RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BENGALURU, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1 Name of the candidate and K.SIRISHA

Karnataka College Of Nursing,

Address
33/2, Thirumenehalli,

Jakkur Post, Hobli,

Bengaluru-64,

Karnataka.

2 Name Of The Institution Karnataka College Of Nursing

3 Course Of Study And M.Sc (Nursing)

Obstetrics And Gynecological Nursing

Subject

4 Date of Admission to course 01-06-2011

5 Title Of The Topic “A study to evaluate the effectiveness of

Amla with ghee to improve the hemoglobin

level among antenatal mothers in selected

areas in Bangalore.”

1
6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION:

“Life is magic, the way nature works seems to be quite magical.”

-- Jonas Salk

Amla is the most widely used herb in the ayurveda, it helps in

balancing three Doshas, Vayu, Pitta and Kapha and helps in digestive problems, heart

problems, improves defense mechanism, improves eye sight, adds a natural glow to hair

and body and is a store house of Vitamin C.1

The scientific names of Gooseberry are Amlica Embillicus and

Phylanthus Emblica. The fruit is popularly known as Amla in Hindi. Other names are

Alona, Aola, Amalaki, Amla-berry, Dharty, amala, Aawallaa, Embelic, Nellikai, Nillika,

and Usareekai.1

Emblica Officinalis is Cooling, Refrigerant, and Diuretic. It has

Anabolic, Antibacterial, Antidiarrhoeal, Antidysenteric, Expectorant, Antispasmodic,

Antipyretic, Antioxidative, Antiviral, Antiemetic, Antihepatotoxic, Immunomodulator

and Resistance building properties.1

It’s antibacterial, carminative, hypoglycemic, stomachic,

hypotensive and astringent action prevents infection, helps in healing of ulcers, treatment

2
of jaundice, dyspepsia and cough and controls hyperacidity. Alma is a good Cardio Tonic

and its mild stimulant action on heart helps to control blood pressure.2

Gooseberry remains a popular Tonic consumed across the Globe.

81.2% of gooseberry fruit is water, thus it is a very good source of skin moisturizing. It is

the richest natural source of Vitamin C. 100 gm. of Amla contains about 700 mg. of

vitamin C, which is thirty times the amount found in oranges. It also contains calcium,

iron, protein, tannic acids, sugar, phosphorus, carbohydrates etc.2

The provision of iron supplements to pregnant women is one of the

most widely practiced public health measures, yet surprisingly little is known about the

benefits of supplemental iron for the mother or her offspring during fetal or postnatal life.

The purpose of this article is to examine published information on the effects of anemia

and iron deficiency on pregnancy outcome and to identify current gaps in the

information.2

A high proportion of women in both industrialized and developing

countries become anemic during pregnancy. Estimates from the World Health

Organization report that from 35% to 75% (56% on average) of pregnant women in

developing countries, and 18% of women from industrialized countries are anemic.

However, many of these women were already anemic at the time of conception, with an

estimated prevalence of anemia of 43% in non-pregnant women in developing countries

and of 12% in women in wealthier regions. The prevalence of iron deficiency is far

greater than the prevalence of anemia and iron deficiency (low serum ferritin and sparse

or absent stainable iron in bone marrow) often develops during the later stages of

pregnancy even in women who enter pregnancy with relatively adequate iron stores. For
3
this reason, and because of doubts concerning the benefits of iron supplementation on

pregnancy outcome, there is uncertainty about whether routine iron supplementation of

pregnant women is necessary.3

Eating a Gooseberry (Amla) everyday also helps in improving in

blood and curing Anemia as it is a good source of vitamin C> Also taking 3 spoons of

Gooseberry juice with 3 spoons of pure Ghee for 21 days will definitely cures Anemia.2

Taking Amla and Black Till (black sesame seeds) in equal quantity

with honey or ghee cures mental and physical weaknesses. Taking milk in the morning

after licking one teaspoon of ground Amla powder mixed with honey imparts freshness

and strength to the body. Intellect gets sharpened if one takes the pulp of fresh Amla or

