NUTRITIONAL STATUS OF PREGNANT WOMEN WITH

SPECIAL
REFERENCE TO ANAEMIA
 LIST OF FIGURES
Figures Particulars Page No.
1 Conceptual frame work 11

2 Research process 28

LIST OF GRAPHS
Graphs Particulars Page No.
1 Distribution of mothers according to sociodemographic 33
data

2 Distribution of mothers according to base line data 36

3 Distribution of subjects according to level of knowledge 38

of disease aspects and prevention of anaemia

4 Distribution of mothers according to various aspects of 40

anaemia

5 Distribution of mothers according to knowledge on 42

causes

6 Distribution of mothers according to knowledge on signs 44

and symptoms of anaemia

7 Distribution of mothers according to practices regarding 50

diet

8 Distribution of mothers according to hygienic practices 52

9 Distribution of mothers according to practices regarding 54

treatment

X
 TABLE OF CONTENTS

Chapter Particulars Page No.

I INTRODUCTION 1
™ Need for the study
™ Statement of the problem
™ Objectives of the study
™ Operational definitions
™ Hypotheses
™ Assumptions

II REVIEW OF LITERATURE 12
™ Literature related to prevalence of anaemia in
pregnant mothers
™ Literature related to knowledge and practices
of anaemia in pregnant mothers
™ Literature related to treatment of anaemia in
pregnant mothers
III RESEARCH METHODOLOGY 21
™ Research Approach
™ Research Design
™ Setting of study
™ Population
™ Sample size & sampling technique
™ Method of data collection
™ Development & description of tool
™ Validity
™ Reliability of the tool
™ Procedure of data collection
™ Pilot study
™ Plan of data analysis
™ Research process

VI
Chapter Particulars Page No.
IV ANALYSIS AND INTERPRETATION OF DATA 29

V MAJOR FINDINS, DISCUSSION, MAJOR 60

FINDINGS, SUMMARY & CONCLUSION

VI BIBLIOGRAPHY 78

APPENDICES 84

ABSTRACT 129

ABBREVIATIONS 132

VII
 LIST OF TABLES

Table No Particulars Page No

1 Distribution of mothers according to sociodemographic 31

data

1b Distribution of mothers according to base line data 34

2 Mean, median and standard deviation of knowledge 37

scores of the registered pregnant mothers regarding
prevention of the anaemia

3 Distribution of subjects according to level of knowledge 37

of disease aspects and prevention of anaemia

4a Distribution of mothers according to knowledge on 39

various aspects of anaemia

4b Distribution of mothers according to knowledge on 41

causes

4c Distribution of mothers according to knowledge on 43

signs and symptoms of anaemia

5a Distribution of mothers according to knowledge on 45

sources of iron rich foods

5b Distribution of mothers according to knowledge on 46

personal hygiene

5c Distribution of mothers according to knowledge on 47

treatment

6a Distribution of mothers according to practices 48

regarding diet

6b Distribution of mothers according to hygienic practices 51

VIII
Table No Particulars Page No

6c Distribution of mothers according to practices 53

regarding treatment

7 Mean and standard deviation of practices scores 53

regarding prevention of anaemia among registered
pregnant mothers

8a Association between knowledge and age 55

8b Association between knowledge and Women’s 55

Education

8c Association between knowledge and Family income 56

8d Association between knowledge and Gravid status of 56

mothers obstetric score

9a Association between practices and age 57

9b Association between practices and women’s education 57

9c Association between practices and family income 58

9d Association between practices and gravid status of 58

mothers obstetric score

10 Association between knowledge and practices 59

regarding prevention of anaemia among registered

pregnant mothers

IX
 LIST OF APPENDICES
Appendix Particulars Page No.
A Letter requesting opinion and suggestions from 84
experts

B Blue print 86

C Tool for data collection 87

D Content validation proforma 113

E Criteria checklist for evaluation of tool 116

requesting suggestions and opinions from the
experts

F List of experts 120

G Certificate of validation 121

H Letter seeking permission to conduct study 126

I Master chart 127

XI
 Abbreviations

CHAPTER I

INTRODUCTION

“Maternal death is an avoidable tragedy : we can prevent it”1

- The White Ribbon Alliance

“Out of sheer love, affection and compassion, the would be mother bears all

the agony to protect the child with grace and dignity, that is really the greatness of

MOTHERHOOD” - Maharishi Kashyap.

Pregnancy, motherhood and childbirth are not at all romance and dreamy

nostalgia but it is a serious reality which has its own inherent risks to health and

survival both for the woman and for the infant she bears, which are present in

every society and in every setting.32

Anaemia in pregnancy exists world wide but it is a very common problem

in most of the developing countries, India being one of them. An estimated 60% of

all pregnant women in developing countries all over the world have anaemia, out

of which 40% of maternal deaths are related to anaemia.32

“BE ALERT NOT ALARMED”. Every five minutes, one woman in India

dies from complications related to pregnancy and childbirth. This adds upto a total of

130,000 women. It was also estimated that 200 women die each year in

pregnancy and childbirth due to anaemia related complications which means six out

of every 10 pregnant women selected are anaemic.1

In country like India, anaemia is frequently severe and contributes

significantly to maternal mortality and reproductive health morbidities. In India it

contributes upto 16% of maternal deaths and among all anaemias, nutritional

1
 Abbreviations

anaemia is the most common one. It is one of the major public health problem in

our country. The reason is that majority of women in reproductive age group have

limited iron stores, 40% have small stores and 20% have none. Secondly, their diet

does not contain adequate iron or iron absorption is hampered by various factors.

Lastly, increased iron requirement during pregnancy causes mobilization of iron

stores which leads to iron deficiency anaemia.2

Prevention of anaemia in pregnancy is still a dream for much of India and

particularly, for its rural areas. About 80% of our population live in the villages.

