A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING MENOPAUSAL PROBLEMS AND

ITS REMEDIAL MEASURES AMONG MIDDLE AGED WOMEN IN SELECTED

RURAL AREAS, BANGALORE.

By
Ms. JINY JAMES
Dissertation Submitted to the Rajiv Gandhi University of Health Sciences

Bangalore, Karnataka

In partial fulfillment of the requirements for the degree of

MASTER OF SCIENCE
IN
COMMUNITY HEALTH NURSING
Under the guidance of

Mrs. R.CHITRA

HOD

Department of Community Health Nursing

Acharya College of Nursing- 560032

2012

I
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “A study to evaluate the effectiveness of structured

teaching programme on knowledge regarding menopausal problems and its remedial measures

among middle aged women in selected rural areas, Bangalore” is a bonafide and genuine

research work carried out by me under the guidance of Mrs. R. Chitra M.Sc(N), HOD,

Department of Community Health Nursing, Acharya College of Nursing, Cholanagar, R.T.

Nagar Post, Bangalore. The Thesis is not submitted for any other diploma or degree course

with any other university what so ever.

Place: Bangalore Signature of the Candidate

Date: Ms. Jiny James

II
 CERTIFICATION BY THE GUIDE

This is to certify that the dissertation entitled “A study to evaluate the effectiveness of

structured teaching programme on knowledge regarding menopausal problems and its

remedial measures among middle aged women in selected rural areas, Bangalore” is a

bonafide research work done by Ms. Jiny James in partial fulfillment of the requirement for the

degree of Masters of Science in Community Health Nursing.

Place: Bangalore Signature of the Guide

Date: Mrs. R.Chitra

HOD

Department of Community Health Nursing

III
 ENDORSEMENT BY THE HOD/PRINCIPAL/HEAD OF THE
INSTITUTION

This is to certify that the dissertation entitled “A study to evaluate the effectiveness of

structured teaching programme on knowledge regarding menopausal problems and its

remedial measures among middle aged women in a selected rural areas, Bangalore” is a

bonafide research work done by Ms.Jiny James under the guidance of Mrs. R. Chitra, M Sc

(N), HOD of Community Health Nursing, Acharya College of Nursing, Cholanagar, R.T. Nagar

Post, Bangalore-560032.

Signature of the HOD Seal & Signature of the Principal

Mrs.R.Chitra, M Sc (N)

Place: Bangalore

Date: Prof. Chitra R, M Sc (N)

IV
 COPY RIGHT

DECLARATION OF THE CANDIDATE

I hereby declare that Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka,

shall have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic or research purpose.

Place: Bangalore Signature of the Candidate

Date: Ms. Jiny James

© Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

V
 ACKNOWLEDGEMENT

“Commit to the Lord

Whatever you do and
Your plans will succeed.”
Proverbs: 16:3
It is better to trust in the lord than to put confidence in man.

I thank Lord Almighty for his unconditional love, treasures of wisdom and knowledge

bestowed upon me, which enlighten me to complete the study successfully.

Many thanks to……

Mrs. Poornima Reddy Managing Director of Acharya College of Nursing for your

encouragement and constant support during my studies.

Mrs.(Prof) R Chitra, M Sc (N), Principal HOD of Community Health Nursing, main

designer and guide of my study, Acharya College of Nursing for your gentle and persistent
nudges toward excellence.

Mrs. Ponnarasi, M Sc (N), Professor, HOD of Medical and Surgical Nursing, Acharya College
of Nursing for your detailed and constructive comments throughout this work.

Mrs Sofiya Rani, , M Sc (N), Lecturer in Community Health Nursing, Acharya College of

Nursing for your time and expertise to help shape this study.

VI
Ms. Navya C.D M.Sc (N), Lecturer in Psychiatric Nursing Acharya college of nursing for
her inspiration for the success of this study.

Mrs.Bindu S Kumar, M Sc (N), Lecturer in Child Health Nursing Acharya College of

Nursing for helping me craft words and ideas to mould this study.

Mrs. Kalayarasi G, M.Sc(N), HOD of OBG Nursing, Mrs.Baby Kalyani S, M.Sc(N),

Lecturer in Child Health Nursing, Acharya College of Nursing for her detailed and constructive
comments throughout this work.

The entire team of all the experts who spared their valuable time and effort for content validity
and refining of the tool.

The Medical Officer, PHC, Kadusonappahalli, Bangalore. Mr. Javaraya , Health worker,
Dodda Gubby, and the participants of my study who gave me the opportunity to work with them

and gave me untiring help during my study period, without whom this study cannot be
completed.

Library staffs of Acharya College of Nursing, Rajiv Gandhi University of Health Sciences,
Indian Medical Association (IMA), Bangalore and my Classmates for their help and co-
operation in one way or other in the completion of this dissertation.

Prof S. Prem Kumar for the preparation of the manuscript.

Mr. H.S. Surendra for his expert guidance and suggestions in statistical analysis.
It is my privilege to thank my former colleagues and friends in Holds worth memorial Hospital,
Mysore.

I am thankful to Ms Madhushree S. for the Kannada version of my tool and the structured
teaching programme and for helping me during my data collection period.

VII
 I am deeply indebted to my lovable father Mr. James K Thomas, mother Mrs. Mercy and my

sister Ms.Jaisy James and my brother Mr. Jijo James and my friend Mrs.Jincy Joyees, for
their inspiration, constant support, patience and prayers for the completion of my dissertation.

It is my pride and prestige to express my gratitude to Mr. Tim Mathew for his personal
interest, patience and constant encouragement.

My sincere thanks and gratitude to all those who directly or indirectly helped in the successful
completion of this dissertation.

. With heartfelt gratitude and prayers

Ms. Jiny James.

Place: Bangalore

Date:

LIST OF ABBREVIATIONS USED

.
HRT Hormone Replacement Therapy

VIII
BMD Bone Mineral Density

% Percentage

ANOVA Analysis Of Variance

HT Hormone Therapy

PHC Primary Health Centre.

STP Structured Teaching Programme

SPSS Statistical Package for Social Sciences

χ2 Chi Square

df Degrees of Freedom

Reliability

SD Standard Deviation

ABSTRACT
BACKGROUND AND PURPOSE OF THE STUDY:

IX
 The status of women in modern India is a sort of a paradox. Menopause is the physiologic cessation
of menses associated with declining ovarian function. It is usually complete after 1 year of
amenorrhea. Many women approach menopause with uncertainty about what will happen and how
to deal with changes that occur. It is necessary for all the women to understand menopause which
will make them to cope up with menopausal symptoms and will also improve quality of life of
menopausal women. There are various remedial measures to treat menstrual problems. Some
women may find relief from menopausal symptoms with herbal or alternative remedies, however
most have not been studied or shown to be of benefit scientifically and some, like black cohosh,
have been occasionally linked to liver damage. Hormone therapy can help relieve the symptoms of
menopause. OBJECTIVES: 1. To assess the pretest knowledge level of middle aged women
regarding problems of menopause and its remedial measures. 2. To evaluate the effectiveness of
structured teaching programme on knowledge regarding menopausal problems and its remedial
measures among middle aged women.3. To find out the association between the pre test knowledge
level of middle aged women with selected socio-demographic variables. DESIGN: One group pre
test and post test pre experimental design was selected for the study. SUBJECTS: The participants
were 60 middle aged women in selected rural areas, Bangalore. SAMPLING METHOD: A
convenience sampling technique was used to select the sample of the study. DATA
COLLECTION TOOL: A structured interview schedule was used to collect data from the
subjects. DATA ANALYSIS: The obtained data was analyzed using descriptive and inferential
statistics and interpreted in terms of objectives and hypothesis of the study. The level of
significance was set at 0.05 levels. RESULT: In the pre test, the subjects had inadequate
knowledge with a mean percentage of 37.4% and a standard deviation of 12.9% whereas in the post
test, there was a significant mean knowledge gain of 80.2% and a standard deviation of 6.8%. A
significant association was found between age (χ 2 = 7.72*) age at menarche (χ 2 = 5.04*) number of
children (χ 2 = 7.09*) type of family (χ 2 = 5.45*) previous source of information (5.92*) source of
information (8.72*) and the mean pre test knowledge scores at 0.05 level of significance.
CONCLUSION: In the pre test, about 71.7% of the samples had inadequate knowledge, whereas in
the post test of the samples 68.3% had gained adequate knowledge. These findings indicate that the
structured teaching programme was effective in enhancing the knowledge of the middle aged
women regarding menopausal problems and its remedial measures.

Key words: Structured teaching programme, Knowledge, middle aged women, Menopause,
Remedial measures.

TABLE OF CONTENTS

X
CHAPTER CONTENT PAGE NO

1 INTRODUCTION 1-8

2 OBJECTIVES 9 – 16

3 REVIEW OF LITERATURE 17 – 29

4 METHODOLOGY 30 - 44

5 RESULTS 45 - 72

6 DISCUSSION 73 - 77

7 CONCLUSION 78 - 83

8 SUMMARY 84 - 88

9 BIBLIOGRAPHY 89 - 94

10 ANNEXURE 95 - 165

LIST OF TABLES

XI
TABLE
NO TABLES PAGE NO

1 Frequency and percentage distribution of middle aged women

48
according to personal characteristics.
2 Frequency and percentage distribution of middle aged women
52
according to family related characteristics.

3 Pre test knowledge level of middle aged women regarding

56
menopausal problems and its remedial measures .
4 Aspect wise pre test mean knowledge scores of respondents
58
regarding menopausal problems and its remedial measures.
5 Post test knowledge level on menopausal problems and its
59
remedial measures.
6 Aspect wise post test mean knowledge scores of respondents
61
regarding menopausal problems and its remedial measures.
7 Overall pre test and post test mean knowledge scores
62
regarding menopausal problems and its remedial measures.
8 Comparison of pre test and post test knowledge scores level of
respondents regarding menopausal problems and its remedial
64
measures.
9 Aspect wise mean pre test and post test knowledge scores
regarding menopausal problems and its remedial measures
66
10 Association between mean pre test knowledge scores and
68
socio demographic variables of respondents regarding
menopausal problems and its remedial measures.

LIST OF FIGURES
FIGURE PAGE
NO: FIGURES NO:

XII
 1 Conceptual framework based on modified Pender’s Health promotion
16
model.
2 Schematic representation of Research Design. 31

3 Schematic outline of research plan.

32
4 Cylinder Diagram representing the distribution of respondents by age
50
group and marital status.
5 Bar Diagram representing the distribution of respondents by
51
Classification of Respondents by qualification and occupation.
6 Conical Diagram representing the distribution of Respondents by Age
at menarche and age at marriage. 51
7 Cylinder Diagram representing the distribution of respondents by
religion and number of children. 54
8 Cylinder Diagram representing the distribution of respondents by type 54
of family and family income.

9 Bar Diagram representing the distribution of respondent by Family

members, Previous source of information and Source of Information. 55
10 Cylinder Diagram representing the distribution of respondents on Pre
test Knowledge level on Menopausal Problems & its Remedial 57
Measures.
11 Conical Diagram representing the distribution of respondents on Post
60
test Knowledge level on Menopausal Problem & its Remedial
Measures

12 Bar diagram representing the Overall Pre test and Post test Mean
Knowledge on Menopausal Problems & its Remedial Measures. 63
13 Cylindrical Diagram representing the Classification of Respondent 65
on Knowledge level on Menopausal & its Remedial Measures.

14 Cylindrical Diagram representing the Aspect wise Mean Pre test and 67
Post test Knowledge on Menopausal & its Remedial Measures

XIII
15 Conical Diagram representing the association between Age group
(years) and Pre test Knowledge level on Menopausal Problems & its 70
Remedial Measures

16 Conical Diagram representing the association between Age at

Menarche (years) and Pre test Knowledge level on Menopausal 70
Problems & its Remedial Measures

17 Conical Diagram representing the Association between Type of

Family and Pre test Knowledge level on Menopausal Problems & its 71
Remedial Measures

18 Bar Diagram representing the association between Previous source of

Information and Pre test Knowledge level on Menopausal Problems 71
& its Remedial Measures.

19 Conical Diagram representing the association between Source of

Information and Pre test Knowledge level on Menopausal Problems 72
& its Remedial Measures.

LIST OF ANNEXURES

XIV
ANNEXURE TITLE PAGE NO
NO
1. Letter requesting permission to conduct pilot study 95

2. Letter seeking permission to conduct main study 96

3. Letter granting permission to conduct pilot study 97

4. Letter granting permission to conduct main study 98

5. Letter requesting experts opinion for content validation 99

of the research tool
6. Acceptance form for tool validation 100

7. Certificate for validation 101

8. Criteria checklist for the validation of structured 102

teaching programme
9. Criteria checklist for the validation of tool 104

10. Consent form of subjects. 107

11. Certificate of Editing 108

12 List of valuators’ 109

13 Blueprint of structured knowledge questionnaire 111

14. Tool 112

15. Scoring key of structured knowledge questionnaire 126

16. Structured Teaching Programme 127

17 Kannada translation of tool and STP 144

XV
 1. INTRODUCTION

“NO ONE CAN MAKE YOU FEEL INFERIOR WITHOUT YOUR CONSENT”

ELEANOR ROOSEVELT.

The status of women in modern India is a sort of a paradox. If on one hand she is at the

peak of ladder of success, on the other hand she is mutely suffering the violence afflicted on her by

her own family members. As compared with past women in modern times have achieved a lot but in

reality they have to still travel a long way. The women have left the secured domain of their home

and are now in the battlefield of life, fully armored with their talent, and proven themselves. But in

India they are yet to get their dues. [1]

Middle age is the period of age beyond young adulthood but before the onset of old age.

Various attempts have been made to define this age, which is around the third quarter of the average

life span of human beings. It is the period between early adulthood and old age. A baby, although

destined to have the mental ability and dexterity is greatly superior to any other species, is delivered

into this world at a relatively early stage of development and is totally reliant on parental care. [2]

Middle-aged adults often show visible signs of aging such as loss of skin elasticity and

graying of the hair. Physical fitness usually wanes, with a 5–10 kg (10-20 lb) accumulation of body

fat, reduction in aerobic performance and a decrease in maximal heart rate. Strength and flexibility

also decrease throughout middle age. However, people age at different rates and there can be

significant differences between individuals of the same. There are many problems which women in

India have to go through daily. [3]

1
 Nature does not allow a child to bring a baby into the world and similarly avoids a baby

having a mother who is beyond middle age. Menopause is the physiologic cessation of menses

associated with declining ovarian function. It is usually complete after one year of amenorrhea. A

natural menopause occurs at the time nature intended. Artificial menopause tends to be medically

related. This is usually surgical - the ovaries are removed typically during hysterectomy. It is, a

normal biological shift in mid to late 30′s, when estrogen and progesterone levels decline gradually.

Estrogen is the main female hormone responsible for all reproductive functions. Menopause is due

to estrogen deficiency. This deficiency brings about lots of changes in sex hormones. [2]

18 October is World Menopause Day and as the world’s population ages, there will be

increasing numbers of women entering menopause and living beyond post menopause. The

potential symptoms of menopause may have a negative impact on the quality of daily life. The sex

ratio of India shows that the Indian society is still prejudiced against female. [4]

Women may experience physical and emotional changes during menopause but that doesn’t

mean life has taken a turn for the worse; Many women are prompted at this time to ‘take stock’ of

their lives and set new goals. The menopause occurs at a time when many women may be juggling

roles as mothers of teenagers, as careers of elderly parents, and as members of the workforce.

Experts suggest that creating some ‘me time’ is important to maintain a balance in your life.

Menopause can be seen as a new beginning: it’s a good time to assess your lifestyle and your health

and to make a commitment to strive for continuing ‘wellness’ in the mature years. [5]

There are various remedial measures to treat menstrual problems. Some women may find

relief from menopausal symptoms with herbal or alternative remedies, however most have not been

studied or shown to be of benefit scientifically and some, like black cohosh, have been occasionally

2
linked to liver damage.Hormone therapy can help relieve the symptoms of menopause. It can

replace female hormones no longer made by the ovaries. Bio identical hormones – mixtures of

hormones supplied by compounding chemists – may be touted as beneficial and more “natural” than

hormone replacement therapy (HRT) but there is inadequate evidence for their safety and

effectiveness. [6]

Many women approach menopause with uncertainty about what will happen and how to

deal with changes that occur. It is necessary for all the women to understand menopause which will

make them to cope up with menopausal symptoms and will also improve quality of life of

menopausal women. However, they agreed that education about menopause is extremely important

for both men and women. [7]

However, the public health care system does not aknowledge the special health needs of

older women. There has been extensive research on menopause in the west but in India only a few

institutes have recognized the potential of research on the subject. [7]

3
 NEED FOR THE STUDY

Menopause is the transition period in a woman's life. After the age of 40years, ovaries

reduce their production of sex hormones. As a result, the menstruation as well as other body

functions is disturbed. Finally the menstruation cease permanently. This ultimate pause is described

as menopause. Needless to say that this phase also marks the end of fertility in women. [7]

It is commonly known as the "change of life," and is described by biomedical researchers

and feminist scholars alike as a time of transition and border crossing. Biomedical literature

suggests that menopause primarily represents negative change. Its research focuses on

biological/bodily change. Alternatively, feminist literature on menopause proposes that menopause

can represent positive change or a neutral experience for individual women, depending on the

individual and her circumstances. [8]

However, there are ways to reduce or eliminate some of the symptoms of menopause.

Menopause is different for everyone. Some women notice little difference in their bodies. Others

may find it difficult to cope with their symptoms. The most common symptom of menopause is hot

flushes (hot flashes).As many as 75% of menopausal women in the United States will have them. [9]

Current population of India in 2011 is 1.21 billion. National sex ratio rises to 940 females

for every 1000 males in 2011 from 933 in 2001. Population of Karnataka is 6.1 crores which is 5%

of India’s 1.21 billion people. The state today has 968 females to every 1000 males. The number of

menopausal women comes in around 43 million and would include women between the ages of 40

to 60. [10]

4
 The increasing focus on girl education and aggressive adult education programmers’ have

pushed up female literacy rate in the state by 11.2%, according to provisional data of census

2011.Today 68.1% women in Karnataka are literate ,as compared to 56.9% in 2001. Kerala has the

highest literacy rate of 92%. The sheer size of these figures indicates the necessity of implementing

menopause education within Karnataka. [10]

India’s population is largely rural based (72%) making it very difficult if not impossible for

women to seek out medical care. Just as women in rural America find it challenging to access

quality medical facilities, women in rural India also face an uphill battle to be seen and heard.

Women in India’s cities fare slightly better in that they are closer to some of the most modern

hospitals and clinics but many women are too poor to take advantage. [11]

India has a deep divide between the educated and uneducated. Despite one of the largest

percentages of post-secondary degree holders in the world, India also has one of the highest

illiteracy rates especially for women (65% based on the 2011 census). Women with lower levels of

education and literacy generally lack access to and knowledge of medical information and medical

assistance. [12]

Women are taught to remain silent and are usually forced to remain at home or work very

close to it. Topics that were once forbidden in Western society: menstruation, reproduction, and

health matters including menopause are still not discussed. As a result, women’s health issues are

given little attention and hardly any funding. [13]

A comparative study was conducted regarding menopausal problems among 180

postmenopausal women (rural 110; urban 70) from Eastern India. A structured schedule was

5
prepared by the researchers to collect data .The result indicated that rural women were more likely

to be affected by hot flushes (78.2%)and night sweats(62.7%) than their urban counterpart. Rural

women reported psychological symptoms such as depression (87.3%), tension (92.7%),

forgetfulness (81.7%), and a lack of concentration (68.2%) than the urban women did. The present

study made an attempt to explore the health problems of menopausal women. [14]

A Cross sectional study was conducted to determine median age at menopause and

frequency of various related clinical symptoms among 256 postmenopausal and 283

perimenopausal educated women of Amritsar district of Punjab. In-depth interviews were

conducted for collecting information about menopause and symptoms associated with it. The result

indicated that clinical symptoms associated with menopause were hot flushes and night sweats

(55.08%), insomnia (53.12%), headache and body-aches (38.28%), fatigue (42.18%), irritability

(35.15%), perspiration (34.76%), palpitation (22.26%), short breath (20.31%), nervous tension

(10.56%) and depression (8.20). [15]

A descriptive study was conducted to assess the knowledge, attitude, problems and

remedial measures adopted by menopausal women among 100 women in south Delhi. Structured

interview schedule and Likert attitude scale was used for this study. The result indicated that 45% of

the subjects were in the age group above 55 years,51% of the subjects were literates and 77% were

house wives.54% of menopausal women had inadequate knowledge regarding menopause.51% of

menopausal women had positive attitude towards menopause.89% of the subject had mood

swings.67% had loss of recent memory,66% had vaginal dryness ,58% had insomnia, 56% hot

flushes, 56% decreased libido , 53% headache, constant fatigue 78% .There was a positive

correlation between knowledge of menopause and its remedial measures. [16]

6
 A cross sectional study was conducted on frequency of menopausal symptoms and their

impact on the quality of life among 202 women of age 40-60 years in pakistan. Menopause specific

quality of life questionnaire was used as an evaluation tool. Mann-Whitney U test and Pearson Co-

efficient of correlation was used for statistical analysis. Most prevalent symptom within study

subjects was body ache 165 (81.7%). Frequencies of some classical symptoms were 134(66.3%)

reported "hot flushes", 139 (68.8%) and 134 (66.3%) reported "lack of energy" and decrease in

"physical strengths" respectively. The score of physical domain were significantly more in

postmenopausal group p<0.002 while psychological domain is significantly high in menopausal

transition group p<0.003.To conclude menopause related symptoms had negative effect on the

quality of life of postmenopausal women. [17]

A study was done on knowledge attitude and practice of menopause, risk and benefits of

hormone replacement therapy, their attitude concerning HRT and menopause among 218 women. A

Questionnaire method was used for this study. The results showed that overall knowledge was

lacking regardless of menopausal status, ethnicity or educational background. Less educated women

were more inclined to believe that HRT was inappropriate principally because they regarded the

menopause as a natural process (p = 0.023). Only 24% of postmenopausal women were practicing

some form of HRT. A minority (7%) had previously been undergoing the therapy but had stopped.

Most postmenopausal women (69%) simply never considered treatment because the majority had

never heard about HRT. This study reveals low awareness of menopausal information and

therapeutic options in a Trinidadian population. [18]

In rural areas, women are generally not perceived to have any meaningful income generation

capacity. Without the power to work and earn a good income, their voices are silenced. The time

7
has come to improve women’s lives everywhere and remember that menopause does not

discriminate Nations around the world should continue to educate women about menopause and the

benefits of preventive health care, Knowledge, Attitudes, and Behaviours regarding Menopausal

Issues among Women from a Rural County.[18]

8
 2. OBJECTIVES

Statement of the problem

“A study to evaluate the effectiveness of structured teaching programme on knowledge regarding

menopausal problems and its remedial measures among middle aged women in selected rural

areas, Bangalore.”

Objectives of the study

The objectives of the study are to:-

1. assess the pretest knowledge level of middle aged women regarding menopausal problems and its

remedial measures

2. evaluate the effectiveness of structured teaching programme on knowledge regarding menopausal

problems and its remedial measures among middle aged women.

3. find out the association between the pre test knowledge level of middle aged women with selected

socio-demographic variables.

Operational definitions

In this study it refers to:

1. Evaluate

The method of estimating and interpreting the effectiveness of structured teaching

programme on the knowledge of middle aged women regarding menopausal problems and its

remedial measures

9
2. Effectiveness

Significant gain in the knowledge as determined by statistical difference between pre test and

post test scores on knowledge level regarding menopausal problems and its remedial measures

among middle aged women.

3. Structured teaching programme

A systematically organized, individualized instruction and discussion prepared to educate

middle aged women from selected rural areas regarding menopause, menopausal problems and its

remedial measures using selected teaching aids for about 45-50 minutes.

4. Knowledge

The correct responses obtained from the middle aged women to the questionnaire regarding

menopausal problems and its remedial measures. It is measured by structured interview schedule.

5. Menopausal problems

The physiological problems like hot flushes and night sweat, irregular periods, vaginal

symptoms, digestive problems, and osteoporosis and Psychological problems include emotional and

cognitive symptoms, sexual dysfunction, insomnia and depression..

6. Remedial measures

Management of those factors that could lead to an adverse consequence including self

care, home remedies and management tending to cure.

10
 7. Middle aged women

Women who are in the age group between 30-50 years.

Assumptions:

In this study it is assumed that:-

• the middle aged women may have some basic knowledge regarding menopausal symptoms and its

remedial measures.

• knowledge of middle aged women is measurable.

• structured Teaching programme could be an effective teaching tool which may enhance knowledge

regarding menopausal symptoms and its remedial measures.

