequency of iron deficiency anaemia in the developing world has

substantial health and economic costs. Women in developing countries are always in

a state of precarious iron balance during their reproductive years. Their iron stores are

not well developed because of poor nutritional intake, recurrent infections, menstrual

blood loss, and repeated pregnancies. Gender discrimination in a country like India

resulting girls lacking access to a balanced diet, adequate health care and proper

education. Thus the average Indian woman enters her reproductive years, and

particularly pregnancy, with iron and foliate deficiency.3

Many affected individuals live in the developing countries. The world health

organization (WHO) estimates that 39% of children younger than 5 years, 48% of

children between 5 and 14 years, 42% of all woman, and 52% of pregnant women in

developing countries are anaemic. In India the second national family health survey

in 1998-1999 (NFHS) showed that 54% rural women of childbearing age were

anaemic compared with 46% of women in urban areas. Prevalence of anaemia more

in many north-eastern states of India i.e. 62% compare to the south-eastern states.3

3

The antenatal diet, also called the prenatal diet, is vitally important for the health

and welfare of baby in utero. A proper diet should promote optimum health and

nutrition in the mother to prepare her for delivery and for nursing after the baby is

born.4 The iron rich foods are liver, meat, egg, green vegetables, green peas, beans,

jaggery etc.5

6.1 NEED FOR THE STUDY

Pregnancy anaemia is one of the important public health problem not only in

India but also in most of southern countries, anaemia in pregnancy has effects may

have deleterious to mother and fetuses.6

Each pregnancy (both primi and multi) depletes 500mg to 1000mg of iron from

the mother’s body. This means that, in order not to pass on iron deficiency to her new

born baby, the ferritin in the mother’s body should be brought up to 200mg/ml, with

corresponding haemoglobin of 14.5gm/dl prior to the date of planned conception.7

Anaemia still constitutes a public health problem in the world, especially in the

developing countries. Nutritional anaemia is found more among rural mother, where

poor dietary intake and parasitic infections are more common. Many women start

their lives with insufficient iron stores but also because of inadequate child spacing,

they have little time to build up their iron levels between pregnancies.8

Iron deficiency with its resultant anaemia is probably the most wide spread

micronutrient deficiency in the world. Women who are pregnant or lactating and

young children are the most affected especially in the developing world. Despite that

only 1 to 3 mg of absorbed iron is required daily at different stages of life, most diets

remain deficient failure to include iron rich foods in the diet and inappropriate dietary

intake coupled with wide variation.3

Iron deficiency is considered to be one of the most prevalent forms of

malnutrition. Yet there has been a lack of consensus about the nature and magnitude

of health consequences, of iron –deficiency in population. The public health

importance of iron deficiency anaemia which were made as part of the global burden

4

of disease (GBD) 2000 project. Based on Meta-analysis of observational studies on

average globally 50% of the anaemia is assumed to be attributable to iron deficiency.

There is an urgent need to develop effective and sustainable interventions to control

iron deficiency anaemia.9

A prospective and descriptive study was conducted to find out the prevalence of

anaemia in pregnancy and to investigate cause of pregnancy in and around Raichur.

The sample consists of 185 patients. The study shows that the prevalence of anaemia

is high (88.64%) and severe degree anaemia is also incidence. The knowledge about

anaemia in pregnant women and complications accruing during pregnancy anaemia is

very poor that is 6.48% if cases only have knowledge and 93.5% are not having

knowledge. The study reveals that, mild degree of anaemia seen (49.18%) the type of

anaemia is microcytic hypochromic anaemia (63.24%) which to iron deficiency

anaemia of nutritional anaemia. multigravida is seen (68.03%) minimum gravid a one

and maximum 5. severe anaemia is seen multigravida that is gravida 4th and 5 th. The

knowledge about anaemia in pregnancy and complication in the patients is very low

(6.48% and) and 94.59% of pregnant women in 3rd trimester attended the care 1st time.

48.64 % of cases lie between the age group 18-24years and shows early pregnancy. 6

The demand of Iron during pregnancy is more due to the physiological changes

and development of fetus. Moreover the pregnant women especially in rural areas in

developing countries have a poor knowledge in this regard.