Most of the pregnant women live where poverty, illiteracy, malnutrition, poor

sanitation, hygiene, gender bias, unequal feeding practices from a young age,

religious taboos and lack of awareness regarding availability of medical facilities

render them prone to health hazards which are preventable.40

Though there is a knowledge explosion, scientific advancement, and

technological development in medicine and health care, our people are still

holding their belief on traditional practices. Some practices are effective but

certainly, some are harmful or ineffective which is based on superstition, false

beliefs, customs and traditions that are deterrent to health.33

Thus, in view of the importance to enhance the knowledge and practices

regarding dietary regulations, iron supplementation and personal hygiene to

prevent anaemia, the nurse plays a vital role in preventing anaemia through health

education and enhance the mother’s knowledge and practices to prevent further

maternal and fetal complications during pregnancy, labour and puerperium and

maintenance of health in prolonging life by a healthy mother and a healthy baby.

2
 Abbreviations

NEED FOR THE STUDY

"PREVENTION IS BETTER THAN CURE"

Prevention of anaemia is a major public health concern throughout the

world. Anaemia in pregnancy is one of the leading causes responsible for maternal

and perinatal morbidity and mortality. According to WHO, in developing

countries the prevalence of anaemia among pregnant women averages 56% that is

ranging between 35 to 100% among different regions of the world. India reported

the prevalence of anaemia to be between 33% to 100%. 9 In India anaemia is the

2nd most common cause of maternal deaths, accounting for 20% of total maternal

deaths. About half of the worlds anaemia women, live in the Indian sub continent

and 88% of them develop anaemia during pregnancy that is atleast 1.3 crore

women.3

Anaemia affects mainly the women in child bearing age group. During

pregnancy the women undergoes certain physiological changes, while the growing

fetus draws its nutrients from maternal blood leading to the demand of additional

nutrients. If the demands are not met it leads to mal-nutrition. A study carried out

in the intensive field practice area of Urban Health Centre of Government Medical

College, in Miraj (1992) by Naik K.R. revealed that (68.18%), pregnant women

were found to be anaemic.46

The consequences of anaemia in pregnancy are very dangerous. If anaemia

is left untreated and uncared; It leads to increased morbidity due to development

of complications like abruption placenta, preterm labour, intra uterine growth

retardation, inter-current infection, heart failure and post-partum haemorrhage,

3
 Abbreviations

pulmonary puerperal venous thrombosis, puerperal sepsis, sub involution, failing

lactation, etc.45 The investigator during her community field experience in

Tamilnadu came across many pregnant mothers with anemia. She felt that the

pregnant women were unaware about the importance of balance diet. They

generally cooked food keeping in mind the taste and preference of family

members. The lady of the house took the food which is left over after consumption

by the family members, which is insufficient for the pregnant mother. Nutrition

taboos also impose favorable, unfavorable impact on pregnancy. Pregnant women

are not given certain food items which are considered to be hot foods leading to

abortions for eg: Jaggery, dates, pappaya, mangoes and eggs. 39 A study conducted

by Atiktriratnawati (2000), on "socio-cultural dimensions of anaemia among

pregnant women in rural areas of Java-Indonesia" shows that, during pregnancy

pregnant women should give attention to foods that they eat and cannot eat,

because they thought that baby will gain weight and it leads to difficult labour.

Among people they had their own way to reduce anaemia by eating some animal's

blood; beside Jamu and Iron tablet. But iron tablet acceptance among pregnant

women seemed to be very low, because of feeling bored and forgetting in taking

regularly.5

The investigator has also gone through the antenatal clinic OPD records of

“K.L.E.S. Hospital and district hospital Belgaum”. It revealed that prevalence of

anaemia in K.L.E.S. hospital was 40%. and district hospital records revealed 80-

90%. After going through the records of community medicine department JNMC

Belgaum (2003) in Shindolli Village of Belgaum rural field showed that

prevalence of anaemia in pregnant women was (69.23%).

4
 Abbreviations

Knowledge and practices are always related. The social values prevailing in

the community were also important contributory factors of anaemia. Every society

has its own traditional belief and practices. People have taken pleasure in using

them. A study was conducted by Nugraheni SA, Dasuk Djaswadi, Ismail Djauhar;

(2003) on "Knowledge, attitude and practice of pregnant women in correlation

with anaemia" it revealed that the lower knowledge about anaemia in pregnant

women increased anaemia risk ‘five times’ and the worse practice about

prevention of anaemia in pregnant women increased anaemia risk ‘six times’; So

the potential risk factors that indicated to increase anaemia were knowledge and

practices about anaemia in pregnant mothers.4

Therefore, the investigator strongly felt the need to study the knowledge

and prevailing practice regarding prevention of anaemia among pregnant mothers

and also to appraise them of how far these practices were beneficial to the

mothers.

5
 Abbreviations

STATEMENT OF THE PROBLEM

A study to assess the knowledge and practices regarding prevention of

anaemia among registered pregnant mothers attending antenatal clinics in selected

hospitals of Belgaum.

OBJECTIVES OF THE STUDY

™ To assess the knowledge regarding prevention of anaemia among registered

pregnant mothers.

™ To identify the practices regarding prevention of anaemia among registered

pregnant mothers.

™ To find out the relationship between knowledge and selected variables

regarding prevention of anaemia among registered pregnant mothers.

™ To find out the relationship between practices and selected variables

regarding prevention of anaemia among registered pregnant mothers.

™ To find out the relationship between knowledge and practices regarding

prevention of anaemia among registered pregnant mothers.

6
 Abbreviations

OPERATIONAL DEFINITIONS

Knowledge:

Responses given by the mothers regarding prevention of anaemia on

questionnaire prepared by the investigator.

Practice :

In this study it refers to the mothers verbal responses given by the mother

regarding certain activities performed by the mother during pregnancy for

prevention of anemia on structured interview with the help of check list.

Prevention of Anaemia :

In this study it refers to methods adopted by pregnant mothers in terms of

dietary intake and iron supplementation to prevent occurrence of anemia during

pregnancy and have an optimum haemoglobin level of l0gm/dl.