Hypothesis

H1: The mean post test knowledge score of middle aged women on menopausal problems and its

remedial measures is significantly higher than the pre-test knowledge score.

H2: There will be a significant association between pre-test knowledge level of middle aged women

on menopausal problems and its remedial measures with the selected demographic variable.

Delimitation

• The sample size is limited to 60 middle aged women.

• The period of study will be limited to 4-6 weeks.

• The study is limited to selected rural areas in Bangalore.

11
CONCEPTUAL FRAME WORK

Conceptual frame work serves as a springboard for theory development and as a building block

for the research study. As this is made up of concepts which are mental images of a

phenomenon, it provides for thinking and interpreting what is seen. A model is used to depict

symbolic representation of concepts. Conceptual framework facilitates communication and

provides for systematic approach to nursing research, education, administration and practice.

The present study is aimed at evaluating the effectiveness of structured teaching programme on

knowledge regarding menopausal problems and its remedial measures among middle aged

women. The investigator has modified Pender’s Health promotion model which was found

suitable to evaluate the effectiveness of STP among middle aged women to improve the

knowledge of middle aged women on menopausal problems and its remedial measures.

The Health promotion model is characterized as the multidimensional nature of person’s

interacting with the environment as they pursue health. In this model individual’s seek to

actively regulate their own behavior and person’s seek to create conditions of living through

which they can express their unique human health potentials.

INPUT

Individual Characteristics and Experiences.

In Health promotion model, it includes personal factors and prior related behavior. Prior related

behavior includes pre test knowledge level in health promoting action regarding menopausal

problems and its remedial measures. The personal factors has been categorized into

biological(Age, Religion, No of Children, Type of Family, Age of Menarche And Marriage,

12
Previous Source of Information) and Socio cultural factors (Marital Status, Qualification,

Occupation, Monthly Income ).

THROUGHPUT

Behaviour specific cognition and affect

Perceived benefits of action

It includes procurement of knowledge and its association which affect the person’s plan to

participate in health promoting behaviours and may facilitate continued practice. The perceived

benefits of action comprises of hypothesis: H1: The mean post test knowledge score of middle aged

women on menopausal problems and its remedial measures is significantly higher than the pre-test

knowledge score. H2: There will be a significant association between pre-test knowledge level of

middle aged women on menopausal problems and its remedial measures with the selected

demographic variable.

Perceived barrier to action

A person’s perception about time inconvenience, expence and difficulty in performing has not

been affected as a barrier by the investigator in the study as convenience sampling technique is

used.

Perceived self efficacy

This concept refers to the conviction that successful administration of STP to improve

knowledge which is the desired outcome has been successfully carried out.

13
Activity related affect

The subjective feelings that occur during an activity can influence the behaviour. A behavior

associated with a positive affect or emotional response is likely to be repeated. Here the subjects

comprehend the knowledge on menopausal problems and its remedial measures. So knowledge

level is likely to be improved.

Interpersonal Influences

The use of charts and pamphlets by the researcher to influence a person’s perception concerning

behavior

Situational Influences

They are direct influence on environment of rural areas where adequate facilities improves the

effectiveness of STP.

OUTPUT

Commitment to a plan of action

This involves activities to assess the knowledge level of subjects after carrying out plan of action

that is post-test

Immediate competing demands

The exposure of teaching programme which demands acquisition of knowledge for the subjects

competes with other household chores at the time of data collection.

14
Behavioural outcome

Health promotion model directed towards improved health, better quality of life and

enhanced functional ability of the subjects. In the study outputs entails post test of the middle

aged woman on menopausal problems and its remedial measures and find whether they have

adequate, moderate or inadequate knowledge level. If the knowledge is adequate or moderate,

structured teaching programme is found to be effective and if the knowledge level is found to

be inadequate, rectification can be done by strengthening the existing knowledge through

continuous monitoring, which is not under the preview of the study.

15
INPUT THROUGHPUT OUTPUT

Perceived benefits of action :

Pre-test procurement of knowledge
Knowledge on and its association
menopausal
problems and
Perceived benefits of action
its remedial Immediate competing
:No perceived barriers
measures demands :Acquisition of
knowledge
Perceived self efficacy:
successful administration of
Personal factors STP
BiologicalAge,
Post test Adequate
Religion, No of
Activity related affect : Knowledge Health
Children, Type knowledge level
samples comprehend STP on promoting
of Family, Age
of Menarche menopausal behavior
And Marriage, problems Moderate
Previous and its knowledge level
Interpersonal
Source of remedial
influences:
Information) measures
charts,
and
pamphlets Inadequate knowledge
Sociocultural
factors(Marital
Status ,
Situational
Qualification,
influences :
Occupation,
favourable
Monthly
ambience in
Income
the sub centre
Feed back

fIgure 1: Conceptual Frame Work on Modified Pender’s Health Promotion Model

16
 3. REVIEW OF LITERATURE

A review of literature enables one to get an insight into the various aspects of the problem under

study. It covers promising methodological tools, throws light on ways to improve the efficiency

of data collection and suggest how to increase effectiveness of data analysis and interpretation.

Review of literature is therefore an essential step in the development of the research project. The

purpose of review of literature is to obtain comprehensive knowledge and in depth information

about the effectiveness of structured teaching programme regarding menopausal problems and its

remedial measures among middle aged middle aged womenin selected rural areas, Bangalore.

The investigator did an extensive search of the existing literature.

The result of studies conducted in various aspects on menopause is presented below:

• Studies related to prevalence of menopausal problems among middle aged women.

• Studies related to knowledge of menopausal problems

• Studies related to remedial measures of menopausal problem.

• Studies related to the effectiveness of structured teaching programme on remedial

measures of menopausal problems.

Studies related to the prevalence of menopausal problems among middle aged women.

A descriptive study was conducted to assess the prevalence and severity of menopausal

symptoms among 495 menopausal middle aged womenaged 40-60. The result showed that 20.7% of

the respondents complained of vaginal dryness, 17.6% with hot flushes, 8.9% with night sweats.

The most prevalent symptoms were low back pain and joint pain reported by 51.4% respondents.

Perimenopausal women (n=124) experienced higher prevalence of vasomotor, urogenital and

17
psychological symptoms compared with pre-perimenopausal (n=178) and post peri-menopausal

women (n=133).[19]

A descriptive study was conducted to assess the prevalence and predictors of night sweats,

dry sweats and hot flushes among menopausal women. They had collected data from 795 subjects

between the ages of 45-55 years by using questionnaire method. The study result showed that 10%

of them complained of night sweats, 9%experienced day sweats and 8% with hot flushes. These

three symptoms were strongly correlated and were associated with reduced quality of life. [20]

A cross-sectional study was conducted to assess the association of osteopenia and

osteoporosis with menopause and compare the health seeking among 925 women. Cluster sampling

was used for this study. . In-depth interviews were conducted at their houses. T-scores were

calculated to get BMD (Bone Mineral Density) for all the subjects through heel ultrasound. The

result indicated that there was a significantly lower score of BMD of postmenopausal women (mean

= -1.833 + 0.65) compared to pre-menopausal women (mean = -1.597 + 0.60, p=0.016). Lower

bone mineral density was found in greater proportion among older females. Majority needed

intervention inclusive of awareness through health education and medication.[21]

A descriptive study was conducted to determine frequency of depression and menopause-

related symptoms among 546 postmenopausal women. Questionnaire method was used. The result

found out was that 97.7% of women reported they had complaints during menopause, while 54.9%

reported that they experienced problems in their sexual lives. The ratio of women whose total scores

were higher than the breakpoint of 17 was 42.2%. Single, widowed, divorced women, primary

18
school or lower education women, with problems in their sexual lives had higher ratios than high

school or lower education graduate women, married women, other women within the

survey(P<.05).[22]

A descriptive study was conducted regarding assessment of menopausal symptoms among

356 middle aged women. Modified menopause rating scale was adopted for this study. The result

indicated that the most prevalent symptoms reported were joint and muscular discomfort (80.1%);

physical and mental exhaustion (67.1%); and sleeping problems (52.2%). Followed by symptoms of

hot flushes and sweating (41.6%); irritability (37.9%); dryness of vagina (37.9%); anxiety (36.5%);

depressive mood (32.6%). Other complaints noted were sexual problem (30.9%); bladder problem

(13.8%) and heart discomfort (18.3%). [23]

A cross-sectional correlation survey was conducted to explore perimenopausalsleep quality,

fatigue, among 85 women. Data were collected through purposive sampling for this study. . The

total score for sleep quality was 7.71 ± 4.66, and 62.4% of women were identified as poor sleepers.

The mean score of perimenopausal fatigue was 3.02 ± 2.41, indicating mild fatigue. Results showed

that the quality of sleep among perimenopausal women was significantly affected by factors

including long-term drug use, hormone and/or nutritional supplement consumption, perimenopausal

status, and tendency toward anxiety and/or depression (t = 5.43, p < .01; t = -3.15, p < .01; t = -3.33,

p < .001; F = 4.33, p < .05; F = 20.20 and 12.73, p < .001.). Fatigue and perimenopausal

disturbances were related to sleep quality (r = .63 and .61, p < .01), and 43% of sleep quality

variance was explained by fatigue and depression. [24]

A non-experimental descriptive design was conducted to assess the perception of physical

and psychological symptoms of perimenopause among 30 perimenopausal women.A non

19
probability convenient sampling technique was adopted. Structured questionnaire and menopausal

rating scale was used to collect data. Result indicated that maximum of women12(40%) had

moderate symptoms ,10(33%) of women had mild symptoms and 8(27%) of women had severe

symptoms.[25]

A clinico-epidemiologic study was conducted on prevalence and characteristics of primary

headaches among 556 women. Kuppermann Index was used for this study. The result indicated that

Seventy-six out of 556 women (13.7%) were affected by headache of either the migraine or tension

type. In 82% of cases onset had preceded the menopause. migraine improved in almost two-thirds

of cases, tension-type headache worsened or did not change in 70% of cases .In women who had

undergone surgical ovariectomy, the natural course of migraine was worse than in those who had a

physiological menopause (P = 0.003). The favorable course of migraine in the postmenopausal

period can be attributed primarily to the absence of variations in sex hormone levels.[26]

Studies related to knowledge of menopausal problems

A descriptive cross sectional study on Knowledge and attitude towards menopause and

Hormone Replacement Therapy among postmenopausal women based on sample of convenience

was conducted at Karachi among 102 postmenopausal women. Structured pretest questionnaire was

used for this study. The result indicated that 97% percent of women had heard about menopause and

29.4% were aware of the symptoms. Four (3.92%) knew the long term implications of menopause.

Out of 102, only 02 (1.96%) respondents were aware of HRT. Decrease libido and frequency was

reported by 33 (32.3%) respondents .The study concluding majority of women lacked sufficient

knowledge on menopause and HRT. [27]

20
 A qualitative study was conducted on expectations, apprehensions and knowledge about the

menopausal period and climacteric symptoms among 39 women .Convenient sampling method was

adopted. The result indicated that apprehensions were described as different climacteric symptoms,

which were well known to the women through their own or other's experiences and women lacked

knowledge about these changes or self-care activities that could prevent problems or mitigate

symptoms.[28]

A community mail-based survey received responses from 665 women to questions in three

areas includes sources of information about menopause, knowledge of health risks associated with

menopause, and knowledge about hormone replacement therapy (HRT). Women received

information from many sources, including healthcare providers, friends, and mothers, but the

number one source of information about menopause was women's magazines (76%). Over half of

women surveyed said they had left healthcare appointments with unanswered questions about

menopause and HRT. Although women seemed to have a basic understanding of the symptoms of

menopause, their knowledge of the long-term health risks affected by menopause was poor. Many

women thought that menopause itself (independent of aging) increased the risk of breast cancer.

This finding may help explain the low percentage of women taking HRT for menopause despite

proven health benefits. It is clear that better education about menopause needs to be accomplished

regarding the long-term risk associated with menopause and the pros and cons of HRT.[29]

A descriptive cross-sectional survey of 215 perimenopausal and post-menopausal low-

income urban women was carried out to characterize knowledge of menopause and HRT and

factors associated with knowledge level. Socio demographic characteristics, patterns of HRT use,

and knowledge about menopause and HRT were collected through a structured interview.

Results revealed a general lack of knowledge about menopause and HRT, particularly relative to

21
heart disease and the role of HRT in prevention. Major independent predictors of increased

knowledge (R2 = 0.31) were having talked with a healthcare provider about HRT, having at least

a high school education, and being less than 60 years of age. These findings emphasize the key

role of providers in educating this vulnerable population about menopause and HRT and the

potential subsequent impact on HRT use. [30]

A study was done to identify the correlations among climacteric symptoms, knowledge of

menopause and health promoting behavior in middle-aged women. Structured questionnaire was

used for this study. The data was analyzed using T-test, ANOVA and Pearson's correlation

coefficients with SPSS/pc program. The result indicated that the relationship between knowledge

of menopause and health promoting behavior was statistically significant with a positive

correlation. Therefore to conclude the knowledge of menopause by middle aged women was in

positively correlated with health promoting behavior. [31]

A survey was undertaken to study women's knowledge of the physical and emotional

changes associated with menopause between two groups of midlife women: a random sample (n

= 381) and a sample of women who attended menopause seminars (n = 95). The mean score for

the commonly available knowledge items was 27 out of 39 (69.2% correct). The mean

biomedical knowledge score was lower, 19.3 out of 35 (55.1 % correct). While the two groups of

women were significantly different in terms of current and past hormone replacement therapy

(HRT) use, we found no differences between them in the mean commonly available knowledge

or biomedical knowledge scores. This finding challenges the widely held assumption that active

information-seekers are more interested and have a better level of knowledge than the general

population. [32]

22
 A descriptive cross sectional study was conducted on knowledge of menopause and

hormone replacement therapy and factors associated with knowledge level among 215 low

income urban women .Structured interview was carried out for this study. Results revealed a

general lack of knowledge about menopause and HRT, particularly relative to heart disease and

the role of HRT in prevention. Major independent predictors of increased knowledge (R2 = 0.31)

were having talked with a healthcare provider about HRT, having at least a high school

education, and being less than 60 years of age. These findings emphasize the key role of

providers in educating this vulnerable population about menopause and HRT and the potential

subsequent impact on HRT use.[33]

Studies related to the remedial measures of menopausal problem.

A 9-year community-based study with annual interviews of 438 Australian-born women

who at baseline were aged 45-55 years, to determine the rate and timing of medical consultations

for menopausal problems during the menopausal transition and to identify baseline and prospective

variables associated with these consultations. 387 women completed the 9-year study, of which

86% consulted a doctor about menopausal problems; with an annual mean of 31%.Hot flushes was

2.1 years after the First Menopausal Period. An increased number of consultations for menopausal

problems was associated with the baseline variables as vasomotor symptoms (p< 0.005), rating

one's health as 'worse than most' (p< 0.005) and taking two or more non-prescription medications

(p< 0.05); and the follow-up variables: dysphoric symptoms (p< 0.05), vasomotor symptoms (p<

0.005) and hormone therapy use (p< 0.001).The study concluding nearly one third of women will

consult a doctor annually during the years of the menopausal transition. [34]

23
 A study was conducted among 197 low-income perimenopausal women to determine

knowledge of menopause and hormone replacement therapy (HRT). A non probability sampling

was used for this study. The result indicated that 58% experienced expected levels of occurrence of

symptoms, but perceived them as not very bothersome, 74.5% had a knowledge deficit related to

menopause and HRT, and 60% had expectations about menopause that underestimated their lifetime

risk of heart disease. Thus it suggests that low-income African-American women need better

information for decision making about prevention.[35]

A descriptive, cross-sectional survey to determine the relationships among perceived health,

menopausal symptoms, and self-care responses in perimenopausal and postmenopausal women

among 101 women over the age of 40 years. Significant correlations were found between self-rated

health and health perceptions (r = .44, p = .0004), self-rated health and total symptoms (r = -.30, p =

.0023), self-rated health and worrisome symptoms (r = -.26, p = .0085), health perceptions and

worrisome symptoms (r = .30, p = .0195), health perceptions and self-care responses (r = .43, p =

.0009), and total symptoms and worrisome symptoms (r = .38, p = .0001). To conclude health is

related to menopausal symptoms and self care. [36]

A study was conducted for Evaluation and management of sleep disturbance during the

menopause transition among midlife women in United States. Evaluation tool was used for this

study. The result indicated that different types of sleep disturbance occurring in midlife women and

presents data supporting the use of hormone therapy, hypnotic agents, and behavioral strategies to

treat sleep problems in this population. [37]

A telephone survey regarding self-reported prevalence of the use of alternative therapies for

menopause symptoms among 886 women aged was conducted in Washington State. Women were

24
asked about eight alternative therapies and their use for menopause symptoms. The proportion of

women who used each therapy was 76.1% for any therapy, 43.1% for stress management, 37.0% for

over‐the‐counter alternative remedies, 31.6% for chiropractic, 29.5% for massage therapy, 22.9%

for dietary soy, 10.4% for acupuncture, 9.4% for naturopath or homeopath, and 4.6% for herbalists.

The proportion of women who used it to manage menopause symptoms was 22.1% for any therapy,

9.1% for stress management, 13.1% for over‐the‐counter alternative remedies, 0.9% for

chiropractic, 2.6% for massage therapy, 7.4% for dietary soy, 0.6% for acupuncture, 2.0% for

naturopath or homeopath, and 1.2% for herbalists. Among women who used these therapies, 89–

100% found them to be somewhat or very helpful. Current users of hormone replacement therapy

were half as likely to use alternative remedies or providers (odds ratio 0.48, 95% confidence limits

0.29, 0.77) as were never users. This study concluded that women who use the alternative therapies

generally find them to be beneficial.[38]

A descriptive study was conducted on knowledge, attitudes, and behaviors regarding

menopausal issues of 209 rural women. Convenient sampling method was adopted. Questionnaire

was used for this study. The results indicated that women (30 -97%) did not know the effect of

25
menopause on the incidence of heart disease, cancer of the gallbladder, urinary incontinence,

vaginal thickness, vision, and frequent bacterial infection. Although most women knew about HRT

they had very little knowledge about its specific benefits and risks. About 50 to 59 % reported that

they would gladly take HRT for different health reasons but 37% of them were anxious because of

its unknown long-term effects. However, they agreed that education about remedies of menopause

is extremely important for women.[39]

Studies related to the effectiveness of structured teaching programme.

A cross sectional intervention type study was conducted to assess and compare the

improvement of knowledge of rural women regarding menopause through an educational

intervention programme among 205 respondents through total house-to- house visit. From the study

findings, it revealed that significant achievement among the respondents regarding the knowledge

on menopause, health care seeking behavior through an educational intervention program imparted

to them. The total intervention program was evaluated ranking their answers and found that before

the intervention the only 27.8% respondents had some knowledge regarding menopause related

problems and 72.2% had no such perception. After intervention respondents it was observed that

49.27% respondents improved their knowledge. Statistically it was found significant. [40]

A study was conducted to evaluate effectiveness of education and awareness on the quality

of life among 62 women aged 44-55 referring to and academic outpatient clinic. Simple random

sampling was used for this study. Data was collected using a modified Hildich questionnaire on

quality-of-life in menopause stage. Mean quality-of-life score in study and control groups, prior to

26
education, was 81.7 and 74.8; changing to 75.3 and 75.8, respectively three months after

intervention. The study group showed a significant improvement in their quality-of-life (P = 0.001).

A significant difference was seen between groups in terms of changing quality-of-life after

intervention (P = 0.001).Thus appropriate training to menopausal women improves their quality-of-

life and promotes their health. [41]

A semi-experimental study with a comparison group was conducted regarding effect caused

by self-help programme for climacteric and menopause on the psychological state of women of

menopausal age among 106 women in primary care of Spain. Interview method was used for

collecting data. Psychological well being was assessed using Goldberg Health questionnaire before

and after the intervention. The result indicated that 82.5% of the women in the control group had

probable psychological disorders, but only 8.3% of those in the intervention group. The difference

was statistically highly significant (P < 0.00001; RR = 9.9; 95% Cl, 3.8-25.3). The results show that

educational programmes were very useful in the Primary Care setting. [42]

An experimental study was conducted to examine the effect of hormone therapy (HT)-

related education and counseling among 119 women. Data was collected using questionnaire and

follow up form. Chi-square was used in data evaluation. The result indicated that there was no

difference between the groups at the third month for those who were continuing HT (P> 0.05), but

at the sixth month a significant difference was found (P< 0.05). The primary reason for stopping HT

at the third month in the experimental group was fear of cancer and in the control group it was the

side effects of HT. At 6 months, the primary reason for stopping HT in the experimental group was

again; fear of cancer but in the control group it was the woman's desire not to continue. There was

27
no significant difference in the groups at either 3 or 6 months in experiencing benefits or side

effects from HT (P> 0.05). Education and counseling services given by nurses or other health care

personnel have an effect on long-term compliance with HT. [43]

A quasi-experimental study was conducted to assess the effectiveness of a perimenopausal

health education intervention for mid-life women. The health education intervention included a

health education brochure, one-on-one teaching. One hundred seventy-nine women were in the

intervention group and 174 women were in the control group. Education effectiveness was assessed

by participants’ scores on four questionnaires at the beginning of the study and 3 months after initial

recruitment. Both groups of women were compared on changes in their scores on health knowledge,

level of perceived uncertainty, health behaviors and perceived perimenopausal disturbances. The

intervention group had significantly reduced scores on perimenopausal disturbances (P<0.005) and

reported increase practice of healthy behaviors (P<0.001) compared to the control group. However,

a significant decrease of perceived uncertainty was only found in the subgroup of women recruited

from the Chinese medicine clinic of the control group (t=2.22; d.f.=58;P<0.05). [44]

A Quasi Experimental study was conducted to assess the effectiveness of structured teaching

programme on knowledge of menopause among 60 menopausal women. Structured questionnaire

and rating scale was used for this study. The result indicated that the comparison of pretest and post

test knowledge level and attitude of menopausal women showed a statistically significant level

(p<0.001). Moderate positive correlation (r=0.63) was found between knowledge and attitude on

menopause. [45]

28
 A descriptive cross sectional study was conducted on knowledge of menopause and

hormone replacement therapy and factors associated with knowledge level among 215 low income

urban women .Structured interview was carried out for this study. Results revealed a general lack of

knowledge about menopause and HRT, particularly relative to heart disease and the role of HRT in

prevention. . Major independent predictors of increased knowledge (R2 = 0.31) were having talked

with a healthcare provider about HRT, having at least a high school education, and being less than

60 years of age. These findings emphasize the key role of providers in educating this vulnerable

population about menopause and HRT and the potential subsequent impact on HRT use.[46]

An evaluation of the long term impact of a health education intervention in primary care, for

premenopausal women (45 years of age), is presented. The intervention included information and

group discussion about menopause, stress management, health behaviours (smoking, exercise, diet)

and treatment choices. Questionnaires were sent to 86 women who had been randomised into two

groups (prepared/control) and were now aged 50 (response rate 91%).The prepared group had

significantly greater knowledge of menopause and attributed fewer symptoms to the menopause

than the controls. There were no group differences in measures of general health or mood, but there

was a tendency for the prepared group to report more interest in sexual activity. Subjective

evaluation of the intervention was positive in terms of increasing knowledge and helping women to

deal with the emotional and practical aspects of the menopause.[47]

29
 4. METHODOLOGY

Methodology represents the framework of a study. It indicates the general pattern for

organizing the procedure to gather valid and reliable data for an investigation. This chapter

presents the description of methodology and the different steps that were taken to collect the data

and organize the data for investigation. It includes description of research approach, research

design, setting, sample technique, sampling, development and description of the tool, pilot study,

data collection and plan for data analysis. The methodology of an investigation is of vital

importance to understand the view of the nature of problem selected for the study and the

objectives to be accomplished.

Research approach

A research approach tells the researcher to know what data to collect and how to analyze

it. Research approach is the most significant part of any research. An evaluative approach was

used for this study to test the effectiveness of structured teaching programme on knowledge

regarding menopausal problems and its remedial measures among middle aged women in rural

areas for problem under investigation.

30
Research Design

Researcher’s overall plan for obtaining answer to the research questions for testing the

research hypothesis is referred to be as the research design. The essential question that the

research design is concerned with is how the study subjects will be brought into the research and

how they will be employed within the research design. The research design used in this study

was Pre-experimental design. (one group pretest and posttest design.)

GROUP PRETEST O1 INTERVENTION POST TEST O2

Middle aged women in Assessment of Administration of Assessment of

rural areas under the knowledge of structured teaching knowledge of
PHC of middle aged programmeon middle aged women
Kaadusonappahalli, women menopausal regarding
Bangalore. regarding problems and its menopausal
menopausal remedial measures. problems and its
problems and its remedial measures
remedial on seventh day.
measures on
day one.