Amla juice with honey or ghee every morning and evening. Taking Amla juice or powder

with honey purifies blood.4

Ghee helps the absorption of not only vitamins and minerals but

also phytonutrients. Ghee has been shown in one rodent study to reduce serum

cholesterol slightly, but not significantly. Fresh Amla juice in between meals helps in

getting rid of mental and physical weakness. Amla oil helps in getting sound sleep and

prevents premature graying of hair. Instilling 2 - 4 Amla juice drops into each nostril can

cure bleeding of nose.5

The juice of fresh Amla fruit is given as tonic, for anti-bilious

remedy. It is also helpful in burning sensation, over thirst, dyspepsia and other ailments

of digestive system especially for pregnant mothers during pregnancy. Dried Amla gives

excellent results in hyperacidity, ulcers and blood impurities. It is also used both

4
internally and externally as a decoction and paste Some of the common uses of Amla

fruit are: Amla expels toxins from body and improves defense mechanism of the body.4

There can be various reasons for constipation during pregnancy due to

various reasons. Women who are troubled by constipation during pregnancy face a lot of

dilemma. It is not possible or advisable to take many medicines safely during pregnancy

and even the doctors do not prefer to prescribe too many drugs since it could have side

effects on the child in the womb. Amla is one of the great solution for constipation during

pregnancy and one of the great natural remedies for constipation because it is low in

sugar and has high fibre content, making it an ideal daily fruit for almost anyone. Amla is

Great a boon for Pregnant Ladies.6

6.1. NEED FOR THE STUDY:

Pregnancy is one of the most exciting and important events in each woman's life

involving many factors that should be considered in advance such as changes in diet,

habits and lifestyle that may be worked out with your doctor before, during and after the

pregnancy. It is important as for mother as well for her future baby. Part of the challenge

of breeding the mothers is confirming the success of our efforts. The mother’s

reproductive cycle is twenty one days long (that is, twenty one days from ovulation to

ovulation, or from the first day of the heat cycle to the first day of the next cycle, etc.)7

Physiological and anatomical alterations develop in many organ systems during

the course of pregnancy and delivery. Early changes are due, in part, to the metabolic

demands brought on by the fetus, placenta and uterus and, in part, to the increasing levels

of pregnancy hormones, particularly those of progesterone and oestrogen. Later changes,

5
starting in mid-pregnancy, are anatomical in nature and are caused by mechanical

pressure from the expanding uterus.8

The pregnancy-induced changes in the cardiovascular system develop primarily

to meet the increased metabolic demands of the mother and fetus. Blood

Volume increases progressively from 6-8 weeks gestation (pregnancy) and reaches a

maximum at approximately 32-34 weeks with little change thereafter. Most of the added

volume of blood is accounted for by an increased capacity of the uterine, breast, renal,

striated muscle and cutaneous vascular systems, with no evidence of circulatory overload

in the healthy pregnant woman. The increase in plasma volume (40-50%) is relatively

greater than that of red cell mass (20-30%) resulting in hemodilution and a decrease in

haemoglobin concentration. Intake of supplemental iron and folic acid is necessary to

restore hemoglobin levels to normal (12 g/dl).8

The major concern about the adverse effects of anemia on pregnant

women is the belief that this population is at greater risk of perinatal mortality and

morbidity. Maternal mortality in selected developing countries ranges from 27 (India) to

194 (Pakistan) deaths per 100000 live births. Some data show an association between a

higher risk of maternal mortality and severe anemia, although such data were

predominantly retrospective observations of an association between maternal hemoglobin

concentrations at, or close to, delivery and subsequent mortality. Such data do not prove

that maternal anemia causes higher mortality because both the anemia and subsequent

mortality could be caused by some other condition. For example, in a large Indonesian

study, the maternal mortality rate for women with a hemoglobin concentration <100 g/L

6
was 70.0/10000 deliveries compared with 19.7/10000 deliveries for non-anemic women.

However, the authors believed that the relation of maternal mortality with anemia

reflected a greater extent of hemorrhage and late arrival at admission rather than the

effect of a prenatal anemic condition. In another study, often cited as showing an

association between maternal anemia and subsequent mortality, approximately one-third

of the anemic women had megaloblastic anemia due to folic acid deficiency. The cutoff

for anemia was extremely low (<65 g hemoglobin/L).9

According to D.C.Dutta anaemia is an indirect cause of death. About

50% of pregnant women worldwide suffer from anaemia during pregnancy. Anaemia is

commonly due to deficiency nutrition, iron. Folic acid, iodine and other

micronutrients).10

According to the standard laid down by WHO, anaemia in pregnancy is

present when the hemoglobin concentration in the peripheral blood is11gm/100ml or less.