Registered pregnant mother :

The mothers whose pregnancy is confirmed and who has completed 12

weeks attending antenatal clinics.

HYPOTHESIS

1. There is significant relationship between knowledge and practices among

registered pregnant mothers attending antenatal clinics regarding
prevention of anaemia at 0.05 level of significance.

2. There is significant relationship between knowledge and selected

demographic variables among registered pregnant mothers attending

7
 Abbreviations

antenatal clinics regarding prevention of anaemia at 0.05 level of

significance.

3. There is significant relationship between practices and selected

demographic variables among registered pregnant mothers attending
antenatal clinics regarding prevention of anaemia at 0.05 level of
significance.

ASSUMPTIONS
• The registered pregnant mothers have some knowledge regarding prevention of

anaemia.

• The registered pregnant mothers perform certain activities regarding

prevention of anaemia.

INCLUSION CRITERIA
All the registered pregnant mothers, those are attending the antenatal

clinics in K.L.E.S Hospital & MRC, and District Hospital, Belgaum.

EXCLUSIVE CRITERIA
Antenatal mothers :

™ Admitted in antenatal wards.

™ Who are not registered.

™ Associated with the complications i.e., Bad, obstetric history, systemic

disease, high-risk pregnancies.

DELIMITATION

The study is delimited only to the registered pregnant mothers attending

antenatal clinics of selected hospitals in Belgaum.

8
 Abbreviations

THEORETICAL FRAMEWORK

The conceptual framework in the present study is based on the ‘health

promotion model’ proposed by Dr. Nola J Pender in the year 1996.

The model was developed as a complement to other health protecting

models like the health belief model. The health promotion model explains the

likelihood that healthy life style patterns or health promoting behavior will when

those are intervened with additional modified knowledge.

Health promotion model identified three variables, which are as follows :

1. INDIVIDUAL CHARACTERISTICS AND EXPERIENCES :

The component consists of prior related behaviour which is solely based on

personal factors, available knowledge and practices. Prior related behavior is a

behavioral factor having direct and indirect effects. It is consistent with the focus

on perceived self-efficacy that future behavior is influenced by success or failure

with prior attempts at similar acts. In the present study, prior related behavior

refers to the existing knowledge and practices of antenatal mothers regarding

prevention of anaemia in the following areas such as :

• Knowledge regarding disease aspects of anemia

• Knowledge regarding prevention of anemia

Practices regarding prevention of anemia. Personal factors are nothing but

biological, Psychological and socio-cultural factors such as age, women’s

education, family income, dietary pattern, obstetric score, Hb level are considered

to influence the future behavior leading to success or failure of health promotion.

9
 Abbreviations

2. ACTIVITY RELATED AFFECT :

It consists of the subject’s positive or negative feeling associated with a

particular behavior that directly influence the performance of the behavior and

indirectly influence it, by enhancing self efficacy.

3. COMMITMENT TO A PLAN OF ACTION :

It includes the concept of intention with a planned strategy that causes the

intention to be formalized into a commitment to oneself or to another.41

That is the planned teaching programme on preventive measures of anemia

leading to health promotion and the desired behavior outcome.

10
Abbreviations

11
 Abbreviations

CHAPTER II

REVIEW OF LITERATURE
Review of literature is an important step in the development of research. It

involves identification, location, scrutiny and summary of written materials that

contain information on research problems.42

The literature relevant to this study was reviewed and arranged in the

following sections.

I. Prevalence of anaemia in pregnant mothers.

II. Knowledge and practices of anaemia in pregnant mothers.

III. Treatment of anaemia in pregnant mother.

I. LITERATURE RELATED TO PREVALENCE OF ANAEMIA IN

PREGNANT MOTHERS :

Brabin L, Nicholas S, Gogate A, Gogate S and Karande A (1995)

undertook a study on prevalence of anaemia among women in Mumbai, India. In

this study the Haemoglobin levels of 2.813 women living in inner city Mumbai

was measured and the prevalence of anaemia among pregnant women was

(63.5%).6

Meda N., Mandelbert L., Cartoux M., Dao B., Ovangre A. and Dabis

F., (1995-96) undertook a study on, “Anaemia during pregnancy in Burklnafaso,

West Africa prevalence and associated factors”. The study revealed that, the

overall prevalence of anaemia was 66%. The prevalence of mild anaemia was

30.8%, moderate anaemia was 33.5% and severe anaemia was 1.7%. Most (i.e.

12
 Abbreviations

74%) of these anaemia’s were not accompanied by any morphological changes in

circulating erythrocytes and 22% were hypochromic (mean cell haemoglobin

concentration <32 gm/dl with microcytosis (5071) ≤ 8071).7

Verhoeff F.H. (1999) carried out a study on “An analysis of the

determinants of anemia in pregnant women in rural Malawi area and a basis for

action”. The results revealed that peak prevalence of moderately severe anaemia (8

gm Hb/dl) was between 26-30 weeks. Factors which were significantly associated

with increased risk were illiteracy and poor nutritional status. The basis of

anaemia prevention in this population of pregnant women was found to be malaria

control and haematinic supplementation.8

Saxena V, Srivastava V.K., Idris M.Z., Mohan U., and Bushan V.,

(1997) conducted a study on “Nutritional status of rural pregnant women”. In this

study four hundred pregnant women were studied. The results showed that 38%

women were found to be suffering from anaemia out of which 3.7% women were

severely anaemic from mild and moderate degree of anaemia. 29.5% women were

taking less calories than recommended because of many socio-cultural reasons

such as illiteracy, poverty and wrong beliefs.9

Kapil U, (1999) conducted a study in urban slum communities of Delhi.