Figure 2: Schematic representation of research design of the study.

31
 RESEARCH DESIGN
community
-Preparation of
Structured Teaching
Population:
Programme(STP) and
Middle aged
Phase I structured Interview
women in rural
Schedule.
areas.
-Content Validity

-Reliability
Sampling Technique
-Pilot Study
Convenience
Sampling Pretest (O1) 1st Day- Data
collection through
structured Interview
schedule.

Study Samples -Administer STP on

Phase II
Menopausal Problems and
60 middle aged its remedial measures in
women in selected rural areas, Bangalore(X)
rural areas under the on 1st Day
PHC of
Kadusonappahalli,
Bangalore.

Posttest (O2), 7th Day

-Evaluation
Phase III
-Comparison of pretest
32
and posttest (paired‘t’ test)

-Analysis and
interpretation of data
 Key:

STP= Structured teaching programme.

O1 = Pretest

X = Intervention and administration of STP.

O2 = Posttest

Community

Figure 3 : Schematic outline of research plan

Variables

Variables are the characteristics that vary among the subjects being studied. It is the focus

of the study and it reflects the empirical aspect of concepts being studied, the investigator

measures the variable.

Dependent Variable

Dependent Variable is the response, behavior or outcome that is predicted or explained in

research. Changes in the dependent variable are presumed to be caused by the independent

variable. In this study, the level of knowledge of middle aged women on Menopausal Problems

and its remedial measures is the dependent variable.

Independent Variables

Independent variable is a variable which influences the dependent variable.In this study, the

structured teaching programme regarding menopausal problems and its remedial measures is the

independent variable.

Socio-Demographic Variables

33
Baseline characteristics such as Age, Religion, No of Children, Type of Family, Age of

Menarche And Marriage, Previous Source of Information, Marital Status, Qualification,

Occupation, Monthly Income are the socio demographic variables.

Setting of the study

The study was conducted at rural areas under the PHC of kadusonappahalli, Bangalore. 60

middle aged women of these rural areas were selected for the study.

Population

The study population consists of:

Universal Population: Universal Middle aged women in rural areas Population.

Accessible Population: Middle aged women in selected rural areas, Bangalore.

Sampling

Sampling refers to the process of selecting a portion of population to represent the entire

population.

Sample

Sample consists of the subjects selected to participate in a research study. In the present study,

samples are the middle aged women who fulfill the inclusion criteria.

Sample size

Sample comprises of 60 middle aged women in rural areas’ in selected rural areas, Bangalore.

Sampling technique

34
In this study, the convenience sampling technique was used to select the samples based on

inclusion and exclusion criteria.

Sampling criteria

1. Inclusion criteria

Middle aged women:

• who are willing to participate in the study.

• Who are in the age group of 30-50 years.

• who are present in the community at the time of data collection

• who can speak Kannada.

2. Exclusion criteria

Middle aged women:

• Who are not willing to participate in the study.

• Who are not present at the time of data collection.

• who is a health personnel.

• who is very sick during the time of data collection.

• who had undergone hysterectomy.

35
Data Collection Instrument

The data collection will be done with the help of a structured Interview Schedule on menopausal

problems and its remedial measures.

SECTION A- It contains socio demographic profile which consist of age, religion, number of

children, type of family, age of menarche and marriage, previous source of information, marital

status, qualification, occupation and monthly income.

SECTION B- It consists of structured interview schedule on menopausal problems and its

remedial measures.

Development and description of the tool

Data collection tools are the procedures or instruments used by the researcher to observe

or measure the key variables in the research problem.

Method of developing instrument:

The following steps were adopted.

a) review of literature,

b) discussion with experts in field of Community health Nursing

c) preparation of blue print,

d) construction of structured interview questionnaire

e) content validity,

f) pre testing of tool,

g) reliability

36
Preparation of blue print:

A blue print of the tool was prepared by the researcher, which includes sections, number

of questions and weighing in percentage for each section

The components of the instrument:

The instrument consists of two sections.

Section A: Socio Demographic Data

The socio demographic data consisted of 12 items pertaining to Age, Religion, No of

Children, Type of Family, Age of Menarche And Marriage, Previous Source of Information,

Marital Status , Qualification, Occupation, Monthly Income .

Section B: Structured Interview schedule

This part of the tool consisted of 34 items covering the content of areas such as meaning,

definition, age, cause and risk factors, common menopausal problems: physiological,

psychological, and remedial measures for the problems.

The items were objective type questions given under the following headings.

Unit I : This unit deals with general information of menopausal problems which includes 18

multiple choice questions regarding introduction, meaning, definitions, age, causes and risk

factors, common problems of menopause: physiological and psychological.

37
Unit II: This unit deals with remedial measures of menopausal problems among middle aged

women in rural areas’ includes 16 multiple choice questions.

Scoring technique:

The structured interview schedule consisted of 34 objective type questions with a single

correct answer. Every correct answer was awarded a score of one (1) and every incorrect/

unanswered answer was awarded zero (0). The maximum score on the structured knowledge

questionnaire was thirty four(34). A scoring key item was prepared showing item numbers and

correct responses.

Obtained score

Percentage = ……………………

Total score

The different levels of knowledge are categorized as follows:

Score (%) Knowledge

≤ 50 Inadequate

51-75 Moderate

>75 Adequate

Development of Structured Teaching Programe (STP)

38
 The STP was developed for middle aged women regarding menopausal problems and its

remedial measures. It was prepared based on review of literature and discussion with experts.

The steps involved in developmentof STP were:

1. review of literature and discussion with the experts,

2. preparedness of final draft of STP

3. preparation of visual aids,

4. content validity of STP and visual aids,

5. preparation of final draft of STP.

Preparation of first draft of STP:

The STP was developed according to the objective planned. The developed STP was

given to 12 experts to establish content validity, and they were requested to give their opinion

and suggestions about the content. They were given the criteria checklist and asked to place a

tick mark (3 ) against agree or disagree. There was 100% agreement on the content of STP from

the experts.

The suggestions were incorporated in the final draft. The STP covered the following

content

1. Introduction

2. Meaning

3. Definitions

4. Age of menopause

5. Common menopausal problems: physiological and psychological

6. Home remedies for menopausal problems

39
7. Management tending to cure for menopausal problems

Development of criteria check list:

Criteria checklist was prepared against which the STP content was to be evaluated. The

criteria checklist consisted of headings such as formulation of objectives, content, organization

of the content, presentation, language, and diagrams. The response column was developed such

as strongly agree, agree, disagree and a column for remarks of the evaluator.

Content validity of STP:

The draft of the STP along with the criteria checklist was given to twelve experts of

whom, 8 were in the field of community health nursing, 1 was in the field of Obstetrical and

Gynaecological nursing, 2 medical officers and 1 statistician. There was 100% agreement by

experts in the content area. Modifications were made as per suggestions after discussing with the

guide.

Preparation of Final Draft of STP:

The final draft of the STP was prepared based on the suggestions given by the experts.

Content Validity:

Content validity refers to the degree to which an instrument measures what it is supposed

to measure. [48]

In order to ensure content validity of the data collection tool, the prepared instrument,

along with the problem statement, objectives, operational definitions and criteria checklist

designed for validation were submitted to 12 experts. The experts were post graduates in

40
community health nursing (8) and obstetrical and gynaecological nursing (1) with more than 3

years experience, physician (2) and statistician (1).

There was 100% agreement on most of the items. Minor suggestions were given. Modification

of item was done according to the suggestions given by experts

Pre-testing of the tool:

Pre-testing is the trial administration of a newly developed instrument to identify flaws

and assess time requirements. [49]

Pre testing was carried out at Doddagubbi, under the PHCof kadusonnappahalli, Bangalore. The

tool was administered to 6 middle aged women and was found to be feasible.

Reliability of the tool:

The reliability of the tool is the degree of consistency with which it measures the

attributes it is supposed to measure.

The reliability of the structure Interview questionnaire was established by using split half

method. In order to establish the reliability, the tool was administered to 6 middle aged women s

in rural area who fulfilled the inclusion criteria. The reliability quotient obtained for the tool was

0.9777.

Pilot Study:

Pilot study is a small preliminary investigation of the same general characters as a major

study. The main aim is to assess the feasibility, practicability and assessment of measurement.

41
 Formal approval was obtained from the Medical Officer of Primary Health Centre,

Kadusonnappahalli, Bangalore on May 2012. The investigator selected 6 samples from

Doddagubby by convenience sampling technique. After a brief self introduction, the investigator

explained the purpose of the study and obtained consent from them. On the first day, data was

collected by structured Interview schedule on knowledge regarding menopausal problems and its

remedial measures and structured teaching programme was given to them on the same day. On

the seventh day, a post test was conducted on knowledge regarding menopausal problems and its

remedial measures, interviewing the same structured questionnaire.

The statistical analysis of the pilot study for the overall knowledge on menopausal

problems and its remedial measures was the mean pre test knowledge scores was 25% and the

same for the mean post test knowledge score was 77.5% . From the above analysis, the

structured teaching programme was found to be effective and the same was used for the main

study.

Data Collection Procedure:

Formal written permission was obtained from concerned authorities before data

collection. The data collection period was one month at the convenience of the respondents.

The subjects were assembled as per the fixed schedule. The purpose of the study was

explained to them and confidentiality was taken from all the middle aged women by explaining

the purpose of study.

The data was collected in the following phases:

Phase 1:

42
 In this phase, pretest was conducted on a total of 60 respondents by interviewing with the

structured questionnaire regarding menopausal problems and its remedial measures and

instructions were given on answering the questionnaire and doubts were clarified. Each women

took 20 minutes to answer demographic data and to fill the questionnaire.

Phase II:

In this phase, a structured teaching programme regarding menopausal problems and its

remedial measures was administered to the subjects and explained to them. All the questions or

queries were clarified which were asked by the subjects.

Phase III:

In this phase, post test was conducted on the 7th day after administration of the structured

teaching programme, the same structured knowledge questionnaire was used. During the

conduction of the study there was no problem aroused and subjects were co operative to conduct

the study. The investigator thanked and appreciated all the subjects for their goodwill. The

collected data was compiled for analysis.

Processing of the data:

Data collected was processed every day. Missed out data were identified and immediately

rectified the next day.

Plan for Data Analysis:

Data analysis is the evaluation of information and its pertinence to the study variable.

43
 The data was analyzed by using both descriptive and inferential statistics based on the

objectives and hypotheses of the study. The plan of data analysis was as follows:

Descriptive statistics:

• Baseline proforma containing sample characteristics were analyzed by using frequency

and percentage distribution.

• The knowledge level of middle aged women regarding menopausal problems and its

remedial measures before and after administration of STP was calculated using descriptive

statistics like frequency, mean, mean percentage and standard deviation.

Inferential statistics:

• The effectiveness of structured teaching programme regarding menopausal problems and

its remedial measures was analyzed by paired ‘t’ test.

• Association between mean pre-test knowledge scores with selected demographic

variables were analyzed by chi-square test.

Ethical Consideration:

Written permission from the authorities of the primary health centre and informed

consent from the subjects were obtained before conducting the study. No ethical issue was

confronted while conducting the study.

44
 5. RESULTS

Statistical analysis is the process of organizing and synthesizing the data in such a way

that research questions can be answered and hypotheses tested. The purpose of the analysis is to

reduce the data into an intelligible and interpretable form, so that the relation of research problem

can be studied and tested.

This chapter deals with the statistical analysis, which is a method of rendering

quantitative information in a meaningful and intelligible manner. Statistical procedure of the data

gathered to assess the knowledge regarding menopausal problems and its remedial measures

among middle aged women, enabled the researcher to organize, interpret and communicate

information meaningfully.

In order to find a meaningful answer to the research questions, the collected data must be

processed, analyzed in some orderly coherent fashion, so that patterns and relationships can be

discussed. Tables and figures are used to explain the results. Analysis is a process of organizing

and synthesizing the data in such a way that research question must be answered and hypotheses

tested.

The analysis and interpretation of data are based on the data collected through structured

interview schedule from 60 subjects in selected rural areas, Bangalore. Organization and

presentation of the obtained data were entered into the master sheet for tabulation and statistical

processing and the results were computed using descriptive and inferential statistics.

45
 Objectives of the study

The objectives of the study are to:-

4. assess the pretest knowledge level of middle aged women regarding menopausal problems and its

remedial measures.

5. evaluate the effectiveness of structured teaching programme on knowledge regarding menopausal

problems and its remedial measures among middle aged women.

6. find out the association between the pre test knowledge level of middle aged women regarding

menopausal problems and its remedial measures with selected socio demographic variables.

Research hypothesis

H1: The mean post test knowledge score of middle aged women on menopausal problems and its

remedial measures is significantly higher than the pre-test knowledge score.

H2: There will be a significant association between pre-test knowledge level of middle aged women

on menopausal problems and its remedial measures with the selected demographic variable.

Organization of the analyzed data

The analysis of data is organized and presented in the form of tables and diagrams

represent under the following headings.

46
Section 1: Demographic Characteristics of Respondents

• Classification of respondents by personal characteristics.

• Classification of respondents by family related characteristics.

Section 2: Overall and Aspect wise Knowledge Scores of Respondents on Menopausal

Problems and its Remedial Measures.

Section 3: Association between Demographic variables and pretest Knowledge level of

Respondents on Menopausal Problems and its Remedial Measures.

Section-1:

Description of socio- demographic profile of the sample

This section deals with the distribution of the samples according to the socio demographic

characteristics. The obtained data on the socio demographic profile are described under the

following sub headings which include age, religion, number of children, type of family, age of

menarche and marriage, previous source of information, marital status, qualification, occupation

and monthly income. The data were analyzed by using descriptive statistics and are summarized

in terms of frequency and percentage.

47
Section -1: Demographic characteristics of middle aged women

TABLE - 1

Classification of Respondents by Personal Characteristics

N=60
Characteristics Category Respondents

Number Percent

Age (years) 31-35 17 28.3

35-40 26 43.4

41-45 17 28.3

Marital Status Married 54 90.0

Widow 6 10.0

Qualification No formal Education 16 26.7

Below 7thStd 36 60.0

SSLC 8 13.3

Occupation Self Employed 19 31.7

Coolie 9 15.0

Agriculture 6 10.0

Homemaker 26 43.3

Age at Menarche (years) 10-11 16 26.7

12-13 44 73.3

Age at Marriage (years) 18-19 43 71.7

48
 20-21 17 28.3

Total 60 100.0

Table 1 depicts the classification of middle aged women by age, marital status, qualification,

occupation, age at menarche(years) and age at marriage(years). The findings indicate that

majority of the women (43.4%) are in the age group of 35-40 years. 31-35 and 41-45 years are

with 28.3% each. With regard to marital status, 90% are married and others were widows (10%),

with 60% having an educational status of below seventh standard. Majority of the women were

home makers (43.3%) whereas self employed, cooli and agricultural workers are with 31.7%,

15% and 10% respectively. 73.3% attained menarche in the age group of 12-13 years.

Interestingly, 71.7% were married by the age group of 18-19 years, and remaining 28.3% by 20-

21 years of age.

49
Figure.4: Classification of Respondents by Age group (years) and Marital status

50
 Figure.5: Classification of Respondents by Qualification and Occupation

Figure.6: Classification of Respondents by Age at Menarche and Age at Marriage

51
 TABLE – 2

Classification of Respondents by family Related Characteristics

N=60
Characteristics Category Respondents

Number Percent

Religion Hindu 31 51.7

Muslim 29 48.3

Number of Children One 11 18.3

Two 29 48.4

Three 20 33.3

Type of Family Nuclear 32 53.3

Joint 28 46.7

Family Income/month Rs.4,000-5,000 29 48.3

Rs.5,001-6,000 21 35.0

Rs.6,000-7,000 10 16.7

Family Members had Yes 0 0.0

Menopausal Problems No 60 100.0

Previous Source of Yes 21 35.0

Information No 39 65.0

Source of information No 39 65.0

Health Personnel 9 15.0

Friends/Neighbours 12 20.0

Total 60 100.0

52
This table represents the percentage and distribution of the middle aged women by family related

characteristics. With regard to religion, majority of women are Hindus (51.7%) and others are

muslims (48.3%). Most of the women have atleast two children (66.7%) and 33.3% had three

children. 53.3% are in nuclear family and 48.3% have family income of Rs. 4,000-5,000.

Surprisingly none of their family members had menopausal problems. Source of health

information for the majority (35%) is from health personnel and friends/Neighbours with 15%

and 20% respectively.

53
 Figure.7: Classification of Respondents by Religion and No. of Children

Figure.8: Classification of Respondents by Type of Family and Family income/month

54
Figure.9: Classification of Respondents by Family members, Previous source of
information and Source of Information

55
Section 2: Overall and Aspect wise Knowledge Scores of Respondentson Menopausal
Problems & its Remedial Measures.

TABLE – 3

Classification of Respondents on Pre test Knowledge level on Menopausal Problems & its
Remedial Measures

Knowledge Category Respondents

Level Number Percent

Inadequate ≤ 50 % Score 43 71.7

Moderate 51-75 % Score 17 28.3

Adequate > 75 % Score 0 0.0

Total 60 100.0

Table 3 represents the percentage distribution of middle aged women on Pre test Knowledge

level on Menopausal Problems & its Remedial Measures. With regard to the women majority

71.7% of them had inadequate knowledge ( < 50%)scores, 28.3% of them had moderate

knowledge (51-75%) scores and none of them had adequate knowledge (>75%) score in the pre

test regarding menopausal problems and its remedial measures.

56
Figure.10: Classification of Respondents on Pre test Knowledge level on Menopausal
Problems & its Remedial Measures

57
 TABLE -4

Aspect wise Pre test Mean Knowledge scores of Respondents on Menopausal Problems &
its Remedial Measures

N=60
No. Knowledge Aspects Statements Max. Respondents Knowledge

Score Mean SD Mean(%) SD(%)

I General Information on 18 18 6.02 2.7 33.4 15.1

Menopause &

Menopausal Problems

II Remedial Measures 16 16 6.70 2.5 41.9 15.6

Combined 34 34 12.72 4.4 37.4 12.9

The data presented in the above table shows the aspect wise mean pretest knowledge

scores of middle aged women regarding menopausal problems and its remedial measures. It

shows that the participants had highest mean percentage score (41.9%) in the area of remedial

measures of menopausal problems and on the aspect regarding general information on

menopause and menopausal problems the mean percentage score was 33.4%. The combined

mean percentage score was 37.4%.

58
 TABLE – 5

Classification of Respondents on Post test Knowledge level on Menopausal Problems & its
Remedial Measures

Knowledge Category Respondents

Level Number Percent

Inadequate ≤ 50 % Score 0 0.0

Moderate 51-75 % Score 19 31.7

Adequate > 75 % Score 41 68.3

Total 60 100.0

The above table shows the frequency and percentage distribution of middle aged women

on post test knowledge level regarding menopausal problems and its remedial measures. Among

the 60 subjects under study, majority 68.3% of them had adequate knowledge level (>75%

score), 31.7% had moderate knowledge level (51-75% score) and none of them had inadequate

knowledge level (≤ 50 % score).

59
Figure.11: Classification of Respondents on Post test Knowledge level on Menopausal
Problem & its Remedial Measures

60
 TABLE -6

Aspect wise Post test Mean Knowledge scores of Respondents on Menopausal Problems &
its Remedial Measures

N=60
No. Knowledge Aspects Statements Max. Respondents Knowledge

Score Mean SD Mean(%) SD(%)

I General Information on 18 18 13.95 1.7 77.5 9.6

Menopause &

Menopausal Problems

II Remedial Measures 16 16 13.33 1.4 83.3 9.0

Combined 34 34 27.28 2.2 80.2 6.6

The data presented in the above table shows the aspect wise mean post test knowledge

scores of middle aged women regarding menopausal problems and its remedial measures. It is

seen that the participants gained the highest mean percentage score (83.3%) in the area of

remedial measures of menopausal problems and on aspect regarding general information on

menopause and menopausal problems the mean percentage score was 77.5% .The combined

mean percentage score was 80.2%.

61
 TABLE – 7

Over all Pre test and Post test Mean Knowledge on Menopausal Problems & its Remedial
Measures

N=60
Aspects Max. Respondents Knowledge Paired ‘t’

Score Mean SD Mean (%) SD (%) Test

Pre test 34 12.72 4.4 37.4 12.9

27.17*

Post test 34 27.28 2.2 80.2 6.6

Enhancement 34 14.57 4.2 42.8 12.2

* Significant at 5% level, t (0.05,59df ) = 2.571

The above table projects the overall pre test, post test and enhancement of mean knowledge

scores regarding menopausal problems and its remedial measures.

The mean pre test knowledge was 37.4% with SD 12.9%. The mean post test knowledge found

to be 80.2% with SD 6.6%. However, the enhancement was proved as mean (42.8%) and SD of

(12.3%). Further, the paired t-test value (27.17*) shows statistical significance at level of p< 0.05

with df (59), establishing the effectiveness of STP.

62
Figure.12: Overall Pre test and Post test Mean Knowledge on Menopausal Problems & its
Remedial Measures

63
 TABLE – 8

Classification of Respondents on pre test and post test Knowledge level on Menopausal
Problems & its Remedial Measures

Knowledge Category Classification of Respondents χ2

Level Pre test Post test Value

Number Percent Number Percent

Inadequate ≤ 50 % Score 43 71.7 0 0.0

Moderate 51-75 % Score 17 28.3 19 31.7 84.11*

Adequate > 75 % Score 0 0.0 41 68.3

Total 60 100.0 60 100.0

* Significant at 5% level, χ2 (0.05,2df ) = 5.991

The above table shows that in the pre test, out of 60 subjects majority of them 71.7% of them had

inadequate knowledge, 28.3% of them had moderate knowledge and no subjects had adequate

knowledge. In the post-test, majority of them 68.3% had adequate knowledge level, 31.7% had

moderate knowledge level and none of them had inadequate knowledge level. The obtained χ2

value 84.11* is greater than the χ2 (0.05) 5.991 which is found to be significant at degree of

freedom 2.

64
Figure.13: Classification of Respondents on pre test and post test Knowledge level on
Menopausal & its Remedial Measures

65
 TABLE – 9

Aspect wise Mean Pre test and Post test Knowledge on Menopausal Problems & its
Remedial Measures

N = 60
No. Knowledge Aspects Respondents Knowledge (%) Paired
Pre test Post test Enhancement ‘t’
Mean SD Mean SD Mean SD Test
I General Information 33.4 15.1 77.5 9.6 44.1 16.4 20.83*
on Menopause &
Menopausal Problems
II Remedial Measures 41.9 15.6 83.3 9.0 41.5 16.0 20.09*

Combined 37.4 12.9 80.2 6.6 42.8 12.2 27.17*

* Significant at 5% level, t (0.05,59df ) = 1.96

The above table shows the aspect wise pre test and post test mean and standard deviation
regarding knowledge of middle aged women on menopausal problems and its remedial
measures.

A paired ‘t’test was done to compare the mean pre test and post test scores on each aspect. For
general information regarding menopause and menopausal problems, the obtained ‘t’ value is
20.03* and it is found to be significant at 0.05 level (‘t’= 0.05 with df (59). In the area of
remedial measures, the obtained ‘t’ value is 20.09* is also significant at 0.05 level (‘t’= 0.05
with df (59).. The obtained ‘t’ value for the combined aspects of knowledge is 27.17* is also
significant at 0.05 level (‘t’= 0.05 with df (59).

From the above statistical information it is evident that the structured teaching
programme was effective in enhancing the knowledge of middle aged women regarding
menopausal problems and its remedial measures in all knowledge aspects under investigation.