During pregnancy plasma volume expands (maximum around 32 weeks) resulting in

haemoglobin dilution. For this reason, haemoglobin level below 10gm/dl at any time

during pregnancy is considered anaemia (WHO, 1993). Hb level at or below 10gm/dl

requires detailed investigations and appropriate treatment. Adopting this lower level, the

incidence of anaemia in pregnancy ranges widely from 40-80 percent in the tropics

compared to 10-20% in the developed countries. Anaemia is responsible for 20% of

maternal deaths in the third world countries. 11

A cross-sectional study was conducted among pregnant women who

had completed 36 weeks of gestation to identify the risk of anemia. Prevalence of an

antenatal risk condition was 52.0%. The common risk conditions included teenage (9.7%)
7
or elderly mother (14.3%), anaemia (8.2%) and abnormal BMI (8.2%). The common risk

conditions due to past pregnancy were: history of abortion (19.3%), past caesarean

delivery (8.0%), and stillbirth/ neonatal death (4.8%). Less than half of the 'at

risk' mothers were educated regarding the risk condition (47.5%) or referred to (48.5%)

by the primary care providers. The majority was advised to deliver at a facility with

emergency obstetric care. One in every two pregnancies in the vavuniya District had an

antenatal risk condition and services should be organized to meet this need.12

An experimental study conducted to assess iron deficiency anaemia is

the most prevalent nutritional problem in the world today. This study was to consider the

effectiveness of consumption of iron fortified ready to eat cereals and amla as two

sources of dietary iron on status of iron nutrition and response of hematological

characteristics of pregnant women. The result showed that adding another food source of

iron such as amla improves the iron status. Additional and longer studies using these two

food products are recommended to further determine the effect of iron fortification on

iron nutrition and status with among the target population, and mainly in young children,

adolescents, womens of reproductive ages and pregnant women.13

Amla strengthens absorption and assimilation of food. It improves

digestion and stimulates our taste buds to relish food better. It can be used by everyone

without fear of gastric irritation, or increased acidity. It can also be used to ease "too

much heat" - a popular belief - in the body. It aids in better absorption and assimilation of

iron from the gut. It also acts as a laxative in large doses due to its high fibre content.4

8
 A study to determine the prevalence of anaemia and the dietary and

socio economic factors associated with anaemia in pregnant women living in an urban

community setting in Hyderabad. About 75% of women at 20to 26 weeks of pregnancy

had mild to moderate anaemia. Pica, tea consumption, and low intake of eggs and red

meat were associated with anaemia. Women of child bearing age should be provided

nutritional education regarding food source of iron, especially prior to becoming pregnant

and taught how food choices can enhance or interfere with iron absorption.13

The mothers need good nutritional supplementation which will prevent

the anaemia during pregnancy. 80% of these deaths can be prevented through actions that

are effective and affordable in developing country settings (WHO, UNICEF, and

UNFPA). Thus in this study, the researcher is going to assess the effectiveness of Amla

with ghee to improve hemoglobin level to prevent the anaemia among antenatal

mothers.10

6.2 REVIEW OF LITERATURE:

An important aspect of research, literature review is to make sure that

is already done in relation to the problem of interest. Several studies which have been

conducted in correlation between amla with ghee and haemoglobin level which needs

more focus for the development of future studies. The investigator with the available

resources was able to review the literature so as to proceed with the study.

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The reviews of this study is organized and presented under the following headings:

I. Incidence/ prevalence of anaemia and its impact.

II. Effectiveness of amla with ghee to improve hemoglobin level.

I. Incidence/ prevalence of anaemia and its impact:

This study was carried out to determine the prevalence of anaemia among

pregnant women receiving antenatal care in two hospitals and a traditional birth home in

order to obtain a broader prevalence data. Pregnant women were enrolled in the study at

their first antenatal visit and were monitored through pregnancy for anaemia. Packed cell

volume (PCV) was used to assess level of anaemia. Questionnaires were also

administered to obtain demographic information. The results shows that three hundred

and sixty five (76.5%) of women were anaemic at one trimester of pregnancy or another.

