A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP)

ON KNOWLEDGE AND ATTITUDE OF ANTENATAL MOTHERS REGARDING IRON DEFICIENCY ANAEMIA AT

PHC KYATHSANDRA, TUMKUR

By

SAROJA NIRMALA KUMARI

DISSERTATION SUBMITTED TO THE RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

In partial fulfillment of the requirements for the degree of

MASTER OF SCIENCE IN NURSING

IN OBSTETRIC AND GYNAECOLOGY

UNDER THE GUIDANCE OF Prof. R. DANASU

HOD in Obstetric and Gynaecology Shridevi College of Nursing, Tumkur.

2004-05

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

KARNATAKA

DECLARATION BY THE CANDIDATE

I here by declare that this dissertation entitled “ A study to assess the

effectiveness of structured teaching programme on knowledge and attitude of

Antenatal Mothers regarding iron deficiency anaemia” is a bonafide and genuine

research work carried out by me under the guidance of Prof. R. Danasu HOD,

Shridevi College of Nursing, Tumkur.

Date : Signature of the Candidate

Place : Tumkur Name : SAROJA NIRMALA KUMARI

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled, “ A study to

assess the effectiveness of structured teaching programme on

knowledge and attitude of Antenatal Mothers regarding iron deficiency

anaemia” is a bonafide research work done by Saroja Nirmala Kumari

II Year M.Sc. Nursing in partial fulfillment of the requirement for the

degree of Master of Science in Nursing.

Date : Signature of the Guide.

Place : Tumkur Name : Prof. R. DANASU M.Sc., (OBG) Designation : HOD in Obstetric and Gynaecology

Shridevi College of Nursing, Tumkur.

ENDORSEMENT BY THE HOD, PRINCIPAL /

HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled, “ A study to assess the

effectiveness of structured teaching programme on knowledge and attitude of

Antenatal Mothers regarding iron deficiency anaemia” is a bonafide research work

done by Saroja Nirmala Kumari II Year M.Sc. Nursing student under the

guidance of Prof. R. Danasu, HOD, Shridevi College of Nursing, Tumkur.

Seal & Signature of the Seal & Signature of the

HOD Principal

Date : Date : Place : Place :

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation in

print or electronic format for academic / research purpose.

Date : Signature of the Candidate Place : Name : SAROJA NIRMALA KUMARI

© Rajiv Gandhi University of Health Science, Karnataka.

ACKNOWLEDGEMENT

I express my most sincere thanks to the Almighty for the blessings upon me

through out the course of this research study.

I extend my heartfelt thanks to my husband Dr. T.H. Rangappa and Chi. Spoorthy for their love and co-operation through out my

research study.

Grateful thanks to Honouralbe Director Dr. Hulinayakar, Shridevi

Educational Trust, Tumkur.

I extend my sincere and affectionate regards to Mr. K. Ramu, M.Sc (N) RN

(Professor), Principal, Shridevi College of Nursing, Tumkur for his timely guidance

and supervision in shaping my research study.

I am highly indebted to Mrs. Danasu. R, M.Sc (N), Obstetrics and

Gynecology, Head of the Dept. in Obstetrics and Gynecology, Shridevi College of

Nursing, Tumkur , for her valuable corrections and necessary advice throughout

my research study.

My sincere thanks to Dr. Mallinath Prabhu, M.D.,HOD obstetrics and

Gynecology, Shridevi Hospital, Tumkur.

My sincere thanks to Dr. Afzal-Ur-Rehman, Medical Officer, PHC,

Kythasandra and Staff of PHC, Kyathasandra, especially to Mrs. Nagarathna

(Auxiliary Nurse midwife) and Anganawadi workers and helpers who assisted me

in my research study.

I wish to extend my thanks to Dissertation Committee members for their

valuable suggestions and encouragement to complete the study.

I like to express my sincere thanks to my friends Mr. Santhosh Kumar,

Mr.K.V. Nagaraj., R. Chidanand , R. Shanthala and Chikkana for the timely help

who showed their patience and intelligence in Computer Work in this research

study (Future Computers and Laser Point, Tumkur).

I extend my thanks to all my family members and specially to staff of Shrive

College of Nursing.

- By Saroja Nirmala Kumari

IInd Year M.Sc. Nursing.

LIST OF ABBREVIATIONS USED

1) No. - Number of samples

2) % - Percentage

3) SD - Standard deviation

4) SEM - Standard error of mean

5) STP - Structured teaching programme

6) Subjects - Antenatal mothers

ABSTRACT Background and objectives :

Effectiveness of structured teaching Programme on iron deficiency anaemia at

PHC, Kyathasandra, Tumkur was conducted in partial fulfillment of requirement of the

degree of master of science in nursing at Shridevi College of Nursing , Tumkur.

The study objectives are

1. To assess the knowledge and attitude of antenatal mothers about iron deficiency

anaemia.

2. To evaluate the effectiveness of structured teaching programme on iron deficiency

anaemia.

3. To correlate the knowledge and attitude on iron deficiency anaemia during

pregnancy with the demographic data of antenatal mothers.

Methods

The research design was quail experimental. The population in antenatal mothers

of all age and all Gravida.

The sample size is 70 antenatal mothers selected by simple random sampling

technique. The tool comprised questionnaire guide. The data obtained from the study

was analyzed using descriptive and inferential statistics.

The study major findings Or Results

1. In the pretest out of 70 antenatal mothers 58 (82.9 %) of mothers had in adequate

knowledge regarding iron deficiency anemia and 11(15.7%) and antenatal mothers

had moderately adequate knowledge regarding iron deficiency anemia.

2. Regarding post test knowledge and attitude 43(61.4%) of antenatal mothers had

moderately adequate knowledge and 25(35.7%) of antenatal mothers had adequate

knowledge. The antenatal mothers showed (p<0.01) significantly increase in

knowledge and regarding iron deficiency anaemia.

3. In relation to effective structured teaching programme. The paired t- test showed

that the teaching programme was statistically significant at p<0.001 level in

antenatal mothers has been markedly increased alter the administration of

structured teaching programme on iron deficiency anaemia.

4. The chi- square test showed P<0.0.05 association between level of knowledge and

attitude of antenatal mothers regarding iron deficiency anaemia.

The finding of the study there is significant difference between pre test and post test.

Interpretation and conclusion :

The study results were interpreted in the form of tables and graphs. (From table no. 1 to

15, 16-30)

The above findings of the present study are consistent with another similar study

was conducted to evaluate the studies structure – teaching programme for anaemic

mothers on their quality of life 1 and 2 years afterwards. The study regulars showed

that, there was a significant increase in overall quality at life in the educated group as

compare to the control group after 1 to 2 years.

The overall findings of the study showed that structured teaching program in very

effective in improving the knowledge and awareness about iron deficiency anaemia

among antenatal mothers.

INDEX

CHAPTER NO. CONTENTS PAGE NO.

1. Introduction 1-3

Statement of Problem

Need for study 4-6

2. Objectives of the study 7-9

Hypothesis

Research Design

Conceptual frame work

3. Review of Literature 10-15

Literatures related to Iron deficiency anaemia

Literatures related to structured teaching programme 15-20

4. Methodology 21-24

Research approach

Research design

Setting

Population

Criteria for sample selection

Instrument

Description of instrument

Scoring procedure

Pilot study

Statistical method 25

5. Results 26

6. Discussion 57

7. Conclusion 59

8. Summery 60

Major findings of study

Nursing implications suggestions 61

Suggestions 62

9. Bibliography 65-67

10. Appendices 68-100

LIST OF TABLES

Table: Knowledge

Sl No. PARTICULARS Page No.

1 Table-1 : Showing Distribution of demographic characteristics among antenatal mothers.

27-28

2 Table – 2 Showing the level of knowledge of antenatal mothers regarding iron deficiency anaemia in Pretest

29

3 Table – 3 Showing the level of knowledge of Post test 30 4 Table – 4 Showing mean and standard deviation in Pre test

and Post scores about iron deficiency anaemia among antenatal mothers.

31

5 Table – 5 Showing improvements in mean and standard deviation pre test and post test scores about iron deficiency anaemia among antenatal mothers.

32

6 Table – 6 Showing Association between level of knowledge and age of antenatal mothers.

33

7 Table – 7 Showing Association between level of knowledge and religion of antenatal mothers.

34

8 Table – 8 Showing Association between level of knowledge and Educational status of antenatal mothers.

35

9 Table – 9 Showing Association between level of knowledge and Occupation of antenatal mothers.

36

10 Table – 10 Showing Association between level of knowledge and Income of antenatal mothers.

37

11 Table – 11 Showing Association between level of knowledge and Gravida of antenatal mothers.

38

12 Table – 12 Showing Association between level of knowledge and family type of antenatal mothers.

39

13 Table – 13 Showing Association between level of knowledge and family members of antenatal mothers.

40

14 Table – 14 Showing Association between level of knowledge and available health resources of antenatal mothers.

41

15 Table – 15 Showing Association between level of knowledge and utilization of health resources of antenatal mothers.

42

Table : Attitude

Sl No. PARTICULARS Page No. 1 Table-1 : Showing Distribution of demographic

characteristics among antenatal mothers.

2 Table – 2 Showing the level of Attitude of antenatal mothers regarding iron deficiency anaemia in Pretest

43

3 Table – 3 Showing the level of Attitude of Post test 44 4 Table – 4 Showing mean and standard deviation in Pre test

and Post scores about iron deficiency anaemia among antenatal mothers.

45

5 Table – 5 Showing improvements in mean and standard deviation pre test and post test scores about iron deficiency anaemia among antenatal mothers.

46

6 Table – 6 Showing Association between level of Attitude and age of antenatal mothers.

47

7 Table – 7 Showing Association between level of Attitude and religion of antenatal mothers.

48

8 Table – 8 Showing Association between level of Attitude and Educational status of antenatal mothers.

49

9 Table – 9 Showing Association between level of Attitude and Occupation of antenatal mothers.

50

10 Table – 10 Showing Association between level of Attitude and Income of antenatal mothers.

51

11 Table – 11 Showing Association between level of Attitude and Gravida of antenatal mothers.

52

12 Table – 12 Showing Association between level of Attitude and family type of antenatal mothers.

53

13 Table – 13 Showing Association between level of Attitude and family members of antenatal mothers.

54

14 Table – 14 Showing Association between level of Attitude and available health resources of antenatal mothers.

55

15 Table – 15 Showing Association between level of Attitude and utilization of health resources of antenatal mothers.

56

LIST OF FIGURES SL.NO. CONTENTS PAGE NO.

1. Conceptual frame work. 1(a)

2. Graphs showing:

i. Percentage distribution of Age of antenatal mothers. 28(a)

ii. Percentage distribution of Income of antenatal mothers. 28(b)

iii. Comparison of Knowledge level in Pre test and Post test. 30(a)

iv. Association between level of knowledge and age of

antenatal mothers.

Association between level of knowledge and Educational

status of antenatal mothers in Post test 35(a)

v. Association between level of knowledge and Occupation

of antenatal mothers in Post test. 36(a)

ANNEXURE – I

LETTER SEEKING FORMAL PERMISSION TO CONDUCT THE STUDY IN PHC, KYATHSANDRA.

From

The Principal Shridevi College of Nursing

Tumkur. To Subject: Requisition for permission to conduct the study on Antenatal mothers in your Institution. Sir, Mrs. Saroja Nirmala Kumari is a final year student of Master of Nursing Course

at Shridevi college of Nursing, Tumkur. She has selected the following topic for her

research project to be submitted to Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka, in partial fulfillment of University requirement for the award of

Master of Nursing Degree.

Topic: “A study to assess the effectiveness of structured teaching Programme

on Knowledge and Attitude regarding Iron Deficiency Anaemia to

Antenatal mothers in PHC Kyathsandra”

She is in need of your permission and esteemed help as she indents to conduct the

Study in your institution from January to March 2005.

I am herewith to request you to kindly grant permission and inform the

concerned authorities and extend the necessary facilities to her at your hospital to enable

Her work on the proposed study.

Thanking you, Yours Faithfully,

Principal. .

ANNEXURE – II

LETTER REQUESTING OPINIONS & SUGGESTIONS FROM EXPERTS

From: Mrs. Saroja Nirmala Kumari II year, M.Sc., (Nsg) Student, Shridevi College of Nursing, Tumkur. To, Through the Principal Shridevi College of Nursing, Tumkur.

Sub : Request for the validation of the tool . Respected Sir/Madam,

I, Mrs. Saroja Nirmala Kumari – II year, M.Sc., (Nsg) Student of Shridevi college

of nursing, Tumkur, have undertaken a dissertation in partial fulfillment of master of

science in Nursing programme. The tool for my project has to be validated by experts. The

dissertation topic and objective of the study are as follows.

Topic: “A study to assess the effectiveness of structured teaching Programme

on Knowledge and Attitude regarding Iron Deficiency Anaemia to

Antenatal mothers in PHC Kyathsandra”

Objectives of the study :

1. To assess the knowledge of primigravid women on specific self care activities.

2. To educate the primigravid women with structured teaching programme regarding

specific self care activities.

3. To evaluate the effectiveness of structured teaching programme on specific self

care activities among primigravid women.

4. To associate the demographic data and knowledge on specific self care activities

among the primigravid women.

Here with I am enclosing : 1. Structured interview schedule

2. Criteria check list for evaluation of tool.

3. Structure teaching programme.

4. Content validity certificate.

5. Criteria rating scale for validating the structure-teaching programme.

I request you kindly to go through the content of tool and give your valuable opinion on

the same especially whether the required criteria are met in the tools developed. Please

suggest modifications wherever applicable.

Yours faithfully, (Saroja Nirmala Kumari)

LIST OF EXPERTS FOR CONTENT VALIDITY

1. Ms. Lalitha, M.Sc. (N), Lecturer OBG

Government College of Nursing, Bangalore.

2. Mr. Tilagavathi, M.Sc. (N),

HOD, OBG,

Oxford College of Nursing,

J.P. Nagara, Bangalore.

3. Ms. Shanti. Ida. M.Sc.,(N),

HOD, OBG

M.S. Ramaiah College of Nursing,

Bangalore.

4. R. Danasu, M.Sc. (N)

HOD, OBG

College of Nursing.

1

CHAPTER –I

INTRODUCTION

Iron clearly is the body’s gold, a precious mineral to be hoarded and closely

guarded. A low hemoglobin level may represent a dietary iron deficiency.

Iron is found not only in every cell, of the human body but also in all living

things, both plants and animals. Iron forms a major component of the proteins,

hemoglobin in red blood cells and myoglobin in muscle cells. The daily requirement of

iron by a woman is twice as great as a man’s but anyone who loses blood loses iron.