66
Figure.14: Aspect wise Mean Pre test and Post test Knowledge on Menopausal & its
Remedial Measures

67
Section - 3 : Association between Demographic variables and Knowledge level of
Respondents on Menopausal Problems & its Remedial Measures
TABLE – 10
Association between Demographic variables and Pre test Knowledge level on Menopausal
Problems & its Remedial Measures
n=60
2
Demographic Category Sa Respondents Knowledge χ P
Variables mp Inadequate Moderate Value Value
le N % N %
Age (years) 31-35 17 15 88.2 2 11.8 7.72* P<0.05
35-40 26 20 76.9 6 23.1
41-45 17 8 47.1 9 52.9
Marital Status Married 54 39 72.2 15 27.8 0.08 P>0.05
Widow 6 4 66.7 2 33.3 NS
Qualification No formal 16 11 68.7 5 31.3 0.12 P>0.05
Education NS
Below 7thStd 36 26 72.2 10 27.8
SSLC 8 6 75.0 2 25.0
Occupation Self Employed 19 11 57.9 8 42.1 2.70 P>0.05
Coolie 9 7 77.8 2 22.2 NS
Agriculture 6 5 83.3 1 16.7
Homemaker 26 20 76.9 6 23.1
Age at Menarche 10-11 16 8 50.0 8 80.0 5.04* P<0.05
(years) 12-13 44 35 79.5 9 20.5
Age at Marriage 18-19 43 32 74.4 11 25.6 0.57 P>0.05
(years) 20-21 17 11 64.7 6 35.3 NS
Religion Hindu 31 22 71.0 9 29.0 0.12 P>0.05
Muslim 29 21 72.4 8 27.6 NS
Number of Children One 11 11 100 0 0.0 7.09* P<0.05
Two 29 21 72.4 8 27.6
Three 20 11 55.0 9 45.0

68
Type of Family Nuclear 32 27 84.4 5 15.6 5.45* P<0.05
Joint 28 16 57.1 12 42.9
Family Income/month Rs.4,000-5,000 29 22 75.9 7 24.1 0.52 P>0.05
Rs.5,001-6,000 21 14 66.7 7 33.3 NS
Rs.6,000-7,000 10 7 70.0 3 30.0
Previous Source of Yes 21 11 52.4 10 47.6 5.92* P<0.05
Information No 39 32 82.1 7 17.9
Source of information No 39 32 82.1 7 17.9 8.72* P<0.05
Health Personnel 9 3 33.3 6 66.7
Friends/Neighbors 12 8 66.7 4 33.3
Combined 60 43 71.7 17 28.3
* Significant at 5% Level, NS : Non-significant

The table presents the association of pre test level of knowledge with selected demographic
variables.

The Chi-square test was carried out to determine the association between the pre test
knowledge level and demographic variables such as age marital status, qualification, occupation,
age at menarche, age at marriage, number of children, type of family, family income /month,
previous source of information. Out of which age (χ 2= 7.72*) age at menarche (χ 2= 5.04*)
number of children (χ 2= 7.09*) type of family (χ 2= 5.45*) previous source of information
(5.92*) source of information (8.72*)were found to be significantly associated with pre test
knowledge at 5% level and the rest of the demographic variables were not significant. Hence
research hypotheses H2 is proved and accepted.

It is evident that pre-test knowledge score is better influenced by age, age at menarche,
number of children, type of family, previous source of information and source of information.

69
 Figure.15: Association between Age group (years) and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures

Figure.16: Association between Age at Menarche (years) and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures

70
 Figure.17: Association between Type of Family and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures.

Figure.18: Association between Previous source of Information and Pre test Knowledge
level on Menopausal Problems & its Remedial Measure.

71
Figure.19: Association between Source of Information and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures

72
 6. DISCUSSION

This chapter presents the major findings and discusses them in relation to similar studies

conducted by other researchers. The aim of this study was to evaluate the effectiveness of

structured teaching programme on knowledge regarding menopausal problems and its remedial

measures among middle aged women in selected rural areas, Bangalore.

Pre-experimental design with one group pre test-post test was used to evaluate the

effectiveness of structured teaching programme regarding menopausal problems and its remedial

measures among 60 middle aged women. A structured interview schedule was used to collect the

data from subjects. Pre test was conducted on first day among middle aged women after

explaining the purpose of the study. Structured teaching programme was conducted among the

samples on first day after conducting pretest examination. Posttest was done on the seventh day

after pretest to evaluate the effectiveness of Structured teaching programme regarding

menopausal problems and its remedial measures.

Objectives of the study

The objectives of the study are to:-

7. assess the pre test knowledge level of middle aged women regarding menopausal problems and its

remedial measures

8. evaluate the effectiveness of structured teaching programme on knowledge regarding menopausal

problems and its remedial measures among middle aged women.

73
9. find out the association between the pre test knowledge level of middle aged women regarding

menopausal problems and its remedial measures with selected demographic variables.

Characteristics of demographic variables

Regarding the demographical variables majority of middle aged women(43.3%) are in the

age group of 35-40 years.With regard to marital status, 90% of the middle aged women were

married and others were widow. While considering their qualification 60% of them having

below 7thstandard education. With regard to occupation 43.3% were homemakers, Majority of

the women were home makers (43.3%) whereas self employed, cooli and agricultural workers

are with 31.7%, 15% and 10% respectively. 73.3% attained menarche in the age group of 12-13

years. Interestingly, 71.7% were married by the age group of 18-19 years, and remaining 28.3%

by 20-21 years of age.

Major Findings of the study

The findings of the study are discussed according to the objectives and hypotheses.

1. To assess the knowledge of middle aged women regarding menopausal problems

and its remedial measures before administering structured teaching programme.

Majority 71.7% of them had inadequate knowledge (≤50%) scores, 28.3% of them had

moderate knowledge (51-75%) scores and none of them had adequate knowledge (>75%) score

in pretest regarding menopausal problems and its remedial measures.

74
 This finding is supported by the study done by H K Sinclair, C M Bond, and R J Taylor on

knowledge of and attitudes to hormone replacement therapy of an age-stratified, computer-

generated, representative sample of 1500 women. A postal questionnaire was used for this

study. The most common reason for postmenopausal women never having taken hormone

replacement therapy was that they had never considered the treatment (70%) and had not

discussed it with a doctor (79%). The results showed that women had a poor knowledge of the

potential risks and benefits of estrogen, lack of knowledge being greatest in the less educated and

older women.[50]

In the present study it was also found that the overall pretest knowledge scores of the

menopausal women regarding menopausal problems and its remedial measures was found to be

inadequate with 37.4% and a standard deviation of 12.9%. The highest mean pretest knowledge

score is noticed in the remedial measures (41.9%) and 33.4% in general information on

menopause and menopausal problems.

2. To evaluate the effectiveness of structured teaching programme on knowledge of

middle aged women regarding menopausal problems and its remedial measures.

In the present study it is observed that the mean post test percentage knowledge score

regarding general information on menopause and menopausal problems was 77.5% which was

higher than the mean pretest knowledge score of 33.4%. Regarding remedial measures it was

found that the mean post percentage knowledge score was 83.3% which was higher than the

mean pretest knowledge score of 41.9%. Regarding all the knowledge aspects under

investigation the enhancement is found to be significant (27.17*) at 0.05 level of significance.

75
 The mean percentage of posttest knowledge scores on menopausal problems and its

remedial measures was 80.2% which was higher than the mean percentage of pretest knowledge

score of 37.4% with an enhancement of 42.8%. A paired ’t’ test was done and it was found to be

significant (t= 27.17*, p<0.05) which indicates the effectiveness of structured teaching

programme regarding menopausal problems and its remedial measures.

This study supports the findings of the study conducted by K.L.M. Liao, M.S. Hunter to

evaluate the short-term outcome of a health education intervention devised among 178 samples

of 45-year old women. Preparation involved two health education sessions carried out in small

groups and covering information and discussion of the normal menopause transition in the

context of mid-life. The women completed pre- and post-intervention (3 and 15 months)

questionnaires which assessed knowledge and beliefs about menopause and a number of health-

related behaviours. Knowledge improved significantly at the follow-up assessments for the

preparation group but not for the control group. [51]

3. find out the association between the pre test knowledge menopausal problems and

its remedial measures and selected demographic variables

In the present study association was sought between pre test knowledge level of

significant middle aged women and selected socio demographic variables where a significant

association was found with age (χ 2= 7.72*) age at menarche (χ 2= 5.04*) number of children (χ
2
= 7.09*) type of family (χ 2= 5.45*) previous source of information (5.92*) source of

information (8.72*)were found to be significantly associated with pre test knowledge at 5% level

76
and the rest of the demographic variables were not significant. Hence research hypotheses H2 is

proved and accepted.

. The study supports the findings of the study conducted by Yangin HB, Kukulu K, Sözer

GA regarding the symptoms and perception of menopause, as well as factors affecting and

influencing this perception with the help of 300 women in menopause. The study used

sociodemographic data from a descriptive survey form. The data were collected by researchers in

face-to-face interviews. The mean menopause age of participating women was x = 45.75 ± 4.7.

A total of 41.3% of the women had primary education, and 62% of the women also had one or

two children. There was a significant relationship between attitudes toward menopause and a

woman's age, educational status, number of children, duration of living with spouse, satisfaction

with marriage, menopausal age, menopause duration. The most important aspect of polyclinic

services related to menopause is to increase and maintain women's quality of life. [52]

77
 7. CONCLUSION

The chapter enlightens the importance of this research study. The purpose of this study was to

evaluate the “Effectiveness of Structured Teaching Program on knowledge regarding menopausal

problems and its remedial measures” in selected rural areas at Bangalore.

This research revealed that there is a significant difference in knowledge of middle aged women

regarding menopausal problems and its remedial measures after Structured Teaching Programme. The

study statistically proved that there is an association between pre test knowledge and selected socio

demographic variables of the middle aged women.

The findings of the study

The following conclusions were drawn on the basis of the data analysis

• Majority of the participants (middle aged women) were in the age group of 35-40 years

(43.4%) followed by 28.3% among 31-35 and 41-45 year age group.

• About 90% of the middle aged women were married and 10% of them are widows.

• Majority of the participants (43.3%) were home makers and 31.7% are self employed.

• 60% of the middle aged women had education below 7 thstandard, 13.3% with SSLC and

others with no formal education.

• 73.3% attained menarche in the age group of 12-13 years.

• 71.7% were married by the age group of 18-19 years, and remaining 28.3% by 20-21

years of age.

• 51.7% of participants are Hindu and the remaining were Muslims.

• Most of the women have atleast two children (66.7%) and 33.3% had three children

• 53.3% of participants belong to nuclear family and 46.7% belong to joint family.

• Family income of the majority is below Rs. 5000.0.

78
 • The mean pre test knowledge score of the mothers regarding menopausal problems and

its remedial measures was inadequate (37.4%)

• The aspect wise mean pretest knowledge score was found to be higher in remedial

measures of menopausal problems (41.9%) followed by 33.4% for general information

on menopause and menopausal problems.

• The overall mean post test knowledge score of middle aged women was found to be

80.2% as compared to mean pretest 37.4% with an enhancement of 42.8%. A paired ‘t’

test result indicated significant difference between the pre test and post test knowledge

score regarding menopausal problems and its remedial measures(t= 27.17*,p<0.05), from

which it can be inferred that structured teaching programme was effective in enhancing

the knowledge of middle aged women.

• A statistically significant association was observed between age (χ 2= 7.72*) age at

menarche (χ 2= 5.04*) number of children (χ 2= 7.09*) type of family (χ 2= 5.45*)

previous source of information (5.92*) source of information (8.72*)with the knowledge

level of middle aged women regarding menopausal problems and its remedial measures.

• Marital status, qualification, occupation, age at marriage, religion, family income/month

did not show any significant association with the knowledge of significant middle aged

women.

NURSING IMPLICATIONS

The result of the study shows that majority of the middle aged women had inadequate knowledge

regarding menopausal problems and its remedial measures during pre test. So the study had several

implications for nursing practice, nursing education, nursing administration and nursing research.

79
 Nursing Education

Nursing education helps the nurse to develop competence in theoretical as well as

practical level. In this present study the nurse educator gives priority to uphold the value of

education to improve the knowledge of middle aged women regarding menopausal problems and

its remedial measures.

• Nurse educators need to lay emphasis on the causes, manifestations and adverse effect of

menopausal problems. Appropriate vitamin Supplements, healthy life style and balanced

diet is to be recommended to prevent menopausal problems.

• Nurse educators should give more prominence on nurses’ role on prevention of

menopausal problems and adequate remedial measures..

• Nurse educators initiate and insist on health education programs among middle aged

women in community as well as in clinic.

Nursing Practice

Nursing practice is an ongoing process of assistance which aims the all-round

development of mankind. The main focus of nursing practice is to reduce the morbidity and

mortality rate and to improve the quality of life.

• Regular health education programs should be carried out for middle aged women by nursing

personnel’s at all level regarding remedial measures of menopausal problems.

• Help the middle aged women to learn their role in controlling causative factors, modifying

the dietary pattern, and preventing complications

• Nurse education has a great part to play in the practice of remedial measures as all the potential

causes discussed could be alleviated by the educational process. Structured teaching program is

80
 considered as an effective education strategy to improve the awareness and knowledge of the

middle aged women in order to practice remedial measures of menopausal problems.

Nursing Administration

Nursing administration is a service sector to control the management operation along with

arrangement of service policies in order to plan for organization. Nursing administrators take

initiatives for continuous education program. Moreover, administration can evaluate the merits

and demerits of an education program.

• In co-operation with the hospital authorities and other health administrators, nurse administrator

should take initiative to organize health education programs for middle aged women regarding

menopausal problems and its remedial measures.

• Appropriate teaching/learning materials needs to be prepared and made available for health

education programs.

• An administrator must be responsible to co-ordinate all health education and public awareness

program.

• An administrator is a motivator to all other nursing personnel to contribute their maximum

potential to build up a safe and healthy women.

• Nurse managers can conduct periodical menopausal problems checkups to take appropriate

measures.

• Nursing leaders are challenged to take the health needs of vulnerable groups especially, by

effective organization and management of health services regarding remedial measures on

menopausal problems.

81
Nursing Research

Nursing research is a systematic investigation and study of materials, sources etc., in

order to establish facts and reach conclusions. A researcher can bring innovative approaches and

modern theories in the field of research. It has been reported that menopausal problems are

unrecognized and may cause serious physical, emotional and behavioural consequences. Further

research is needed to evaluate menopausal problems.

Moreover, it is important to assess what factors that contribute to menopausal problems

and its effects in women’s life. Further research is necessary to examine what kinds of stratergies

are effective for a menopausal women to function in her community. A research study can make

remarkable changes in their knowledge, attitude, potentials and thereby improving the quality of

living.

Limitations of the Study

• The sample size is limited to 60 middle aged women in selected rural areas, Bangalore.

Hence generalization is possible only to the selected settings.

• Duration of data collection is limited to 4 weeks.

• Due to time constraint and the sample availability a convenience sampling technique

was used in the present study.

• Randomization was not done. So the sample may not be the true representation of the

population.

• The qualitative portion of the study consisted of a brief interview and did not involve a

recorded, transcribed and was based solely on the notes of the researcher.

82
Suggestions
• Health education programs on menopausal problems and its remedial measures could be

conducted in regular interval among middle aged women in rural areas.

• Educational programs on stratergies to reduce menopausal problems could be conducted

periodically in hospital as well as community settings.

Recommendations

Based on the findings of the study, following recommendations have been made:

• A similar study can be replicated on a large sample to generalize the findings.

• A similar study can be conducted by including practical aspect.

• A similar study can be carried out to evaluate the efficiency of various teaching

strategies like self-instructional module, pamphlets, leaflets and computer-assisted instruction

on knowledge regarding menopausal problems and its remedial measures.

• Based on study findings, intervention should be given to all women through mass

media, role-play, drama, and puppet show, etc. to enhance the knowledge level.

• A similar study can be undertaken with control group design.

83
 8. SUMMARY

Menopause has been described as a normal, natural, event which is associated with

reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other

hormones. It marks permanent end of sterility and is sometimes called “change of life”. During

this transition a women experiences many physical and psychological changes. Some of women

will have troublesome symptoms whereas others may navigate the transition with few or even no

symptoms. As one approaches menopause, many women wonder if these changes are normal,

and many are confused about treating the symptoms. Thus it is beneficial to educate women

regarding various symptoms of menopause and its treatments as it is an unrecognized topic. In

addition, organizations should make available stratergies such as workshops and other

educational programs that target implementing knowledge on menopausal problems and its

remedies for women well being. Above all, organizations must ensure that they extend their

helping hands to women in all places.

Objectives of the study

The objectives of the study are to:-

10. assess the pre test knowledge level of middle aged women regarding menopausal problems and its

remedial measures

11. evaluate the effectiveness of structured teaching programme on knowledge regarding menopausal

problems and its remedial measures among middle aged women.

84
12. find out the association between the pre test knowledge level of middle aged women regarding

menopausal problems and its remedial measures with selected demographic variables.

Hypothesis

H1: The mean post test knowledge score of middle aged women on menopausal problems and its

remedial measures is significantly higher than the pre-test knowledge score.

H2: There will be a significant association between pre-test knowledge level of middle aged women

on menopausal problems and its remedial measures with the selected demographic variable.

ASSUMPTIONS

In this study it is assumed that:-

• The middle aged women may have some knowledge regarding menopausal symptoms and its

preventive measures.

• Knowledge of middle aged women is measurable.

• Structured Teaching programme could be an effective teaching tool.

The present study is aimed at assessing the effectiveness of structured teaching

programme on knowledge regarding menopausal problems and its remedial measures among

middle aged women at selected rural areas, Bangalore. The investigator has adopted the modified

Health promotion model which was found suitable to evaluate the effectiveness of STP among

middle aged women to improve the knowledge about menopausal problems and its remedial

measures. Health promotion model is characterized as the multidimensional nature of person’s

85
interacting with the environment as they pursue health. Model employ a feedback cycle of input

throughput and output. It provided the comprehensive framework of achieving the objectives of

the study.

One group pretest-post test pre-experimental design was used to evaluate the

effectiveness of STP regarding menopausal problems and its remedial measures among middle

aged women who were selected by convenience sampling method. A structured interview

schedule was used to collect data from the study subjects. The tool for the study was validated by

12 experts. Reliability was obtained by split half method with =0.9777.

Pilot study was conducted among middle aged women in doddagubbi under PHC

Kadusonnappahalli by convenience sampling technique. Afer a brief self introduction, the

investigator explained the purpose of the study and obtained informed consent from them. Data

was collected by structured interview schedule to assess the pre test knowledge on the 1st day.

On the same day STP was given to the group. On the seventh day, a post test was conducted on

knowledge regarding menopausal problems and its remedial measures. The obtained data was

analysed and proved in terms of objectives and hypotheses using descriptive and inferential

statistics.

Findings of the Study

• With regard to marital status, 90% are married and others were widows (10%).

86
 • While considering educational status 60% having qualification below seventh standard.

• Majority of the women were home makers (43.3%) whereas self employed, cooli and

agricultural workers are with 31.7%, 15% and 10% respectively.

• 73.3% attained menarche in the age group of 12-13 years.

• Interestingly, 71.7% were married by the age group of 18-19 years, and remaining 28.3%

by 20-21 years of age.

• Regarding marital status, 56.7% were married and others were unmarried .

• While considering their designation 93.3% were staff nurses and others were head Nurses.

• With regard to total experience in nursing profession, 48.3% had 0-2 years, 13.3% had 2-4

years, 15% had 4-6 years and 23.3% had above 6 years of experience.

• Majority of staff 51.7% were permanent, 33.3% were temporary and 15 % of staff were

working on contract basis.

With regard to the middle aged women, majority 71.7% of them had inadequate

knowledge (≤50%) scores, 28.3% of them had moderate knowledge (51-75%) scores and none of

them had adequate knowledge (>75%) score in pretest regarding menopausal problems and its

remedial measures.

The mean pretest knowledge was 37.4% with 12.9% SD. The mean posttest knowledge

regarding menopausal problems and its remedial measures was found to be 80.2% with SD

6.6%. However, the enhancement was proved as mean (42.8%) and SD of 12.2%. Further, the

paired t-test value (27.17*) shows statistical significance at level of p< 0.05 with 59 df,

establishing the effectiveness of STP.

The paired ‘t’ test was used to test the significance of difference between pretest

knowledge score and posttest knowledge score and found to be significant at p<0.05. The

87
computed statistical test value on general Information on menopausal problems and remedial

measures was t=20.83*, p<0.05 and t=20.09*, p<0.05 respectively.

Further, the result showed that there is significant association between pre test knowledge

level with selected socio demographic variables like which age (χ 2 = 7.72*) age at menarche (χ 2
2 2
= 5.04*) number of children (χ = 7.09*) type of family (χ = 5.45*) previous source of

information (5.92*) source of information (8.72*) among middle aged women regarding

menopausal problems and its remedial measures. Since there was significant association between

the pre test knowledge level and selected socio demographic variables, the research hypotheses

(H2) was accepted.

88
 9. BIBLIOGRAPHY

1. Indian women. [online].[2005 Jun 27];Available from;

http://www.mapsofindia.com/culture/indian-women.html

2. David Viniker. womens Health[online].Available from:

http://www.2womenshealth.com/Menopause.htm

3. Middle age. [online].[12 Apr 2011];Available from: http://en.wikipedia.org/wiki/Middle_age

4.World menopause Day. [online]. [2006];Availablefrom:http://www.menopause.org.au/media-

info/538

5 .The menopause years. [online].[ 2011 feb ] ;

http://www.acog.org/publications/patient_education/bp047.cfm

6.What is menopause. [online]. [2010 july 02];Available

from:http://www.menopause.org.au/consumers/information-sheets/528-what-is-menopause

7. David Zieve. [Sep 11 2010]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001896/

8. Changing menopausal bodies: how women think and act in the face of a reproductive
transition and gendered beauty ideals:A Journal of Research. [online].[2005 July 1 ]; Available
from:URL:http://www.healthcentral.com/menopause/menopause-symptoms-000040_6
145.html?ic=506019

9.People Statistics. [online]. [ 2003] .Available from:

http://www.nationmaster.com/graph/peo_per_liv_in_rur_are-people-percentage-living-rural-
areas

10. Population growth slows,literacy is up. The Times of India. 2011 apr 1;Sect A:1 (col 1)

11. Tammy Elizabeth Southin. Menopause in India and the IMS[online].

http://www.bellaonline.com/articles/art18498.asp

12.Menopause;Time for change. [online].[18 Aug 2010]; Available

from;URL:http://www.nlm.nih.gov/medlineplus/menopause.html

89
13. Census Results Mixed for India’s Women and Girls. [Online].[2001 may];Available from:
http://www.prb.org/Articles/2001/2001.aspx

14. .DoyelDasgupta ,Subha Ray. Menopausal problems among rural and urban women from
Eastern India. [online].Available
from:URL:http://scholar.google.co.in/scholar?hl=en&q=.Menopausal+problems

15. ShardaSidhu, AvneetKaur and MandeepSidhu.Age at Menopause in Educated Women of

Amritsar (Punjab).Kamla-Raj 2005 J. Hum. Ecol., 18 (1): 49-51 (2005).

16.Namratha Sharma. Assessment of the knowledge, attitude, problems faced and remedial
measures adopted by menopausal women;Nightingale Nursing Times;May 2010 Vol:6(2).

17.Nisar N, Sohoo NA. asses the menopause related symptoms and to determine the impact of
these symptoms on the quality of life of menopausal women.J Pak Med Assoc. 2009
Nov;59(11):752-6

18. Akong j, HoonKN,Dial C, et al. Hormone replacement therapy:Knowledge, attitude and

practices of women attending a gynaecology outpatient clinic in Trinid. West Indian Med J 2001
Jun;50(2):155-8.
19. Harvey Chim,Bee Huat Iain Tan ,et al. The prevalence of menopausal symptoms in a
community in Singapore. [online]. [2002 April 25]; 41 ( 4 ): Available from:
URL:http://www.maturitas.org/articleS0378-5122(01)00299-7/abstract

20. Ann Fam .Prevalence and predictors of night sweats, day sweats, and hot flashes in older
primary care patients.AnnFam Med. 2004 Sep-Oct;2(5):391-7.

21. LubnaBaig, Farah AsadMansuri, Saadiya A. Karim. Association of Menopause with

Osteopenia and Osteoporosis: 19(4)
[2009]Availablefrom:URL:http://www.emro.who.int/imemrf/JCPSP_2009_19_4_240.pdf

22.Deveci SE, Açik Y, Dag DG, Tokdemir M, Gündoğdu C. The frequency of depression and
menopause-related symptoms in postmenopausal women living in a province in Eastern Turkey,
and the factors that affect depressive status. [online]. [2010 Apr 1];16(4 ):Available from:
http//www.edeveci@firat.edu.tr

90
23. Rahman SA, Zainudin SR, Mun VL. Assessment of menopausal symptoms using modified
Menopause Rating Scale (MRS) among middle age women in Kuching, Sarawak, Malaysia.Asia
Pac Fam Med. 2010 Feb 22;9(1):5

24. Chang YC, Jou HJ, Hsiao MC, Tsao LI. Sleep quality, fatigue, and related factors among
perimenopausal women in Taipei City.JNurs Res. 2010 Dec;18(4):275-82

25. B.Jayabharathi. perception of physical and psychological symptoms of perimenopause. 7(80

Nov.2011.page:18-20

26. I. Neri , F. Granella ,R. Nappi, G.C. Manzoni ,F. Facchinetti , A.R. Genazzani. Characteristics
of headache at menopause: A clinico-epidemiologic study. [online]. [1992 May 4]; from:
http://www.maturitas.org/article/0378-5122(93)90121-W/abstract

27.HumairaSaeed Malik. Knowledge and attitude towards menopause and Hormone

Replacement Therapy (HRT) among postmenopausal women.Journal of Pakistan Medical
Association. [2008 May 15]; 58(1):164.