Anaemia was noted in 78.8% of pregnant women and among them 47.8% were

moderately anaemic, 29.4% were mildly anaemic and 2.0% had severely anemic.10

Vanden Broek N.R., Conya C.N., Mhango E. and White S.A. (1999)

conducted a study on “Diagnosing anaemia in pregnancy in rural clinics assessing

the potential of the haemoglobin colour scale in Malawi”. The study results

13
 Abbreviations

revealed the distribution of (Hb) measurements obtained by colour counter in the

population of 729 antenatal women examined. Percentage prevalence’s for

categories of anaemia were 58.1% for (Hb) ≤ 8.0gm /dl, only 3 women had an

(Hb) of ≤ 6.0 gm/dl and 49.5% of values obtained were in the range of 10.0 - 11

gm/dl.11

Awasthi. A., Thakur, R., Dave A and Goyal V., (2001) carried out a

study on “Maternal and Perinatal out come in cases of moderate and severe

anaemia”. The study comprised of 200 anaemia cases and non-anaemia (control

cases) out of 200 cases 71.5% had moderate anaemia and 28.5% had severe

anaemia.12

Bentley ME and Griffiths PL, (2003) conducted a study on the

“Prevalence and determinants of anaemia among women in Andhra Pradesh”. The

results showed that prevalence of anaemia was high among all women. Out of it,

(32.4%) of pregnant women had mild anaemia, (14.19%) had moderate anaemia

and 2.2% had severe anaemia.13

II. LITERATURE RELATED TO KNOWLEDGE AND PRACTICES OF

ANAEMIA IN PREGNANT MOTHERS :

Massawe S; Urassa E, Lindmark G and Nystram L; (1995) conducted a

study on "Anaemia in pregnancy perceptional of patients in Dar-es-salaam". A

total of 310 women were interviewed from three MCH clinics. In all these three

clinics more than 90% were aware of the advantages of early booking for antenatal

care but none of the mothers had received any ferrous supplements. The findings

revealed that there was lack of awareness between pregnant mothers related to

anaemia.14

14
 Abbreviations

Ziauddin Hyder. S.M., (1997) carried out a study to investigate the

prevalence of anaemia and the associated factors among pregnant women in two

rural areas of Bangladesh. The results of the study showed that 54% of the women

had anaemia. According to the WHO criteria, area of residence. Literacy and iron

tablet in take were significantly associated with prevalence of anaemia (P < 0.05).

The illiterate women had higher prevalence (60%) than the literate women (23%),

the women who reported to take iron tablet had lower prevalence (36%) than the

women who did not (60%). 15

Saibaba A, Sarma DS, Balakrishna N and Raghuram, (1999) conducted

a study on "utilization of IEC by middle level health personnel in the

implementation of national nutrition programmes". The findings revealed that, to

identify the vulnerable groups prone for anaemia, only 27.0% of respondent’s

mentioned pregnant women, with regard to the target group at whom the anaemia

prophylaxis programme was aimed; only 7.6% answered correctly while 64.0%

gave partially correct answers and it reveals that awareness among public and

pregnant mothers were found to be very low and also they lacked knowledge

regarding the anaemia prophylaxis programme.16

Horner RD, Lackey CJ, Kolasak and Warren K, (1999) undertook a

study on “Pica practices of pregnant women”. The study revealed that the

evidences suggests that pica during pregnancy results in anaemia and may have

serious effects particularly; anaemia on mother and infant.17

Lindsay H.A., (2000) published an article regarding anaemia and iron

deficiency effects on pregnancy out come. An article indicates that maternal iron

deficiency in pregnancy reduces fetal iron stores, perhaps, well into the first year

15
 Abbreviations

of life. The study explains that infants develop iron deficiency anaemia; so the

study concludes that routine iron supplementation during pregnancy is necessary.18

Kaur N and Singh K (2000) conducted a study on “Effect’s of health

education on knowledge, attitudes and practices; about anaemia on knowledge,

attitudes and practices; about anaemia among rural women in Chandigarh”. The

study revealed that socio-economic and demographic characteristics of both the

intervention and control groups were similar. All women in the intervention group

could specify atleast one correct cause of anaemia and identified a sign and

symptom of anaemia, where as, 73.3% and 46.6% women in the control group did

not specify the cause, signs and symptoms of anaemia respectively (P < 0.001).

The knowledge about methods of anemia prevention was significantly, higher in

intervention group compared to control group (P < 0.001). The results showed that

there was significant change in knowledge and attitude of women who received

health education. They concluded that a co-ordinated communication strategy is

required to improve anaemia prevention practices in the community.19

Ejidokun OO (2000) conducted a study on "community attitudes to

pregnancy, anaemia, iron and folate supplementation in urban and rural lagos,

south western Nigeria. The findings revealed that maternal anaemia is not

perceived as a priority health problem by pregnant women. Knowledge of the

signs and symptoms of anaemia is limited among rural pregnant women. The

recognition of maternal complications associated with anaemia is low. To continue

taking iron tablets and communicating of the local beliefs, attitudes and practices

regarding pregnancy is needed to design more and more effective methods of

health education for pregnant women to improve their knowledge.20

16
 Abbreviations

Galloway R, et al; (2002) conducted a study on "women's perceptions of

iron deficiency and anemia prevention and control in 8 developing countries". The

result revealed that while women frequently recognize symptoms of anemia, they

do not know the clinical term for anemia. Half of the women in all countries

consider these symptoms to be priority health concern that requires action and half

do not. Those women who visit prenatal health services are often familiar with

visit prenatal health services are often familiar with iron supplements but

commonly do not know why they are prescribed. The pregnant women believes

that taking too much of iron may cause too much blood or a big baby, making

delivery more difficult. Most of the women were not having adequate

knowledge regarding anaemia prevention.21

Ursell, Bernie (2003) published an article in clinical and laboratory

haematology regarding management of iron deficiency in pregnancy by using

iron-rich spa water (spatone) as a prophylaxis against iron deficiency in

pregnancy. The results showed that out of 102 patients, 31% of the patients, raised

their ferritin levels during trial period compared with 11% in the control group. 22