In pregnancy good nutrition is necessary at all stages of foetal life. Proper

nutrition is absolutely essential during pregnancy and lactation During pregnancy extra

nutrition is required not only for the growing foetus but also for the mother as she

undergoes major changes in her body systems. Any dietary deficiency affects both mother

and foetus as early as 12 weeks of gestation and continues till delivery.

An average Indian family consumes foods that generally cosists of some cereal

based foods like rice, roti, dal and curry. Meat, fish, eggs, fruits, milk are not always

included in daily diet due to the prevailing low economic condition. But a pregnant

woman needs additional calories, proteins as well as lot in addition some micronutrients

such as extra iron are specially required to meet the increased demands of the foetus and

placenta due to increased red cell mass and to compensate the blood loss during

parturition. In order to acquire the extra macro and micro nutrients. A pregnant woman

should take more frequently, foods rich in iron like meat products, pulses, legumes and

green leafy vegetables.

The World Health Organisation (WHO) recommends an extra diet amounting to

150 kcal/ day in the first trimester and 350 kcal/day during rest of the pregnancy. In

addition to dietary modification, a pregnant woman should go for a monthly check up to

detect anemia, increase in weight gain and changes in blood pressure. She should take

tetanus toxoid immunization and calcium, folic acid and iron supplementation.

Since 1992, the Government had launched a special programme of child Survival

and Safe Motherhood mainly for children and women. The programme renders services

2

such as tetanus toxoid immunization, prevention and treatment of anemia, antenatal care

and early identification of maternal complications, conduction of deliveries by trained

personnel, promotion of institutional deliveries, management of obstretic emergencies

and birth spacing for antenatal mother. Inspite of all measures done by the government of

India, about 350-400 maternal death occur in 100,000 birth out of which anemia and

toxaemia account for nearly 30-40 percent.

Anemia is a common nutritional deficiency disease especially prevalent among

women of childbearing age, particularly during pregnancy, and is often a contributory

cause of maternal death.

Anemia is a condition associated with a decrease in the quantity of red blood,

cells, which reduces the ability to transport oxygen to peripheral tissues. World, Wide the

leading causes of anemia is iron deficiency anemia. It is estimated that approximately 1.3

billion individuals in the world. Suffer from anemia making it one of the most important

public health issues on the international agenda. In developing countries. Iron deficiency

afflicts approximately two billion people and is the principal causes of anemia. In India

its prevalence varies from 20% to 97% in different sets of population, mainly pregnant

women and women of child bearing age.

Anemia, a bane of the third world

Stevans, (1999)

Historically (1500 BC) the Ayurvedic literature Charak Samhita described fatigue

and pallor due to bloodlessness, can be cured by ‘Lauha bhasma’ (cakcufued Iron).

During the same period. Egyptian manual of therapeutic ‘Ebers papyrus’ described the

disease characteriesed by pallor, dyspnoea and edema. In Greek Literature (1554- 1700)

Chlorosis / Demeorbo Virginia or green sickness was described as curable by drinking

iron rust dissolved in water.

In United States as many as 2/3 rds of women of reproductive age had signs of

iron deficiency and 5% of them are anaemic because of decresed ability to absorb dietary

iron.

3

Myles (1990) pointed out that woman need to be taught about the sources of Iron

and ways in which absorption can be increased.

Dickason (1990) pointed out that Iron deficiency anemia is the common type of

anemia in pregnancy. Approximately 55% of all pregnant women had a Haemotocrit

(Hct) less than 32% This type of Iron deficiency anemia is ten times more common than

other anemias.

Bobak and Jensen (1991) pointed out that about 90% cases of anemia in

pregnancy are of Iron deficiency type. The remaining 10% of cases embrace a

considerable variety of acquired and hereditary anemias, including Folic Acid Deficiency,

Sickle Cell Anemia and Thalassemia.

Stevens (2000) in his recent review of maternal anemia from developing

countries, showed that the highest prevalence rate was in the reproductive age group. It is

estimated that two third of pregnant women and half of the non pregnant women in south

Asia and Sub-Saharan Africa were anemic. World wide, the leading cause of anemia is

iron deficiency anemia. Prevalence rates are higher in developing countries than in

developed countries.

In developing countries prevalence rates in pregnant women is commonly in the

range of 40% to 60% and 20% to 40 % among other women According to standing laid

down by WHO, anemia in pregnancy is present when the hemoglobin (Hb) concentration

socio-economic deprevation in the developing countries, the level is brought down to

10gm/100ml. Adopting this lower level the incidence of Anemia in pregnancy ranges

widely from 40-80 in tropics compared to 10-20 in the developed countries.

A study conducted in the University Hospital, Varanasi in the year 2000 on 200

anemic pregnant women showed that reduced gestation, higher incidence of premature

labour, pre-term, low birth weight, still birth deliveries, low Apgar score and increased

number of neonatal deaths were likely in anemic mothers. Maternal mortality was 13 bout

of 200 anemic women.

In 1968 the Nutrition society of India constituted a study group to recommend

measures to combat, “Nutritional Anemia”. It recommended prophylactic administration

of iron and folic acid to pregnant women.

4

STATEMENT OF PROBLEM

A study to assess the effectiveness of structured teaching programme on iron

deficiency anemia to the antenatal mothers Kyatasandra PHC, Tumkur.

NEED FOR THE STUDY

According to WHO (1991) in the world 500,000 women die every year as a result

of pregnancy and childbirth. This means that every minute of a day there is one maternal

death, 99% of these deaths occur in the developing countries. The maternal mortality rate

in the world is 390/100,000 live birth, In India 100,000 women die every year as a result

of pregnancy and childbirth, which means one maternal death in every five minutes. The

maternal mortality rate is 340/100,000 women of reproductive ages.

NEED FOR THE STUDY 1. One of the micro nutrient i.e. Iron which is available in local low cost vegetable

and greens and red meat liver etc., The women in pregnancy their will be double demand

of the same and also because of lack of education about daily requirement is the main

reason for Iron defiency anaemia and a structured teaching programme may enhance the

knowledge and change the attitude of pregnant mothers to take Iron rich diet. An STP

may change their practice of cooking it is not sufficient to cope up with the deficient of

Iron which occurs due to pregnancy. The investigator hope it is an urgent need to develop

new method/ material to educate women about Iron defiency anaemia. According WHO

1991 in world 50,000 women die every year as a result of pregnancy & child birth. Every

minute there will be one maternal death. The M.M.R. 390/- 100000 Live Birth. 1991-

2001 India latest 4071 in world.

The indirect causes of maternal death mainly account for 25% of cases and are

due to associated medical diseases that worsen during pregnancy, the commonest being

anemia followed by jaundice and heart diseases.

According to WHO (1991) the maternal death due to anemia is 17.6% in India.

Anemia is often a contributory cause of maternal death and is notoriously responsible for

intrauterine growth retardation, pre-term labour, intrauterine death and low birth weight

5

babies. So, the investigator was interested in educating the antenatal mothers regarding

iron deficiency anemia.

The indirect causes of maternal death mainly account for 25% of cases and are

due to associated medical diseases that worsen during pregnancy, the commonest being

anemia followed by jaundice and heart diseases.

According to WHO (1991) the maternal death due to anemia is 17.6% in India.

Anemia is often a contributory cause of maternal death and is notoriously responsible for

intrauterine growth retardation, pre-term labour, intrauterine death and low birth weight

babies.

The National Nutritional Anemia Control programme includes pregnant women,

feeding, women, family planning acceptors and children in its target group and renders

service to control anemia. Indian Council of Medical Research (ICMR) (1989) stated, the

prevalence rate of anemia is as high as 62% The ICMR study had made the observation

and concluded that the high drop out and non compliance rate of 47.2% and significantly

low consumption of tablets were serious constraints in the success of any national

programme for the control of anemia in pregnant women.

The Survey conducted by ICMR during 1987-1989 in six states of India found

that out of 1968 women (62.3%) had Hb less than 11g/dl. The District Nutrition Survey

(1999-2000), reported that prevalence of Hb less than 11g/dl was in 61%. 79%, 84%,

91% in the districts of Himachal Pradesh, Uttar Pradesh, Bihar, Assam, and Kashmir

respectively was shown. These national data suggest high prevalence of nutritional

anemia in pregnancy.

PHC Kyatasandra Hospital in Tumkur conducted a survey and concluded that

the prevalence of anemia among 3.844 mothers was 75.9%.

The central purpose of antenatal care is to identify high risk cases as early as

possible. Abut 0.9 % of maternal deaths of total deaths occur globally. India accounts one

quarter of maternal death world wide. India stands very high maternal mortality rate in

the world. Showing an average MMR of 407 per 1 lakh live birth. More than 1 lakh die

due to pregnancy related causes. MMR in Karnataka is 195 per lakh live birth. The major

6

causes for maternal mortality are anaemia (19%) toxaemia (8%) hemorrhage (29%)

sepsis (16%) obstrueted labour (10%) abortion (9%) and other (9%) park. K 2005 )

The investigator is native of Bangalore who is residing at Tumkr, she used to go to

villages and urban slums and attending antenatal clinics in her 20 years of services, her

observation of the local population and results of the above mentioned study arise on

interest to the investigator to take up the areas (urban & rural areas of Kyathasandra for

conducting the study she observed mothers in antenatal clinics and made vistts to

antennal mothers who had complaints of tiredness, giddiness, fatigue, general malise,

inability to work efficiently. Most of them were diagnosed to be anemia. The investigator

discussed the these problems with the nurses in charge of the clinic and the area, they

expressed that though they were distributing iron and folic acid tablets to mothers they

were not taking the supplement to the whole course and discontinuing and also not taking

the diet which is rich in iron and folic acid the reasons given by ANM/the antenatal

mothers is that

- if they use haematinics the baby will be dark

- the baby will be big and delivery becomes & difficult

- there will be vomiting sensation

- they may abort

- they should not take any tablets during pregnancy.

All the above said reasons is not true scientifically and shows that lack of current

information and no proper health education (method and medias) regarding iron and folic

acid supplementation and diet. The importing of knowledge about iron and folic acid

necessity is a urgent and continuously needed by the mothers of respective area. The

investigator was interested in educating the mothers regarding iron deficiency anemia

7

CHAPTER - II

OBJECTIVES OF THE STUDY

1. To assess the knowledge of antenatal mothers about iron deficiency anemia

2. To evaluate the effectiveness of structured teaching programme on iron deficiency

anemia.

3. To correlate the knowledge and attitude on iron deficiency anemia during

pregnancy with the demographic data of the antenatal mothers.

HYPOTHESIS:

THERE IS A SIGNIFICANT DIFFERENT IN THE KNOWLEDGE OF

ANTENATAL MOTHERS REGARDING IRON DEFICIENCY ANEMIA BEFORE

AND AFTER THE STRUCTURED TEACHING PROGRAMME.

RESEARCH DESIGN Research design will be Quasi experimental design i.e., the group will be given pre and post test. Research design can be shown in figures as given below. R O1 X 02 Key : R : Randomisation

O1 : Pre test group

X : STP (Intervention)

02 : Post –test group

Randomisation will be applied in case of selecting the sample and structured teaching

programme will be administered to same group and the effectiveness of STP will be

evaluated

OPERATIONAL DEFINITIONS OF TERMS

Effectiveness

It refers to determine the extent to which structured teaching programme has

brought about the result intended and is measured in terms of significant knowledge

gained in the post test.

8

STRUCTURED TEACHING PROGRAMME It refers to the systematically developed information and the audiovisual aids designed to

teach the antenatal women regarding iron deficiency anemia.

KNOWLEDGE Knowledge refers to verbal responses of women about the meaning of anemia, causes, signs and symptoms, investigation, complications, prevention and treatment. IRON DEFICIENCY ANEMIA

Iron deficiency anemia is the condition in which hemoglobin is less than 10gm%

and occurs mainly due to deficiency of Iron.

ANTENTAL MOTHERS:

Pregnant women form 12 weeks to 40 weeks of gestation.

ASSUMPTIONS OF THE STUDY:

1. Structured teaching programme will improve mothers

knowledge on iron deficiency anemia

2. Structured teaching programme will enable antenatal mothers to

seek medical help as early as possible.

HYPOTHESIS OF THE STUDY: There is a significant difference in the knowledge of antenatal mothers regarding

iron deficiency anemia before and after the structured teaching programme.

LIMITATIONS OF THE STUDY:

1. The sample size was limited to 70 antenatal mothers.

2. The period of study was limited to six weeks.

3. The findings of this study cannot be generalized.

PROJECTED OUTCOMES :

This study may determine the effectiveness of structured teaching programme on

iron deficiency anemia. It would throw light on the knowledge of antenatal mothers about

9

iron deficiency anemia. It would also determine the relationship between the knowledge

and demographic characteristics. This study would help them to take preventive measures

against iron deficiency anemia and be ware of the treatment available for iron deficiency

anemia and also would establish the need for appropriate health education strategy in

preventing iron deficiency anemia.

CONCEPTUAL FRAMEWORK:

The conceptual framework for this study was derived from “General System

Theory” Ludwing Von Bertalanffy, (1968) According to general system theory, a system

is a set of components or unit interacting with each other within a boundary that filters the

kind and the rate of flow of inputs and outputs to and from the systems.

Systems can be open or closed. Open system are open for the exchanges of matter,

energy and information. The open system receives various inputs. Inputs are the sources

needed by the system. Inputs are transformed in a process called throughput. Here matter,

energy and information are continuously processed through the system and released as

outputs. The system returns output to the environment in and altered state, affecting the

environment. The feedback is the environmental responses to the systems. Feedback may

be position negative and neutral.

In this study, the pretest assess the existing knowledge attitude of antenatal

mothers regarding iron deficiency anemia occurring during pregnancy. The input

structured teaching programme includes the definition, causes, signs and symptoms,

investigations, complications, prevention and treatment. The through put is the

transformation of knowledge among antenatal mothers regarding iron deficiency anemia.

The output is the result of changes in knowledge found among the pregnant

women after a post test regarding iron deficiency anemia, interpreted as inadequate

knowledge, Moderately adequate knowledge and adequate knowledge.

In this study a feedback is necessary those who belong to the group that falls

under inadequate and moderately adequate knowledge group Subsequently sessions and

followup will increase their knowledge.

10

CHAPTER –III

REVIEW OF LITERATURE

A review of literature relevant to the present study was aimed at identifying the

knowledge of antenatal mothers regarding iron deficiency anemia.