28. C. Berterö RNT. A qualitative study of women's expectations, apprehensions and knowledge
about the climacteric period.. [online]. 2003 Apr 29 [ 2003jun];50(2) Available
from:URL:http://onlinelibrary.wiley.com/doi/10.1046/j.1466-7657.2003.00185.x/full

29. cynthiaclinkingbeard, barbara a. minton, judydavis, and kellimcdermott. Journal of Women's

Health & Gender-Based Medicine. October 1999, 8(8): 1097-1102.
doi:10.1089/jwh.1.1999.8.1097.

30. Susan E. Appling, Jerilyn K. Allen, Shirley Van Zandt, Sharon Olsen, Rosemarie Brager, and
JuleHallerdin. Knowledge of Menopause and Hormone Replacement Therapy Use in Low-
Income Urban Women . Journal of Women's Health & Gender-Based Medicine. January 2000,
9(1): 57-64. doi:10.1089/152460900318975

31. Lee KJ, Chang CJ, Yoo JH. A Study on the Relationship among Climacteric Symptoms,
Knowledge of Menopause and Health Promoting Behavior in Middle-Aged Women.Korean J

91
Women Health Nursing journal. December 2003 9(4):400-409.

32. Ms. Stephanie Fox-Young, Mary Sheehan. Women's Knowledge About the Physical and
Emotional Changes Associated with Menopause. [online]. [1999 Apr];29(2) Available from:
URL: http://www.tandfonline.com/doi/abs/10.1300/J013v29n02_03

33. Susan E. Appling, Jerilyn K. Allen, Shirley Van Zandt, et al. Knowledge of Menopause and
Hormone Replacement Therapy Use in Low-Income Urban Women. Journal of Women's Health &
Gender-Based Medicine. [2004 jul 7];9(1)

34. J. R. Guthrie, L. Dennerstein, J. R. Taffe and V. Donnelly. Health care-seeking for

menopausal problems.[online]. [2003 jun]; 6(2):112-117.Availablefrom:URL:
http://informahealthcare.com/doi/abs/10.1080/cmt.6.2.112.117

35. Holmes-Rovner M, Padonu G, Kroll J, Breer L, Rovner DR, Talarczyk G.et al. African-
American women's attitudes and expectations of menopause.Am J Prev Med. 1996 Sep-
Oct;12(5):420-3.

36. Linda .Bernhard ,Leahsheppard . Health, Symptoms, Self-Care, and Dyadic Adjustment in
Menopausal Women. [online]. [2006 jul28];Available from:
http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.1993.tb01829.x/abstract

37. Joffe H, Massler A, Sharkey KM. Evaluation and management of sleep disturbance during
the menopause transition. [online].[ 2010 Sep15];28(5):Available from:
http://www.ncbi.nlm.nih.gov/pubmed/20845239.

92
38. Newton, Katherine M, Buist.et al. Use of Alternative Therapies for Menopause Symptoms:

Results of a Population‐Based Survey. [online].[1995 july]; 66(1): Available from:

http://www.ncbi.nlm.nih.gov/pubmed .

39. Srijana M. Bajracharya. Knowledge, Attitudes, and Behaviors regarding Menopausal Issues
among Women from a Rural County.Available from: http://www.maturitas.org/article/S0378-
5122(98)00033-4/abstract

40. Nahid Yasmin1, Sayeeda Sultana,2ShahinAkhterJahan Habib3, Khodeza Khatun4.

Intervention approach to the menopausal women in rural bangladesh. Bangladesh Medical
Journal.[2009 jan ];38(1):Available from:http://www.ncbi.nlm.nih.gov/pubmed/20626238

41Forouhari S, Khajehei M, Moattari M, Mohit M, Rad MS, Ghaem H. The Effect of Education
and Awareness on the Quality-of-Life in Postmenopausal Women.Indian J Community Med.
2010 Jan;35(1):109-14.

42. García Sánchez C, Martínez García C, Alfaro Aroca M.et al; Health education: repercussions
of a self-help program on the psychological status of perimenopausal women. [online]. [ 1998
Sep 15 ];22(4):215-9. Available from: URL:http://www.ncbi.nlm.nih.gov/pubmed/11677916

43. Akkuzu, Gülcihan RN, Eroğlu, Kafiye RN.The effect of education and counseling services
on compliance to therapy of women taking hormone therapy for the first time.Available from
URL: http://journals.lww.com/menopausejournal/Abstract/2005/12060

44. Lee-Ing Tsao, Lee-Ing Tsao. Effectiveness of a perimenopausal health education intervention
for mid-life women in northern Taiwan. 2003 jul 20[cited 2004 sep];54(3):321-28.
Available from: URL: http://www.pec-journal.com/article/S0738-3991(03)00205-2/abstract

93
45. B.Jayabharathi. Knowledge of menopause among menopausal women. NNT;7(12)March
2012,page 14-6

46. Susan E. Appling, Jerilyn K. Allen, Shirley Van Zandt, et al. Knowledge of Menopause and
Hormone Replacement Therapy Use in Low-Income Urban Women. Journal of Women's Health
& Gender-Based Medicine. [2004 jul 7];9(1)

47. Myra Hunter, Irene O’Dea. Patient education and counseling. [online] [1999 Nov];
38(3):249-255. Available from:URL: http://www.pec-journal.com/article/S0738-
3991(98)00143-8/abstract
48. Polit BF, Beck CT. Nursing research : generating and assessing guidance for nursing
practice. 8th ed New Delhi,(India):Wolters Kluwer;2008.

49. Burns N, Grove SK. The Practice of Nursing Research. London; W.B Saunders;1987.

50.H K Sinclair, C M Bond, and R J Taylor. Hormone replacement therapy: a study of women's
knowledge and attitudes.Br J Gen Pract. 1993 September; 43(374): 365–370.Available
from:URL:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1372520/

51. K.L.M. Liao, M.S. Preparation for menopause: prospective evaluation of a health education
intervention for mid-aged women. [cited 1998 jun 8];29(3):215-24. Available from:
URL:ww.sciencedirect.com/science/article/pii/S0378512298000334

52. Yangin HB, Kukulu K, Sözer GA. The perception of menopause among Turkish women.

J Women Aging 2010 22(4)[290-305]. Available from: URL:

http://www.ncbi.nlm.nih.gov/pubmed/20967683

94
Annexure – 1

95
Annexure – 2

96
Annexure – 3

97
Annexure – 4

98
99
Annexure – 5

Annexure – 6

100
 ACCEPTANCE FORM FOR TOOL VALIDATION

Name:

Designation:

Name of the College:

Statement of acceptance or non- acceptance:

I gave my acceptance to validate the tool on:

A study to evaluate the effectiveness of structured teaching programme regarding menopausal

problems and its remedial measures among middle aged women in selected rural areas.

Date:
Name and Designation

Signature

Annexure – 7

101
102
 ANNEXURE 8

CRITERIA CHECK LIST FOR THE VALIDATION OF THE STRUCTURED

TEACHING PROGRAMME

Dear Sir/Madam,

Please go through the criteria listed below which have been formulated evaluating and validating

the structured teaching programme regarding menopausal problems and its remedial measures

among middle aged women in selected rural areas.

Please read each statement carefully and place a tick (√) mark against the appropriate column

which expresses your opinion about the Structured teaching programme. Please give your

suggestions in the remarks column.

S.No Criteria A DA Remarks

1. Formulation of the objectives

a. Comprehensive

b. Realistic

c. Stated in terms of learners

behavioral outcome

2. Selection of the content

a. Accurate

b. Adequate

c. Relevant

103
 d. According to the level of
understanding of middle aged women

3. Organization of the content

a. Logical sequence

b. Integration

4. Language

a. Simple and clear

5. Feasibility and predictability

a. Acceptable to clients

b. Interesting

c. It will be of practical use for the

formal and informal teaching

6. Audio visual aids

a. Simple and understandable

b. Appropriate

c. Aids in understanding the content

matter

7. Any other suggestion

A – Agree

DA – Disagree

Signature of the evaluator with the seal

Annexure- 9

104
 CRITERIA CHECKLIST FOR VALIDATION OF THE TOOL

Instruction

Kindly go through the items in the structured knowledge questionnaire regarding menopausal

problems and its remedial measures among middle aged women in selected rural areas. Please give

your suggestion regarding accuracy, relevancy and appropriateness of the items in the content.

There are three response columns in the scale namely, strongly agree (SA), Agree (A), and

Disagree (DA). Please tick mark (√) against the specific column. If you disagree to any item

please give your comments in the remark column.

Socio-demographic profile

Item

No SA A DA Remarks and Suggestions

1.

2.

3.

4.

5.

6.

7.

8.

9.

105
 10.

11.

12.

CRITERIA CHECK LIST FOR THE VALIDATION OF STRUCTURED KNOWLEDGE

QUESTIONNAIRE

Item

No SA A DA Remarks and Suggestions

10

11

12

13

14

15

16

106
17

18

19

20

21

23

24

25

26

27

28

29

30

31

32

33

34

Annexure -10

CONSENT FORM

107
 I am herewith give my consent to participate in the study conducted by Ms. Jiny James,

student of Acharya Nursing college on “A study to evaluate the effectiveness of structured

teaching programme on knowledge regarding menopausal problems and its remedial measures

among middle aged women in selected rural areas, Bangalore

Thanking you

Signature of the respondent

Annexure 11

108
109
 Annexure 12

LIST OF EVALUATORS

1. Mr. Prasanna Kumar

Lecturer and P.G. Guide
Community Health Nursing
Govt.College of Nursing
Bangalore.
2. Mr. B. Jayakumar
Lecturer, Community Health Nursing
NIMHANS College of Nursing
Bangalore.
3. Mrs. Suseela. J. R
HOD, Community Health Nursing
Padmashree College of Nursing
Bangalore.
4. Mr.Manjunath.H.R
Lecturer, Community Health Nursing
Kempegowda College of Nursing
Bangalore.
5. Mr. Prakash
Head of the Department
Community Health Nursing
Govt.College of Nursing
Bangalore.
6. Mrs. Nethravathi. V.
Asst.Lecturer, OBG
Kempegowda College of Nursing
Bangalore.

110
7. Ms.Shruthi.S
Lecturer
M.S Ramaiah Institute of Nursing Education and Research
Bangalore
8. Ms. A. SanthamLillypet
Professor
M.S Ramaiah Institute of Nursing Education and Research
Bangalore.
9. Mrs. V.T Lakshmamma
Principal
Kempegowda college of Nursing
Bangalore.
10. H.S. Surendra
Associate professor
Dept. of Agril.Statistics
GKVK, Bangalore
11. Dr.Rajeshwari.R
M.B.B.S. MS(OBG)
Consultant, Bangalore.
12. Dr. Vagdevi. S. K
Lady Medical Officer
Cholanayaknahalli Health Center
R.T. Nagar Post
Bangalore.

111
 Annexure-13

BLUE PRINT – Knowledge regarding menopausal problems and its

remedial measures.

Sl.No. Content Number of Total percentage

statements Number of
statements
1. General information
on menopausal 1--18 18 52.9%
problems.
2. Remedial measures on
menopausal problems. 19--34 16 47.058%

Total 1--34 34 100%

112
 Annexure – 14

TOOL USED FOR ASSESSMENT OF KNOWLEDGE AND EVALUATION OF STP

Structured Interview Schedule to determine the knowledge of middle aged women on

menopausal problems and its remedial measures

This structured Interview Schedule is designed for collecting relevant information from

respondents regarding menopausal problems and its remedial measures.

Questionnaire is divided into two parts:

Part-1: Consists of twelve questions related to demographic variables of the middle aged women

from selected rural areas, Bangalore.

Part-2: Consists of 34 items regarding the knowledge of middle aged women on menopausal

problems and its remedial measures which is divided into two sections.

Section A: Deals with general information on menopause and problems of menopause includes

18 multiple choice questions regarding meaning, definition, age of menopause, causes,

incidence, risk factors and common problems of menopause

Section B: This section deals with remedial measures which include 16 multiple choice

questions regarding home remedies and management tending to cure.

INSTRUCTIONS TO THE PARTICIPANTS.

Dear Participants,

This part of the questionnaire is related to demographic variables of participants. Kindly tick (√)

in the space provided for the answer, you find appropriate from the options given. This

113
information provided will be kept confidential.

PART-1

DEMOGRAPHIC PROFILE

Instruction: Place a tick mark in the appropriate space provided against each item

1. Age(years)
a) 31-35 [ ]
b) 35-40 [ ]
c) 41-45 [ ]

2. Religion
a) Hindu [ ]
b) Muslim [ ]
c) Christian [ ]
d) Any other [ ]

3. Marital status
a) Single [ ]
b) Married [ ]
c) Widow [ ]
d) Separated [ ]

4. Number of children if any

a. Nil [ ]
b. One [ ]
c. Two [ ]
d. Three and above [ ]

5. Type of family
a) Nuclear [ ]

114
 b) Joint [ ]
c) Extended [ ]
6. Qualification
a) No formal education [ ]
b) below 7th standard [ ]
c) SSLC [ ]
d) PUC and above

7. Occupation
a) Self employed [ ]
b) Coolie worker [ ]
c) Agriculture [ ]
d) Homemaker [ ]

8. Monthly income of the family(Rs)

a) 4,000-5,000 [ ]
b) 5,000-6,000 [ ]
c) 6,000-7000 [ ]

9. Age at menarche(years)
a) 10-11 [ ]
b) 12-13 [ ]

10. Age at marriage(years)

a) 18-19 [ ]
b) 20-21 [ ]

11. Is there anyone in your family who has menopausal problems?

a) Yes [ ]
b) No [ ]

115
12. Previous source of information
a) Yes [ ]
b) No [ ]
If yes, Source of information
a) Electronic media [ ]
b) Print media [ ]
c) Health Personnel [ ]
d) Relatives. Family members [ ]
e) Friends/ Neighbors [ ]

PART-2

Below there are questions under section A and B, and you are requested to tick ( √ )

the most appropriate answer from the choice given.

STRUCTURED INTERVIEW SCHEDULE

SECTION-A- GENERAL INFORMATION ON MENOPAUSE AND MENOPAUSAL

PROBLEMS

1. The word menopause, literally, means

a) Absence of menstruation [ ]

b) Suppression of normal menstruation [ ]

c) Onset of menustration [ ]

d) Irregularity in monthly cycles [ ]

2. The average age of menopause of an Indian women is

a) 45 years [ ]

116
 b) 48 years [ ]

c) 50 years [ ]

d) 55 years [ ]

3. Irregular menstruation prior to menopause is called

a) Perimenopause [ ]

b) Polymenorrhoea [ ]

c) Change of life [ ]

d) Dysmenorrhoea [ ]

4. Menopause is complete when women do not have a period for about

a) 6 months [ ]

b) 8 months [ ]

c) 10 months [ ]

d) 12 months [ ]

5. Induced menopause happens when women receive, except

a) Radiation [ ]

b) Chemotherapy [ ]

c) Medications [ ]

d) Stimulus [ ]

6. Hormones that helps to control women’s menustral cycle are

a) Estrogen and progesterone [ ]

117
 b) Thyroid hormone [ ]

c) Growth hormone [ ]

d) Oxytocin and vasopressin [ ]

7. The most common acute symptom of menopause is

a) Vaginal dryness [ ]

b) Hot flushes [ ]

c) Fatigue [ ]

d) Stressful life events [ ]

8. Hot flush is most pronounced in

a) Legs and Hands [ ]

b) Head and Chest [ ]

c) Neck and Abdomen [ ]

d) Thighs and Toes [ ]

9. Drug which cause more severe and prolonged hot flushes

a) Tamoxifen [ ]

b) Paracetamol [ ]

c) Meftal spas [ ]

d) Vicks Action 500 [ ]

118
10. Common symptoms of vaginal dryness include

a) Itching [ ]

b) GI distress [ ]

c) Insomnia [ ]

d) Weight gain [ ]

11. Vaginal changes lead to

a) Vaginal infections [ ]

b) Hot flushes [ ]

c) Uterine infections [ ]

d) Night sweats [ ]

12. Serious symptom of menopause is

a) Hair loss [ ]

b) Osteoporosis [ ]

c) Digestive problem [ ]

d) Allergies [ ]

13. As a result of osteoporosis about 33% of women over 50 will experience

a) Bone fractures [ ]

119
b) [ ]

c) [ ]

d) [ ]

14. The strong indication of menopausal stage

a) Decrease in sexual desire [ ]

b) Decrease in physical activity [ ]

c) Increase in sexual desire [ ]

d) Increase in physical activity [ ]

15. Cause of menopausal sexual dysfunction is

a) Loss of partner [ ]

b) Irritability [ ]

c) Loss of memory [ ]

d) Menopausal changes [ ]

16. One of the reasons for insomnia during menopause is

a) Night mare [ ]

b) Hot flash [ ]

c) Memory loss [ ]

d) Irrational thinking. [ ]

120
17. Leading cause of menopausal depression is

a) Anxiety [ ]

b) Phobia [ ]

c) Stress [ ]

d) Tiredness [ ]

18. Risk for depression during menopause is increased due to

a) Medication [ ]

b) Brain damage [ ]

c) Spinal cord injury [ ]

d) Surgical menopause [ ]

SECTION –B REMEDIAL MEASURES

19. Natural source that can combat estrogen deficiency is

a) Soya bean [ ]

b) Spinach [ ]

c) Carrot [ ]

d) Strawberry [ ]

121
20. Hot flushes during menopause can be decreased by

a) Sunflower oil [ ]

b) Badam oil [ ]

c) Olive oil [ ]

d) Flax seed oil [ ]

21. Hot flushes during menopause can be curable with

a) Yoga [ ]

b) Warm baths [ ]

c) Vitamin supplements [ ]

d) Air conditioning [ ]

22. During menopause, breathing exercises helps to regulate

a) Frigidity [ ]

b) Body temperature [ ]

c) Bone strength [ ]

d) Blood pressure [ ]

23. Good dietary source of iron

a) Dates [ ]

b) Biscuits [ ]

122
 c) Wheat [ ]

d) Suppota [ ]

24. Vitamin which can be used to reduce vaginal dryness is

a) Vitamin A [ ]

b) Vitamin B [ ]

c) Vitamin D [ ]

d) Vitamin E [ ]

25. To get enough calcium during menopause ,take lot of

a) Dairy products [ ]

b) Meat products [ ]

c) Oil products [ ]

d) Vegetable products [ ]

26. Best exercise during menopausal stage of a women’s life is

a) Swimming [ ]

b) Skipping [ ]

c) 50m run [ ]

d) Walking [ ]

123
27. Milder symptoms of menopausal depression can be relieved by

a) 3- 10 minutes physical activity per week [ ]

b) 30 minutes physical activity per week [ ]

c) 60 minutes physical activity per week [ ]

d) 130 minutes physical activity per week [ ]

28. .Home remedy for sexual dysfunction during menopause is

a) Medication [ ]

b) Surgery [ ]

c) Family counseling [ ]

d) Intimacy with partner. [ ]

29. Insomnia during menopause can be reduced by

a) Caffeine [ ]

b) Nicotine [ ]

c) Alcohol [ ]

d) Daily exercise [ ]

30. To improve sleep during menopause, limit fluid intake in the

a) Morning [ ]

124
b) Evening [ ]

c) Night [ ]

d) Early morning [ ]

31. For menopausal depressive client, Nervous system is balanced by

a) Meditation [ ]

b) Sedentary life [ ]

c) Medicines [ ]

d) Surgery [ ]

32. Nature’s best tranquiliser to treat menopausal depression is

a) Maturity [ ]

b) Eating [ ]

c) Exercise [ ]

d) Trait [ ]

33. Most effective way to treat symptoms of menopause is

a) Hormone therapy [ ]

b) Physiotherapy [ ]

c) Immune therapy [ ]

d) Thermotherapy [ ]

125
34. Burning and vaginal pain after intercourse can be relieved by the following

measures, except

a) Applying betadine [ ]

b) Sitz bath [ ]

c) Warm water soak [ ]

d) Cold packs [ ]

126
 Annexure –15

SCORING KEY:

Note: Each right answer carries ONE score and each wrong answer carries ZERO
score.
CORRECT TOTAL CORRECT TOTAL
Sl.No RESPONSE SCORE Sl.No RESPONSE SCORE
1 A 1 18 D 1
2 C 1 19 A 1
3 A 1 20 D 1
4 D 1 21 C 1
5 D 1 22 B 1
6 A 1 23 A 1
7 B 1 24 D 1
8 B 1 25 A 1
9 A 1 26 D 1
10 A 1 27 B 1
11 A 1 28 D 1
12 B 1 29 D 1
13 A 1 30 B 1
14 A 1 31 A 1
15 D 1 32 C 1
16 B 1 33 A 1
17 C 1 34 D 1

127
 Annexure -16

STRUCTURED TEACHING
PROGRAMME
ON
MENOPAUSAL PROBLEMS AND ITS
REMEDIAL MEASURES

127
Topic : Problems of menopausal women and its remedial measures

Group : Middle aged women

Place : Primary health centre, Kadusonappahalli

Duration : 1hour

Method of teaching : Lecture cum discussion

Teaching aid : charts, Flash cards.

GENERAL OBJECTIVE

On completion of this Structured Teaching Programme, women will acquire adequate knowledge on
menopausal problems and its remedial measures and develop desirable attitude to comprehend it.

SPECIFIC OBJECTIVES: At the end of this teaching programme, middle aged women will be able to,

™ enumerate the meaning of menopause

™ define menopause
™ state the age of menopause
™ enlist causes and risk factors
™ explain the common problems of menopause
™ describe remedial measures

128
 CONTENTS TEACHING
SPECIFIC
SL.NO TIME LEARNING AV AIDS EVALUATION
OBJECTIVES
ACTIVITIES

1 2min To introduce INTRODUCTION Investigator

the topic introduces the
Menopause is a normal physiological topic and the
process, not a disease, but it can have a middleaged
big impact on a woman's wellbeing. It is women getting
helpful if women are able to learn what to ready to
expect and what options are available to receive the
assist the transition, if that becomes knowledge.
necessary

The
investigator
To review the Review of previous knowledge
2 2min asks questions
previous Have you heard about menopause?
knowledge and the
Do you know the problems of
regarding women
problems of menopause?
menopausal How will you manage problems of answer.
women and its menopause at home?
remedial
measures. enumerate the
meaning of
3 2min To enumerate MEANING OF MENOPAUSE menopause
the meaning of Investigator
menopause The word "menopause" literally means enumerates the
the "end of monthly cycles" from meaning of
the Greek word pausis (cessation) and the menopause
root men- (month), because the word and women
"menopause" was created to describe this listen.
change in human females. define

129
4 1min To define DEFINITION menopause?
menopause
Menopause is time in a woman's life Investigator
when her periods (menstruation) defines women
eventually stop and the body goes through understands
changes that no longer allow her to get
Investigator state the age of
pregnant.
To state the menopause ?
age of AGE OF MENOPAUSE
menopause.
5 2min states the age
The age of menopause ranges between
45-55 years, average being 50 years. of menopause
and the
Perimenopause, oftern accompanied by women listens
irregularities in the menustral cycle along
with the typical symptoms of early
menopause, can begin up to 10 years prior
to the last menstrual period. Menopause is
complete when you have not had a period
for 1 year. This is called postmenopause.