Anaemia were more prevalent among primi gravid (80.6%) than the multi gravidae

(74.5%). Two hundred and eleven women (57.8%) had moderate anaemia while 147

(40.3%) had mild anaemia and 7 (1.9%) were severely anaemic. All severe anaemic were

under 30 years old. However, in all the antenatal centers more women were anaemic in

the 2nd trimester of pregnancy. The conclusion shows that educating women on early

antenatal booking and health interventions is necessary to reduce the problem of

anaemia.14

An exploratory study was conducted to identify the prevalence of

anemia is regarded as a major risk factor for unfavorable pregnancy outcomes, the main

objectives of this study were to study the hemoglobin levels and prevalence of anemia

among pregnant women and to evaluate potential associations of hemoglobin and anemia

10
with women's characteristics. The hospital-based study was conducted in 380 pregnant

women. Their blood samples were tested and related socio-demographic information was

collected. Multiple linear regression models and multiple logistic regression model were

used to assess the association of pregnant women's characteristics with hemoglobin level

and the occurrence of anemia. The results show that the mean hemoglobin concentration

was 127.6 g/L (range: 55.0-190.0 g/L). Prevalence rate of anemia in this study was

70.0%, 77.9% and 41.3%, respectively for three altitude-correction methods for

hemoglobin (CDC method, Dirren et al. method, and Dallman et al. method. The

conclusion shows the hemoglobin level was low and prevalence rate of anemia was high

among pregnant women. Gestational age, ethnicity, residence and income were found to

be significantly associated with the hemoglobin level and the occurrence of anemia in the

study population.15

A descriptive study states that nutritional anaemia is one of India’s major

health problems in Punjab. The prevalence of anaemia ranges from 33% to 89% among

pregnant women and is more than 60% among adolescent girls. The survey data showed

that 84.9% of pregnant women were anaemic (haemoglobin less than 70gm/L), and

60.1% had moderate anaemia (haemoglobin more or equal to 70 to 100 gm/L).16

An exploratory study was conducted to investigate nutrition and health

status of pregnant women in India.16 counties cities in 8 Provinces in India were selected

to investigate nutrition and health information for pregnant women. Results shows that

the averaged age of pregnant women was 27.1 years old and 6.3 percent of pregnant

women are over 35 years old. The proportion rates of pregnant women who consumed

supplements before or during pregnance accounted for 81.8% in city and 57.8% in rural

11
(P < 0.01). Anaemia prevalence was 14% with significant difference between urban and

rural, P < 0.01. The rate of sural spasm during pregnancy was 39.3%. Low daily intakes

of protein, retinol equivalence, calcium, iron were the major nutritional problem. Calcium

deficiency was the leading problem. Pregnant women got health improvement kowlege

mainly from relatives, friends, hospitals or medical centers, books and televisions,

furthermore, internet was a main media for city women. Conclusion reveals Low daily

intakes of protein and micronutrients were major problems for pregnant women.17

A retrospective and cross-sectional study was conducted to determine

the prevalence of anaemia in antenatal clinic attendees; to investigate the effects of parity,

age, gravidity, previous abortions, child spacing and other factors on the prevalence

of anaemia in pregnancy. Antenatal records of 2287 pregnant women attending 40 public

healthcare centers were used. Data pertaining to the investigated variables were recorded.

The national prevalence of anaemia was calculated and chi-square tests, odds ratios and

logistic regression were used to assess the relationship between anaemia and each

variable. The results of this study shows that prevalence of anaemia was 15.3% (95% CI

13.4%, 16.6%). significant difference in the prevalence of anaemia was found among the

different clinics. At the first haemoglobin reading, age was inversely related to the

presence of anaemia, whereas gestational age at first visit was directly related. At the

final haemoglobin reading, parity, gravidity, and previous spontaneous abortions were

directly related to the prevalence of anaemia, while the number of visits was

inversely related. Age was inversely associated to the severity of anaemia while gravidity

was directly related. The women under 24 years and those commencing antenatal care

after the first trimester are still at a higher risk for developing anaemia. Early

12
commencement of antenatal care and close monitoring of the risk groups identified

should be strongly advocated.18

A cross-sectional study for collecting data on socio-economic and

anthropometric (weight, height) variables, Hb, dietary pattern (FFQ) and peripheral

smear examination for classifying nutritional and iron deficiency anaemia (IDA).Rural

women (n 418) of childbearing age (15-35 years). Mean Hb was 11·07 g/dl. Seventy-

seven per cent of the women were anaemic (Hb < 12 g/dl) and 28 % had IDA, indicating

that a large proportion of the women had nutritional anaemia. Higher prevalence of IDA

was associated with several socio-demographic and maternal parameters, but multiple

logistic regression analysis showed significant (P < 0·05) risk of IDA with lower body

weight (<40 kg), short maternal height (<145 cm), younger age at marriage (<19 years)

and higher parity (≥ 2). Various socio-cultural reasons associated with low consumption

of green leafy vegetables(GLV) included non-cultivation of GLV, priority for selling

them rather than home consumption, dislike of GLV by husband and children, and lack of

awareness about different recipes for GLV. Conclusion shows that low consumption of