PART –1

LITERATURE RELATED TO IRON DEFICIENCY ANEMIA

PART-II

A. LITERATURE RELATED TO THIS STUDY

B. LITERATURE RELATED TO STRUCTURE TEACHING PROGRAMME

C. CONCEPTUAL FRAME WORK

PART-1 LITERATURE RELATED TO IRON DEFICIENCY ANEMIA

Mary (1990) stated pregnancy is a time of numerous changes in women’s

physical, psychological and social disposition. These changes coupled with a desire to

have a healthy pregnancy outcomes are powerful motivation forces for women to engage

in learning about selected health problems.

Almost 80% of all anemia in pregnancy are caused by predominance of

etiological factors such as:

1. Inadequate iron content of the diet and

2. Lack of adequate iron stores a majority of women during their reproductive years.

Classification of Anemia * Physiological anemia of pregnancy

During pregnancy hemodilution occurs and leads to physiological anemia

* Pathological anemia

a. Deficiency anemia

• iron deficiency

• folic acid deficiency

11

• vitamin B12 deficiency

• protein deficiency

b. Hemorrhagic

Occurs following bleeding in early months or post partum Hemorrhage, Chronic

Hookworm infestation and Bleeding piles.

c. Hemolytic

• Familial – congenital, jaundice and sickle cell anemia

• Acquired – Malaria and Severe infections

d. Bone marrow insufficiency

e. Hemoglobinopathies

Iron deficiency is mainly nutritional in origin. There are two types of dietary iron,

haem and non-haem. Haem iron is found in foods of animal origin such as meat, fish,

poultry and its bio-availablity is high with absorption being 20-30% non haem iron is

found is foods of plant origin especially whole grains, cereals, tubers, vegetables and

pulses. Its bio-availabity is lower and is determined by the presence of enhancing and

inhibiting factors consumed in same meals. Enhancer of non-haem absorption include

meat, poultry, fish and vitamin-C. Exogenous iron in addition to food can also be

obtained from iron pots used as cooking vessels.

Causes of Anemia

* Increased demands

• Physiological: Though about 300mg of iron is conserved due to amenorrhoea,

there is a net need of 450 to 600 mg during pregnancy due to foetal demands

(350-400mg) placental demands (150mg), Postpartum bleeding (100-200mg)

and loss in breast milk (150mg)

• Interval between two successive pregnancies less than two years

• More than four pregnancies

• Multiple pregnancy

• Pregnancy below age of 21 years (teen-age pregnancy)

12

* Decreased intake of iron

• Poor diet

• Excessive morning sickness

* Decreased absorption

• Decreased gastric acidity

• Dietary imbalance causing formation of insoluble salt

* Hook worm infestation is the principle cause of iron deficiency anemia in developing

countries. Adult hookworms live in the duodenum and jejunum (small intestine) attached

to the intestinal mucosa from which they suck blood causing a chronic blood loss,

depleting body iron resources.

Signs and symptoms

1. Lassitude, a feeling of exhaustion and weakness may be the earliest manifestations.

2. Other features are anorexia, indigestion, palpitation caused by ectopic beats,

dysponea, giddiness and swelling of the legs.

On Examination

1. There is varying degrees of pallor evidence of glossitis and

stomatitis

2. Oedema of the legs may be due to hypoproteinemia or associated

pre eclmpsia

3. A soft systolic murmur may be heard in the mitral area due to

physiological mitral incompetence. Crepitation may be heard at the base of the

lungs due to congestion.

Investigation done in iron deficiency anemia

1. Haemoglobin

2. Peripheral smear

3. Blood indices

13

4. Urine is examined for presence of protein, sugar, pus cell and culture for

infection.

5. Stool routine for hookworm and occult blood

6. Bone marrow sideroblast count

Complications

The effect of anemia on the mother are predisposition to inter current infection,

preterm labour, associated malnutrition these may predispose to pregnancy induced

hypertension, poor tolerance to antepartum and postpartum hemorrhage, strain on even an

uncomplicated labour may causes cardiac failure and puerperal sepsis.

The effects of anemia on fetus include prematurity, intrauterine growth

retardation, intrapartum foetal death.

Prevention and Treatment of Iron Deficiency Anemia

Physiological anemia is common in pregnancy due to increased fetal demands.

Without iron therapy even pregnant woman who enjoy excellent nutrition will conclude

pregnancy with an iron deficit. Diet alone cannot replace gestational iron losses. In

pregnancy successful iron therapy can be carried out in most cases with oral iron

supplement (eg. Ferrous sulphate-200mg daily). It is important to teach the woman about

the importance of iron therapy. It is necessary to instruct the woman in dietary ways to

decrease the risk of anemia, pregnant women who were endurable should receive

parenteral iron therapy.

The following are the suggestions given by Usha Krishna (1992) to tackle anemia

in pregnancy:

1. Risk based approach to the problem due to available limited resources.

2. Early detection of pregnancy and screening of anemia.

3. Appropriate antenatal care.

4. Hb estimation in second trimester for every pregnant woman so as to identify

and rationalize the route and doses of iron therapy

5. Health education regarding proper utilization of iron and folate rich foods.

6. Cultivation of green leafy vegetables, wheat ragi etc.,

14

7. Health education to improve the utilization of existing facilities and

improvement in health care delivery system to cater to the need, right at their

doorstep, will go a long way in reducing maternal anemia.

The National Nutritional Anemia Prophylaxis Programme

There is no doubt about its necessity, in developing countries where iron and

folate deficiency is very common. Adverse effects on maternal and foetal health can be

prevented or reversed by adequate supplementation. In 1968 the Nutrition Society of

India (NSI) constituted a study group to recommend measures to combat nutritional

anemia in the country. The group recommended prophylactic administration iron and

folic acid to pregnant women. On the basis of this report, the ministry of Health and

Family Welfare in 1970 initiated the National Nutritional Anemia Porphylaxis

programme (NNAPP) – this included pregnant and lacting women, family planning

acceptors (women) and children. The Government revived the programme under the new

name “National Anemia Control Programme”

The “National Nutritional Anemia Control Programme” is an excellent document,

Comprehensively covering the promotion of consumption of foods rich is iron, provision

of iron and folate supplements in the form of tablets to high risk groups (like pregnant and

lacting mothers, IUD users, children under five) Identification and treatment of severe

anemia.

Apart from the various measures mentioned for the prevention and treatment of

anemia which is a curse in the third world, attempts are being made to fortify common

salt with iron as in the case of iodine to prevent iodine deficiency disorders.

15

REVIEW OF LITERATURE 1. “Pregnancy is special let us make is safe” WHO 1998

The primary aim of antenatal is to achieve a healthy baby from the healthy mother.

Ideally it starts from the conception and continues throughout. The central purpose of

antenatal care is to identify high risk cases as early as possible. About 0.9% maternal

death of total deaths occurred globally, India accounts one quarter of maternal death

world wide. India stands very high maternal mortality rate in the world showing an

average of MMR of 407 per 1 lakh live birth more than I lakh women die each year due

to pregnancy related causes. Estimated MMR in Karnataka is 195 per lakh live birth. The

major causes of maternal mortality are anemia (19% toxemia 8%) haemorrhage (29%)

sepsis (16%) obstructed labour (10%) abortion (9%) and other (9%) (Park .K 2005) 39

2. A study was conducted by E.L. Guind .W promoted al this study was conducted to

determine the effects of severe antenatal maternal anemia on pregnancy out come. The

retrospective study compared with the groups with anemia (Hb%<8g/dl and Hb%>10g/dl)

Iron deficiency anemia was most commonest cause for anemia maternal anemia was

found to be significantly associated with more frequent preterm birth (29.2% / 9.2%)

and increased low birth weight (2933g / 3159g) many studies indicated that routine iron

supplementation may have beneficial effects on pregnancy out come severe anemia

adverse effect for the new born and can be prevented by treating early in pregnancy. 38

3. A study was conducted on “Comparison of screening methods for anemia in

pregnant women in Awassa, Ethiopia ” screening of anemia is essential for implementing

and monitoring effective antenatal programmes. Overall prevalence of anemia Hb <

11g/dl was 15% mild anaemia Hb%<10-10.g/dl Moderate anemia Hb%-7to 9.9g/dl severe

anemia < 7g/dl. W.H.O color scale were calculated for Hb% cutoff points <11. <10 and

<9g /dl. The diagnosis of anemia based clinical symptoms remains reliable and iron and

folic acid supplemention prevents the anemia in pregnancy and normal weight babies are

expected at term (Tromed. Int health 2003-April 8 (4) 301-309) 37

4. A Study was Conducted on “Prevalence of multiple micro-nutrient deficiency

amongst pregnant women in rural area of Haryona ” to assess the prevalence of micro-

nutrient deficiency. The study revealed that deficiency of micro-nutrients during

pregnancy are known cause of L.B.W. there is a high prevalence of micro-nutrient

16

deficiency due to poor dietary in take of food and low frequency of non-consumption of

food groups rich in micro-nutrients there were 31.8% of illiteracy and majority 81.9%

belong to lower middle socio-economic studies 70% pregnant women were vegetarian

food items rich in micro-nutrients were generally consumed less frequently. 35

5. A Study was Conducted on “Iron supplementation during pregnancy”. The study

revealed that pregnant women are at high risk for iron deficiency anemia. Routine Iron

supplementation during pregnancy has been almost universally recommended to prevent

maternal anemia, to improve maternal iron status in puerperal even in women who enter

pregnancy with adequate iron stores and also there is an association between maternal

iron status in pregnancy and iron status of infants post portum routine iron

supplementation during pregnancy seems to be right strategy to prevent maternal anemia

in developing countries where traditional diet provides inadequate iron. 36

6. A Study was Conducted on “Iron deficiency anemia it is prevalent in a sample of

pregnant women at delivery in Germany ” to determine the prevalence and risk factors of

iron deficiency pregnancy the study revealed that studies on leucocyte count correlated

significantly with ferration value. Low education level young maternal age were

significant factors in iron deficiency anemia which is prevalent in Germany it could

prevented by routine iron supplementation. 37

7. A Study was Conducted on “Elevated plasma haemocystine in early pregnancy is

a risk factor foe development of non severe anemia”

The literature communicate the haemocystenianemia has been identified as arise

factor for development of atherosclerosis and thrombic phenomenon elevated level of

plasma of haemocystine has been related increse rise of coronary cerebral and peripheral

artery disease. Haemocyteinamia results in adverse outcome includes pregnancy loss.

Preterm delivery low birth weight babies, development of pre-eclampsia, intrauterine

growth retardation, abruptio – placentae and folic acid deficiency leads to neural tube

defects. 1

8. A Study was Conducted on “The relation ship of race of women use of health

information resources”.

17

The Study represents first step towards the health seeking behaviour of adult

women and potential changes necessary to dissemination of health information. Health

information resources should focus on quality standard for health information and

examination of competitiveness and readability. 2

9. A Study was Conducted on “Iron deficiency in women role of carbonyl” – says

that their should be clear awareness about Iron deficieny among health care personnel.

According to this literature Iron deficiency in women, role of carbonyl Iron is common

and preventable. Only awareness / health education about Iron deficiency among health

care personal / community is required urgently. 3

10. A Study was Conducted on nutritional anemia at department of hematology

(USA) revealed that Iron deficiency is a public health problem in all countries and

prevention or treatment are the major goals. The increased understanding of Iron

metabolism and absorption may clarify the etiology of diseases due to lack of Iron. This

confirmed that there should be increased awareness about the importance of Iron 4

11. A Study was Conducted on routine sereening at Thripoli in an attempt to answer

the value of screening. The hematocrit charts of pregnant women over the last eight

years were reviewed. The mean value of hematocrit in sample was 35.87. The

prevalence of anemia was 31% among primigravida. The age group 15 to 19 years had

the highest risk for developing anemia. Increased parity was associated with intake of

Iron and it concluded that there is need for more critical consideration of iron

supplementation. The question of routine screening with hematocrit in the first prenantal

visit should be reevaluated and patients who are at risk should be screened 5

12. A Study was Conducted on iron supplementation at Denmark that in order to

avoid iron deficiency in pregnancy. Prophylactic Iron supplement should be considered

and Iron supplements may be administered on a general selective basis. The selective

approach implies screening serum ferritin in early pregnancy. In order to identify the

degree of anemia so that dosage and frequency of prophylactic iron can be administered

accordingly 6

13. A Study was Conducted on regarding the effectiveness of primary level antenatal

care in decreasing anemia at term at Tanzania college of health sciences. This study

18

revealed that Tanzania the prevalence of anemia in pregnancy is high inspite of ahigh

antenatal attendance and an established national policy of routine hematinic

supplementation. The study confirmed that an adequate supply of Iron tablets seems to

be the most important active antenantal programme when anemia is highly prevalent and

booking is late 7

14. A Study was Conducted on reported that iron supplementation through food-iron

fortification may be best approach that has successfully reduced iron deficiency in most

developing countries. The fortification of salt, sugar, spice mixtures and backery

products with a short shelf-life are valid approaches to this end. Alternatively haem iron

can be used to fortify cereal based food staples in developing countries such as tortillas

or chappathies. Thus a variety of options is available to solve the technical problem of

food iron fortification 8

15. A Study was Conducted on iron supplementation during pregnancy. They

recommended a routine supplementation during the second half of the pregnancy. The

importance of increasing the consumption of foods that are rich in iron (meat, fish,

fortified cereals)y improving the bioavailability of the ingested iron (drinking orange

juice with the meal or eating meat) and using weekly supplements rather than daily

supplements. 9

16. A Study was Conducted on prevalence of anemia in pregnancy at pucllpa regional

hospital, Peru. 1,015, pregnant women were assessed and the potential association

between anemia and chronological age, schooling, previous pregnancies and weight gain

during pregnancies was also assessed. The prevalence of anemia is 70.1%. Anemia is

directly related to number of previous pregnancies and inversely related to weight gain

during pregnancy. The result shows that the prevalence of anemia is high. 10

17. A Study was Conducted to assess the compliances of pregnant women on iron

supplementation at a large scale iron supplementation programme was conducted for the

70,000 pregnant women. The problem identified were such a late entry to antenatal care,

high drop out rate from antenatal care, and misdirected continued testing of women who

were not anemic at registration. The study recommended that in most countries attention

should be directed towards changing dietary habits to enhance the availability of local

food stuffs that are rich in iron. 11

19

18. A Study was Conducted in National University Hospital at Singapore to determine

the prevalence and predictors of anemia in Pregnancy. All women delivered at the

hospital had their Hb estimated. Less than 11gm/dl, blood was taken to establish causes

of anemia. Data was collected with regard to their antenantal progress, and factors

predisposing to anemia in pregnancy. The most common cause of anemia is iron

deficiency and its prevalence is (81.3%). The most common cause of anemia is iron

deficiency and its prevalence is (81.3%). The occurrence of anemia in pregnancy is

related to low social economic is (81.3%). The occurrence of anemia in pregnancy is

related to low socio economic status of the women. Multiparous women of the lower

socio-economic class who tend to book late in pregnancy were found to have highest risk

of anemia. The study confirm that Iron deficiency anemia is the most common cause of

anemia in pregnancy and is a major health problem developing and developed

countries. 12

19. A Study was Conducted on the importance of time intervals between child birth

and anemia in pregnancy. During pregnancy some parameters have been studied in order

to detect anemia, amount of erythrocytes, haemotocrits, haemoglobin and iron in the

serum of 100 women. The greater group of pregnant women (68%) decided for the

second pregnancy after two years while 32% after four years atleast. All parameters

related to anemia were present in the groups of shorter time intervals between births.