CAUSES AND RISKFACTORS

To enlist enlist causes
6 4min Investigator
causes and Causes and risk factors
enlists causes,
risk factors of of menopause?
• Estrogen and progesterone are and risk
menopause factors of
female hormones naturally
produced by a woman's ovaries.. menopause
Estrogen and progesterone help and the
control a woman's menstrual women
cycle. As menopause nears, a understands.
woman's ovaries stop producing
estrogen and progesterone, greatly
lowering levels of these hormones

130
 in the body. Lowered estrogen
levels might cause menopause
symptoms and can lead to changes
in a woman's body
Risk factors

• Certain surgeries and medical

treatment can induce menopause.
Surgical menopause is when
medical treatments cause a drop in
estrogen. This can happen if your
ovaries are removed, or if you
receive chemotherapy or hormone
therapy for breast cancer. explain the
common
7 22min To explain the COMMON MENOPAUSAL Investigator problems of
common PROBLEMS explains menopause?
problems of common
menopause PHYSIOLOGICAL PROBLEMS problems of
menopause
Hotflushes and night sweat and women
understands
Hot flushes are the most common acute
change among women undergoing
menopause. It is a feeling of warmth that
spreads over the body and is often most
pronounced in the head and chest.. Hot
flushes usually last from 30 seconds to
several minutes. Women taking the breast
cancer treatment drug tamoxifen may
experience more severe and prolonged hot
flushes. Diseases that can cause hot
flushes are Panic disorder, Infection,

131
Cancer, Diabetes, Thyroid disease and
Obesity
IRREGULAR PERIODS
Abnormal menopause bleeding is one of
the most frequent complaints of women
during the perimenopause. It is not
unusual to have irregular bleeding
(bleeding usually decrease in amount and
frequency) for up to 6 months before
menstrual periods stop completely. Heavy
bleeding that is excessive or prolonged
(more than 7 days) should be investigated
by your doctor.
VAGINAL SYMPTOMS
Vaginal symptoms may include vaginal
dryness, itching, or irritation and/or pain
with sexual intercourse (dyspareunia).
The vaginal changes also lead to an
increased risk of vaginal infections.
DIGESTIVE PROBLEMS
Hormonal imbalance during
perimenopause is one of the primary
causes of digestive problems. Some of the
common symptoms of digestive
problems: Cramps, Bloating, Gas,
Constipation, Diarrhoea
OSTEOPOROSIS
Osteoporosis is perhaps the most serious
symptom of menopause because it can
lead to severe health problems such as

132
chronic back pain and broken bones.
About 33% of women over 50 will
experience bone fractures as a result of
hormonal fluctuations. A hall mark of this
disease is an increase loss of bone mass
and strength.
PSYCHOLOGICAL PROBLEMS
EMOTIONAL AND COGNITIVE
SYMPTOMS
Women in perimenopause often report a
variety of thinking (cognitive) and/or
emotional symptoms, including fatigue,
memory problems, irritability, and rapid
changes in mood. Some women face the
problem of memory loss and lack of
concentration before their menopause.
SEXUAL DYSFUNCTION

An initial loss or decrease in sexual desire

can be a strong indicator of menopausal
stage. Estrogendeficiency is a major cause
of decreased vaginal lubrication and
sexual dysfunction in menopausal
women. The elasticity of the vaginal wall
may decrease and the entire vagina can
become shorter or narrower

INSOMNIA
Insomnia is very common just before and
after menopause. Sometimes it is due to

133
 night sweats, which are hot flashes.
Women often wake up in the wee hours in
the morning and have great difficulty
getting back to sleep.

DEPRESSION
Stress is the leading cause of depression
during menopause.Sometimes menopause
can make you feel more than a little sad;
often it can make you downright
depressed. Women who have gone
through surgical menopause are also at
increased risk for depression. Investigator describe the
describes the remedial
8 23min To describe REMEDIAL MEASURES remedial measures of
the remedial measures of menopause?
measures of Home Remedies for menopause : To menopause
menopause. increase your levels of estrogen try and women
increasing your consumption of plants comprehends.
which contain estrogenic substances:
(legumes)
soybeans, soy sprouts, crushed flaxseeds,
garlic, green beans, sesame seeds, wheat,
yams, pumpkin seeds, cucumbers, corn,
apples, cabbage, beets, olive oil, papaya,
oats, peas, sunflower seeds, are all
important sources of natural estrogens .

134
REMEDIES FOR PHYSIOLOGICAL
PROBLEMS

1. Hotflush

• Drink atleast 3 litres of water

every day.
• Flaxseed and flaxseed oil
may decrease hot flashes.
• Keeping ice water or another
cold beverage on hand during
the day and night.
• It can be curable with vitamin
supplements and healthy diet
• Taking a cool shower before
bed.
• Take 800mg of evening prime
rose oil, 3 times a day.
• Do regular exercise.
• Wear lighter clothing.
• Keep your bedroom cool at night.
• Try to reduce your stress levels.
• Avoid potential triggers, such as
spicy food, caffeine, smoking and
alcohol.
• Breathing techniques where you
breathe slowly and deeply. This
sort of controlled breathing just as
you start a hot flush can shorten
and lessen it.It regulate your body
temperature.

135
 2. Abnormal and irregular
menopausal bleeding

Consult physician immediately.Pump up

your iron intake. Iron is found in lean red
meat, poultry, fish, eggs, dates, jaggery,
spinach, leafy green vegetables, nuts, and
enriched grain products. Sesame seeds
mixed with cumin seeds and served with
honey are thought to be a great home
remedy for irregular periods. Vegetable
and fruit juices are good for ensuring that
you have enough vitamins and nutrients
whilst also helping irregular periods.
Grape and carrot juice are two of the most
common examples if this. some people
have found that unripe green papaya can
normalize irregular periods during
menopause.
3. Vaginal dryness

• Vitamin E oil(Cod liver

oli,Ground nuts)
• Vaginal moisturizers
• Water-based vaginal lubricants
may be a boon to sexual comfort.
• Increase your intake of vitamin
C.(lemon,orange)
• Apply flaxseed oil
• 800 IU vitamin E oil is used as a

136
 toner for Dry skin.
• Practicing kegal exercise:Try to
stop the flow of urine when you
are sitting on the toilet. Imagine
that you are trying to stop passing
gas. Be careful not to tighten your
stomach, legs, or other muscles.
Don't hold your breath. Repeat,
but don't overdo it.. Lie on the
floor. Pull in the pelvic muscles
and hold for a count of 3. Then
relax for a count of 3. Work up to
10 to 15 repeats each time you
exercise.

Digestive problems

Stress reduction by meditation, relaxation

exercises or counseling is necessary. Try
adding physical activities like walking or
biking to your daily routine.
By eating a diet lower in carbohydrates
(reducing rice products) and higher in fat
and protein, you can often ease symptoms
of heartburn and indigestion.. Eliminate
bread and baked good for one week.

Osteoporosis

• Walk, it is the best exercise during

this biological phase of a women’s
life. Add spurts of power during

137
 brisk walking.
• Eating and drinking two to
four servings of dairy products,
richest source of calcium and
other calcium-rich foods a day
will help ensure that you are
getting enough calcium in your
daily diet.
• Make sure to get enough vitamin
D.
• Avoid alcohol intake and
smoking.
• Maintain a healthy weight

REMEDIES FOR PSYCHOLOGICAL

PROBLEMS
Emotional problems
Steps such as making sure to get regular
exercise, eating healthy and practicing
mind-body techniques such as meditation
or yoga alleviate emotional symptoms. By
simply including three 30 minute-long
sessions of physical activity such as
walking, and cycling into a weekly
routine a woman can greatly relieve her
milder symptoms of depression
Sexual dysfunction
During menopause, if your sex drive isn't
what it once was but you don't think you
need counseling, you should still take

138
time for intimacy with your partner.
Enjoy your time together -- you can take
long romantic walks, have candlelit
dinners, or give each other back rubs and
more foreplay.
Insomnia

• Take bath before sleep,read a

book,meditate.Sleep only in the
bedroom. Get up at the same time
each morning. Cool your bedroom

• Eat lot of fresh fruits and

vegetables,cut down on sugar
,alcohol and caffeine. Limit fluid
intake in the evening.

• . A short course of estrogen – less

than a year—can be taken as per
doctor’s order.. .

Depression

The pleasure of achieving something

overcomes distress or misery. Exercise
also plays an important role in the
treatment of depression. It is nature's best
tranquilliser. Meditation will enable the
hormonal glands to return to a correct
state of hormonal balance

Management tending to cure

139
Three approaches can be considered for
treating menopausal symptoms: (1)
lifestyle changes, (2) alternative remedies,
and (3) drugs and surgery

Lifestyle changes
These can include changes such as
reducing stress, exercising more
frequently, and eating a postmenopause-
friendly diet rich in calcium and other
essential nutrients.
Alternative treatments
Ranging from acupuncture and hypnosis
to the more common herbal remedies,
many women find that combining these
with lifestyle changes makes a significant
positive impact on their lives.
Prescription drugs
It usually involves some form of hormone
replacement therapy
(HRT),Vaginalestrogen therapy and
Calcium suppliments.Isoflavones, which
are natural oestrogens will be prescribed
by doctors.
Hormone therapy (HT) (consists
of estrogens or a combination of estrogens
and progesterone),is used to control the
symptoms of menopause
Vaginal estrogen therapy is an option in
the treatment of vaginal dryness, which
may be an alternative with a lower risk of
side effects than hormone replacement

140
 therapy. Applying Betadine topically on
the outer vaginal area, and soaking in a
sitz bath or soaking in a bathtub of warm
water may be helpful for relieving
symptoms of burning and vaginal pain
after intercourse..
For some women, surgery is the another
alternative. Many women think that
hysterectomy is the only choice left.

CONCLUSION
9 2 min To conclude
the topic Menopause is an unavoidable change that
every woman will experience, assuming
she reaches middle age and beyond. It is
helpful if women are able to learn what to
expect and what options are available to
assist the transition, if that becomes
necessary.

141
 REFERENCES

1. D.C.Dutta;Textbook of Gynaecology,5 thedition,New central book agency,Delhi,2008,Page 55-61.

th
2. Lewis, Heitkemper, Dirksen, O’Brien, Bucher. Medical surgical nursing. 7 ed. Missouri: Mosby; 2007.P.

th
3. Brunner and Suddarth. Text book of medical surgical nursing. 9 ed. Lippincott: Philadelphia; 2007. P.703-739

4. Available from URL http://www.caretohealthy.com/menopause/perimenopause-and-post-menopause-symptoms-and-

remedies.html

5. Available from URLwww.emedicinehealth.com/menopause/page3_em.htm

6. Available from URL http://menopause.about.com/od/moodandmenopause/a/MenoDepression.htm

7. 34 Menopause Symptoms Treatments Available from URL: http://www.34-menopause-symptoms.com/treatments.htm

8. Whales and humans linked by 'helpful grandmothers - BBC News

th
9. Lippincott Manual of Nursing Practice, 8 ed, Jaypee Brothers, : Philadelphia,2006.p.122-137

142
 w½ªÀ½PÉAiÀÄ£ÀÄß ¥ÀjÃQëøÀ®Ä G¥ÀAiÉÆÃV¸ÀĪÀ G¥ÀPÀgÀt
ªÀÄzsÀåªÀÄ ªÀAiÀĹì£À ºÉAUÀ¸ÀgÀ°è£À ªÉÄ£ÉÆÃ¥Á¸ï (gÀeÉÆä ªÀÈwÛ) ¸ÀªÀÄAiÀÄzÀ°è£À vÉÆAzÀgÉUÀ¼ÀÄ ªÀÄvÀÄÛ
CzÀgÀ ¥ÀjºÁgÀ ªÀÄzÀÄÝUÀ¼À §UÉÎV£À w¼ÀĪÀ½PÉAiÀÄ£ÀÄß ¥ÀjÃQë¸À®Ä ¹zÀÞ¥Àr¹gÀĪÀ PÀæªÀĪÁzÀ ¥Àæ±ÉßUÀ¼ÀÄ.

¥Àæ±ÉßUÀ¼À£ÀÄß JgÀqÀÄ ¨sÁUÀªÁV PÉÆqÀ¯ÁVzÉ.

¨sÁUÀ - 1 EzÀgÀ°è 12 ¥Àæ±ÉßUÀ¼ÀÄ ¤ªÀÄä ¥ÀjZÀAiÀÄzÀ §UÉÎ

¨sÁUÀ - 2 EzÀgÀ°è 34 ¥Àæ±ÉßUÀ¼ÀÄ EzÀÄÝ CzÀ£ÀÄß JgÀqÀÄ UÀÄA¥ÀÄUÀ¼ÁV ¤ÃqÀ¯ÁVzÉ.

UÀÄA¥ÀÄ - C : F ¥Àæ±ÉßUÀ¼ÀÄ ¤ªÀÄUÉ ªÉÄ£ÉÆÃ¥Á¸ï §UÉÎ EgÀĪÀ w¼ÀĪÀ½PÉAiÀÄ£ÀÄß
¥ÀjÃQë¸À®Ä G¥ÀAiÉÆÃV¹gÀĪÀ ¥Àæ±ÉßUÀ¼ÀÄ.
UÀÄA¥ÀÄ - D : F UÀÄA¦£À°è ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀªÀÄAiÀÄzÀ°è£À vÉÆAzÀgÉUÀ¼À ¥ÀjºÁgÀ
ªÀĢݣÀ §UÉÎAiÀÄ w¼ÀĪÀ½PÉAiÀÄ£ÀÄß PÀÄjvÀÄ.

¸ÀÆZÀ£É : ¸ÀjAiÀiÁzÀ GvÀÛgÀzÀ ªÀÄÄAzÉ (✓

) UÀÄgÀÄw¹

¨sÁUÀ - 1
1. ªÀAiÀĸÀÄì
C) 31- 35 ªÀµÀðUÀ¼ÀÄ o
D) 35- 40 ªÀµÀðUÀ¼ÀÄ o
E) 40-45 ªÀµÀðUÀ¼ÀÄ o

2. zsÀªÀÄð
C) »AzÀÄ o
D) ªÀÄĹèA o
E) PÉæöʸÀÛgÀÄ o
F) EvÀgÉ o

3. «ªÁºÀ fêÀ£À
C) C«ªÁ»vÉ o
D) «ªÁ»vÉ o
E) «zsÀªÉ o
F) ¨ÉÃgÉAiÀiÁVgÀĪÀªÀgÀÄ o
144
4. ªÀÄPÀ̼À ¸ÀASÉå
C) ªÀÄPÀ̽®è o
D) MAzÀÄ o
E) JgÀqÀÄ o
F) ªÀÄÆgÀÄ ªÀÄvÀÄÛ C¢üPÀ o

5. PÀÄlÄA§zÀ «zsÀ
C) «¨sÀPÀÛ PÀÄlÄA§ o
D) C«¨sÀPÀÛ PÀÄlÄA§ o
E) zÉÆqÀØzÁzÀ PÀÄlÄA§ o

6. ±ÉÊPÀëtÂPÀ CºÀðvÉ
C) C£ÀPÀëgÀ¸ÉÜ o
D) 7£Éà vÀgÀUÀwªÀgÉUÉ o
E) 7 jAzÀ 10£Éà vÀgÀUÀw o
F) ¦.AiÀÄÄ.¹. ªÀÄvÀÄÛ C¢üPÀ o

7. PÀÄlÄA§zÀ wAUÀ¼À DzÁAiÀÄ

C) gÀÆ. 4000 - gÀÆ. 5000 o
D) gÀÆ. 5000 - gÀÆ. 6000 o
E) gÀÆ. 6000 - gÀÆ. 7000 o

8. AiÀiÁªÀ ªÀAiÀĹì£À°è IÄvÀĸÁæªÀ ¥ÁægÀA¨sÀªÁ¬ÄvÀÄ

C) 10 ªÀµÀð¢AzÀ 11 o
D) 12 ªÀµÀð¢AzÀ 13 o

9. ªÀÄzÀĪÉAiÀiÁzÀ ªÀAiÀĸÀÄì
C) 18 ªÀµÀð¢AzÀ 19 o
D) 20 ªÀµÀð¢AzÀ 21 o

10 ¥Àæd£À£À QæAiÉÄUÉ ¸ÀA§A¢ü¹zÀ ±À¸ÀÛç aQvÉì DVzÉÃAiÀÄ ?

C) ºËzÀÄ
D) E®è

ºËzÀÄ, CAzÀgÉ, AiÀiÁªÀ ±À¸ÀÛç aQvÉì ¸ÀÆa¹ _________________

145
11. ªÀÄ£ÉAiÀÄ°è ªÉÄ£ÉÆÃ¥Á¸ï vÉÆAzÀgÉ EgÀĪÀ ªÀåQÛ EzÁÝgÀ ?

C) ºËzÀÄ

D) E®è

12. EzÀgÀ §UÉÎ ªÉÆzÀ¯Éà w¼ÀĪÀ½PÉ EvÀÛ

C) ºËzÀÄ

D) E®è

ºËzÀÄ CAzÀgÉ, AiÀiÁªÀÅzÀgÀ ªÀÄÆ®PÀ

1. «zÀÄåvï G¥ÀPÀgÀt
2. ¦æAmï «ÄÃrAiÀÄ
3. DgÉÆÃUÀå C¢üPÁjUÀ½AzÀ
4. ¸ÀA§A¢üPÀjAzÀ
5. ¸ÉßûvÀjAzÀ

146
 ¨sÁUÀ - 2

UÀÄA¥ÀÄ - 1

ªÉÄ£ÉÆÃ¥Á¸ï ªÀÄvÀÄÛ CzÀgÀ vÉÆAzÀgÉUÀ¼À §UÉV£À w¼ÀĪÀ½PÉAiÀÄ£ÀÄß ¥ÀjÃQë¸À®Ä EgÀĪÀ ¥Àæ±ÉßUÀ¼ÀÄ.

1. ªÉÄ£ÉÆÃ¥Á¸ï£À CxÀð
C) IÄvÀĸÁæªÀ ¤®Äè«PÉ o
D) IÄvÀĸÁæªÀ PÀrªÉÄAiÀiÁUÀĪÀÅzÀÄ o
E) IÄvÀĸÁæªÀ ¥ÁægÀA¨sÀªÁUÀĪÀÅzÀÄ o
F) IÄvÀĸÁæªÀzÀ KgÀÄ¥ÉÃgÀÄ o

2. ¨sÁgÀwÃAiÀÄ ªÀÄ»¼ÉAiÀÄgÀ°è AiÀiÁªÀ ªÀAiÀĹì£À°è ªÉÄ£ÉÆÃ¥Á¸ï DUÀÄvÀÛzÉ

C) 45 ªÀµÀð o
D) 48 ªÀµÀð o
E) 50 ªÀµÀð o
F) 55 ªÀµÀð o

3. ªÉÄ£ÉÆÃ¥Á¸ï DUÀĪÀ ªÉÆzÀ®Ä IÄvÀĸÁæªÀ KgÀÄ¥ÉÃgÀÄ DUÀĪÀÅzÀ£ÀÄß K£ÀÄß PÀgÉAiÀÄÄvÁÛgÉ

C) ¥ÉjªÉÄ£ÉÆÃ¥Á¸ï o
D) ¥Á°ªÉÄ£ÉÆÃjAiÀÄ o
E) fêÀ£À ±ÉÊ°AiÀÄ §zÀ¯ÁªÀuÉ o
F) £ÉÆë¤AzÀ PÀÆrgÀĪÀ IÄvÀĸÁæªÀ o

4. JµÀÄÖ wAUÀ¼ÀªÀgÉUÉ IÄvÀĸÁæªÀ E®è¢zÀÝgÉ ªÉÄ£ÉÆÃ¥Á¸ï JAzÀÄ w½AiÀÄÄvÁÛgÉ

C) 6 wAUÀ¼À PÁ® o
D) 8 wAUÀ¼À PÁ® o
E) 10 wAUÀ¼À PÁ® o
F) 12 wAUÀ¼À PÁ® o

5. AiÀiÁªÀ PÁgÀt¢AzÀ ªÀÄ»¼ÉAiÀÄÄ ªÉÄ£ÉÆÃ¥Á¸ï ºÉÆAzÀĪÀÅ¢®è

C) gÉÃrAiÉÄñÀ£ï (QgÀt ¥Àæ¸ÁgÀ) o
D) gÁ¸ÁAiÀĤPÀ aQvÉì o
E) OµÀ¢ü ªÀÄvÀÄÛ ªÀiÁvÉæUÀ¼À ¸ÉêÀ£É o
C) GvÉÛÃdPÀ ¥ÀzÁxÀð (ºÁªÉÆÃð£ï / ZÉÆÃzÀ£À) o

147
6. IÄvÀÄ ZÀPÀæªÀ£ÀÄß AiÀiÁªÀ ºÁªÉÆÃð£ï/ZÉÆÃzÀ£À »rvÀzÀ°è Ej¸ÀÄvÀÛzÉ
C) F¸ÉÆÖçÃd£ï ªÀÄvÀÄÛ ¥ÉÆæeɸÉÖgÉÆãï o
D) vÉÊgÁAiÀiïØ ºÁªÉÆÃð£ï o
E) ¨É¼ÀªÀtÂUÉAiÀÄ ZÉÆÃzÀ£À / ºÁªÉÆÃð£ï o
F) DQìmÉÆù£ï ªÀÄvÀÄÛ ªÁå¸ÉÆ¥Éæ¹£ï o

7. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÁªÀiÁ£Àå UÀÄt ®PÀët

C) vÉêÀ«®èzÀ / §tV£À AiÉÆä ªÀiÁUÀð o
D) ªÉÄÊ ©¹AiÀiÁzÀ C£ÀĨsÀªÀ o
E) DAiÀiÁ¸À o
F) MvÀÛqÀzÀ fêÀ£À o

8. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è ªÉÄÊ ©¹AiÀiÁzÀ C£ÀĨsÀªÀ J°è PÁt§ºÀÄzÀÄ

C) PÁ®Ä ªÀÄvÀÄÛ PÉÊUÀ¼À°è o
D) vÀ¯É ªÀÄvÀÄÛ JzÉAiÀÄ°è o
E) PÀvÀÄÛ ªÀÄvÀÄÛ ºÉÆmÉÖAiÀÄ ¨sÁUÀzÀ°è o
F) vÉÆqÉ ªÀÄvÀÄÛ PÁ®Ä ¨ÉgÀ¼ÀÄUÀ¼À°è o

9. AiÀiÁªÀ OµÀ¢ü/ªÀiÁvÉæ ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è CwºÉZÀÄÑ ©¹AiÀiÁzÀ C£ÀĨsÀªÀªÀ£ÀÄß ¤ÃqÀÄvÀÛzÉ.