Mah-e-munir A., Mohammad A.A. and Misbahul I.K., (2004) conduced

a study on “Anaemia in pregnant women of railway colony, Multan”. The results

showed had microcytic hypochromic anaemia observed in 76% women, 64%

never used hemantinics, and no women had good dietary habits. The study

concluded that a comprehensive approach is required regarding health education

and management of anaemia in pregnant population.23

Miaffo et al., (2004) carried out a study “Malaria and anaemia prevention

in pregnant women of rural Burkinafaso”. It is a cross sectional qualitative survey

17
 Abbreviations

among 225 antenatal women of 8 villages. The results revealed that malaria and

anaemia were considered to be the biggest problems during pregnancy knowledge

using bed nets and good nutrition was less prominent. There was an urgent need to

implement malaria and anaemia prevention programmes on a large scale.24

III. LITERATURE RELATED TO TREATMENT OF ANAEMIA IN

PREGNANT MOTHERS:

Ekstrom EL, Hyder. Z, Choudhary AM.R, Lonnerdal. B and person

L.A (1998) conducted a study on “In a trial comparing weekly and daily

supplementation of iron”. According to WHO classification, pregnant mothers

were classified into mild, moderate and severe categories. The results showed that

after 12 weeks of supplementation, haemoglobin (Hb) increased in all three

categories. In the two highest haemoglobin categories (mild and moderate), a

maximum response was achieved after about 50 tablets. A maximum response in

the two lowest categories did not produce a normal haemoglobin, resulting in a

high remaining prevalence of anaemia after twelve weeks of supplementation.25

Grover V, Aggarwal OP, Gupta A, Praveen Kumar and Tiwari RS;

(1998) conducted a study on "Effect of daily and alternate day iron and folic acid

supplementation to pregnant females on the weight of the New born" the findings

revealed that a total of 200 pregnant women were enrolled for the study out of

which only 120. Of these 120 women, 64 were given iron and folic acid tablets

daily (Group-1) and 56 were given iron and folic acid tablets on alternate days

(Group II). Most of these belonged to lower middle socio-economic group; Nearly

60% of these women were illiterate. The findings has been roved for a long time

18
 Abbreviations

that regular iron supplementation during pregnancy is very helpful in increasing

the favorable outcome of the pregnancy in the form of decreased maternal

morbidity and mortality decreased fetal loss, increased weight and better survival

of the new born.26

Sharma JB, Arora BS, Kumar. S, Goel. S and Hamija. A., (2002)

carried out a study on “Helminth and protozoan intestinal infections; an important

cause for anaemia in pregnant women”. The study revealed that intestinal

infections were directly proportional to the severity of anaemia out of 110 anaemic

pregnant women, 26.66% cases were in haemoglobin (Hb) 10-11gm% group,

43.54% were in Hb, 8 to 9.9 gm% group and 72.72 % were in Hb, 6 to 7.9 gm%

group and 90.90% were in Hb less than 6gm% group. The study concludes that

routine screening and treatment for all pregnant women is necessary to prevent

anaemia.27

Alamgirmurshidi (2002) undertook a study on “Assessment of iron

supplementation activities among pregnant women in an Upazila of Bangladesh”.

Total 236 pregnant women were selected. Out of it 95 (40.3%) received iron from

any source. Pregnant women with formal education and working in garments had

significantly high rate of intake of iron supplements as compared to those who

were illiterate and women who were housewives (P < 0.05), 22% were not at all

aware of taking iron tablets. The iron supplementation activities among the

pregnant women was very unsatisfactory in Sreepur, Upazila of Gaziapur

District.28

19
 Abbreviations

Ringels, et al; (2003) conducted a study on "Awareness of folic acid for

neural tube defect prevention among Israeli women”. The study shows that out of

920 women interviewed, only 51 (5.5%) had heard of folic acid and 27 (2.8%)

were reported to have taken it. Awareness of folic acid was significant among

women aged 17-29 years, among women who were aware of folic acid, only non-

religious women tended to take it. The study is evident about poor level of

awareness among women.29

Moulessehoul S, Demmouche A, Chafi Y and Benali M (2004) carried

out a longitudinal study on “Effect of iron supplementation among pregnant

women”. The study showed that 31 out of 83 (37.3%) women had severe anaemia

(Hb < 11 g/110ml), 16 had moderate anaemia (7gm/dl < or = Hb <10gm/dl) and

15 had mild anaemia (10gm/dl < or = Hb < 11 gm/dl). The prevalence of anaemia fell

from 34.1% in the first trimester before supplementation to 6.3% in the third

trimester. These findings suggested that iron supplementation is a good strategy for

treating and preventing anemia during pregnancy.30

Ma AG, Chen XC, Wang Y, XuRx, Zheng MC and Lijsi (2O04)

conducted a study on "The multiple vitamin status of Chinese pregnant women

with anaemia and non-anemia in the last trimester". They founded that the subjects

with iron deficiency anaemia had much higher rates of vitamin C, foliate and

vitamin B12 deficiencies than those in non anaemia subjects and the deficient rates

reached 64.04%. The findings revealed that multiple vitamin deficiencies,

especially ascorbic acid, retinol and folic acid may be associated with anaemia or

iron deficiency in pregnant women in the last trimester.31

20
 Abbreviations

CHAPTER III

RESEARCH METHODOLOGY
Methodology of research includes the general pattern of organizing the

procedure for gathering valid and reliable data for problem under investigation

(Polit and Hungler, 1991).42

This chapter deals with the description of the research methodology

adopted by the investigator to study and analyze the knowledge and practice

regarding preventions of anemia among registered pregnant mothers.

The various steps undertaken to conduct the study includes research

approach, research design, setting, population sample and sampling techniques,

pilot study and plan for data analysis.

Research approach:

Since, the present study is aimed at identifying the knowledge and practices

regarding prevention of anemia among registered pregnant mothers, a descriptive

research method is felt to be appropriate and thus used for the study.