Thus in the first trimester anemia was detected time intervals between births. Thus in the

first trimester anemia was detected in13.3% of pregnant womens while only 7.1% in

those with the longer intervals between deliveries. In the third trimester 50% of antenatal

mothers were anemic with short time intervals between births and only 21.4% of women

with long time interval between births were anemic. Greater presence of anemia in

women with shorter time interval between pregnancies may be statistically significant.

Therefore frequent pregnancies are one of the causes of anemia. They are more often

detected in multipara with shorter time intervals between deliveries 13

20. A study was conducted about determinants of anemia in pregnant women in rural

Malawi. Hematological data are presented on 4104, pregnant women attending the

antenantal Clinic. The mean (S.D) Hb concentration was significant by low in

primigravida (8.7 (1.60g/dl) than secondgravida (9.1(1.5g/dl) or multigravidae (9.2 (1.5

g/dl). This study reveals that iron deficiency anemia is significantly high among

20

primigravida than multigravidae. Other factors significantly associated with increased

risk of moderately severe anemia in primigravidae were illiteracy and poor nutritional

status. This study confirms lack of awareness and low economic status as the causes for

iron deficiency anemia among primi than multi. 14

21. A study was conducted in Paediatric Medical unit at Delhi among 32 mothers

caring for children with tuberculosis meningitis to assess the effectiveness of a planned

teaching programme on the knowledge and skill. The knowledge scores of mother’s

nearly doubled afer inervention with STPfrom the mean score 29.34 to 56.71. Based on

the results of the study it is recommended that planned teaching programmes may be

conducted regularly. 15

22. A quasi experimental study was carried out by at Durgabai General Hospital to

evaluate the effectiveness of structured teaching programme in the management of

discomforts during pregnancy to the antenatal mothers. The mean regarding knowledge of

discomforts in the pre test was 17.78 and in the post test it was 76.00. This showed that

the structured teaching programme was effective and increased the level of knowledge. 16

21

CHAPTER –IV

METHODOLOGY

RESEARCH APPROACH

RESEARCH DESIGN

In this study quasi-experimental design was used.

SETTING

This study was conducted in the antenatal clinic of Kyathasandra primary Health Centre,

Tumkur. The PHC covers 30,465 Population. The primary health centre has a laboratory,

medical pharmacy and a labour room for emergency delivery. Antenatal clinic is

conducted every Wednesday from 8.00 am to 4.00 pm where 25-30 antenatal mothers

attend the clinic for regular checkup among them atleast 2-3 mothers showed signs and

symptoms of anemia 5 to 8 deliveries are conducted in a week. Complicate cases are

referred to Government maternity hospital and central Government Hospital

Kyathasandra, Tumkur.

POPULATION

All the antenatal mothers from 12 weeks to 40 weeks of gestation attending the

antenatal clinic at Kyathasandra PHC Tumkur

SAMPLE

A sample of 70 antenatal mothers who met the inclusion criteria, were selected.

CRITERIA FOR SAMPLE SELECTION INCLUSTION CRITERIA

1. All the antenatal mothers from 12 weeks to 40 weeks of gestational age.

2. Antenatal mothers of all age groups.

3. Both primigravida and multigravida mothers

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EXCLUSION CRITERIA

1. Antenatal Mothers who were selected for pilot study.

2. Antenatal Mothers who were unable to understand Kannada

METHOD OF SAMPLE SELECTION

The study was conducted in the Antenatal Clinic of Kyathasandra PHC The

antenatal clinic was conducted every Wednesday from 8 am to 4 pm On an average 20 to

25 antenatal mothers attend this clinic. Their names were written in a small slip of papers

of uniform size by the investigator. The slip of papers were mixed well. Then the required

number of slips 10-20 were picked up at random. Thus a total number of 70 samples were

selected by using Simple Random Sampling Method.

INSTRUMENT

The instrument used for data collection was an interview guide. This was

developed based on the objectives of the study and thorough review of literature.

DESCRIPTION OF INSTRUMENT

The instrument interview guide consists of two parts as in Appendix A and C.

Part –1

Consists of the information on demographic variables such as age, religion,

educational status, occupation, gravida, family income, type of family number of family

members, health resources available near to the area, and utilization of health services.

PART-II

a) Consists of multiple choice questionnaire to assess the knowledge of the antenatal

mothers about iron deficiency anemia. The questions were related to general information,

causes signs and symptoms, investigations, complications, prevention and treatment. The

total number of questions were 30.

23

SCOORING PROCEDURE Part-1

Information on demographic data was collected from the selected mothers on 10

variables and this was not scored but used for descriptive analysis.

PART-II DESCRIPTION OF TOOL MULTIPLE CHOICE QUESTIONS

a) It consists of 30 multiple choice question. Mothers were interviewed and the

answers were written in the box provided against each question. Each correct answer was

given a score of “One” and wrong answer was given a score of “Zero”

b) Likerts Scale : Likerts sacle for measuring attitude scoring 1 to 5. It consists of 20

Itmes 5 points scale the score will be given as follows

1) Strongly Agree - 5

2) Agree – 4

3) Slightly Agree – 3

4) Strongly Dis agree – 2

5) Dis agree - 1

SCORE INTERPRETATION: The instrument consists of 30 multiple choice questions regarding iron deficiency

anemia. The maximum score was and the minimum score was O.

Based on the scoring the percentage of knowledge was calculated using the

formula

Obtained Score ------------------- X 70 Total Score The score were interpreted as follows:

< 50 – Inadequate 51-75 – Moderately adequate > 75 - Adequate

The content validity of this instrument was obtained from Medical & Nursing experts

24

PILOT STUDY The pilot study was conducted on ten samples of antenatal mothers was met the

inclusion criteria in a primary health centre at Kyathasandra, Tumkur form 1-1-2005 to

10-1-2005 initially permission was obtained form women medical officer of PHC

Kyathasandra the pretest was conducted by using the planned interview guide for the

mothers. The structured teaching programme was conducted. At the end of the teaching

programme, handouts regarding iron rich sources were distributed. After 7 days the post

test was conducted and the results were analysed based on the mothers scores. These ten

mothers were exclude for main study. The feasibility was determined by doing the pilot

study.

Based on the results of the pilot study the following changes were made in the

demographic data, Q.No. 3 in educational status, the multiple choice middle school was

deleted.

DATA COLLECTION PROCEDURE

The main study was conducted form 15-1-2005 to 20-2-2005. Antenatal mothers

who attended the antenatal clinic at Kyathsandra, PHC and who met the inclusion criteria

were selected by using simple random sampling method. After making them seated

comfortable, instructions were given to them during the interview. First part of the

interview guide on the demographic variable was complete, after which the second part of

the interview guide on knowledge about iron deficiency anemia was completed using an

interview schedule where the investigator ticked a “ √ ” mark in the given column if the

response was correct and a “X” mark if the response was not correct.

The duration of the interview ranged from 15 to 20 minutes for each mothers.

Thus a total 12 mothers were interviewed each week.

A planned teaching programme was conducted for 45 minutes after the pre test,

consisting of information regarding general information, definition, causes, signs and

symptoms, investigations, complications, prevention and treatment of iron deficiency

anemia. Audiovisual aids (charts and handouts) related to iron deficiency anemia and

iron rich sources were used for teaching.

25

Teaching programme was rendered as scheduled below:-

Sl No Groups Date of

Pretest Timing Teaching date Post test date

1 I 1*15� 15-1-05 8 to 4 pm 15-1-05 22-1-05

2 II 16*30� 22-2-05 8 to 4 pm 22-2-05 28-1-05

3 III 31*46� 28-1-05 8 to 4 pm 28-1-05 06-2-05

4 IV 47*62� 06-2-05 8 to 4 pm 06-2-05 13-2-05

V 63*70� 13-2-05 8 to 4 pm 13-2-05 20-2-05

*Pre test * Post test Then 10 minutes was allotted for discussion. All the mothers participated in the teaching

programme with great interest. After the completion of pre test and STP an identify

sticker with number was attached over the antenatal card to identify the mothers for the

post test. The same procedure was adopted for 6 weeks. They were Co-operative and

attentive. Each week 12 mothers were selected. After 7 days, of STP post was conducted

with the same questionnaire for the same group of mothers.

STATISTICAL METHOD

The statistical methods used for analysis were number, percentage mean, standard

deviation, paired, ‘t’ test, and chi-square.

No. Data Analysis Methods Remarks

1 Descriptive Statistics

Number, percentage, mean and standard deviation

To describe the demographic variable. To assess the knowledge of pre and post test.

2 Inferential Statistics

Paired ‘t’ test Analyzing the effectiveness between the pre and post test

3 Inferential statistics

Chi-square test Analyzing the association between demographic characteristics and knowledge about iron deficiency anemia among antenatal mothers

26

CHAPTER –V

RESULTS ANALYSIS AND FINDINGS

This chapter deals with statistical analysis. Statistical analysis is a method of rendering

quantitative information in meaningful and intelligible manner. Statistical procedure

enables the researcher to organize, analyse, evaluate, interpret and communicate

numberical information meaningfully on iron deficiency anemia was tabulated, analysed

and interpreted under the following sections.

SECTION – A : Distribution of demographic variables of antenatal mothers. SECTION – B : Distribution of the level of knowledge among Antenatal mothers

regarding Iron deficiency anemia in pre and post test.

SECTION – C : Distribution between pre and post test results of antenatal mothers

knowledge regarding Iron deficiency anemia.

SECTION – D : Association between knowledge regarding Iron deficiency anemia in

pre and post test among antenatal mothers with the Demographic variables of the

antenatal mothers

SECTION – E : Associations between attitude regarding Iron deficiency anemia in pre

and post test among antenatal mothers with the demographic variable of the antenatal

mothers.

27

SECTION –A : DEMOGRAPHIC CHARACTERISTICS OF ANTENATAL MOTHERS

Table 1 : Frequency and percentage distribution of demographic variables among

antenatal mothers.

Sl. No.

DIFFERENT VARIABLES NUMBER %

1 AGE <20 yrs 21-25 yrs 26-30 yrs >31 yrs

10 36 17 07

14.3 51.4 24.3 10.0

2 RELIGION Hindu Christian Muslims Others

57 11 02 -

81.4 15.7 2.9 -

3 EDUCATIONAL STATUS Non-literate Primary High school Higher secondary Any other degrees

12 9 36 13 -

17.1 12.9 51.4 18.6

- 4 OCCUPATION

Employed Agriculture Coolie House wife

16 2 4 48

22.9 2.9 5.7 68.8

5 FAMILY INCOME Less than Rs. 1000/- Rs. 1001-2000/- Rs. 2000-3000/- > 3001/-

53 14 3 -

75.7 20.0 4.3 -

6 GRAVIDA Primi gravida Mutty gravida

39 31

55.7 44.3

7 FAMILY STRUCTURE Nuclear Joint

35 35

50.0 50.0

8 NO. OF FAMILY MEMBERS 3 members 4-5 members > 6 members

21 17 32

30 24.3 45.7

28

9 HEALTH RESOURCES Government Private Health Post Others

5 4 61 -

7.5 5.7 87.1

- 10 UTILIZATION OF HEALTH

SERVICES Government Private Health Post Others

30 2 38 -

42.9 2.9 54.3

-

Table 1, reveals that out of 70 antenatal mothers, 10(14.3) mothers age was less

than 20 years, 36(51.4%) mothers were between 21-25 years, only 7(10%) mothers were

in the age group of more than 30 years. Fifty Seven (81.4%) were Hindus. Thirty Six

(51.4%) mothers studied up to High School and 12 (17.1%) were non literate. Forty

Eight (68.6%) were house wives. Out of 70 antenatal mothers 53 (75.7%) mothers family

income was <1000 rupees, 39(55.7%) were primi gravida and 31(44.3%) were multi

gravida. Thirty Five (50%) mothers were from nuclear family and 35 (50%) mothers

were from joint family, 61(87.1%) antenatal mothers were residing near by health post,

38 (54.3%) utilized the health services of the health post.

29

SECTION –B : DISTRIBUTION OF LEVEL OF KNOWLEDGE AMONG ANTENATAL MOTHERS REGARDING IRON DEFICIENCY

ANEMIA.

Table 2 : Level of knowledge of antenatal mothers regarding iron deficiency

anemia in pre test.

Level of Knowledge (%) Sl. No. Different Aspects

< 50 51 - 75 > 75 No. % No. % No. % 1 General Information 58 82.9 10 14.3 2 2.9 2 Causes 52 74.3 13 18.6 5 7.1 3 Signs/symptoms 47 67.1 15 21.4 8 11.4 4 Complications 34 48.6 30 42.9 6 8.6

5 Prevention & treatment 62 88.6 7 10.0 1 1.4

6 Iron rich sources 42 60.0 27 38.6 1 1.4 49 70.2 17.0 24.3 3.8 5.5

Table (2) shows that 58(82.9%) antenatal mothers had inadequate knowledge

about general information on iron deficiency anemia. Fifty-two (74.3%) antenatal

mothers had inadequate knowledge about causes and 62 (88.6%) antenatal mothers had

inadequate knowledge on preventive aspect of iron deficiency anemia. In all aspects 49

(70.2%) antenatal mothers had inadequate knowledge and only 17 (24.3%) had

moderately adequate knowledge, and none of the antenatal mothers had adequate

knowledge in the pre test regarding iron deficiency anemia.

30

Table 3 : Level of knowledge of antenatal mothers regarding iron deficiency

anemia in post test.