So there is a need to identify the knowledge of multigravida mothers with iron

deficiency anaemia regarding antenatal diet. For this reason the investigator felt that

there is a need to assess the knowledge on antenatal diet and provide intervention to

the multigravida mothers with iron deficiency anaemia.

6.2 REVIEW OF LITERATURE

5

A review of literature is a body of text that aims to review the critical points of

current knowledge and methodological approaches on a particular topic, the role of

the literature review is to formulate and clarify the research problems, to ascertain

what is already known in relation to problem of interest, for developing a broad

conceptual context, facilitate cumulating of scientific knowledge for interpreting the

result of the study.

THE REVIEW OF LITERATURE IS CATEGORISED INTO FOLLOWING

SUBHEADINGS:-

1. Literature related to Iron deficiency anaemia.

2. Literature related to antenatal diet. .

3. Literature related to multigravida with Iron deficiency anaemia.

4. Literature related to knowledge regarding antenatal diet among multigravida

mothers with Iron deficiency anaemia.

1) Literature related to Iron deficiency anaemia:

A descriptive observational study was conducted on anaemia in the postnatal

patient admitted at RGH; the samples of total 160 female patients with anaemia were

clinically evaluated to establish the relationship between severity /type of anaemia

with the socio economic status, age, parity and the past obstetrical history. The study

result shows that among 160 cases of anaemia, the iron deficiency anaemia was the

most common (87.5%), thalassemia trait was in 3% of the cases. 47.5% of women

were between 25-30 years of age, 83.7% of them belonged to the lower

socioeconomic class. 52.5% of patient were multigravida, and 67.5% of patients had

moderate anaemia.10

2) Literature related to antenatal diet:

A study was conducted in Delhi to determine the effect of different dietary

habits on prevalence of anaemia during pregnancy by questioning the woman during

pregnancy their dietary habits (vegetarian diet, jhatka or halal meat) and assessing

their haemoglobin levels. The study shows that most women were in the second

(26%) or third trimester (63.2%) of pregnancy. Prevalence of anaemia was found to

6

be very high of 1150 women, 96% were anaemic (89.8% mildly anaemic, 5.3%

severely anaemic). Anaemia was seen in 96.18% cases in vegetarian women, 95.3%

in halal meat eaters, and 96.2% in jhatka meat eaters. 11

3) Literature related to multigravida with Iron deficiency anaemia:

A study was conducted on red cell indices and serum ferritin in anaemia of

pregnancy, the study stated that iron deficiency is more likely in multigravidas than

primigravidas. The study reveals that, a total of 90 pregnant women were studied

compromising of 30 anaemic primigravidas (Hb<10gm/dl), 30 anaemic

multigravidas, 15 apparently healthy primigravida and 15 healthy and multigravidas

as controls. A positive correlation was obtained between Hb and serum ferritin in

anaemic primigravidas and non-anaemic primigravidas and also, in multigravidas.

The investigator concluded that iron deficiency is the main type of anaemic in

Nigerian pregnant woman.12

A study was conducted to investigate the possible contribution and impact of

anaemia and iron status on pregnancy and its outcome in a Nigerian population. The

total of 349 pregnant women aged 15-40 years at gestational age 25 week were

analyzed for plasma iron and haemoglobin using cyanmethaemoglobin method.

Anaemia and iron deficiency were recorded in 252 (72.2%) and 222 (63.6%) of the

women respectively, with 03% severely anaemic while 38.4% and 33.5% were

moderately and mildly anaemic and respectively. An inverse relationship was

observed between anaemia and iron deficiency with lower prevalence of iron

deficiency found among groups with high prevalence of anaemia, parity and antenatal

attendance have significant (p<0.05) effect on maternal haemoglobin with

multiparous women having higher prevalence of anaemia and more than 10 antenatal

attendance being associated with lower prevalence.13

A prospective study was conducted to determine the prevalence and

determinants of anaemia among pregnant women attending a tertiary sahelian hospital

in north-eastern Nigeria. A total of 1,040 pregnant women enrolled at their first

antenatal visit were monitored through pregnancy for anaemia. The study shows that,

the overall prevalence of anaemia, malarial parasitaemia and schistomiasis was

7

72.0%, 22.1% and 3.8% respectively. Mild, moderate and severe anaemia constituted