Research design:

The research design spells out the basic strategies. The research adopts to

develop information that is accurate and interpretable and incorporates some of the

most important methodological decisions that to research makes in conducting a

research study (Polit and Hungler, 1991).42

In this study, non-experimental descriptive design was adopted to find out

the level of knowledge and practices regarding prevention of anemia among

registered, pregnant mothers.

21
 Abbreviations

Research setting:

The study was conducted in the “Obstetrics and Gynecological Out Patient

Department, of K.L.E.S Hospital and MRC, Belgaum”.

Population:

In this study the population were registered pregnant mothers attending

antenatal clinics in the obstetrics and gynecological unit of K.L.E.S Hospital and

MRC, Belgaum.

Sample size:

The sample cluster consisted of 105 registered pregnant mothers attending

antenatal clinics.

Sampling technique:

Polit and Hungler, (1995) states that “Sampling refers to the process of

selecting the samples for the study”.42

A technique of purposive (non-probability) sampling was adopted.

Criteria for sample selection:

i. Inclusion criteria:

All the registered pregnant mothers attending the antenatal clinics in

K.L.E.S Hospital and MRC, Belgaum.

22
 Abbreviations

ii. Exclusive Criteria:

Antenatal mothers :

™ Admitted in antenatal wards.

™ Who are not registered.

™ Associated with the complications such as systemic disease and high-

risk pregnancies.

METHODS OF DATA COLLLECTION:

A formal permission to conduct the study was obtained from the authorities of

the hospital.

A structured interview schedule with the option of ‘yes’, ‘no’, or ‘do not

know’ and a checklist with the option ‘yes’ or ‘no’, was developed after extensive

review of related literature and in consultation with experts in the field of

Obstetrics and Gynaecological Nursing, statistics in order to assess the knowledge

and practices regarding prevention of anemia among registered pregnant mothers

attending antenatal clinics.

Development and description of the tool:

To prepare the tool the following steps were carried out which are as follows :

1. Literature review

2. Preparation of blueprint

Literature review:

Literature review from books and journals were reviewed and were used to

develop the tool.

23
 Abbreviations

Preparation of blue print:

The Blue Print (Appendix B) pertaining to the domain of learning i.e,

knowledge and practices were prepared.

Description of the tool:

To achieve the set objective of the tool was organized in following 3

sections :

Section I :

Elicits the sociodemographic and baseline data of the mothers such as age,

religion, marital status and educational status. Family income, occupation,

obstetric score, hemoglobin level etc. There were totally 13 items in this section.

Section II :

It is divided into 2 subsections for the convenience of getting required

information.

A. Elicits the knowledge regarding anemia.

B. Elicits the knowledge regarding prevention of anemia. Totally there were

36 questions which were divided into A and B

Each question had 3 options, yes / no /do not know. Those mothers who gave

correct answer were given score ‘1’. Those who gave wrong answer were given

score ‘0’ and it was graded as

1. < X -1 SD - poor knowledge

2. X - 1 SD to + 1SD - average knowledge 3.

>X + 1SD - Good knowledge

24
 Abbreviations

Section III :

The practices in registered pregnant mothers regarding prevention of

anemia were found out with the help of checklist with the options of (yes or No ).

Totally, there were 23 Questions. Which were divided into diet, hygiene and

treatment. The common responses were grouped. Those mothers who give

correct answers were given score ‘1’. Those who gave wrong answer were given

score ‘0’ and it was graded as:

1. Beneficial practices

2. Non-beneficial practices.

Content validity :

The tool, and the blueprint were submitted to the experts for content

validity. The experts (Appendix F) were from the field of nursing, medicine and

research.

The experts were requested to review and verify the items for adequacy,

clarity, appropriateness and meaningfulness. Some modification of the items were

done on the basis of suggestions and comments given by the experts. The tool was

translated into Kannada and Marathi (Appendix C).

Suggestions given to change were:

1. Items on knowledge:

a. Q. No: 17 “Palpitation and breathing difficulty are the important symptoms

of anemia”, was corrected to “palpitation and breathing difficulty are the

signs of anemia “

b. Q. No 26 was included for e.g. “Iron tablet should not be taken along with

milk or any hot drinks.”

25
 Abbreviations

c. This question was added “Dates and dry grapes” are rich sources of iron.

d. “Intake of papaya during pregnancy leads to abortion.” This question was

deleted.

2. Items on practices :

One question was included i.e. “Do you wash the vegetables before

cutting?”

Reliability of the tool :

The reliability of the tool was tested by introducing the tool among 16

pregnant mothers, attending antenatal clinics. This was done by critically

evaluating the questions based on difficulty index and discriminative to index. To

estimate the reliability for the entire test, co-efficient of co-relation was done by

estimating coefficient of correlation and applying Spearman’s “Brown proficiency

formula and Yules (Q) test”, for coefficient and research was found to be r =1.

Procedure for data collection :

A formal permission to conduct the study was obtained from the authorities of

the hospital.

The nature of the study was briefly explained to them and it was ensured by

the investigator that the normal routine of the hospital would not be distrupted. A

time schedule was planned which is as follows, 10.00am to 1 noon and 3 pm to 4

pm. The mothers who fulfilled the criteria laid down for study, were selected.

After selection of the samples, the pregnant mothers were made to sit down in any

available quite place. The pregnant mothers were interviewed personally, by the

26
 Abbreviations

investigator. The interview was taken for about 30 to 45 minutes. Everyday 5-6

mothers were interviewed, totally 105 clients were interviewed from 05.08.05 to

05.09.05

Pilot study :

The main aim of study is to find out practicability, feasibility and reliability

of the study. (Polit and Hungler 1991).42

The pilot study was conducted on 16 patients in the Obstetrics and

Gynaecological OPD of K.L.E.S Hospital and MRC Belgaum from 1.08.2005 to

3.08.2005 for 3 days with the purpose of testing the proficiency of the instrument to

be used for data collection. Samples were collected from obstetrics and

antenatal OPD of K.L.E.S Hospital Belgaum. During the pilot study the

investigator noticed that it was necessary to modify the tool; because the medical

terms were not understood by the patients. The time taken to complete the tool was

30 minutes for each patient.