Level of Knowledge (%) Sl. No. Different Aspects

< 50 51 - 75 > 75 No. % No. % No. % 1 General Information 13 18.6 7 10.0 50 71.4 2 Causes 8 11.4 20 28.6 42 60.0 3 Signs/symptoms 6 8.6 17 24.3 47 67.1 4 Complications 6 8.6 14 20.0 50 71.4 5 Prevention & treatment 10 14.3 31 44.3 39 55.7 6 Iron rich sources 2 2.9 18 25.7 50 71.4

7 10.7 18 25.5 46 66.2

Table (3), shows that 50(71.4%) antenatal mothers had adequate knowledge about

general information, complication and iron rich sources. In overall aspects, 46(66.2%)

had adequate knowledge, 18(25.5%) had moderately adequate knowledge and only 7

(10.7) antenatal mothers had inadequate knowledge about Iron deficiency anemia in the

post test. This shows that there is an improvement in the level of knowledge among

antenatal mothers regarding iron deficiency anemia after the structured teaching

programme.

31

Table 4 : Mean and Standard deviation of Pre and Post test scores about iron

Deficiency anemia of antenatal mothers.

PRE TEST POST TEST Sl. No. Different Aspects

MEAN S.D MEAN S.D 1 General information 30.86 20.9 78.86 26.79 2 Causes 32.38 30.55 82.38 24.56 3 Signs/symptoms 27.14 26.49 70.71 23.69 4 Complications 33.57 24.03 73.21 24.2 5 Prevention & treatment 30.2 17.12 73.88 20.78 6 Iron rich sources 42.24 22.48 84.49 14.34 Over all average 32.73 23.60 77.26 22.39

Table 4, shows that in pretest inadequacy of knowledge is found among the

antenatal mothers in various aspects of iron deficiency anemia. Regarding iron rich

sources the mean is 42.24 with standard deviation 22.48 and in the aspect of signs and

symptoms and investigation, the mean is 27.14 with standard deviation 26.49. In overall

aspect of pretest the mean is 33.38 with standard deviation 23.6. In post test

improvement is shown in all the aspects especially on General information, causes and

source. In the post test in the general information it shows mean value of 78.86 with

standard deviation 26.79. In the causes the mean is 82.38 with standard deviation 24.56

and in iron rich sources the mean is 84.49 with standard deviation 14.34 in the post test.

But in post test overall improvement is shown with the mean 77.26 and standard

deviation 22.42

32

SECTION –C : COMPARISON BETWEEN PRE AND POST TEST

RESULTS OF ANTENATAL MOTHERS KNOWLEDGE

REGARDING IRON DEFICIENCY ANEMIA.

Table 5 : Improvement mean and standard deviation of Pre and Post test scores

about “Iron deficiency anemia” among antenatal mothers.

Improvement ScoreSl.

No.

Level of knowledge in

Different aspects MEAN S.D

Paired 't’

Test

1 General information 48.00 30.53 13.15 ***

2 Causes 50.00 31.47 13.29 ***

3 Signs/symptoms 43.57 29.08 12.54 ***

4 Complications 39.64 28.71 11.55 ***

5 Prevention & treatment 43.67 22.00 16.6 ***

6 Iron rich sources 42.24 25.56 13.83 ***

Over all average 44.52 27.89 13.49 ***

*** - P < 0.001 level significant.

Table 5 shows, that the level of knowledge regarding causes, the mean is 50.00

with standard deviation of 31.47 and the Paired ‘t’ test value is 13.29 i.e. P < 0.001 level.

In the aspect of complications the mean is 39.64 with the standard deviation 28.71 and

Paired ‘t’ test value is 11.55 i.e. P<0.001. In the overall knowledge the mean is 44.52

with standard deviation 27.89 and is significant at P<001 level.

33

SECTION –D : ASSOCIATION BETWEEN KNOWLEDGE REGARDING

IRON DEFICIENCY ANEMIA IN PRE AND POST TEST AMONG

ANTENATAL MOTHERS WITH THE DEMOGRAPHIC VARIABLES OF

THE ANTENATAL MOTHERS.

Table 6 : Association between level of knowledge and age of antenatal mothers.

Level of Knowledge (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Age

No. % No. % No. % No. %

1 < 20 Years 10 100.0 0 0.0 5 50 5 50.0

2 21-25 26 72.2 10 27.8 11 30.6 25 69.4

3 26-30 15 88.2 2 11.8 9 52.9 8 47.1

4 >31 7 100.0 0 0.0 2 28.6 5 71.4

x2 = 6.73, df = 3, P = 0.08 (N.S) x2 = 3.30, df = 3, P = 0.35 (N.S)

Table 6, shows in the pre test most of the mothers in all the age groups had

inadequate knowledge and less mothers had moderately adequate knowledge.

Statistically there in no significant difference between the level of knowledge and age

group of mothers in pretest was found. In post test five (71.4%) mothers in the age group

above 31 years and eight (47.1%) antenatal mothers in the age group of 26-30 years had

adequate knowledge. Statistically there is no significant association between level of

knowledge and age of antenatal mothers.

34

Table 7 : Association between level of knowledge and religion of antenatal

mothers.

Level of Knowledge (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Religion

No. % No. % No. % No. %

1 Hindu 51 89.5 6 10.5 22 38.6 35 61.4

2 Christian 5 45.5 6 54.5 5 45.5 6 54.5

3 Muslim 2 100.0 0 0.0 0 0.0 2 100.0

x2 = 13.0, x2 = 1.48, df = 2, P = 0.49 (N.S)

Table 7 , reveals, in pre test two(100%) antenatal Muslim mothers had inadequate

knowledge and six (54.5%) antenatal Christian mothers had moderately adequate

knowledge. In post test also two (100%) Antenatal Muslim mothers had adequate

knowledge. Six (54.5%) Christian antenatal mothers had adequate knowledge. But

statistically there is no significant association between the level of knowledge and

religion of antenatal mothers.

35

Table 8 : Association between level of knowledge and educational status of

Antenatal mothers.

Level of Knowledge (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Educational Status

No. % No. % No. % No. %

1 Non literate 12 100.0 0 0 8 66.7 4 33.3

2 Primary 9 100.0 0 0.0 4 44.4 5 55.6

3 High school 27 75.0 9 25.0 14 38.9 22 61.1

4 Higher

secondary 10 76.9 3 23.1 1 7.7 12 92.3

x2 = 6.23, df = 3, P = 0.10 (N.S) x2=9.36, df=3, P<0.05(Significant)

Table 8, shows that most of the antenatal mothers had inadequate knowledge in

the pre test. There is no significant difference found between the level of knowledge and

the educational status of the antenatal mothers. Twelve (92.3%) antenatal mothers

educated up to higher secondary school had adequate knowledge and only one (7.7%)

antenatal mother had moderately adequate knowledge. There were 12 non-literate

mothers among them 4(3.3%) mothers had adequate knowledge and remaining 8(66.7%)

mothers had moderately adequate knowledge. This shows as the educational status

increases the level of knowledge also increases. Statistically there is a significant

(P<0.05) association between the level of knowledge and educational status of the

antenatal mothers.

36

Table 9 : Association between level of knowledge and occupation status of

Antenatal mothers.

Level of Knowledge (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Occupation

No. % No. % No. % No. %

1 Horticulture 15 93.8 1 6.3 4 25.0 12 75.0

2 Agriculture 2 100.0 0 0.0 2 100.0 0 0.0

3 Coolie 3 75.0 1 25.0 2 50.0 2 50.0

4 Employed 38 79.2 10 20.8 19 39.6 29 60.4

x2 = 2.38, df = 3, P = 0.49 (N.S) x2=4.67, df=3, P<0.20(N.S)

Table 9, shows that in pre test two (100%) antenatal mothers who were agriculture

workers had inadequate knowledge. There is no significant difference in the level of

knowledge and occupation of antenatal mothers. In the post test 29 (60.4%) antenatal

mothers, who were employed had adequate knowledge. Twelve (75%) antenatal mothers

who were housewives had adequate knowledge. Statistically there is no significant

association between the level of knowledge and occupation of the antenatal mothers.

37

Table 10: Association between level of knowledge and income of the

Antenatal mothers.

Level of Knowledge (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75 Income

No. % No. % No. % No. %

<1000 44 83.0 9 17.0 24 45.3 29 54.7

1001 - 2000 12 85.7 2 14.3 3 21.4 11 78.6

2001-3000 2 66.7 1 33.3 0 0.0 3 100.0

x2 = 0.63, df = 2, P = 0.73 (N.S) x2=4.63, df=2, P<0.10(N.S)

Table 10, shows 44 (83.0) antenatal mothers with income less than Rs. 1000/-, 12

(85.7%) antenatal mothers with income of Rs. 1001-2000/- and 2 (66.7%) antenatal

mothers with income of Rs. 2001-3000/- had inadequate knowledge in the pre test.

Statistically there is no significant difference between level of knowledge and economic

status of the mothers in the pre test. In the Post test 29(54.7%) antenatal mothers with

income less than Rs. 1000, 11(78.6%) antenatal mothers with income of Rs. 2001-3000/-

and 3 (100%) antenatal mothers with income of Rs. 2001-3000/- had adequate

knowledge. Statistically there is no significant association between the level of

knowledge and income of antenatal mothers.

38

Table 11 : Association between level of knowledge and Gravida of

Antenatal mothers.

Level of Knowledge (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Gravida

No. % No. % No. % No. %

1 Primi 32 82.1 7 17.9 15 38.5 24 61.5

2 Multy 26 83.9 5 16.1 12 38.7 19 61.3

x2 = 0.04, df = 1, P = 0.84 (N.S) x2=0.0004, df=1, P<0.98(N.S)

Table –11, shows that in the pretest 32(82.1%) primi antenatal mothers had

inadequate knowledge and 26 (83.9%) multigravid antenatal mothers had inadequate

knowledge. There is no significant difference between the level of knowledge and

gravida of the antenatal mothers in pre test. In the posttest 24 (61.5%) primigravid

mothers had adequate knowledge, 19 (61.3%) multigravid mothers had adequate

knowledge. Statistically there is no significant association between level of knowledge

and gravida of antenatal mothers.

39

Table 12 : Association between level of knowledge and Family type of

Antenatal mothers.

Level of Knowledge (%) Pre Test Post Test

< 50 51 - 75 51-75 > 75 Type of Family

No. % No. % No. % No. % Nuclear 31 88.6 4 11.4 12 34.3 23 65.7 Joint 27 77.1 8 22.9 15 42.9 20 57.1

x2 = 1.61, df = 1, P = 0.20 (N.S) x2=0.54, df=1, P=0.46(N.S)

Table – 12, reveals that in the pre test 31(88.6%) antenatal mothers had nuclear

family and 27 (77.1%) antenatal mothers had from joint family and inadequate

knowledge. There is no significant difference between the level of knowledge and family

type among antenatal mothers in the pre test. In the post test, there were 23(65.7%)

antenatal mothers were from nuclear family and 20(57.1%) antenatal mothers were from

joint family had adequate knowledge. Statistically there is no significant association

between the level of knowledge and the family type of the antenatal mothers.

40

Table 13 : Association between level of knowledge and Family members of

Antenatal mothers.

Level of Knowledge (%) Pre Test Post Test

< 50 51 - 75 51-75 > 75 Sl. No. Type of Family

No. % No. % No. % No. % 1 < 3 17 81.0 4 19.0 8 38.1 13 61.9 2 3 - 5 15 88.2 2 11.8 5 29.4 12 70.6 3 > 6 26 81.3 6 18.8 14 43.8 18 56.2

x2 = 0.46, df = 2, P = 0.79 (N.S) x2=0.97, df=2, P=0.62(N.S)

Table –13, shows that in pre test 15 (88.2%) antenatal mothers with family members of

three to five had inadequate knowledge. In the post test 12 (70.6%) antenatal mothers

with family members of three to five and 13(61.45%) antenatal mothers with family

members less than three members had adequate knowledge in the post test. This implies

that there is no significant association between level of knowledge and family members

of antenatal mothers.

41

Table 14 : Association between level of knowledge and available health

resources near to the area of Antenatal mothers.

Level of Knowledge (%) Pre Test Post Test

< 50 51 - 75 51-75 > 75 Sl. No.

Available health resources near to

the area No. % No. % No. % No. %

1 Government 5 100.0 - - 2 40.0 3 60.0 2 Private 2 50.0 2 50.0 1 25.0 3 75.0 3 Health Post 51 83.6 10 16.4 24 39.3 37 60.7

x2 = 0.49, df = 2, P = 0.13 (N.S) x2=0.33, df=2, P=0.85(N.S)

Table 14, shows that in the pre test 51(83.6%) antenatal mothers with health post near to

the residing area had inadequate knowledge and five (100%) antenatal mothers with

Government hospital near to the area had inadequate knowledge. Statistically there is no

significant difference between the level of the knowledge and available health resources

in the pre test. In the post test 37(60.7) antenatal mothers with health post near to the area

had adequate knowledge, Three (75%) antenatal mothers with private hospital near to the

area had adequate knowledge. This shows statistically there is no significant association

between level of knowledge and available health resources near to the area of antenatal

mothers.

42

Table 15 : Association between level of knowledge and Family members of

Antenatal mothers.

Level of Knowledge (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No.

Utilization of

Health services

No. % No. % No. % No. %

1 Government 24 80.0 6 20.0 11 36.7 19 63.3

2 Private 2 100.0 - - 1 50.0 1 50.0

3 Health post 32 84.2 6 15.8 15 39.5 23 60.5

Table 15, reveals that in the pre test Two (100%) antenatal mothers utilizing the

private health services had inadequate knowledge and 32(84.2%) antenatal mothers

utilizing the health services from health post had inadequate knowledge. In post test

19(63.3%) antenatal mothers utilizing the government health services had adequate

knowledge, 23(60.5%) antenatal mothers utilizing the health services from the health post

had adequate knowledge. Statistically there is no significant association between the

level of knowledge and utilization of health services of the antenatal mothers.

43

SECTION –B : DISTRIBUTION OF LEVEL OF ATTITUDE AMONG ANTENATAL MOTHERS REGARDING IRON DEFICIENCY

ANEMIA.

Table 2 : Level of Attitude of antenatal mothers regarding iron deficiency

anemia in pre test.

Level of Attitude (%) Sl. No. Different Aspects

< 50 51 - 75 > 75 No. % No. % No. % 1 General Information 58 82.9 10 14.3 2 2.9 2 Causes 52 74.3 13 18.6 5 7.1 3 Signs/symptoms 47 67.1 15 21.4 8 11.4 4 Complications 34 48.6 30 42.9 6 8.6

5 Prevention & treatment 62 88.6 7 10.0 1 1.4

6 Iron rich sources 42 60.0 27 38.6 1 1.4 49 70.2 17.0 24.3 3.8 5.5

Table (2) shows that 58(82.9%) antenatal mothers had inadequate Attitude about

general information on iron deficiency anemia. Fifty-two (74.3%) antenatal mothers had

inadequate Attitude about causes and 62 (88.6%) antenatal mothers had inadequate

Attitude on preventive aspect of iron deficiency anemia. In all aspects 49 (70.2%)

antenatal mothers had inadequate Attitude and only 17 (24.3%) had moderately adequate

Attitude, and none of the antenatal mothers had adequate Attitude in the pre test regarding

iron deficiency anemia.