GLV, which are treasures of micronutrients including Fe, is associated with genuine

social reasons. This indicates a need for developing action programmes to improve

nutritional knowledge and awareness leading to enhanced consumption of Fe-rich foods

for preventing anaemia in rural India.19

A comparative study conducted to comparing the outcome of

haemoglobin level in 308 pregnant women near term with compliance of iron

supplementation during the preceeding pregnancy pregnancy stages. Data were collected

using an interview based questionnaire for assessment of supplementation compliance

13
and the women were divided into three categories: strictly complaint, partially complaint

and non complaint. Haemoglobin levels improved significantly only among strictly

complaint pregnant women by 1.3gm/dl, decreased among partially complaint women by

0.36gm/dl and significantly decreased among non-complaint by 1.4gm/dl. Strategies to

improve compliance and effective iron supplementation among pregnant women should

be implemented.20

II. Effectiveness of amla with ghee to improve hemoglobin level:

A pre experimental study was did to identify the efficacy for both

employers and employees (young working women 18 to 23 years of age) was undertaken

to determine whether culturally acceptable dietary changes in lunches in the workplace

and at home could bring about a behavioral change and improvement in their iron-

deficiency anemia status. Maximum weight was given to increasing consumption of idly,

a popular cereal-based-fermented food, or of gooseberry juice. Four small factories were

selected in periurban Bangalore, with a sample of 302 women. The 180-day interventions

were supervised at the workplace. In unit 1 (72 women), the intervention consisted of idly

four times a week. Unit 2 (80 women) received 20 ml of gooseberry juice (containing 40

mg of vitamin C) three times a week . Women in unit 3 (70 women), the positive control,

received 400 mg albendazole once plus ferrous sulfate tablets (60 mg elemental iron) two

times a week. Unit 4 (70 women) served as the negative control and received no

intervention. The pre-post impact measures were dietary and nutrient intake, knowledge

and practice, and hemoglobin status. The results shows in units 1, 2, and 3,

the hemoglobin status of the women improved significantly from 11.10 to 12.30 g/dl,

11.20 to 12.70 g/dl, and 11.50 to 13.00 g/dl, respectively. In unit 4 there was no change:

14
the values were 10.90 g/dl before and after intervention. The conclusion show that the

type of workplace lunch was of greater significance.21

An experimental study to assess the reported efficacy of natural

Amla with ghee in reducing the iron deficiency anaemia (IDA), the efficacy of natural

Amla with ghee was compared to that of clinical in an open trial involving 20 patients

with iron deficiency anaemia (IDA) who were in steady clinical states. All patients were

admitted to hospital for the 4 weeks duration of the trial for bed rest, with daily providing

medication and Amla with ghee. Fifteen patients with a total of 19 anaemia patients

(7gms/dl) were evaluable at the end of the trial. Eleven anaemia patients were receiving

Amla with ghee and medication while 8 were receiving only medication. Results shows

that after 4 weeks the 19 patients receiving medication with Amla with ghee were

increased hemoglobin levels (between the ranges of 12-13 g/dl) than comparing to the 8

members receiving only medication (9-10g/dl). The conclusion shows that significant

differences were found in rates of reducing of the anaemia in either treatment groups.

This trial was support the suggestion that natural Amla with ghee can use as a

complimentary therapy for curing anaemia.22

A pre experimental study conducted on seven men and three

women (mean age, 31.2 years; range, 20-45 years) received a strictly controlled regular

diet during a 2-week control period, followed by the regular diet supplemented with daily

consumption of Amla juice. At the end of each period, blood samples were withdrawn for

assays of blood glucose, blood minerals, vitamin C, glutathione reductase,

immunoglobulin E, hemoglobin, blood indices and cells, serum ferritin, serum iron, and

iron-binding capacity. Results showed that Amla juice increased antioxidant agents; it