37.8%, 39.4% and 0.9% respectively. Anaemia was most common among the

multipara and women presenting in late stages of pregnancy. This study confirms the

high prevalence of anaemia in pregnancy, so appropriate intervention strategies are

necessary to reduce the prevalence of anaemia.14

A study was conducted to identify the prevalence of anaemia among pregnant

women attending antenatal care units of selected hospitals of Udupi district. The

sample used is 1,077 pregnant women were screened for anaemic using

cyanmethaemoglobian method, during the first antenatal visit. The prevalence of

anaemia was found to be 50.14% which is nearly equivalent to the prevalence rate

reported in the literature for Karnataka. Findings of the study revealed that the

prevalence was higher among young women, women belonging to low

socioeconomic status and women with short pregnancy intervals and higher parity.

Study suggests implementing various preventive strategies, especially advocacy and

monitoring of the iron and folic acid supplementation.1

A prospective case control study was conducted of infants from birth to one year

in a lower middle-class urban setting, in Amman Jordan. The objective was to

examine the relationship between maternal anaemia and iron deficiency during

infancy. A sample of 107 anaemic (Hb<11gm/dl) and 125 non anaemic mothers was

selected at 37 weeks gestation and matched for age and parity, and infant data at birth

obtained. The study shows that the incidence of iron deficiency anaemia was very

high in this infants at 72% by research criteria (51% of Hb<10.5gm/dl). Anaemia

during pregnancy compromises the health of mothers in traditional cultures, where

women tend to have several children close together after marriage with an in adequate

interval to replenish nutritional stores.15

8

4) Literature related to knowledge regarding antenatal diet among multigravida

with iron deficiency anaemia.

A study was conducted on anaemia during pregnancy: most preventable yet

most prevalent. The objective of the study was the relationship between maternal

haemoglobin and perinatal outcomes. The sample used total 1200 women, and to

highlight the importance of antenatal care to improve maternal health, maternal and

foetal outcomes. The study reveals that out of 1200 women, 787 were anaemic

(67.2%) <11gm of haemoglobin and 413 were non anaemic. Puerperal complications

were 2.5 times more in anaemic than non-anaemic women’s. The study concluded

that regular patient education by imparting proper knowledge regarding iron-rich

foods, food fortification, and implementation of anaemia prophylaxis programme

from adolescence, regular antenatal care from first trimester has a vital role in

assessing and managing maternal anaemia timely, and it directly affects the perinatal

outcome.16

9

6.3 STATEMENT OF THE PROBLEM

“A study to Assess the effectiveness of Individual Teaching Programme on

knowledge regarding antenatal diet among multigravida mothers with Iron

deficiency anaemia attending antenatal OPD in selected maternity Hospitals, at

Bijapur”

6.4 OBJECTIVES OF THE STUDY To assess the pre test knowledge of multigravida mothers regarding antenatal

diet to be measured by structured interview schedule.

To plan and implement Individual Teaching Programme regarding antenatal

diet among multigravida mothers.

To evaluate effectiveness of Individual Teaching Programme regarding

antenatal diet among multigravida mothers.

To find out association between pre-test knowledge score with their selected

demographic variables.

6.5 OPERATIONAL DEFINITIONS Assess

It refers to the statistical measurement of level of knowledge regarding

antenatal diet among multigravida mothers with iron deficiency anaemia.

Effectiveness It refers to the extent to which the Individual Teaching Programme on

antenatal diet has achieved the desired effect in improving the knowledge,

among multigravida mothers.

Individual Teaching ProgrammeIt refers to the systematically developed information designed to teach the multigravida mothers regarding antenatal diet.

KnowledgeIt refers to the awareness or information that multigravida mothers with iron deficiency anaemia possess regarding antenatal diet.

Antenatal diet It refers to the diet that Includes food items rich in iron, the mother has to take

during her gestational period.