44

Table 3 : Level of Attitude of antenatal mothers regarding iron deficiency

anemia in post test.

Level of Attitude (%) Sl. No. Different Aspects

< 50 51 - 75 > 75 No. % No. % No. % 1 General Information 13 18.6 7 10.0 50 71.4 2 Causes 8 11.4 20 28.6 42 60.0 3 Signs/symptoms 6 8.6 17 24.3 47 67.1 4 Complications 6 8.6 14 20.0 50 71.4 5 Prevention & treatment 10 14.3 31 44.3 39 55.7 6 Iron rich sources 2 2.9 18 25.7 50 71.4

7 10.7 18 25.5 46 66.2

Table (3), shows that 50(71.4%) antenatal mothers had adequate Attitude about

general information, complication and iron rich sources. In overall aspects, 46(66.2%)

had adequate Attitude, 18(25.5%) had moderately adequate Attitude and only 7 (10.7)

antenatal mothers had inadequate Attitude about Iron deficiency anemia in the post test.

This shows that there is an improvement in the level of Attitude among antenatal mothers

regarding iron deficiency anemia after the structured teaching programme.

45

Table 4 : Mean and Standard deviation of Pre and Post test scores about iron

Deficiency anemia of antenatal mothers.

PRE TEST POST TEST Sl. No. Different Aspects

MEAN S.D MEAN S.D 1 General information 30.86 20.9 78.86 26.79 2 Causes 32.38 30.55 82.38 24.56 3 Signs/symptoms 27.14 26.49 70.71 23.69 4 Complications 33.57 24.03 73.21 24.2 5 Prevention & treatment 30.2 17.12 73.88 20.78 6 Iron rich sources 42.24 22.48 84.49 14.34 Over all average 32.73 23.60 77.26 22.39

Table 4, shows that in pretest inadequacy of Attitude is found among the antenatal

mothers in various aspects of iron deficiency anemia. Regarding iron rich sources the

mean is 42.24 with standard deviation 22.48 and in the aspect of signs and symptoms and

investigation, the mean is 27.14 with standard deviation 26.49. In overall aspect of

pretest the mean is 33.38 with standard deviation 23.6. In post test improvement is

shown in all the aspects especially on General information, causes and source. In the post

test in the general information it shows mean value of 78.86 with standard deviation

26.79. In the causes the mean is 82.38 with standard deviation 24.56 and in iron rich

sources the mean is 84.49 with standard deviation 14.34 in the post test. But in post test

overall improvement is shown with the mean 77.26 and standard deviation 22.42

46

SECTION –C : COMPARISON BETWEEN PRE AND POST TEST

RESULTS OF ANTENATAL MOTHERS ATTITUDE

REGARDING IRON DEFICIENCY ANEMIA.

Table 5 : Improvement mean and standard deviation of Pre and Post test scores

about “Iron deficiency anemia” among antenatal mothers.

Improvement ScoreSl.

No.

Level of Attitude in

Different aspects MEAN S.D

Paired 't’

Test

1 General information 48.00 30.53 13.15 ***

2 Causes 50.00 31.47 13.29 ***

3 Signs/symptoms 43.57 29.08 12.54 ***

4 Complications 39.64 28.71 11.55 ***

5 Prevention & treatment 43.67 22.00 16.6 ***

6 Iron rich sources 42.24 25.56 13.83 ***

Over all average 44.52 27.89 13.49 ***

*** - P < 0.001 level significant.

Table 5 shows, that the level of Attitude regarding causes, the mean is 50.00 with

standard deviation of 31.47 and the Paired ‘t’ test value is 13.29 i.e. P < 0.001 level. In

the aspect of complications the mean is 39.64 with the standard deviation 28.71 and

Paired ‘t’ test value is 11.55 i.e. P<0.001. In the overall Attitude the mean is 44.52 with

standard deviation 27.89 and is significant at P<001 level.

47

SECTION –D : ASSOCIATION BETWEEN ATTITUDE REGARDING

IRON DEFICIENCY ANEMIA IN PRE AND POST TEST AMONG

ANTENATAL MOTHERS WITH THE DEMOGRAPHIC VARIABLES OF

THE ANTENATAL MOTHERS.

Table 6 : Association between level of Attitude and age of antenatal mothers.

Level of Attitude (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Age

No. % No. % No. % No. %

1 < 20 Years 10 100.0 0 0.0 5 50 5 50.0

2 21-25 26 72.2 10 27.8 11 30.6 25 69.4

3 26-30 15 88.2 2 11.8 9 52.9 8 47.1

4 >31 7 100.0 0 0.0 2 28.6 5 71.4

x2 = 6.73, df = 3, P = 0.08 (N.S) x2 = 3.30, df = 3, P = 0.35 (N.S)

Table 6, shows in the pre test most of the mothers in all the age groups had

inadequate Attitude and less mothers had moderately adequate Attitude. Statistically

there in no significant difference between the level of Attitude and age group of mothers

in pretest was found. In post test five (71.4%) mothers in the age group above 31 years

and eight (47.1%) antenatal mothers in the age group of 26-30 years had adequate

Attitude. Statistically there is no significant association between level of Attitude and age

of antenatal mothers.

48

Table 7 : Association between level of Attitude and religion of antenatal

mothers.

Level of Attitude (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Religion

No. % No. % No. % No. %

1 Hindu 51 89.5 6 10.5 22 38.6 35 61.4

2 Christian 5 45.5 6 54.5 5 45.5 6 54.5

3 Muslim 2 100.0 0 0.0 0 0.0 2 100.0

x2 = 13.0, x2 = 1.48, df = 2, P = 0.49 (N.S)

Table 7 , reveals, in pre test two(100%) antenatal Muslim mothers had inadequate

Attitude and six (54.5%) antenatal Christian mothers had moderately adequate Attitude.

In post test also two (100%) Antenatal Muslim mothers had adequate Attitude. Six

(54.5%) Christian antenatal mothers had adequate Attitude. But statistically there is no

significant association between the level of Attitude and religion of antenatal mothers.

49

Table 8 : Association between level of Attitude and educational status of

Antenatal mothers.

Level of Attitude (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Educational Status

No. % No. % No. % No. %

1 Non literate 12 100.0 0 0 8 66.7 4 33.3

2 Primary 9 100.0 0 0.0 4 44.4 5 55.6

3 High school 27 75.0 9 25.0 14 38.9 22 61.1

4 Higher

secondary 10 76.9 3 23.1 1 7.7 12 92.3

x2 = 6.23, df = 3, P = 0.10 (N.S) x2=9.36, df=3, P<0.05(Significant)

Table 8, shows that most of the antenatal mothers had inadequate Attitude in the

pre test. There is no significant difference found between the level of Attitude and the

educational status of the antenatal mothers. Twelve (92.3%) antenatal mothers educated

up to higher secondary school had adequate Attitude and only one (7.7%) antenatal

mother had moderately adequate Attitude. There were 12 non-literate mothers among

them 4(3.3%) mothers had adequate Attitude and remaining 8(66.7%) mothers had

moderately adequate Attitude. This shows as the educational status increases the level of

Attitude also increases. Statistically there is a significant (P<0.05) association between

the level of Attitude and educational status of the antenatal mothers.

50

Table 9 : Association between level of Attitude and occupation status of

Antenatal mothers.

Level of Attitude (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Occupation

No. % No. % No. % No. %

1 Horticulture 15 93.8 1 6.3 4 25.0 12 75.0

2 Agriculture 2 100.0 0 0.0 2 100.0 0 0.0

3 Coolie 3 75.0 1 25.0 2 50.0 2 50.0

4 Employed 38 79.2 10 20.8 19 39.6 29 60.4

x2 = 2.38, df = 3, P = 0.49 (N.S) x2=4.67, df=3, P<0.20(N.S)

Table 9, shows that in pre test two (100%) antenatal mothers who were agriculture

workers had inadequate Attitude. There is no significant difference in the level of

Attitude and occupation of antenatal mothers. In the post test 29 (60.4%) antenatal

mothers, who were employed had adequate Attitude. Twelve (75%) antenatal mothers

who were housewives had adequate Attitude. Statistically there is no significant

association between the level of Attitude and occupation of the antenatal mothers.

51

Table 10: Association between level of Attitude and income of the

Antenatal mothers.

Level of Attitude (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75 Income

No. % No. % No. % No. %

<1000 44 83.0 9 17.0 24 45.3 29 54.7

1001 - 2000 12 85.7 2 14.3 3 21.4 11 78.6

2001-3000 2 66.7 1 33.3 0 0.0 3 100.0

x2 = 0.63, df = 2, P = 0.73 (N.S) x2=4.63, df=2, P<0.10(N.S)

Table 10, shows 44 (83.0) antenatal mothers with income less than Rs. 1000/-, 12

(85.7%) antenatal mothers with income of Rs. 1001-2000/- and 2 (66.7%) antenatal

mothers with income of Rs. 2001-3000/- had inadequate Attitude in the pre test.

Statistically there is no significant difference between level of Attitude and economic

status of the mothers in the pre test. In the Post test 29(54.7%) antenatal mothers with

income less than Rs. 1000, 11(78.6%) antenatal mothers with income of Rs. 2001-3000/-

and 3 (100%) antenatal mothers with income of Rs. 2001-3000/- had adequate Attitude.

Statistically there is no significant association between the level of Attitude and income

of antenatal mothers.

52

Table 11 : Association between level of Attitude and Gravida of

Antenatal mothers.

Level of Attitude (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No. Gravida

No. % No. % No. % No. %

1 Primi 32 82.1 7 17.9 15 38.5 24 61.5

2 Multy 26 83.9 5 16.1 12 38.7 19 61.3

x2 = 0.04, df = 1, P = 0.84 (N.S) x2=0.0004, df=1, P<0.98(N.S)

Table –11, shows that in the pretest 32(82.1%) primi antenatal mothers had

inadequate Attitude and 26 (83.9%) multigravid antenatal mothers had inadequate

Attitude. There is no significant difference between the level of Attitude and gravida of

the antenatal mothers in pre test. In the posttest 24 (61.5%) primigravid mothers had

adequate Attitude, 19 (61.3%) multigravid mothers had adequate Attitude. Statistically

there is no significant association between level of Attitude and gravida of antenatal

mothers.

53

Table 12 : Association between level of Attitude and Family type of

Antenatal mothers.

Level of Attitude (%) Pre Test Post Test

< 50 51 - 75 51-75 > 75 Type of Family

No. % No. % No. % No. % Nuclear 31 88.6 4 11.4 12 34.3 23 65.7 Joint 27 77.1 8 22.9 15 42.9 20 57.1

x2 = 1.61, df = 1, P = 0.20 (N.S) x2=0.54, df=1, P=0.46(N.S)

Table – 12, reveals that in the pre test 31(88.6%) antenatal mothers had nuclear

family and 27 (77.1%) antenatal mothers had from joint family and inadequate Attitude.

There is no significant difference between the level of Attitude and family type among

antenatal mothers in the pre test. In the post test, there were 23(65.7%) antenatal mothers

were from nuclear family and 20(57.1%) antenatal mothers were from joint family had

adequate Attitude. Statistically there is no significant association between the level of

Attitude and the family type of the antenatal mothers.

54

Table 13 : Association between level of Attitude and Family members of

Antenatal mothers.

Level of Attitude (%) Pre Test Post Test

< 50 51 - 75 51-75 > 75 Sl. No. Type of Family

No. % No. % No. % No. % 1 < 3 17 81.0 4 19.0 8 38.1 13 61.9

2 3 - 5 15 88.2 2 11.8 5 29.4 12 70.6

3 > 6 26 81.3 6 18.8 14 43.8 18 56.2

x2 = 0.46, df = 2, P = 0.79 (N.S) x2=0.97, df=2, P=0.62(N.S)

Table –13, shows that in pre test 15 (88.2%) antenatal mothers with family members of

three to five had inadequate Attitude. In the post test 12 (70.6%) antenatal mothers with

family members of three to five and 13(61.45%) antenatal mothers with family members

less than three members had adequate Attitude in the post test. This implies that there is

no significant association between level of Attitude and family members of antenatal

mothers.

55

Table 14 : Association between level of Attitude and available health

resources near to the area of Antenatal mothers.

Level of Attitude (%) Pre Test Post Test

< 50 51 - 75 51-75 > 75 Sl. No.

Available health resources near to

the area No. % No. % No. % No. %

1 Government 5 100.0 - - 2 40.0 3 60.0

2 Private 2 50.0 2 50.0 1 25.0 3 75.0

3 Health Post 51 83.6 10 16.4 24 39.3 37 60.7

x2 = 0.49, df = 2, P = 0.13 (N.S) x2=0.33, df=2, P=0.85(N.S)

Table 14, shows that in the pre test 51(83.6%) antenatal mothers with health post near to

the residing area had inadequate Attitude and five (100%) antenatal mothers with

Government hospital near to the area had inadequate Attitude. Statistically there is no

significant difference between the level of the Attitude and available health resources in

the pre test. In the post test 37(60.7) antenatal mothers with health post near to the area

had adequate Attitude, Three (75%) antenatal mothers with private hospital near to the

area had adequate Attitude. This shows statistically there is no significant association

between level of Attitude and available health resources near to the area of antenatal

mothers.

56

Table 15 : Association between level of Attitude and Family members of

Antenatal mothers.

Level of Attitude (%)

Pre Test Post Test

< 50 51 - 75 51-75 > 75

Sl.

No.

Utilization of

Health services

No. % No. % No. % No. %

1 Government 24 80.0 6 20.0 11 36.7 19 63.3

2 Private 2 100.0 - - 1 50.0 1 50.0

3 Health post 32 84.2 6 15.8 15 39.5 23 60.5

Table 15, reveals that in the pre test Two (100%) antenatal mothers utilizing the

private health services had inadequate Attitude and 32(84.2%) antenatal mothers utilizing

the health services from health post had inadequate Attitude. In post test 19(63.3%)

antenatal mothers utilizing the government health services had adequate Attitude,

23(60.5%) antenatal mothers utilizing the health services from the health post had

adequate Attitude. Statistically there is no significant association between the level of

Attitude and utilization of health services of the antenatal mothers.