C) lªÉÆAQì¦ß o
D) ¥ÁågÁ¹mÁä¯ï o
E) ªÉÄ¥sÁÛ¯ï «íPÁìPÁë£ï 500 o

10. MtVzÀ AiÉÆä ªÀiÁUÀðzÀ PÁgÀt

C) vÀÄjPÉ o
D) fÃuÁðAUÀzÀ vÉÆAzÀgÉ o
E) ¤zÉÝ ºÀvÀÛ¢gÀĪÀÅzÀÄ o
F) vÀÆPÀ ºÉZÀÄѪÀÅzÀÄ o

11. AiÉÆä ªÀiÁUÀðzÀ §zÀ¯ÁªÀuɬÄAzÀ K£ÀÄ DUÀÄvÀÛzÉ

C) AiÉÆäªÀiÁUÀðzÀ ¸ÉÆÃAPÀÄ o
D) ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀªÀÄAiÀÄzÀ°è£À ªÉÄÊ ©¹AiÀiÁzÀ C£ÀĨsÀªÀ o
E) UÀ¨sÀðPÉÆñÀzÀ ¸ÉÆÃAPÀÄ o
C) gÁwæ ¸ÀªÀÄAiÀÄzÀ°è ¨ÉªÀgÀĪÀÅzÀÄ o

12. ªÉÄ£ÉÆÃ¥Á¸ï£À UÀA©üÃgÀªÁzÀ UÀÄt ®PÀët

C) PÀÆzÀ®Ä GzÀgÀĪÀÅzÀÄ o
D) N¸Éé÷åÃ¥ÉÆgÉÆù¸ï/J®Ä§ÄUÀ¼ÀÄ mÉƼÁîUÀÄ«PÉ o
E) fÃuÁðAUÀzÀ vÉÆAzÀgÉ o
F) C®fð/PÉlÖ ¥ÀjuÁªÀÄ ©ÃgÀÄ«PÉ o

148
13. N¸Éé÷åÃ¥ÉÆgÉÆù¸ï¤AzÁV 50 ªÀµÀð ªÉÄîànÖgÀĪÀ ºÉAUÀ¸ÀgÀ°è ¸ÀgÀ¸Àj 33%gÀµÀÄÖ d£À F
vÉÆAzÀgÉUÀ¼À£ÀÄß C£ÀĨsÀ«¸ÀÄvÁÛgÉ
C) ªÀÄÆ¼É ªÀÄÄjvÀ o
D) C¢üPÀ gÀPÀÛzÉÆvÀÛqÀ o
E) ¸ÀPÀÌgÉ PÁ¬Ä¯É o
C) PÁå£Àìgï o

14. ªÉÄ£ÉÆÃ¥Á¸ï£À ¤zsÀðj¸À®Ä EgÀĪÀ ªÀÄÄRå ®PÀët

C) ¯ÉÊAVPÀ ¸ÀA¥ÀPÀð ºÉÆAzÀĪÀ D¸ÀQÛ PÀrªÉÄAiÀiÁVgÀĪÀÅzÀÄ o
D) zÉÊ»PÀ ZÀlĪÀnPÉUÀ¼ÀÄ PÀrªÉÄAiÀiÁUÀĪÀÅzÀÄ o
E) ¯ÉÊAVPÀ ¸ÀA¥ÀPÀð ºÉÆAzÀĪÀ D¸ÀQÛ ºÉZÀÄѪÀÅzÀÄ o
F) zÉÊ»PÀ ZÀlĪÀnPÉUÀ¼ÀÄ ºÉZÀÄѪÀÅzÀÄ o

15. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è ¯ÉÊAVPÀ QæAiÉÄAiÀÄ vÉÆAzÀgÉUÀ¼À PÁgÀt

C) eÉÆvÉUÁgÀgÀ£ÀÄß PÀ¼ÉzÀÄPÉÆAqÀgÉ/¸ÀAUÁwAiÀÄ ¸ÁªÀÅ o
D) ªÀÄÄAUÉÆÃ¥À o
E) £É£À¦£À ±ÀQÛ PÀ¼ÉzÀÄPÉÆAqÀgÉ o
F) ªÉÄ£ÉÆÃ¥Á¸ï£À §zÀ¯ÁªÀuɬÄAzÀ

16. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è ¤zÉÝ §gÀ¢gÀĪÀÅzÀgÀ ªÀÄÄRå PÁgÀt

C) zÀÄB¸Àé¥Àß o
D) ªÉÄÊ ©¹AiÀÄ C£ÀĨsÀªÀ o
E) £É£À¦£À ±ÀQÛ PÀ¼ÉzÀÄPÉƼÀÄîªÀÅzÀÄ o
F) PÁgÀt E®èzÀ AiÉÆÃZÀ£É o

17. ªÉÄ£ÉÆÃ¥Á¸ï£À PÉÆgÀUÀÄ/¤gÀÄvÁìºÀzÀ PÁgÀt

C) aAvÉ/DvÀAPÀ o
D) ¨sÀAiÀÄ o
E) MvÀÛqÀ o
F) ¸ÀĸÀÄÛ o

18. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è£À ¤gÀÄvÁìºÀ AiÀiÁªÀ PÁgÀt¢AzÀ ºÉZÁÑUÀÄvÀÛzÉ

C) ªÀiÁvÉæUÀ½AzÀ o
D) ªÉÄzÀĽ£À vÉÆAzÀgÉUÀ½AzÀ o
E) ªÉÄzÀļÀÄ §½AiÀÄ vÉÆAzÀgÉ o
F) ±À¸ÛÀç aQvÉìAiÀÄ ªÀÄÆ®PÀzÀ ªÉÄ£ÉÆÃ¥Á¸ï

149
 UÀÄA¥ÀÄ-2

UÀÄt¥Àr¸ÀĪÀ «zsÁ£ÀUÀ¼ÀÄ

19. F¹ÖçÃd£ï PÉÆgÀvÉAiÀÄ£ÀÄß £ÉʸÀVðPÀªÁV ºÉÃUÉ ¸Àj¥Àr¸À§ºÀÄzÀÄ ?

C) ¸ÉÆÃAiÀÄ ©Ã£ïì o
D) ¥Á®Pï ¸ÉÆ¥ÀÄà o
E) PÁågÀmï o
F) ¸ÁÖç¨ÉåÃj o

20. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è£À ªÉÄÊ ©¹AiÀÄ C£ÀĨsÀªÀªÀ£ÀÄß ºÉÃUÉ PÀrªÉÄ ªÀiÁqÀ§ºÀÄzÀÄ ?

C) ¸ÀÆAiÀÄðPÁAw JuÉÚ o
D) ¨ÁzÁ«Ä JuÉÚ o
E) D°ªï JuÉÚ o
F) CUÀ¸É ©ÃdzÀ JuÉÚ o

21. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è ªÉÄÊ ©¹AiÀÄ C£ÀĨsÀªÀªÀ£ÀÄß UÀÄt¥Àr¸ÀĪÀ §UÉÎ

C) AiÉÆÃUÀ o
D) ©¹ ¤Ãj£À ¸ÁߣÀ o
E) fêÀ¸ÀvÀéªÀ£ÀÄß ºÉZÁÑV ¸Éë¸ÀĪÀÅzÀÄ o
F) PÉÆÃuÉAiÀÄ°è ªÁAiÀÄÄ ¸ÀAZÁgÀªÀ£ÀÄß ºÀzÀUÉƽ¸ÀĪÀÅzÀÄ o

22. ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀªÀÄAiÀÄzÀ°è G¹gÁlzÀ ªÁåAiÀiÁªÀÄ AiÀiÁªÀÅzÀ£ÀÄß «ÄwUÉƽ¸ÀÄvÀÛzÉ.

C) GvÁìºÀ»Ã£ÀvÉ o
D) zÉúÀzÀ GµÀÚvÉ o
E) ªÀÄƼÉAiÀÄ ±ÀQÛ o
F) gÀPÀÛzÀ MvÀÛqÀ o

23. PÀ©âuÁA±À ºÉZÀÄÑ EgÀĪÀ DºÁgÀ ¥ÀzÁxÀð

C) RdÆðgÀ o
D) ©¹ÌÃlÄ o
E) UÉÆâü o
F) ¸À¥ÉÆÃl o

150
24. AiÉÆä ªÀiÁUÀðzÀ ¤Ãj£ÁA±ÀªÀ£ÀÄß PÁ¥ÀqÀ®Ä AiÀiÁªÀ fêÀ¸ÀvÀé ªÀÄÄRåªÁVzÉ
C) fêÀ¸ÀvÀé (J) o
D) fêÀ¸ÀvÀé (©) o
E) fêÀ¸ÀvÀé (r) o
C) fêÀ¸ÀvÀé (F) o

25. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀAzÀ¨sÀðzÀ°è AiÀiÁªÀ DºÁgÀ ¥ÀzÁxÀðUÀ½AzÀ ºÉZÀÄÑ PÁå°ìAiÀÄA zÉÆgÉAiÀÄÄvÀÛzÉ

C) ºÁ°£À GvÀà£ÀßUÀ½AzÀ o
D) ªÀiÁA¸À ¥ÀzÁxÀðUÀ½AzÀ o
E) JuÉÚ ¥ÀzÁxÀðUÀ½AzÀ o
F) vÀgÀPÁjUÀ½AzÀ o

26. ªÉÄ£ÉÆÃ¥Á¸ï£À ¸ÀªÀÄAiÀÄzÀ°è AiÀiÁªÀ ªÁåAiÀiÁªÀÄ GvÀÛªÀĪÁVgÀÄvÀÛzÉ

C) FdĪÀÅzÀÄ o
D) fVAiÀÄĪÀÅzÀÄ o
E) 50 «ÄÃ. NqÀĪÀÅzÀÄ o
F) £ÀqÉzÁqÀĪÀÅzÀÄ o

27. ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀªÀÄAiÀÄzÀ°è£À ¤gÀÄvÁìºÀªÀ£ÀÄß AiÀiÁªÀ jÃw ¥ÀjºÀj¸À§ºÀÄzÀÄ

C) ªÁgÀPÉÌ 3-10 ¤«ÄµÀUÀ¼À PÁ®zÀ zÉÊ»PÀ ZÀlĪÀnPɬÄAzÀ o
D) ªÁgÀPÉÌ 30 ¤«ÄµÀUÀ¼À PÁ®zÀ zÉÊ»PÀ ZÀlĪÀnPɬÄAzÀ o
E) ªÁgÀPÉÌ 60 ¤«ÄµÀUÀ¼À PÁ®zÀ zÉÊ»PÀ ZÀlĪÀnPɬÄAzÀ o
F) ªÁgÀPÉÌ 130 ¤«ÄµÀUÀ¼À PÁ®zÀ zÉÊ»PÀ ZÀlĪÀnPɬÄAzÀ o

28. ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀAzÀ¨sÀðzÀ°è£À ¯ÉÊAVPÀ QæAiÉÄAiÀÄ vÉÆAzÀgÉ ¤ªÁðºÀuÉAiÀÄ£ÀÄß ºÉÃUÉ ªÀiÁqÀ§ºÀÄzÀÄ?

C) ªÀiÁwæ / OµÀ¢ü vÉUÉzÀÄPÉƼÀÄîªÀÅzÀÄ o
D) ±À¸ÀÛç aQvÉìAiÀÄ ªÀÄÆ®PÀ o
E) D¥ÀÛ ¸ÀªÀiÁ¯ÉÆÃZÀ£É o
F) ¸ÀAUÁwAiÉÆqÀ£ÉAiÀÄ DwäÃAiÀÄvÉ o

29. ¤zÁæ»Ã£ÀvÉAiÀÄ£ÀÄß ºÉÃUÉ PÀrªÉÄ ªÀiÁqÀ§ºÀÄzÀÄ

C) PÉ¥sÉ£ï o
D) ¤PÉÆÃn£ï o
E) ªÀÄzÀå¸ÁgÀ o
F) ¥Àæw ¢£ÀzÀ ªÁåAiÀiÁªÀÄ o

151
30. ¤zÉæAiÀÄ£ÀÄß GvÀÛªÀÄUÉƽ¸À®Ä AiÀiÁªÀ ¸ÀªÀÄAiÀÄzÀ°è ¤Ãj£ÁA±ÀªÀ£ÀÄß vÉUÉzÀÄPÉƼÀÄîªÀÅzÀ£ÀÄß
vÀqÉAiÀĨÉÃPÀÄ ?
C) ¨É¼ÀUÉÎ o
D) ¸ÀAeÉ o
E) gÁwæ o
C) ªÀÄÄAeÁ£É o

31. ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀªÀÄAiÀÄzÀ°è ¤gÀÄvÁì» ºÉAUÀ¸ÀgÀ £ÀgÀªÀÄAqÀ®zÀ ¸ÀªÀÄvÉÆî£ÀªÀ£ÀÄß ºÉÃUÉ

PÁ¥ÁqÀ§ºÀÄzÀÄ ?
C) zsÁå£À ªÀiÁqÀĪÀÅzÀÄ o
D) ºÉZÁÑV PÀĽvÉà PÉ®¸À ªÀiÁqÀĪÀ fêÀ£À ±ÉÊ° o
E) ªÀiÁvÉæ / OµÀzsÀUÀ½AzÀ o
F) ±À¸ÀÛç aQvÉì o

32. ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀªÀÄAiÀÄzÀ°è£À ¤gÀÄvÁìºÀzÀ £ÉʸÀVðPÀ aQvÉì

C) ¥sËæqsÀzÉ±É ºÉÆAzÀĪÀÅzÀÄ o
D) Hl ªÀiÁqÀĪÀÅzÀÄ o
E) ªÁåAiÀiÁªÀÄ o
F) «±ÉõÀ UÀÄt ºÉÆA¢gÀĪÀÅzÀÄ o

33. ªÉÄ£ÉÆÃ¥Á¸ï£À ®PÀëtUÀ¼À aQvÉìAiÀÄ GvÀÛªÀĪÁzÀ «zsÁ£À ?

C) ºÁªÉÆÃð£ï aQvÉì PÀæªÀÄ o
D) zÉÊ»PÀ aQvÉì PÀæªÀÄ o
E) EªÀÄÆå£ï aQvÉì PÀæªÀÄ o
F) vÀªÉÆð aQvÉì PÀæªÀÄ o

34. F PɼÀV£ÀªÀ°è AiÀiÁªÀÅzÀ£ÀÄß ¯ÉÊAVPÀ ¸ÀA¥ÀPÀðzÀ £ÀAvÀgÀzÀ AiÉÆäªÀiÁUÀðzÀ°è£À £ÉÆêÀ£ÀÄß

¤ªÁj¸À®Ä G¥ÀAiÉÆÃV¸ÀĪÀÅ¢®è.
C) ©ÃmÁr£ï OµÀ¢ü ºÀZÀÄѪÀÅzÀÄ o
D) ¹mï¨Ávï (PÀĽvÀÄ ªÀiÁqÀĪÀ ¸ÁߣÀ) o
E) ¨ÉZÀÑVgÀĪÀ ¤Ãj£À°è £É£É¸ÀĪÀÅzÀÄ o
F) PÉÆïïØ ¥ÁåPï o

152
 ªÉÄ£ÉÆÃ¥ÉƸï
(ªÀÄÄlÄÖ CAvÀåUÉƼÀÄîªÀÅzÀÄ)
vÉÆAzÀgÉUÀ¼ÀÄ ªÀÄvÀÄÛ
CzÀgÀ aQvÀì PÀæªÀÄzÀ ²PÀët

153
«µÀAiÀÄ : ªÀÄ»¼ÉAiÀÄgÀ°è IÄvÀÄZÀPÀæ ¤®ÄèªÀÅzÀjAzÁUÀĪÀ ¥ÀjuÁªÀÄUÀ¼ÀÄ
UÀÄA¥ÀÅ : ªÀÄzsÀå ªÀAiÀĹì£À ªÀÄ»¼ÉAiÀÄgÀÄ
¸ÀܼÀ : UÁæ«ÄÃt DgÉÆÃUÀå PÉÃAzÀæ
¸ÀªÀÄAiÀÄ : MAzÀÄ (1) UÀAmÉ
PÀ°PÉAiÀÄ «zsÁ£À : G¥À£Áå¸À ªÀÄvÀÄÛ ZÀZÉð
±ÀæªÀt G¥ÀPÀgÀt : avÀæ¥Àl

d£ÀgÀ¯ï GzÉÝñÀUÀ¼ÀÄ
F PÀæªÀħzÀÞªÁzÀ ²PÀët PÁAiÀÄðPÀæªÀÄzÀ CAvÀåzÀ°è ¥ÀæwAiÉƧ⠪ÀÄ»¼ÉAiÀÄ ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀAzÀ¨sÀðzÀ°è£À vÉÆAzÀgÉUÀ¼ÀÄ ªÀÄvÀÄÛ CzÀgÀ aQvÁì
«zsÁ£ÀzÀ §UÉÎ w¼ÀĪÀ½PÉAiÀÄ£ÀÄß CjvÀÄPÉÆAqÀÄ CzÀ£ÀÄß CªÀgÀ fêÀ£ÀzÀ°è C¼ÀªÀr¹PÉƼÀÄîªÀÅzÀÄ.

ªÉÄ£ÉÆÃ¥ÉƸï£À CxÀðªÀ£ÀÄß w½¹

ªÉÄ£ÉÆÃ¥ÉƸï£À «ªÀgÀuÉ
v

ªÉÄ£ÉÆÃ¥ÉƸï£À ºÉÆAzÀĪÀ ªÀAiÀĸÀÄì

v

ªÉÄ£ÉÆÃ¥ÉƸï AiÀiÁgÀ°è, CzÀgÀ PÁgÀtUÀ¼À£ÀÄß ¥ÀnÖªÀiÁr

v

ªÉÄ£ÉÆÃ¥ÉƸï£À ¸ÁªÀiÁ£Àå vÉÆAzÀgÉUÀ¼À£ÀÄß «ªÀj¹

v

ªÉÄ£ÉÆÃ¥ÉƸï£À aQvÉì «zsÁ£ÀUÀ¼À£ÀÄß «ªÀj¹

v

154
1. 2 ¤. ²PÀëPÀgÀÄ ¥ÁoÀzÀ ¦ÃpPÉ : vÀ¤SÉzÁgÀgÀÄ «µÀAiÀĪÀ£ÀÄß
«µÀAiÀĪÀ£ÀÄß ªÉÄ£ÉÆÃ¥Á¸ï ¸ÁªÀiÁ£ÀåªÁzÀ zÉÊ»PÀ §zÀ¯ÁªÀuÉ, ¥ÀjZÀ¬Ä¸ÀÄvÁÛgÉ ªÀÄvÀÄÛ
w½¸ÀĪÀgÀÄ EzÀÄ PÁ¬Ä¯ÉAiÀÄ®è, DzÀgÉ EzÀjAzÀ ºÉtÂÚ£À ªÀÄzsÀåªÀÄ ªÀAiÀĹì£À
DgÉÆÃUÀåzÀ ªÉÄÃ¯É ¥ÀjuÁªÀÄ ©ÃgÀÄvÀÛzÉ. ªÀÄ»¼ÉAiÀÄgÀÄ «µÀAiÀĪÀ£ÀÄß
w½AiÀÄ®Ä ¹zÀÞgÁVzÁÝgÉ
vÀ¤SÉzÁgÀgÀÄ «ªÀj¸ÀÄwÛzÁÝgÉ
ªÀÄ»¼ÉAiÀÄgÀÄ CxÀð
ªÀiÁrPÉÆArzÁÝgÉ

2. 2 ¤. ²PÀëPÀgÀÄ w¼ÀĪÀ½PÉAiÀÄ£ÀÄß CjAiÀÄ®Ä EgÀĪÀ ¥Àæ±ÉßUÀ¼ÀÄ : vÀ¤SÉzÁgÀgÀÄ ¥Àæ±ÉßUÀ¼À£ÀÄß

«µÀAiÀÄzÀ C) ªÉÄ£ÉÆÃ¥Á¸ï §UÉÎ F ªÉÆzÀ®Ä PÉý¢ÝÃgÀ ? PÉüÀÄvÁÛgÉ, ªÀÄ»¼ÉAiÀÄgÀÄ
¥ÀƪÀð ¨Á« D) ªÉÄ£ÉÆÃ¥Á¸ï£À vÉÆAzÀgÉUÀ¼À §UÉÎ w½¢¢ÝÃgÀ ? GvÀÛj¸ÀÄvÁÛgÉ
¥Àæ±ÉßUÀ¼À£ÀÄß E) ªÀÄ£ÉAiÀÄ°è ªÉÄ£ÉÆÃ¥Á¸ï vÉÆAzÀgÉUÀ¼À ¤ªÁðºÀuÉ
PÉüÀĪÀgÀÄ ºÉÃUÉ ªÀiÁqÀÄwÛÃgÀ ?

3. 2 ¤. «µÀAiÀÄzÀ ªÉÄ£ÉÆÃ¥Á¸ï£À CxÀð : vÀ¤SÉzÁgÀgÀÄ ªÉÄ£ÉÆÃ¥Á¸ï£À ªÉÄ£ÉÆÃ¥Á¸ï£À

CxÀð "ªÉÄ£ÉÆÃ¥Á¸ï" ¥ÀzÀªÀÅ VæÃPï ¨sÁµÉ¬ÄAzÀ CxÀðªÀ£ÀÄß ºÉüÀÄwÛzÁÝgÉ CxÀ𠫪Àj¹
w½¸ÀĪÀgÀÄ ¥ÀjZÀAiÀĪÁVzÉ. EzÀgÀ CxÀð IÄvÀÄ ZÀPÀæ ¤®ÄèªÀÅzÀÄ/ ªÀÄ»¼ÉAiÀÄgÀÄ PÉüÀÄwÛzÁÝgÉ
IÄvÀÄ ZÀPÀæzÀ CAvÀå.

4. 1 ¤. «ªÀj¸ÀĪÀgÀÄ «ªÀgÀuÉ :
ªÉÄ£ÉÆÃ¥Á¸ï ªÀÄ»¼ÉAiÀÄ fêÀ£ÀzÀ MAzÀÄ ¨sÁUÀ. ªÀÄ»¼ÉAiÀÄgÀÄ ªÉÄ£ÉÆÃ¥Á¸ï
IÄvÀÄ ZÀPÀæ ¤®ÄèªÀ ¸ÀªÀÄAiÀÄ CAqÁtÄ ©qÀÄUÀqÉ D°¸ÀĪÀgÀÄ JAzÀgÉãÀÄ ?
DUÀĪÀÅ¢®è ªÀÄvÀÄÛ CzÀgÀ PÁAiÀÄðPÀëªÀÄvÉ PÀrªÉÄ
DUÀĪÀÅzÀ£Éßà `ªÉÄ£ÉÆÃ¥Á¸ï' JAzÀÄ PÀgÉAiÀÄÄvÁÛgÉ.
155
5. 2 ¤. ²PÀëPÀgÀÄ ªÉÄ£ÉÆÃ¥Á¸ï ºÉÆAzÀĪÀ ªÀAiÀĸÀÄì : ªÉÄ£ÉÆÃ¥Á¸ï
ªÉÄ£ÉÆÃ¥Á¸ï ªÉÄ£ÉÆÃ¥Á¸ï PÁt¹PÉƼÀÄîªÀ ªÀAiÀĸÀÄì ¸ÀĪÀiÁgÀÄ AiÀiÁªÀ ªÀAiÀĹì£À°è
PÁt¹PÉƼÀÄîªÀ 45-55 ªÀµÀðUÀ¼ÀÄ, ¸ÁªÀiÁ£ÀåªÁV 50 ªÀµÀð. PÁt¸ÀĪÀÅzÀÄ
ªÀAiÀĸÀì£ÀÄß
w½¸ÀĪÀgÀÄ
6. 4 ¤. PÁgÀtUÀ¼À£ÀÄß PÁgÀtUÀ¼ÀÄ : vÀ¤SÉzÁgÀgÀÄ ªÉÄ£ÉÆÃ¥Á¸ï PÁgÀtUÀ¼À£ÀÄß ªÀÄvÀÄÛ
«ªÀj¸ÀĪÀgÀÄ IÄvÀÄ ZÀPÀæ ¤®ÄèªÀ ¸ÀªÀÄAiÀÄ CAqÁtÄ ©qÀÄUÀuÉ ¸ÀAzÀ¨sÀðzÀ°è DUÀĪÀ vÉÆAzÀgÉUÀ¼À£ÀÄß
DUÀĪÀÅzÀgÀ®è KgÀÄ¥ÉÃgÀÄ DUÀĪÀÅzÀÄ. EzÀjAzÀ vÉÆAzÀgÉUÀ¼ÀÄ §UÉÎ ¥ÀnÖ ªÀiÁqÀ®Ä
ªÀÄ»¼ÉAiÀÄ zÉúÀzÀ°è C£ÉÃPÀ §zÀ¯ÁªÀuÉUÀ¼ÀÄ DUÀÄvÀÛªÉ. w½¸ÀÄvÁÛgÉ ªÀÄ»¼ÉAiÀÄgÀÄ ºÉüÀĪÀgÀÄ
PÉüÀÄvÁÛgÉ
C¥ÁAiÀÄPÁj ¸ÀAzÀ¨sÀðUÀ¼ÀÄ :
PÉ®ªÀÅ ±À¸ÀÛç aQvÉìUÀ¼ÀÄ F¸ÉÆÖçÃd£ï ¥ÀæªÀiÁtªÀ£ÀÄß
PÀrªÉÄUÉƼÀ¸ÀÄvÀÛzÉ. EzÀjAzÀ ªÉÄ£ÉÆÃ¥Á¸ï ºÉÆAzÀĪÀ
¸ÁzsÀåvÉUÀ¼ÀÄ ºÉZÀÄÑvÀÛzÉ.
7. 22 ¤. ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀAzÀ¨sÀðzÀ°è£À ¸ÁªÀiÁ£Àå vÉÆAzÀgÉUÀ¼ÀÄ vÀ¤SÉzÁgÀgÀÄ ªÉÄ£ÉÆÃ¥Á¸ï ¸ÁªÀiÁ£Àå
zÉÊ»PÀ vÉÆAzÀgÉUÀ¼ÀÄ
l ¤AzÀ DUÀĪÀ ¸ÁªÀiÁ£Àå vÉÆAzÀgÉUÀ¼ÉãÀÄ ?
sªÉÄÊ ©¹AiÀiÁUÀĪÀÅzÀÄ ªÀÄvÀÄÛ gÁwæ ¸ÀªÀÄAiÀÄzÀ°è vÉÆAzÀgÉUÀ¼À §UÉÎ
¨ÉªÀgÀĪÀÅzÀÄ. «ªÀj¸ÀÄvÁÛgÉ ªÀÄ»¼ÉAiÀÄgÀÄ
sIÄvÀÄ ZÀPÀæzÀ KgÀÄ¥ÉÃgÀÄ CxÀðªÀiÁrPÉÆArzÁÝgÉ
sAiÉÆä ªÀiÁUÀðzÀ°è vÉêÀ«®èzÉ EgÀĪÀÅzÀÄ, vÀÄjPÉ
ªÀÄvÀÄÛ ¯ÉÊAVPÀ ¸ÀA¥ÀPÀðzÀ ¸ÀªÀÄAiÀÄzÀ°è £ÉÆë£À
C£ÀĨsÀªÀUÀ¼ÀÄ.
156
 s
fÃuÁAUÀzÀ vÉÆAzÀgÉUÀ¼ÀÄ
s
N¸ÉÖ÷åægÉÆù¸ï / J®Ä§ÄUÀ¼À mÉƼÁîUÀÄ«PÉ

ªÀiÁ£À¹PÀ vÉÆAzÀgÉUÀ¼ÀÄ
l
AiÉÆÃZÀ£À PÁAiÀÄðzÀ°è §zÀ¯ÁªÀuÉ
s AiÉÆÃZÀ£À ±ÀQÛAiÀÄ°è KgÀÄ¥ÉÃgÀÄ, £É£À¦£À ±ÀQÛ
PÀrªÉÄAiÀiÁUÀĪÀÅzÀÄ, ¸ÀĸÀÄÛ EvÁå¢.
s̄ ÉÊAVPÀ QæAiÉÄAiÀÄ°è£À vÉÆAzÀgÉUÀ¼ÀÄ
s ¤zÉÝ §gÀzÉ EgÀĪÀÅzÀÄ
s ¤gÀÄvÁìºÀ

sªÉÄÊ ©¹AiÀiÁUÀĪÀÅzÀÄ ªÀÄvÀÄÛ gÁwæ ¸ÀªÀÄAiÀÄzÀ°è

¨ÉªÀgÀĪÀÅzÀÄ.
ªÉÆ£ÉÆÃ¥Á¸ï ºÉÆAzÀĪÀ ¸ÀAzÀ¨sÀðzÀ°è ¸ÁªÀiÁ£ÀåªÁV
PÁt¹PÉƼÀÄîªÀ §zÀ¯ÁªÀuɬÄAzÀ ªÉÄÊAiÀÄ®è
©¹AiÀiÁUÀĪÀ/¨ÉZÀÑUÁUÀĪÀ C£ÀĨsÀªÀªÀ£ÀÄß ¤ÃqÀÄvÀÛzÉ.
vÀ¯É ªÀÄvÀÄÛ JzÉAiÀÄ ¨sÁUÀzÀ°è Cw ºÉZÀÄÑ
©¹AiÀÄ C£ÀĨsÀªÀªÁUÀÄvÀÛzÉ.
F C£ÀĨsÀªÀ PÉêÀ® 30 ¤«ÄµÀUÀ½AzÀ PÉ®ªÀÅ
¤«ÄµÀUÀ¼ÀÄ EgÀÄvÀÛzÉ.
¸ÀÛ£ÀzÀ PÁå£ÀìgïUÉ aQvÉì ¥ÀqÉAiÀÄÄwÛgÀĪÀ ªÀÄ»¼ÉAiÀÄgÀ°è
F C£ÀĨsÀªÀ ºÉZÀÄÑvÀÛzÉ.
157
s IÄvÀÄ ZÀPÀæzÀ KgÀÄ¥ÉÃgÀÄ
ªÉÆ£ÉÆÃ¥Á¸ï ºÉÆAzÀĪÀ ªÉÆzÀ®Ä ¥ÀæwAiÉƧâ
ªÀÄ»¼ÉAiÀÄÄ C£ÀĨsÀ«¸ÀĪÀ ¸ÁªÀiÁ£ÀåªÁzÀ vÉÆAzÀgÉAiÉÄÃ
IÄvÀÄ ZÀPÀæzÀ KgÀÄ¥ÉÃgÀÄ.