Multigravida mothers with Iron deficiency anaemia It refers to the, the mother who has previously been pregnant; she may have

10

aborted, still birth, dead, or have delivered a viable baby with hemoglobin

level less than 11gm/dl.

6.6 ASSUMPTIONS Multigravida mothers with iron deficiency anaemia may have some

knowledge regarding antenatal diet.

Individual Teaching Programme may be help to improve the knowledge of

multigravida mothers with iron deficiency anaemia regarding antenatal diet.

6.7 HYPOTHESES

The following hypotheses will be tested at 0.05 level of significance.

H1: There is significant increase in knowledge of multigravida mothers with

iron deficiency anaemia regarding antenatal diet after implementation of

Individual teaching programme.

H2: There is a significant association between the knowledge score of

multigravida mothers with iron deficiency anaemia with their selected

demographic variables.

6.8 DELIMITATIONS

The study is delimited to

1. Antenatal diet with rich in Iron content foods.

2. The Individual Teaching programme to the Multigravida mothers with Iron

deficiency anaemia.

MATERIALS AND METHODS

7.1 Sources of data collection

Multigravida mothers with iron deficiency anaemia in selected maternity hospitals

at Bijapur.

7.1.1 Research design

A Quasi- experimental design will be used.

7.1.2 Research approach

11

7 An Evaluative approach will be used for the study.

7.1.3 Setting of the study

The study will be conducted in antenatal OPD at the Selected maternity

Hospitals at Bijapur.

7.1.4 Population

The population under study includes the multigravida mothers with Iron

deficiency anaemia attending antenatal OPD in selected maternity hospitals at

Bijapur.

7.1.5 VARIABLES Independent Variable: Individual Teaching Programme.

Dependent Variable: Knowledge of multigravida mothers with iron

deficiency anaemia.

Demographic variables: Age, education, occupation, income, number of

children, and past obstetric history.

7.2 METHOD OF DATA COLLECTION

7.2.1 Sampling procedure

The sample for the study will be selected by Convenient Sampling technique.

7.2.2 Sample Size

In this study the sample size will be 40 multigravida mothers with Iron

deficiency anaemia.

7.2.3 Inclusion Criteria

Multiparous mothers with iron deficiency anaemia irrespective of gestational

age.

Mothers who are willing to participate in the study.

7.2.4 Exclusion Criteria

Mothers who are primigravida.

Mother who are not available at the time of data Collection.

Mothers with any other associated conditions other than iron deficiency

anaemia

7.2.5 INSTRUMENTS USED

Individual structured knowledge Questionnaire.

Tool 1

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Part A : Proforma for collecting demographic Data

Part B: structured interview schedule.

Tool 2:

Individual teaching Programme regarding antenatal diet.

7.2.6 DATA COLLECTION METHOD

1) Permission will be obtained from the concerned authority.

2) Purpose of conducting study will be explained to the subjects.

3) Informed consent will be obtained from subjects.

4) Data would be collected using:

a) Structured interview schedule.

7.2.7 METHOD OF DATA ANALYSIS:

Data will be analysed according to the objectives of the study and by using

appropriate statistical techniques descriptive (mean, median, frequency, percentage)

and inferential (paired t-test, chi-square test) will be present in the form of tables,

Graphs and diagrams.

7.2.8 Duration of the study : 4- 6 weeks

7.3: 7.3 Does the study the require any investigation or intervention to be Conducted

on the patient or human beings or animals (if So, please Describe briefly).

No, Data include only verbal response, No intervention is carried out.

7.4: Has ethical clearance been obtained from your institution in case of 7.3?

Yes, Ethical clearance will be obtained from the ethical committee of the

Institution.

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8 3. Gautam C, Sana L, Sekhi. Iron deficiency anaemia in pregnancy and the

rationality of iron supplements prescribed during pregnancy. Medscap J med 2008

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pregnancy. Hematologi 2007; 92(2):539.

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Northeastern Nigeria. Journal of obstetrics and gynecology 2007; 27(7):676-9.

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risk factor for iron deficiency anaemia in infancy; a case control study in Jordan.

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