57

CHAPTER – VI & VII

DISCUSSION AND CONCLUSSION

The aim of the present study was to evaluate the effectiveness of structured

teaching programme regarding iron deficiency anemia among antenatal mothers.

A total of 70 antenatal mothers were selected for the study, Pre test was conducted

by using structured interview guide. A structured teaching programme was conducted by

the investigator. After 7 days the post test was conducted by using the same

questionnaire.

The first objective was to assess the knowledge o antenatal mothers on iron

deficiency anemia. The data analysis showed that 58 (82.9%) antenatal mothers had

inadequate knowledge before structured teaching programme, as shown in table 2. This

result revealed that the antenatal mothers were unaware of iron deficiency anemia due to

inadequacy of knowledge.

Table– 4 revealed that most of the antenatal mothers had inadequate knowledge in

all the aspects except iron rich sources with mean 42.24. During post test, it was found

that antenatal mothers gained knowledge in all the aspects, particularly regarding causes

of iron deficiency anemia and iron rich sources the knowledge gained by the antenatal

mothers was very high. The mean value was 82.38 and 84.49.

As measured by pre test (Table 2) 58 (82.9%) antenatal mothers had adequate

knowledge(<50) regarding iron deficiency anemia 12917.1%) had moderately adequate

knowledge (51-75) and none of the antenatal mothers had adequate knowledge (>75)

most of the antenatal mothers had inadequate knowledge especially regarding prevention

62 (88.6%) and General information 82.9%). This results showed that antenatal mothers

in that population had adequate knowledge and awareness about iron deficiency anemia,

its prevention on a treatment.

The post test (Ta ble 3) revealed that 50 (71.4%) antenatal mothers showed

adequate knowledge regarding General information, complication and iron rich sources,

specially, in overall aspect 43 (61.4%) antenatal mothers showed adequate knowledge, 25

(35.7%) antenatal mothers showed moderately adequate knowledge and only two (2.9%)

antenatal mothers showed inadequate knowledge regarding iron deficiency anemia. The

58

mean score was 33.38 before 33.38 and 77.52 after the STP. This showed that the

knowledge has increased markedly after structured teaching programme.

This result was supported by a study conducted by Sunita Katyal (2000) the

effectiveness of planned teaching programme on improving the knowledge and skill of

mothers caring for children with tuberculosis, the results revealed out the post test scores

were nearly double the pre test scores out of maximum 75 scores, the mothers obtained a

mean score of 29.34 before the STP and 65.71 after the STP regarding the level of

knowledge among the mothers. So a planned teaching programme has increased the

knowledge and forms the basis for creating awareness among mothers.

The second objective was to evaluate the effectiveness of structured teaching

programme on iron deficiency anemia to the antenatal mothers – after seven days the post

test was conducted using the same questionnaire for the same 70 antenatal mothers. Table

–5 revealed that a marked improvement was found in overall scores of antenatal mothers

regarding iron deficiency anemia (which was highly significant paired ‘t’ value P<0.001).

It shows that structured teaching programme was effective. Thus the hypothesis that there

is an association between the level of knowledge of the antenatal mothers before and after

STP regarding iron deficiency anemia is accepted at P>0.001 level. This findings is

supported by the results of the study conducted by Jayalakshmi (2000) which had shown

a marked improvement in the knowledge regarding minor disorders and its management

among primi and multi gravid mother after a structure teaching programme.

The findings was also supported by another study conducted by Hoffbrand –

AV(1999) which reveals that increased understanding of iron metabolism and absorption

may clarify the etiology of diseases due to lack of iron through planned teaching among

the public for the prevention of nutritional anemia specially iron deficiency anemia. So

this results emphasizes that continuous health education programme regarding the

prevention of iron deficiency anemia, should be conducted in antenatal clinics of all

health post because iron deficiency anemia is one of the main cause for maternal deaths.

The third objective was to associate demographic data with knowledge on iron

deficiency anemia among antenatal mothers. There was statistically no significant

difference between knowledge and demographic characteristic such as age, religion,

gravida occupation, family income, type of family, number of family members, health

resources available near to the area, and utilization of health services.

59

Table 8 showed that, there was statistically significant (P<0.05) association

between the level of knowledge and the educational status of the mothers. It showed that

12(92.3%) of them had adequate knowledge with educational status of higher secondary,

this result revealed that as the educational status increases the level of knowledge also

increases. As the educational status increases the level of understanding capacity among

antenatal mothers also increases. Through education the exposure to environment, mass

media is high hence, antenatal mothers of high educational status showed increased level

of knowledge in post test.

Table 1 revealed that, 10 (100%) antenatal mothers of age <20 years had

inadequate knowledge than other age group. This showed lack of awareness about iron

deficiency anemia among the mothers of age group less than 20 years. These findings

were supported by a study conducted by Abyad et.al., (1999) on pregnant women on

prevalence of anemia, the result of the study revealed that the prevalence of the anemia

among the primigravida is 31% and the pregnant women under the age group of 15-19

years had the highest risk for developing anemia. This may be due to lack of awareness

of the physiological demand for iron due to growth and development. Inn post test

Antenatal mothers of all age group showed increase in the knowledge regarding iron

deficiency anemia, Statistically there was no association between the age and knowledge

level of antenatal mothers.

Table 10 showed that statistically there was no association between the income

and level of knowledge but, the findings revealed that 44 (83.0%) antenatal mothers had

income of less than Rs. 1000 showed inadequate knowledge during pre test. This results

revealed that inadequate knowledge and low income may increase the risk of iron

deficiency anemia. This study was supported by a study conducted by Singh.K (1998)

reported that the occurrence of anemia in pregnancy is related to low economic status of

women and multiparity but, In the post test antenatal mothers showed increase in

knowledge regarding iron deficiency anemia.

The overall findings of the study showed that structured teaching programme is

very effective in improving the knowledge and awareness about iron deficiency anemia

among antenatal mothers.

60

CHAPTER – VIII

SUMMARY AND RECOMMENDATION

This study was a quasi experimental study to evaluate the effectiveness of

structured teaching programmed regarding iron deficiency anemia among antenatal

mothers.

This study was conducted from 15-3-2005 to 31-4-2005 in the antenatal clinic of

Kyathasandra PHC, Tumkur. A total number of 70 antenatal mothers were randomly

selected as per selection criteria. An interview guide was used to assess the knowledge

regarding iron deficiency anemia, before and after STP, After the pre test, the structure

teaching programme on iron deficiency anemia was conducted by the investigator. Seven

days after structure teaching programmed the post test was conducted by using the same

interview guide. The data was grouped and analysed using descriptive statistics and

inferential statistics.

MAJOR FINDINGS OF THE STUDY :

1. In the pre test out of 70 antenatal mothers 58(82.9%) antenatal mothers had

inadequate knowledge regarding iron deficiency anemia and 11(15.7%) antenatal

mothers had moderately adequate knowledge.

2. Regarding the post test knowledge 43(61.4%) antenatal mothers had adequate

knowledge and 25(35.7%) antenatal mothers had moderately adeaute knowledge.

The antenatal mothers showed a statistically significant (P<0.01) increase in

knowledge regarding iron deficiency anemia.

3. In relation to effectiveness of structure teaching programme. The paired t-test

showed that the teaching programme was statistically significant at P<0.001 level

in antenatal mothers. This data proved that the knowledge of antenatal mothers

has been markedly increased after the administration of structured teaching

programme on iron deficiency anemia.

4. The chi-square test showed a significant (P<0.05) association between educational

status and knowledge of antenatal mothers regarding iron deficiency anemia.

61

NURSING IMPLICATIONS

NURSING PRACTICE:

Nurses play a vital role in the preventive aspects of health problems. According

to this study more than 80% of antenatal mothers had inadequacy of knowledge on iron

deficiency anemia in pretest. Much effort must be made by the nurses to increase the

knowledge about iron deficiency anemia among the antenatal mothers. As prevention is

better than cure concentrated efforts should be taken in the prevention of iron deficiency

anemia.

Iron deficiency anemia is a topic, which has to be handled, by professional nurses.

Motivating the women and making them to come for early screening, needs a tactful

approach, which is possible only by a nurse with a knowledge of reproductive health.

The current emphasis on health for all demands that every individual should be self-

sufficient and self-reliant. Therefore assessment of learning needs is an essential step

towards developing knowledge of mothers. Health education session should be scheduled

periodically by nurses at antenatal clinics.

NURSING EDUCATION

Both the professional and non-professional students can be enlightened with the

knowledge and prevention of iron deficiency anemia. At high school it can be

incorporated with the social education, which creates awareness and helps in early

detection. In service education and continuing education to nurse midwives on antenatal

care including the prevention and treatment of iron deficiency anemia is to be given in all

institutions.

NURSING RESEARCH

Continuing research and health education will make the public and general

professionals to understand about iron deficiency anemia. Health promotion and

education campaign must take higher profile inorder to increase public awareness about

iron deficiency anemia and the importance of iron supplementation.

62

RECOMMENDATION

1. Health education session can be scheduled periodically in antenatal clinic.

2. Health education module related to importance of iron can be imparted to all the

antenatal mothers during their visits.

3. In-service education to nurse midwives on antenatal care including the prevention

and treatment of iron deficiency anemia can be given in all institutions.

4. Health education about iron deficiency anemia can be given to the college

students because they are the future mothers.

SUGGESTIONS FOR FUTHER STUDY

1. Similar study can be conducted as a longitudinal study using larger sample.

2. A study can be done in urban and rural setting and results can be compared.

The same study can be conducted on the health workers of various programmes like

village health nurses, auxiliary nurse midwives.

63

Chapter -IX

ABSTRACT

Background and objectives :

Effectiveness of structured teaching Programme on iron deficiency anaemia at

PHC, Kyathasandra, Tumkur was conducted in partial fulfillment of requirement of the

degree of master of science in nursing at Shridevi College of Nursing , Tumkur.

The study objective are

1. To assess the knowledge and attitude of antenatal mothers about iron deficiency

anaemia.

2. To evaluate the effectiveness of structured teaching programme on iron

deficiency anaemia.

3. To correlate the knowledge and attitude on iron deficiency anaemia during

pregnancy with the demographic data of antenatal mothers.

Methods The research design was quail experimental. The population in antenatal mothers

of all age and all Gravida.

The sample size is 70 antenatal mothers selected by simple random sampling

technique. The tool comprised questionnaire guide. The data obtained from the study

was analyzed using descriptive and inferential statistics.

The study major finding are (Results)

1. In the pretest out of 70 antenatal mothers (%) of mothers had in adequate

knowledge regarding iron deficiency anemia and(%) and antenatal mothers had

moderately adequate knowledge regarding iron deficiency anemia.

2. Regarding post test knowledge attitude (%) of antenatal mothers had moderately

adequate knowledge and (%) of antenatal mothers had adequate knowledge. The

antenatal mothers showed (p<) significantly increase in knowledge and regarding

iron deficiency anaemia.

64

3. In relation to effective structured teaching programme. The paired t- test showed

that the teaching programme was statistically significant at <0.001 level in

antenatal mothers has been markedly increased alter the administration of

structured teaching programme on iron deficiency anaemia.

4. The chi- square test showed P<0.001 association between level of knowledge and

attitude of antenatal mothers regarding iron deficiency anaemia.

5. The chi-square test showed Significant (p<) association between level of

knowledge/altitude and medias which premises knowledge on iron deficiency

anemia.

The finding of the study there is significant difference between pre test and post test.

Interpretation and conclusion :

The study results were interpreted in the form of tables and graphs. (From table no. 1 to

15, 16-30)

The overall findings of the study showed that structured teaching program in very

effective in improving the knowledge and awareness about iron deficiency anaemia

among antenatal mothers.

65

Chapter -X

BIBLIOGRAPHY

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68

APPENDICES

69

APPENDIX-A

STRUCTURED INTERVIEW GUIDE

PART-1 DEMOGRAPHIC DATA

1. Age

a. Below 20 years

b. 21-25 years

c. 26-30 years

d. 31 and above

2. Religion

a. Hindu

b. Christian

c. Muslim

d. Others

3. Education status

a. Non literate

b. Primary School

c. High school

d. Higher Secondary School

e. Any Degree

4. Occupation

a. Employed

b. Agriculture

c. Cooly

d. House wife

70

5. Family income

a. Less than Rs. 1000/-

b. Rs. 1001-Rs. 2000/-

c. Rs. 2001-Rs. 3000/-

d. Above Rs. 3001/-

6. Gravida

a. Primigravid

b. Multigavida

7. Family Structure

a. Nuclear

b. Joint

8. Number of family members

a. 3 members

b. 4-5 members

c. 6 members

9. Health resources available near to area

a. Government

b. Private nursing homes

c. Health post

d. Voluntary health services

10. Utilisation of health services

a. Government

b. Private nursing homes

c. Health post

d. Voluntary health services

71

PART –II MULTIPLE CHOICE QUESTIONNARIE TO ASSESS

THE KNOWLEDGE OF ANTENATAL MOTHERS ON IRON

DEFICIENCE ANEMIA

1. Anemia means reduced

a. Hemoglobin level in the blood

b. Body fluid

c. WBC level in the blood

d. Platelet in the blood.

2. The most common type of anemia during pregnancy is

a. Iron deficiency anemia

b. Folic acid deficiency anemia

c. Vitamin B deficiency anemia

d. Megaloblstic anemia

3. In India, pregnant women is said to be anemic when hemoglobin

level is less than……… gm%

a. 13

b. 12

c. 11

d. 10

4. The iron store which is lost during delivery is regained within

a. 2 months

b. 6 months

c. 2 years

d. 3 years

5. One of the causes which leads to decreased intake of iron is

a. Over eating

b. Inadequate diet

c. Heavy work load

d. Mental stress

72

6. One of the causes which leads to decreased absorption of iron is

a. Intestinal infestation

b. Constipation

c. Emotional Disturbance

d. Morning sickness

7. Increased loss of iron during antenatal period is caused by

a. Congenital anomalies

b. Anorexia Nervosa

c. Fever

d. Antepartum hemorrhage

8. The early symptom of iron deficiency anemia during pregnancy is

a. Weakness

b. Oliguria

c. Alopecia

d. Palpitation

9. The predominant sign of iron deficiency anemia during pregnancy is

a. Wrinkles on the face

b. Pallor

c. Blurring of vision

d. Excessive sweating

10. Examination of stool is done during pregnancy mainly to rule-out

a. Hookworm infestation

b. Roundworm infestation

c. Tape worm infestation

d. Presence of Amoeba

73

11. The reason for urine examination in case of iron deficiency anemia

is to detect

a. Blood pressure

b. Hb level in the blood

c. Infection

d. Bladder incontience

12. One of the complication of iron deficiency anemia during pregnancy is

a. Gestational diabetes

b. Placenta previa

c. Twin Pregnancy

d. Preterm labour

13. One of the complic

a. Paralysis

b. Shock

c. Retained Placenta

e. Pain

14. One of the complications of iron deficiency anemia during puerperium is

a. Anorexia

b. Vomiting

c. Puerperal psychosis

d. Puerperal sepsis

15. One of the effects of anemia on the baby is

a. Jaundice

b. Post maturity

c. Prematurity

d. Congenital heart dsease

74

16. The daily requirements of iron during pregnancy is…..mg

a. 20 to 30

b. 40 to 60

c. 70 to 80

d. 90 to 100

17. The requirement of iron during postnatal period is….mg/day

a. 10 to 12

b. 20 to 22

c. 30 to 32

d. 40 to 42

18. The important preventive aspect of iron deficiency anemia is

a. Frequent pregnancy

b. Exercise and relaxation

c. Teenage pregnancy

d. Iron supplementation and iron rich foods.