15
increased blood vitamin C concentration by 47% and glutathione reductase by 7%,

increased serum iron by 20% and decreased plasma ferritin by 11%. It may be concluded

that Amla juice increased antioxidant agents, serum iron and blood indices, and trace

elements and decreased immunoglobulin E, liver and muscle enzymes, and fasting blood

sugar in healthy subjects.23

An experimental was conducted to assess the effectiveness Oral

administration of Emblica officinalis (Linn.) Was found to be effective in protecting

mothers against the anaemia. Not only hemoglobin and also protects hematological and

biochemical modulation in blood. The 30 mothers were taking daily Emblica officinalis

duration of eight weeks. A significant increase in the RBC, WBC, hemoglobin, and

hematocrit values was observed in the mothers treated with Emblica officinalis extract as

compared to the hematological values observed the mothers in an other group 21

members without treatment of Emblica officinalis. The results show that the mothers

need any nutritive supplementation which will increase the hematological values to meet

the needs of mother and also fetus. Suggestions of this study are the supplementation of

Emblica officinalis can prevents the anaemia in pregnant mothers.24

A quasi experimental study States that effectiveness of

gooseberry supplementation in prevention of anaemia among antenatal mothers at the

selected hospitals in Kerala. A sample consists of 60 primi gravid mothers and multi

gravid 30 in experimental and 30 in control group was chosen by purposive sampling

technique was used for this study. The result of the study shows that post test results

showed that the level of anaemia in experimental group 29 (96.7 %) had mild anaemia,

one (3.3%) had moderate anaemia and no women had severe anaemia, and in control

16
group 25 (83.3%) had mild anaemia, five (16.7%) had moderate anaemia and no body

had severe anaemia. The level of practice among antenatal women in first trimester

showed that 23 (76.7%) were moderately practice, 7 (23.3%) were adequately practice

and no one had inadequate practice25

A study conducted a study to assess that iron deficiency anaemia is

the most prevalent nutritional problem in the world today. This study was to consider the

effectiveness of consumption of iron fortified ready to eat cereals and amla as two

sources of dietary iron on status of iron nutrition and response of hematological

characteristics of pregnant women. The result showed that adding another food source of

iron such as amla improves the iron status. Additional and longer studies using these two

food products are recommended to further determine the effect of iron fortification on

iron nutrition and status with among the target population, and mainly in young children,

adolescents, womens of reproductive ages and pregnant women.26

An experimental study states that iron deficiency anaemia in

pregnant women can be reduced by increasing the consumption of cereal- based

fermented foods or gooseberry juice. The 90 days intervention was supervised at the peri

urban area in Bangalore. In unit 1 (70 women), received 20 ml of gooseberry juice

(containing 40 mg of vitamin c) three times a week plus information, education,

communication (IEC) once a month. Unit 3 (70 women) the positive control, received

ferrous sulphate tablets (60 mg elemental iron), no IEC was given. Unit 4 (70 women)

served as the negative control and received no intervention. In units 1 and 2 the

haemoglobin status of the mother improved significantly from 4.20 to 5.70g/dl and 4.5 to

6 g/dl respectively. In unit 3 there was no change the values were 10.90 g/dl before and

17
after intervention. The results showed that the haemoglobin level of the pregnant women

can easily be improved by the iron supplements. For the pregnant women with anaemia

liberal intake of ascorbic acid (vit-c) is necessary as it is good for the proper absorption of

iron.27

6.3 STATEMENT OF PROBLEM:

“A study to evaluate the effectiveness of Amla with ghee to improve the

hemoglobin level among antenatal mothers in selected areas at Bangalore.”

6.4 OBJECTIVES OF THE STUDY:

 To assess the hemoglobin level among antenatal mothers in experimental group

and control group

 To assess the effectiveness of amla with ghee in improving hemoglobin level

among antenatal mothers (in experimental group).

 To compare the hemoglobin level among antenatal mothers between

experimental group and control group.

 To associate the hemoglobin level with their selected socio demographic

variables between experimental group and control group.

6.5 HYPOTHESIS:

 H1: There will be statistically significant difference in the post test hemoglobin

level between experimental group and control group.

 H2: There will be statistically significant association of post test hemoglobin level

among in antenatal mothers with their selected socio demographic variables.

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6.6 OPERATIONAL DEFINITIONS:

Evaluate: It refers to assess the effectiveness of amla with ghee in improving

hemoglobin Level with the help of checklist.

Effectiveness: It refers to the desired change brought by the Supplementation of amla

with ghee in improving the hemoglobin level.