Plan for analysis :

1. The data was collected and analyzed by using descriptive and inferential

statistical method according to the objectives.

2. The responses on different items were tabulated in a master sheet.

3. The scores were expressed through percentage for meaningful and easy

handling of calculation.

4. Statistical treatment used for the analysis were :

™ Mean
™ Median
™ Standard deviation
™ Chi-square test

27
 Abbreviations

RESEARCH PROCESS

Target Registered pregnant mothers

population attending antenatal clinics

Sample size 105 in number

Sampling Purposive sampling

Instrument Structured interview

Data Collection
™ Socio-demographic variable
™ Knowledge regarding anaemia
™ Knowledge regarding prevention
of anaemia
™ Practices regarding prevention of
anaemia

Descriptive and
Analysis
inferential statistics

28
 Abbreviations

CHAPTER IV

ANALYSIS AND INTERPRETATION OF DATA

The purpose of the data analysis is to reduce the data to manageable and

interpretable form, so that the research problems can be st udied and tested.44

Abedellah and Levine (1979) state that “Interpretation of tabulated data can

bring to light the real meaning of the findings of the study”.

This chapter deals with analysis and interpretation of data collected to

assess the knowledge and practices regarding prevention of anaemia among

registered pregnant mothers attending antenatal clinics in selected hospitals of

Belgaum.

The analysis and interpretation of the data of this study were based on, data

collected through structured interview schedule and checklist of registered

pregnant mothers attending antenatal clinics, (N = 105).

The results were computed using descriptive and inferential statistics based

on the objectives of the study. The data has been organized and analyzed under the

following headings :

1. The demographic and baseline data in relation to age, women’s education,

husband’s education, religion, type of family, women’s occupation, family

income, diet, registration, obstetric score, menstrual history and birth

spacing between previous pregnancies and hemoglobin level.

2. Item-wise analysis of subjects regarding knowledge of anemia and its

prevention of anaemia.

3. Item-wise analysis of subjects regarding practices related to prevention of

anaemia.

29
 Abbreviations

4. Distribution of level knowledge according to selected variables, that is age,

women’s education, family income and Gravida.

5. Distribution of classification of practices according to selected variables,

that is age, women’s education, family income and Gravida.

6. Association between the knowledge and practices regarding prevention of

anaemia among registered pregnant mothers.

30
 Abbreviations

SECTION I :
TABLE NO. 1A
Distribution of mothers according to sociodemographic data
N = 105
S.No Variables Frequency (f) Percentage (%)
1 Age :
15-19 yrs 21 20.00
20-24 yrs 56 53.33
25-29 yrs 24 22.85
30 yrs and above 4 3.80
2 Women’s education :
No formal education 35 33.33
Primary education 16 15.23
Secondary education 30 28.57
Higher secondary education 12 11.42
Graduate 12 11.42
3 Husband’s education :
No formal education 6 5.71
Primary education 22 20.95
Secondary education 34 32.38
Higher secondary education 24 22.85
Graduate 19 18.09
4 Religion :
Hindu 71 67.61
Muslim 27 25.71
Christian 5 4.76
Any other 2 1.90
5 Type of family :
Nuclear family 58 55.23
Joint family 47 44.76
6 Woman’s occupation :
House wife 100 95.23
Labourer 3 2.85
Professional 2 1.90
7 Family’s income :
Below Rs. 2000/ month 23 21.90
Rs. 2001 - 3000/ month 41 39.04
Rs. 3001 - 4000/ month 28 26.66
Rs. 4001 - 5000/ month 12 11.53
Rs. 5001 & above 1 0.95
8 Diet :
Vegetarian 28 26.66
Mixed 77 73.33

31
 Abbreviations

Table no. 1A describes that majority i.e. 56 (53.33%) of mothers belonged

to 20-24 years of age, only 4 (3.80%) were in the age group of 30 years and above.

According to educational status, maximum 35 (33.33%) of the mothers had no

formal education while 12 (1142%) had higher secondary education and also 12

(11.42%) were graduates. Husband’s educational status revealed that 34

(32.38%) had secondary education and only 6 (5.71%) had no formal education.

Regarding religion majority 71 (61.61%) of mothers belonged to Hindu

religion, 27 (25.71%) of the mothers belonged to Muslim religion, 5 (4.76%) of

the mothers belonged to Christian religion and only 2 (1.9%) of the mothers

belonged to other religion.

Further, the table shows that majority 58 (55.23%) of the mother’s

belonged to nuclear family and only 47 (44.76%) belonged to joint family.

Regarding occupational status of women majority 100 (95.23%) of the

mother’s were Housewives and 2 (1.90%) were professionals.

From the financial point of view, the family income indicates that majority

41 (39.04%) of the family income ranged between Rs. 2001-3000 per month and 1

(0.95%) ranged between Rs. 5001 and above per month.

Regarding diet majority 77 (73.33%) of the mothers were taking mixed

diet, whereas 28 (26.66%) of the mothers were taking vegetarian diet.

32
 Abbreviations

Graph - 1
Distribution of mothers according to sociodemographic data

33
 Abbreviations

TABLE NO. 1 B
Distribution of mothers according to base line data
N = 105

S.No Variables Frequency (f) Percentage (%)

9 Registered during
1st trimester 59 56.19
2nd trimester 38 36.19
3rd trimester 10 9.52
10 Obstetric score
Primigravida 33 31.42
Multigravida 72 68.57
11 11.1 Menstrual history
Less than 3 days 4 3.80
Between 3 to 5 days 97 92.38
More than 5 days 4 3.80
11.2 Amount of blood flow
Heavy & regular 41 39.04
Heavy & irregular 3 2.85
Scanty & regular 58 55.23
Scanty & irregular 3 2.85
12 Birth spacing between previous
pregnancies
< 2 years 18 17.14
2 - 3 years 49 46.66
> 3 years 7 6.66
13 Haemoglobin level (According to
WHO classification :
Mild degree (9.1 - 11 gm/dl) 53 50.47
Moderate degree (7.1 - 9.0 29 27.61
gm/dl)
Severe degree (<7.0 gm/dl) 3 2.85

The data presented in table 1b reveals that 59 (56.19%) of mothers were

registered during 1st trimester, where as 38 (36.19%) of mothers were registered

during 2nd trimester, only 10 (9.52%) of the mothers were registered during 3 rd

trimester.