19. The recommended done of iron tablets (Feso) per day during

Pregnancy………….mg

a. 200

b. 300

c. 400

d. 500

20. One of the common effects of oral intake of iron is

a. Abdominal pain

b. Head ache

c. Vomiting

d. Chest pain

75

21. The richest source of iron is

a. Roots

b. Green leaves & leafy vegetables

c. Nuts and oil seeds

d. Tubers

22. The cereal which is rich in iron is

a. Vermicelli

b. Raw rice

c. Semolina

d. Skipped Millet

23. The richest source of iron, among pulses is

a. Peas

b. Field bean

c. Soya bean

d. Lentils

24. The easily available green leaves which is good source of iron

a. Drumstick leaves

b. Carrot leaves

c. Cauliflower leaves

d. Mint leaves

25. The richest source of iron among vegetables is

a. Sundaikal

b. Cho-Cho

c. Knol-Khol

d. Bottle gourd

76

26. The richest source of iron among fruits is

a. Banana

b. Green grapes

c. Pineapple

d. Dates

27. Education status

a. Jack fruit

b. Banana

c. Lemon

d. Apple

28. The source which inhibits the absorption of iron is

a. Butter milk

b. Ragi conjee

c. Curd

d. Tea

29. A Severely anemia pregnant women is treated with

a. Taking excessive rest

b. Paenteral therapy

c. Maintaining Hygiene

d. Regular exercise

30. Parenteral iron therapy is indicated in mothers who have

a. Intolerance to oral intake of iron

b. Hb level of 13.5 my/dl

c. Pregnancy induced Hypertension Fevar

Pre test Score…….. Post test Score………

77

Table –1 : Frequency and percentage distribution of demographic variable among antenatal mothers

APPENDIX-B

STRUCTURED TEACHING PROGRAMME

Topic : Iron Deficiency Anemia Group : Antenatal mothers from 12 week to 40

Weeks of gestation Place of Teaching : Antenatal clinic, Kyathasandra Helath

Centre, Tumkur Instructor : Saroja Nirmala Kumari

(MSC) II year student Time : 45 minutes Method of Teaching : Lecturer cum Discussion Teaching Aids : Charts, Handouts, Picuture Overall Objectives On completion of this structured teaching programme the Antenatal Mothers will

be able to gain knowledge & understanding on iron deficiency anemia, and develop

desirable attitudes in apply this knowledge in the early detection and prevention of

complications of iron deficiency anemia.

78

Behavioural Objectives

After structured teaching programme the antenatal mother is able to.

1. define anemia

2. list out the causes of iron deficiency anemia

3. mention the signs and symptoms of iron deficiency anemia

4. enlist the simple investigations done incase of iron deficiency

anemia

5. State the complications of iron deficiency anemia

6. Discuss the steps for prevention of iron deficiency anemia

7. explain the treatment for iron deficiency anemia

79

Introduction

Good morning, I am a post graduate nursing student from college of Nursing,

Sridevi College of Nursing Tumkur. I have come here to teach you about the knowledge

of iron deficiency anemia and its prevention. I request you to participate in this class. At

the end of the class, you all are requested to clarify your doubts.

Behavioural Objectives Content Teacher’s Activity

Define iron deficiency

anemia

Anemia is a common complication of pregnancy

Anemia is associated with an increase incidence of

premature births, an higher perinatal mortality and

significant increase in material death. The

commonest anemia in pregnancy is iron deficiency

anemia.

Iron deficiency anemia is the condition in which

hemoglobin is less than 10gms per Dl and accurse

mainly due to deficiency of iron.

Explaining

List out the causes of

iron deficiency anemia

CAUSES OF IRON DEFICIENCY ANEMIA

1) Increased demand due to

i) Hemodilution

ii) Too frequent or too many pregnancies,

(usually, it takes two years to regain the

lost iron during delivery)

iii) Teenage pregnancy

iv) Hydatidiform mole

v) Maltiple pregnancy

2) Decrease intake of iron due to

i) Inandequate diet

ii) Loss of appetite and vomiting

iii) Poor socioeconomic factors

Explaining with the help of chart

80

Behavioural Objectives Content Teacher’s Activity

3) Decreased absorption in Gastro intestinal Tract due to

i) Decreased gastric Acidity

ii) Dietary imbalance

iii) Intestinal infestation

4) Increased loss of iron due to

i) Antepartum hemorrhage

ii) Bleeding hemorrhoids

iii) Hookworm infestation

Explaining

Mention the signs and

symptoms of iron

deficiency anemia

SIGNS AND SYMPTOMS

a) Signs:

i) pallor

ii) glossitis

iii) stomatitis

iv) odema of legs

b) Symptoms: Early Symptoms

i) the first symptom is weakness

ii) anorexia

iii) Indigestion

iv) Dyspnoea

v) giddiness

Late symptoms

i) palpitation

ii)Swelling of legs

Explaining with help of charts

Enlist the simple investigations done in case of iron deficiency anemia

INVESTIGATION

The simple investigation done to detect iron

deficiency anemia is

i) Testing the hemoglobin in the blood

ii) Stool is examined to detect hookworm infestation

iii) Urine is examined mainly to detect any infection

Explaining

81

Behavioural Objectives Content Teacher’s Activity

State the complications of iron deficiency anemia

COMPLICATIONS

a. During pregnancy

i) Intercurrent infection

ii) Heart failure at 30-32 weeks

iii) Preterm labour

b. During Labour

i) Uterine inertia-Associate with short labour and small baby

ii) Post partum hemorrhage

iii) Cardiac failure

iv) Shock

c. During Puerperium

i) Puerperal sepsis

ii) Subinvolution

iii) Failing lactation

iv) Pulmonary embolism

d. Effect on Baby

i) Prematurity

ii) Intra Uterine Growth Retardation iii) Anemia a few months after birth iv) Intrauterine death

v) Still birth

Explaining with the help of chrts

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Behavioural Objectives Content Teacher’s Activity

Discuss the steps for prevention of iron deficiency anemia

PREVENTION

During pregnancy

a. Avoidance of frequent child birth a

minimum interval between

pregnancies should be at least two

years

b. Supplementary iron therapy

i) Even with a well balanced diet

supplementary iron should be a

routing after the patient becomes

free from nausea and vomiting

due to pregnancy

ii) Daily administration of iron tablets

is 200mg of ferrous sulphate per

day for atleast 100 days during

pregnancy.

iii) Effect of oral iron tablets

1) Blackly stool

2) Constipation

Intolerance leads to 3) Nausea

4) Vomiting

5) Diarrhoe.

Discussing & Explaining with chart and handout

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Behavioural Objectives Content Teacher’s Activity

In such case of intolerance to the oral therapy stop taking oral iron and go for parental therapy.

c. Adequate Treatment for Hookworm infestation

i) Deworming is usually done at the 3rd month of the pregnant women who is infested with worm.

ii) Good sanitation iii) Use chappals while walking iv) Avoid Barefoot while waling v) Avoid open field defection

d. Early detection of hemoglobin should be estimated at the first 28th and finally 36th week of gestation. e. Iron rich diet A realistic balanced diet rich in iron and protein should be prescribed

Daily requirement of iron during Antenatal Period 40mg 60mg per day Postnatal Period 30mg 32mg per day it should be easily digestible

IRON RICH SOURCES Cereals – wheat, Jower, Bajra, Rice flakes, samia, Ragi, handpounded Rice. Richest Source of Iron among Cereals Bajra or Skipped millet Pulses – Bengal gram dhal, cowpea, green gram, Horse gram, khesari dhal, peas, roasted, Soyabeans, Roasted Bengal Gram, Richiest sources of iron among pulses soyabeans. Green leaves - Amaranth polygonides amaranth spined, amaranathus trists cauliflower greens, cow pea leaves, kuppameni, mayalu, Mint, Modakathan Keerai, Mukarrate keerai, Mustard leaves, parsley, paruppu Keerai, Fenguric leaves. Richest source of iron among greenleaves in Amaranthus triests

84

Behavioural Objectives Content Teacher’s Activity

VETETABLES Lotus stem, onion stalks, plantain green, Sundakai, Brinjal cluster beans cauliflower Double leaves ladies finger, Tomato, Richest Source of Iron among greenleaves FRUITS Raisin, Dates, Lime, Amla, Watermelon, Sappota, Seethaphal, Pomegranate, Richest source of iron among fruits is dates ANIMLA FOODS Meat, liver, fish, poultry, prawn Richest Sources of iron among animal foods is liver NUTS Groundnut, Cashwnuts, Coconut SUGAR – jaggery FOODS ENHANCING ABSORPTION OF IRON The substance which enhance the absorption is all vitamin –c rich source frits and vegetables like amla, lemon, guave, lime, orange, grape fruit, tomato and drumstick sprouted pulse. FOOD INHIBITING ABSORPTION OF IRON The substance which inhibits the absorption of iron is tea, coffee, milk. Iron utensils should be preferably used for cooking. Water used in rice and vegetables for cooking should not be discarded.

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Behavioural Objectives Content Teacher’s Activity

Explain the treatment for iron deficiency

anemia

CURATIVE TREATEMNT a. When the Hb level is less then 7.5mg the woman should be hospitalized b. ORAL IRON THERAPY i) Administer 200mg of ferrous sulphate thrice daily with or after meals ii) The treatment should be continued till the blood picture is normal. iii) Thereafter a maintenance dose of one tablet daily to be continued till at least three months following delivery C. INDICATION FOR PARENTERAL THERAPY i) Intolerance to iron tablets ii) Antenatal mother is not co-operative iii) Cases seen for the first time during the last 8-10 seeks with severe anemia.

Explaining

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HANDOUTS ON IRON RICH SOURCES

CEREALS Wheat, Jowar, Bajra, Rice, Flakes, Ragi, handpounded Rice Richest source of iron among cereals Bajara or skipped millet. PULSES Bengal gram dhal, Cowpea, green gram, Horse gram, Khesari dhal, peas roasted, Soyabeans, Roasted Bengal gram. Richest Source of Iron among pulses Soyabeans GREEN LEAVES Amaranath Polygonoides, Amarnath spined Amaranthus, tristis, cauliflower greens, Cow Pea leaves, Kuppameni, Mayalu, Mint, Modakathan, Keerai, Mukarrate, Keerai, Mustard Leaves, Parsely, Paruppu Keerai, Fengureen leaves & Drum stick leaves Richest Source of iron among green leaves is Amaranathus tristis VEGETABLES Louts stem, Onion stalks Plantain green Brinjal, Cluster beans, Califlower, double beans, Ladies finger, Tomato. Richest source of iron among green leaves . FRUITS Raisin, Dates, Lime, Amla, Watermelon, Sappota, Seethaphal, Pomegranate Richest sources of iron among fruits is Dates. ANIMALS FOODS Meat, Liver, Fish, Poultry, Prawn. Richest Source of iron among animal foods in Liver. NUTS Groundnut, Cashewnuts, Coconut Richest Source of iron among Nuts is Coconut SUGAR – Jaggery THE SUBSTANCE WHICH ENHANCE THE ABSORPTION Amla, Lemon, Guava, Lime, Orange, Grape, Fruit, Tomatao, Drumstick and Sprouted pulse THE SUBSTANCE WHICH INHIBITS THE ABSORTPTION OF IRON Tea, Coffee, Milk

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Measuring attitude of antenatal mothers regarding iron deficiency anaemia

SA A SLA DA SDA

5 4 3 2 1

1

Mothers who have had a iron rich diet

can produce normal weight babies

2 Maternal anaemia can be prevented by

iron supplementation and iron rich diet

3 The diet sources which are rich in iron

meat, liver, green leafy vegetables.

4 The diet sources which inhibit iron

absorption are tea/coffee/milk

5 Citrus fruits enhances absorption of

iron

6 Anaemia leads to low birth weight

babies still birth, abortions.

7 Iron and folic acid supplementation

ineffective in prevention of anaemia

8 Anaemia in pregnancy may be due to

worm infestation

9 Antenatal check ups and regular

maintaining of Hb% helps in

prevention of anaemia.

10 Food is another cause for anaemia in

pregnancy

11 Frequency of child birth increases the

chance of anaemia in mothers

12 Anemic mothers should not eat more

food

13 Anaemic mothers should not drink milk

14 Poor economic status leads to anaemia

15 Health education is not necessary in

pregnancy

113

16 Routine exercise will reduce chances of

anaemia

17 Taking iron and folic acid tablets leads

to giving birth to dark child

18 Anaemic mothers can do normal

delivery

19 Routine urine examination is necessary

to find out anemia in mothers

20 Improvement in knowledge only

sufficient in prevention of anaemia

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ANNEXURE – III

CRETERIA RATING SCALE FOR VALIDATING THE STRUCTURED TEACHING PROGRAMME.

Respected Madam / Sir, Kindly go through the content and rate the content in the appropriate column and give your expert opinion and suggestions in the marks column if found not relevant or needs modification.

Sl No. Content Relevant Not relevant

Needs Modification

Remarks

1 Objectives: Client oriented Realistic of achieve

II Content selection: Reflects the objective According to the

clients’ cognitive Aims at high level of

wellness of the client

III Organization of content: Logical sequence Continuity Integration

IV Language Simple Clear and

understandable

V Visual images used: Simple Clear and

understandable Represents adequately

the concept of the content

VI Feasibility and practicability of the STP Permits self learning Useful to Antenatal

Mothers .

Suggestions : ____________________________________________________________

__________________________________________________________

Signature of the Expert.

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