IÄvÀÄ ZÀPÀæ CAvÀåUÉƼÀÄîªÀ 6 wAUÀ¼À ªÉÆzÀ®Ä

IÄvÀĸÀæªÀzÀ°è §zÀ¯ÁªÀuÉ GAmÁUÀĪÀÅzÀÄ ¸ÁªÀiÁ£Àå.
IÄvÀÄ ¸ÀæªÀªÀÅ 7 ¢£ÀPÀÆÌ ªÉÄïÉAiÀiÁzÀgÉ vÀPÀët ªÉÊzÀågÀ
¸À®ºÉ ¥ÀqÉAiÀÄĪÀÅzÀÄ GvÀÛªÀÄ.

s fÃuÁAUÀzÀ vÉÆAzÀgÉUÀ¼ÀÄ
¸É¼ÉvÀ, G§â¸À, ªÀÄ®§zÀÞvÉ, ¨Éâü, EvÁå¢
vÉÆAzÀgÉUÀ¼À£ÀÄß PÁt§ºÀÄzÀÄ.

sN¸ÉÖ÷åÃ¥ÉÆgÉÆù¸ï
EzÀÄ C¥ÁAiÀĪÁzÀ ®PÀët, KPÉAzÀgÉ EzÀjAzÀ
ªÀÄ»¼ÉAiÀÄ DgÉÆÃUÀåzÀ ªÉÄÃ¯É ¨Áj ¥ÀjuÁªÀÄ
GAmÁUÀÄvÀÛzÉ (¨É£ÀÄß £ÉÆêÀÅ, ªÀÄÆ¼É ªÀÄÄjvÀ)

50 ªÀµÀð ªÉÄîàlÖ ªÀÄ»¼ÉAiÀÄgÀ°è ¸ÀgÀ¸Àj 33%gÀµÀÄÖ

ªÀÄ»¼ÉAiÀÄgÀÄ ªÀÄÆ¼É ªÀÄÄjvÀ¢AzÀ vÉÆAzÀgÉUÉqÁVzÀÝgÉ.
EzÀjAzÀ ªÀÄƼÉAiÀÄ ±ÀQÛAiÀÄÄ PÀrªÉÄAiÀiÁUÀÄvÀÛzÉ.

158
ªÀiÁ£À¹PÀ vÉÆAzÀgÉUÀ¼ÀÄ
s
¥ÉjªÉÄ£ÉÆÃ¥Á¸ï ªÀÄ»¼ÉAiÀÄgÀ°è AiÉÆÃZÀ£É ªÀÄvÀÄÛ
DvÀAPÀ«gÀÄvÀÛzÉ CzÀgÀ eÉÆvÉUÉ eÁÕ¥ÀPÀ ±ÀQÛ.

ÉÊAVPÀ QæAiÉÄAiÀÄ°è£À vÉÆAzÀgÉUÀ¼ÀÄ

s̄
ªÉÄ£ÉÆÃ¥Á¸ï ºÉÆAzÀĪÁUÀ ¯ÉÊAVPÀ ZÀlĪÀnPÉAiÀÄ°è
D¸ÀQÛ PÀrªÉÄAiÀiÁUÀĪÀÅzÀÄ MAzÀÄ ªÀÄÄRåªÁzÀ ®PÀët.
F vÉÆAzÀgÉAiÀÄÄ F¹ÖçÃd£ï PÉÆgÀvɬÄAzÀ
GAmÁUÀÄvÀÛzÉ.

¤zÉÝ ¨ÁgÀzÉ EgÀĪÀÅzÀÄ

s
ªÉÄ£ÉÆÃ¥Á¸ï£À ªÉÆzÀ®Ä ªÀÄvÀÄÛ £ÀAvÀgÀzÀ
¸ÁªÀiÁ£ÀåªÁzÀ vÉÆAzÀgÉAiÉÄà ¤zÁæ»Ã£ÀvÉ. EzÀPÉÌ
PÁgÀt ªÉÄÊ ©¹AiÀiÁUÀĪÀÅzÀÄ ªÀÄvÀÄ ¨ÉªÀgÀĪÀÅzÀÄ.
ªÀÄ»¼ÉAiÀÄjUÉ F ¸ÀAzÀ¨sÀðzÀ°è ¤zÉݬÄAzÀ
JZÀÑgÀUÉÆAqÀgÉ ªÀÄgÀÄ ¤zÉÝ §gÀ®Ä vÀÄA¨Á
PÀµÀÖªÁUÀÄvÀÛzÉ.

¤gÀÄvÁìºÀ
s
ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀªÀÄAiÀÄzÀ°è£À MvÀÛqÀ ªÀÄ»¼ÉAiÀÄgÀ£ÀÄß
¤gÀÄvÁìºÀUÉƽ¸ÀÄvÀÛzÉ.
EzÀÄ ºÉZÀÄÑ ±À¸ÀÛç aQvÉì ªÀÄÆ®PÀ ªÉÄ£ÉÆÃ¥Á¸ï
ºÉÆA¢zÀ ªÀÄ»¼ÉAiÀÄgÀ°è PÁt¸ÀÄvÀÛzÉ.
159
8. 23 ¤. aQvÉìAiÀÄ aQvÉìAiÀÄ PÀæªÀÄUÀ¼ÀÄ vÀ¤SÁzÁgÀgÀÄ ªÀÄ»¼Á ªÉÄ£ÉÆÃ¥Á¸ï£À
PÀæªÀÄUÀ¼À£ÀÄß ªÀÄ£ÉAiÀÄ°è£À aQvÉìAiÀÄ PÀæªÀÄUÀ¼ÀÄ : gÉÆÃVUÀ½UÉ ªÉÄ£ÉÆÃ¥Á¸ï vÉÆAzÀgÉUÀ¼À£ÀÄß
«ªÀj¸ÀĪÀªÀgÀÄ F¸ÉÆÖçÃd£ï ªÀÄlÖªÀ£ÀÄß ºÉZÀÄÑ ªÀiÁqÀ®Ä ºÀ¹gÀÄ ¨ÁgÀzÀAvÉ vÀqÉUÀlÄÖªÀ vÀqÉAiÀÄĪÀ
¸ÉÆ¥ÀÄà ªÀÄvÀÄÛ vÀgÀPÁjUÀ¼À£ÀÄß ªÀÄvÀÄÛ zsÁ£ÀåUÀ¼À£ÀÄß PÀæªÀÄUÀ¼À£ÀÄß «ªÀj¸ÀĪÀgÀÄ «zsÁ£ÀUÀ¼ÉãÀÄ ?
ºÉZÁÑV ¸Éë¸À¨ÉÃPÀÄ.

¸ÉÆÃAiÀĩãïì, CUÀ¸É ©ÃdzÀ ¥ÀÄr, ¨É¼ÀÄî½, ºÀ¹gÀÄ

©Ã£ïì, J¼ÀÄî, UÉÆâü, PÀÄA§¼ÀPÁ¬Ä ©Ãd, ¸ËvÉPÁ¬Ä,
eÉÆüÀ, ¸ÉçÄ, J¯ÉPÉÆøÀÄ, D°ªï JuÉÚ, ¥ÀgÀAV
ºÀtÄÚ, Nmïì (vÉÆÃPÉUÉÆâü zsÁ£Àå) §mÁtÂ,
¸ÀÆAiÀÄðPÁAw ©Ãd J®èªÀÅ zÉúÀzÀ°è£À F¸ÉÆÖçÃd£ï
CA±ÀªÀ£ÀÄß ºÉZÀÄÑ ªÀiÁqÀÄvÀÛzÉ.

zÉÊ»PÀ vÉÆAzÀgÉUÀ¼À aQvÁì PÀæªÀÄUÀ¼ÀÄ

ªÉÄÊ ©¹AiÀiÁUÀĪÀÅzÀÄ
¥Àæw¢£À 3 °Ãlgï ¤ÃgÀ£ÀÄß PÀÄrAiÀĨÉÃPÀÄ.
t

CUÀ¸É ©Ãd ªÀÄvÀÄÛ CzÀgÀ JuÉÚ ªÉÄÊ

t
©¹AiÀiÁUÀĪÀÅzÀ£ÀÄß PÀrªÉÄ ªÀiÁqÀÄvÀÛzÉ.
vÀtÚVgÀĪÀ ¤ÃgÀ£ÀÄß ¨É¼ÀUÉÎ ªÀÄvÀÄÛ gÁwæ
t
PÉÊAiÀÄ°èqÀ¨ÉÃPÀÄ.

160
GvÀÛªÀĪÁzÀ DºÁgÀ¢AzÀ ªÀÄvÀÄÛ fêÀ¸ÀvÀéªÀżÀî
t
DºÁgÀ¢AzÀ UÀÄt¥Àr¸À§ºÀÄzÀÄ.
ªÀÄ®UÀĪÀ ªÉÆzÀ®Ä vÀtÂÚÃj£À°è ¸ÁߣÀ ªÀiÁqÀĪÀÅzÀÄ.
t
¦æªÀiïgÉÆøï JuÉÚ ¥Àæw¢£À ªÀÄÆgÀÄ ¨Áj
t
G¥ÀAiÉÆÃV¸ÀĪÀÅzÀÄ.
ªÁåAiÀĪÀÄ ªÀiÁqÀĪÀÅzÀÄ.
t
ºÀUÀÄgÀªÁzÀ §mÉÖAiÀÄ£ÀÄß G¥ÀAiÉÆÃV¸ÀĪÀÅzÀÄ
t
ªÀÄ®UÀĪÀ PÉÆoÀrAiÀÄ£ÀÄß vÀtÚUÉ EqÀĪÀÅzÀÄ.
t
¤ªÀÄä MvÀÛqÀªÀ£ÀÄß PÀrªÉÄ ªÀiÁrPÉƼÀÄîªÀÅzÀÄ
t
zsÀƪÀÄ¥Á£À, ªÀÄzsÀå¥Á£À PÁgÀªÁzÀ ¥ÀzÁxÀðUÀ¼À£ÀÄß
t
vÉUÉzÀÄPÉƼÀî¨ÁgÀzÀÄ.

IÄvÀÄ ZÀPÀæzÀ gÀPÀÛ¸ÀæªÀ

vÀPÀët ªÉÊzÀågÀ ¸À®ºÉ ¥ÀqÉAiÀĨÉÃPÀÄ
t

PÀ©âuÁA±À«gÀĪÀ DºÁgÀªÀ£ÀÄß ¸Éë¸À¨ÉÃPÀÄ.

t
GzÁºÀgÀuÉUÉ : ªÀiÁA¸À, «ÄãÀÄ, RdÆðgÀ,
¨É®è, ¥Á®Pï ¸ÉÆ¥ÀÄà, ºÀ¹gÀÄ ¸ÉÆ¥ÀÄà vÀgÀPÁjUÀ¼ÀÄ,
zsÁ£ÀåUÀ¼ÀÄ EvÁå¢.

AiÉÆä ªÀiÁUÀðzÀ°è vÉêÀ«®èzÉ EgÀĪÀÅzÀÄ

fêÀ¸ÀvÀé 'E' JuÉÚ (PÀqÀ¯É ©Ãd)
t

161
AiÉÆä ªÀiÁUÀðzÀ°è vÉêÁA±ÀªÀ£ÀÄß PÁ¥ÁqÀĪÀ
t
zÀæªÀªÀ£ÀÄß G¥ÀAiÉÆÃV¸ÀĪÀÅzÀÄ.
fêÀ¸ÀvÀé '¹' EgÀĪÀ DºÁgÀªÀ£ÀÄß ºÉZÀÄÑ
t
¸É빪ÀÅzÀÄ.
GzÁ: QvÀÛ¯É ºÀtÄÚ
CUÀ¸É ©ÃdzÀ JuÉÚAiÀÄ£ÀÄß ºÀZÀÄѪÀÅzÀÄ
t
QUÀí¯ï ªÁåAiÀiÁªÀĪÀ£ÀÄß C¨sÁå¸À ªÀiÁqÀĪÀÅzÀÄ.
fÃuÁðAUÀzÀ vÉÆAzÀgÉUÀ¼ÀÄ
PÁ¨ÉÆÃðºÉÊqÉæÃmï PÀrªÉÄ EgÀĪÀ DºÁgÀªÀ£ÀÄß
t
¸Éë¸À¨ÉÃPÀÄ.
Cw ºÉZÀÄÑ ¥ÉÆænãï CA±À«gÀĪÀ DºÁgÀªÀ£ÀÄß
t
¸Éë¸À¨ÉÃPÀÄ.
N¸ÉÖ÷åÃ¥ÉÆgÉÆù¸ï
ZÀlĪÀnPɬÄAzÀ £ÀqÉzÁqÀĪÀÅzÀÄ.
t

PÁå°ìAiÀĪÀiï CA±À«gÀĪÀ DºÁgÀ ªÀÄvÀÄÛ

t
¥Á¤ÃAiÀÄUÀ¼À£ÀÄß JgÀqÀjAzÀ £Á®ÄÌ ¨Áj
vÉUÉzÀÄPÉƼÀî¨ÉÃPÀÄ.
fêÀ¸ÀvÀé `r' AiÀÄ£ÀÄß vÉUÉzÀÄPÉƼÀî¨ÉÃPÀÄ.
t

zsÀƪÀÄ¥Á£À ªÀÄvÀÄÛ ªÀÄzsÀå¥Á£ÀªÀ£ÀÄß ªÀiÁqÀ¨ÁgÀzÀÄ.

t

zÉúÀzÀ vÀÆPÀªÀ£ÀÄß ¸ÀjAiÀiÁV £ÉÆÃrPÉƼÀî¨ÉÃPÀÄ.

t

162
ªÀiÁ£À¹PÀ vÉÆAzÀgÉUÀ¼À ¤ªÁðºÀuÉUÉ
vÉUÉzÀÄPÉƼÀî¨ÉÃPÁzÀ PÀæªÀÄUÀ¼ÀÄ
¨sÁªÀ£ÁvÀäPÀ vÉÆAzÀgÉUÀ¼ÀÄ :
¥Àæw ¢£À ªÁåAiÀĪÀÄ ªÀiÁqÀĪÀÅzÀÄ, GvÀÛªÀĪÁzÀ
t
DºÁgÀ ¸ÉêÀ£É, zsÁå£À, AiÉÆÃUÀ J®èªÀÅ ¨sÁªÀ£ÁvÀäPÀ
vÉÆAzÀgÉUÀ¼À£ÀÄß zÀÆgÀ ªÀiÁqÀ®Ä ¸ÀºÁAiÀÄ ªÀiÁqÀÄvÀÛzÉ.
zÉÊ»PÀ ZÀlĪÀnPÉUÀ¼ÀÄ ªÀÄ£À¹ì£À DgÉÆÃUÀåªÀ£ÀÄß
PÁ¥Ár MvÀÛqÀ¢AzÀ zÀÆgÀ ªÀiÁqÀÄvÀÛzÉ.
¯ÉÊAVPÀ QæAiÉÄAiÀÄ vÉÆAzÀgÉUÀ¼ÀÄ
ªÉÄ£ÉÆÃ¥Á¸ï ¸ÀAzÀ¨sÀðzÀ°è ¯ÉÊAVPÀ ZÀlĪÀnPÉAiÀÄ
t
D¸ÀQÛ PÀrªÉÄAiÀiÁUÀÄvÀÛzÉ. EzÀ£ÀÄß D¥ÀÛ
¸ÀªÀįÉÆÃZÀ£É¬ÄAzÀ ¸Àj¥Àr¸À§ºÀÄzÀÄ.
¤zÉÝ E®è¢gÀĪÀÅzÀÄ
ªÀÄ®UÀĪÀ ªÉÆzÀ®Ä ¸ÁߣÀ ªÀiÁqÀĪÀÅzÀÄ, ¥ÀĸÀÛPÀ
t
NzÀĪÀÅzÀÄ ªÀÄvÀÄÛ zsÁå£À ªÀiÁqÀĪÀÅzÀjAzÀ
GvÀÛªÀĪÁzÀ ¤zÉÝ ªÀiÁqÀ§ºÀÄzÀÄ.
Cw ºÉZÀÄÑ vÀgÀPÁj ªÀÄvÀÄÛ ºÀtÄÚUÀ¼À£ÀÄß ¸Éë¸À¨ÉÃPÀÄ.
ªÀÄzÀå¸ÁgÀ«gÀĪÀ ¥ÀzÁxÀðUÀ¼À£ÀÄß vÉUÉzÀÄPÉƼÀî¨ÁgÀzÀÄ.
¤gÀÄvÁìºÀ
zsÁå£À ªÀÄvÀÄÛ ªÁåAiÀĪÀÄ¢AzÀ ¤gÀÄvÁìºÀªÀ£ÀÄß
t
zÀÆgÀªÀiÁqÀĪÀÅzÀÄ.

163
 ¤ªÀðºÀuÉ
fêÀ£À±ÉÊ°AiÀÄ §zÀ¯ÁªÀuÉ
t
ªÉÊPÀ°àPÀ PÀæªÀÄUÀ¼ÀÄ
t
ªÀiÁvÉæ / OµÀ¢ü ªÀÄvÀÄÛ ±À¸ÀÛç aQvÉì
t

fêÀ£À ±ÉÊ°AiÀÄ §zÀ¯ÁªÀuÉ

MvÀÛqÀªÀ£ÀÄß PÀrªÉÄ ªÀiÁqÀĪÀÅzÀÄ ªÁåAiÀĪÀÄ
t
PÁå°ìAiÀÄA CA±À«gÀĪÀ DºÁgÀªÀ£ÀÄß ºÉZÀÄÑ
t
¸Éë¸ÀĪÀÅzÀÄ.

ªÉÊPÀ°àPÀ PÀæªÀÄUÀ¼ÀÄ
ªÉÊzÀågÀ ¸À®ºÉ¬ÄAzÀ ªÀiÁvÉæ vÉUÉzÀÄPÉƼÀîªÀÅzÀÄ.
t
ºÁªÉÆÃð£ïì£À KgÀÄ¥ÉÃgÀ£ÀÄß ¸Àj¥Àr¸ÀĪÀÅzÀÄ.
t
qÁ|| ¸À®ºÉAiÀÄAvÉ OµÀzÉÆÃ¥ÀZÁgÀ
t

9. 2 ¤. «µÀAiÀÄzÀ OµÀzÉÆÃ¥ÀZÁgÀ
ªÀÄÄPÁÛAiÀÄ ºÁªÉÆÃð£ï j¥ÉÆèøïªÉÄAmï aQvÉì (ºÁªÉÆÃð£ÀÄ
t
§zÀ®Ä ¥ÀÆgÉÊPÀ aQvÉì) [HRT] AiÉÆäAiÀÄ°è
J¸ÉÆÖçÃd£ï aQvÉì ªÀÄvÀÄÛ PÁå°ìAiÀÄA ªÀiÁvÉæUÀ¼À
¸ÉêÀ£É.
ºÁªÉÆÃð¤£À aQvÉì [HT] ºÁªÉÆÃð¤£À aQvÉì¬ÄAzÀ
t
ªÉÄ£ÉÆÃ¥Á¸ï£À vÉÆAzÀgÉUÀ¼À£ÀÄß ¤AiÀÄAwæ¸ÀĪÀÅzÀÄ.
164
AiÉÆäAiÀÄ vÉêÁA±ÀªÀ£ÀÄß vÀqÉUÀlÖ®Ä J¸ÉÆÖçÃd£ï
t
aQvÉì ¤ÃqÀĪÀÅzÀÄ.

ÉmÁqÉÊ£ï ªÀÄįÁªÀÄÄ£ÀÄß AiÉÆäAiÀÄ ºÉÆgÀ

ẗ
¥ÀzÀgÀzÀ°è ºÀZÀÄѪÀÅzÀÄ CxÀªÀ ¹mïÓ¨Ávï aQvÉì
(©¹ ¤Ãj£À ¨Ávï l©â£À°è ¸Àé®à ¸ÀªÀÄAiÀÄ «±ÁæAw
vÉUÉzÀÄPÉƼÀÄîªÀÅzÀÄjAzÀ ¸Àé®à DgÁªÀÄzÁAiÀÄPÀ-
ªÁVgÀĪÀÅzÀÄ). EzÀjAzÀ ªÉÄÊxÀÄ£À QæAiÉĬÄAzÀ
GAmÁzÀ AiÉÆäAiÀÄ Gj, HvÀ, £ÉÆêÀÅ
¤ªÁgÀuÉAiÀiÁUÀĪÀÅzÀÄ.

PÉ®ªÀÅ ªÀÄ»¼ÉAiÀÄgÀÄ UÀ¨sÀðPÉÆñÀzÀ vÉUɸÀĪÀ ±À¸ÀÛç

t
aQvÉì¬ÄAzÀ ªÀiÁvÀæ ªÉÄ£ÉÆÃ¥Á¸ï£ÀÄß
ºÉÆÃUÀ¯Ár¸ÀĪÀ «zsÁ£À JAzÀÄPÉƼÀÄîªÀgÀÄ. DzÀgÉ
PÉ®ªÀjUÀµÉÖà ±À¸ÀÛç aQvÉì CUÀvÀåªÁVgÀÄvÀÛzÉ.

¹zÁÝAvÀ
ªÀÄ»¼ÉAiÀÄ fêÀ£ÀzÀ°è ªÉÄ£ÉÆÃ¥Á¸ï J£ÀÄߪÀÅzÀÄ
t
vÀqÉAiÀįÁgÀzÀ MAzÀÄ QæAiÉÄ. EzÀgÀ §UÉÎ ¥ÀæwAiÉƧâ
ªÀÄ»¼ÉAiÀÄ w½zÀÄPÉƼÀÄîªÀÅzÀÄ GvÀÛªÀÄ.

165