Amla with Ghee: Instruction will be given to the mothers, to have 3 spoons of amla juice

with 3 spoons of pure Ghee once in a day before lunch to antenatal mothers to improve

hemoglobin level.

Hemoglobin: A hemoprotein composed of globin and heme that gives red blood cells

their characteristic color; function primarily to transport oxygen from the lungs to the

body tissues.

Antenatal mother: It refers to the time of the pregnancy between the weeks of 16-20.

6.7 ASSUMPTIONS:

The study is based on the following assumptions;

 Antenatal mothers need to have 11-14gm/100ml of hemoglobin to meet the needs

of mother and fetus.

 Amla with ghee helps the antenatal mothers to improve their hemoglobin levels

and nutritional status during pregnancy.

19
6.8 DELIMITATIONS:

The study will be delimited to:

1. Antenatal mothers residing in selected areas at Bangalore.

2. 60antenatal mothers.

7. MATERIAL AND METHODS:

7.1. Sources of data: Antenatal mothers in selected areas at Bangalore.

7.2. Methods of data collection: Observational check-list to assess the anaemia among

antenatal mothers.

7.2.1. Type of study or research approach: Quantitative research approach.

7.2.2. Research design: True experimental design - Pre-test and Post-test control group

design.

7.2.3. Variables:-

(a) Study variable:

(a) Independent variable is Amla with ghee

(b) Dependent variable is hemoglobin level among antenatal mothers.

(b) Attribute variable: Socio-demographic variables which include age, education,

family income of pregnancy.

7.3. Sampling Technique: Simple random sampling technique.

7.4. Sample and sample size: 30 antenatal mothers for experimental group and

30 antenatal mothers for control group in selected areas that fulfill the selection criteria.

20
7.5. Selection criteria:

(a) Inclusion criteria:

The criteria that specify the characteristics that subjects in the population must

possess are referred to as the inclusion criteria.

The study includes antenatal mothers who are:-

 The antenatal mothers who have gestational age between 16-20 weeks.

 The mothers having hemoglobin level less than 11-14gms/100ml.

 Who are willing to participate in this study.

(b) Exclusion criteria:

The study excludes antenatal mothers who are:-

 The mothers with other diseases (Pre eclamsia, gestational diabetes etc).

 Not present at the time of data collection.

7.6. INSTRUMENTS TO BE USED:

SECTION-A:

Questions regarding demographic variables.

SECTION-B:

TOOL-1: Observational check-list to assess the anaemia among antenatal mothers.

7.7. Duration of the study: 4 weeks period of data collection.

21
7.8. Tool or Instruments:

Section-A: socio-demographic profile which includes age and trimester.

Section-B: Amla with ghee in improving hemoglobin level among antenatal mothers.

7.9. Data collection procedure: formal permission will be obtained from concerned

authorities after brief introduction about self and the purpose of the study, written content

will be obtained from the subjects. After the socio-demographic profile and tool will be

administered to the subject under study.

7.10. Data analysis method: The data will be analyzed using descriptive statistics and

inferential statistics based on the objectives.

7.11.1: Demographic data would be analyzed using frequency percentage.

7.11.2. Percentage, mean, standard deviation and paired T- test would be used to find out

the effectiveness.

7.11.3. Chi square test will be used to associate the post test level of practice on amla

with honey.

7.11.4. The Chi-square will be used to find out the correlation of practice on amla and

ghee with selected demographic variables.

7.12. Does the study require any investigations or interventions to be conducted on

patients or other humans or animals?

NO

7.13. Has ethical clearance obtained from the institution?

Not Applicable.

22
LIST OF REFERENCES:

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2. living.oneindia.in/.../amla-juice-benefits-infections-020611-aid0158

3. www.who.int/vmnis/publications/anaemia_prevalence/en/index.html

4. http://www.ecoindia.com/flora/trees/amla-plant.html

5. en.wikipedia.org/wiki/Ghee

6. http://www.overcomeconstipation.com/constipation-during-pregnancy-remedies

7. http://www.naturalnews.com/pregnant_women.html

8. www.uptodate.com/.../maternal-cardiovascular-and-hemodynamic-

9. www.ajcn.org/content/71/5/1280S.

10. D.C. Dutta, text book of obstetrics, new central book agency (p) ltd: 7th edition,

page. No: 264-272.

11. Annamma Jacob, text book of midwifery, jaypee’s publications: page. No; 262-

266.

12. Milman N, iron in pregnancy- how do we secure an appropriate iron status in the

mother and child, Ann Nutr Metab 2007; 59(1):50-4.

13. N Baig-Ansari , A study to determine the prevalence of anaemia living in an

urban community setting in Hyderabad, PubMed-2008:18693477.

14. Demarche , A study was carried out to determine the prevalence of anaemia

among pregnant women receiving antenatal care, PubMed-2011 ; 21608439

23
15. Y Xing, An exploratory study was conducted to identify the prevalence of

anemia is regarded as a major risk factor for unfavorable pregnancy Journal

List › BMC Public Health › v.9; 2009.

16. Vitull K. Gupta, arun Kumar maria, rajiV Kumar, jaGjeet SinGh Bahia, Sonia

arora et al, to Study the Prevalence of Anaemia in Females with Respect to the

Age, Body Mass Index (BMI), Activity Profile and the Socioeconomic Status in

Rural Punjab, http://www.jcdr.net/articles/PDF/1513/29-%202932.

17. Ms.Indu Capoor, a retrospective and cross-sectional study was conducted to

determine the prevalence of anaemia in antenatal mothers,

http://www.novartisfoundation.org/platform/content/element/293.

18. EO Uche-Nwachi, A Odekunle, S Jacinto, M Burnett, M Clapperton, Y David, S

Durga, K Greene, J Jarvis, C Nixon, R Seereeram, C Poon-King, and R Singh,

Anaemia in pregnancy: associations with parity, abortions and child spacing in

primary healthcare clinic attendees, Afr Health Sci 2010 March; 10(1): 66–70.

19. Rao S, Joshi S, Bhide P, Puranik B, Kanade A, Social dimensions related

to anaemia among women of childbearing age from rural India,

Public Health Nutr 2011 Feb;14(2):365-72.

20. F Habib, E Habib Zein Alabdin, M Alenazy, R Nooh, Compliance to iron

supplementation during pregnancy, journal of the Institute of Obstetrics and

Gynaecology 08/2009; 29(6):487-92.

21. Gopaldas, Tara, Iron-deficiency anemia in young working women can be reduced

by increasing the consumption of cereal-based fermented foods or gooseberry

24
 juice at the workplace,food and nutrition bulletin, Food & Nutrition Bulletin, March

2002, Volume 23, Number 1; pp. 94-105.

22. Mallikarjuna rao k. et al, reported efficacy of natural Amla with ghee in reducing

the iron deficiency anaemia (IDA), http://nipccd.nic.in/reports/ran.pdf.

23. Ashok Kumar Panda, Sangram Mishra and Susanta Kumara Mohapatra, regular

diet supplemented with daily consumption of Amla juice for anaemia, Journal

advances in development of research 2(2)2007;287-294.

24. Jaijay K. et al,Oral administration of Emblica officinalis (Linn.) Was found to be

effective in protecting mothers against the anaemia, International journal of

applied research in naturalproducts june-july 2010, vol 3(2), pp.28-35.

25. Sindhu menon H.et al, effectiveness of gooseberry supplementation in prevention

of anaemia among antenatal mothers, ayurveda health tourism, aug 2011’ vol

8(6),pp11-13.

26. A.Nesimi KISIOGLU1.et al, Anaemia prevalence and its affecting factors in

pregnant women of Isparta Province, Biomed res (India)2004; 16(1):11-14.

27. Mt Ruel, M Armar-Klemesu.iron-deficiency anaemia in young working women

can be reduced by increasing the consumption of cereal-based fermented foods or

gooseberry juice, Food and Nutrition Bulletin, 2002 - archive.unu.edu.

28. www.currentnursing.com

29. www.Pubmed.com

30. www.google.com

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25
9.SIGNATURE OF THE K.SIRISHA

CANDIDATE:

10.REMARKS OF THE GUIDE: The study is interesting, effective and affordable

for the mothers to practice and also increase

evidence based support for practice.

11.NAME AND DISEGNITION: Mrs. Poornima Hariaharan

Associate Professor

Department of OBG

Karnataka College of Nursing, Tirumenahalli,

Hegdenagar main road, Jakkur post, Yelahanka

Hobli, Bangalore -64

12.GUIDE:

13.SIGNATURE:

14.CO-GUIDE :

15.SIGNATURE:

16. HEAD OF THE DEPARTMENT:

17.REMARKS OF THE CHAIRMAN & PRINCIPAL:

18. SIGNATURE:

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