34
 Abbreviations

Regarding obstetric score majority 72 (68.57%) of the mothers were

multigravida, where as only 33 (31.42%) of the mothers were primigravida. From

the menstrual history, majority 97 (92.38%) of the mothers had menstrual flow

ranging between (3-5 days and 4 (3.80%) of the mother had less than 3 days and

also 4 (3.80%) of the mothers had more than 5 days. Regarding the amount of

blood flow shows that maximum 58 (55.23%) of the mothers had scanty and

regular flow, 41 (39.04%) of them had heavy and regular periods, 3 (2.85%) of

them had heavy and irregular periods, 3 (2.85%) of them had scanty and irregular

periods.

It was also observed that, Birth spacing between previous pregnancies

shows that majority 49 (46.66%) of the mothers had the range between 2-3 years,

18 (17.14%) of the mothers had > 2 years and 7 (6.66%) of the mothers had < 3

years.

According to WHO classification; the haemoglobin of the mothers shows

that majority 53 (50.47%) of them had mild anaemia, where as 29 (27.61%) of

them had moderate anaemia, only 3 (2.85%) of them had severe anaemia.

35
 Abbreviations

Graph - 2
Distribution of mothers according to base line data

36
 Abbreviations

SECTION II :

KNOWLEDGE REGARDING ANAEMIA AND ITS PREVENTION

TABLE NO. 2

Mean, median and standard deviation of knowledge scores of the registered

pregnant mothers regarding prevention of the anaemia
N = 105

Mean Median SD

18.142 53 4.84

Table No. 2 shows that, the Mean, Median and SD of knowledge scores
regarding disease aspects and prevention of anaemia among registered pregnant
mothers attending antenatal clinics, the mean 18.142, median 53, SD 4.84.

TABLE NO. 3

Distribution of subjects according to level of knowledge of disease aspects and

prevention of anaemia N = 105

Level of knowledge Frequency Percentage %

<X-1SD (<13) Poor 16 15.23
≥ X - 1SD to X + SD (13 + 21) average 76 72.38
>X + 1SD (>21)-Good 13 12.38
Total 105 100

Above table shows the level of knowledge scores regarding. Disease

aspects and prevention of anaemia among registered pregnant mothers.
The level of knowledge was categorized on the obtained mean and
standards deviation of total correct knowledge scores. Out of which 12.38%
mothers had high or good knowledge (X+1SD), 72.38% mothers had average
knowledge (X-1SD to X+1SD), 15.23% mothers had poor knowledge (X-1SD).

37
 Abbreviations

Graph - 3

Distribution of subjects according to level of knowledge of disease aspects and

prevention of anaemia

38
 Abbreviations

TABLE NO. 4 A

Distribution of mothers according to knowledge on various aspects of anaemia

N = 105

I VARIOUS ASPECTS OF ANAEMIA Frequency (f) Percentage (%)

1 Pregnancy creates large demand of iron 95 90.47

2 Increase Hb% in the blood is anaemia 31 29.52

3 Anaemia is a nutritional disorder 55 52.38

4 Haemoglobin value in pregnancy is iron 31 29.52

8gm%

5 Iron required for Hb formation 46 43.80

The above table reveals that 95 (90.47%) of mothers know that pregnancy

creates a large demand of iron, whereas 55 (52.38%) of mothers responded

correctly that anaemia is a nutritional disorder; 46 (43.80%) of mothers responded

correctly that elemental iron is important for haemoglobin formation, whereas

only 31 (29.52%) of mothers were aware of what is anaemia and knew the normal

value of haemoglobin.

39
 Abbreviations

Graph - 4

Distribution of mothers according to various aspects of anaemia

40
 Abbreviations

TABLE NO. 4 B

Distribution of mothers according to knowledge on causes

N = 105

S. Percentage
Causes Frequency (f)
No (%)

1 Obesity in pregnancy 18 17.14

2 Hook worm infestation and malaria 24 22.85

3 Haemorroids during pregnancy 18 17.14

4 History of heavy menstrual flow 20 19.04

5 Bleeding disorders 25 23.80

6 Repeated pregnancies 41 39.04

7 Recurrent abortions 64 60.95

8 Twin pregnancy 17 16.19

9 Faulty dietary habits 91 86.66

From the above table, it is observed that 91 (86.66%) of mothers knew that

faulty dietary habits causes anaemia, 64 (60.95%) of mothers responded correctly

that recurrent abortions causes anaemia. Whereas 41 (39.04%) mothers knew that

repeated pregnancies leads to anaemia, 25 (23.80%) of mothers knew that

bleeding disorders in previous pregnancy labour and puerperium causes anaemia,

24 (22.85%) of them knew that hookworm infestation and malaria is the leading

cause for anaemia. Twenty (19.04%) of the mothers responded correctly that

history of heavy menstrual flow causes anaemia, only 18 (17.14%) were aware that

obesity in pregnancy and harmorroids causes anaemia.

41
 Abbreviations

Graph - 5

Distribution of mothers according to knowledge on causes

42
 Abbreviations

TABLE NO. 4 C

Distribution of mothers according to knowledge on signs and symptoms of

anaemia

N = 105

S. No Signs And Symptoms Frequency (f) Percentage (%)

1 Tiredness and weakness 84 80.00

2 Pallor of the face, eyes, lips, tongue and 57 54.28

nails

3 Palpitation and breathing difficulty 11 10.47

The above table shows that, majority 84 (80%) of the mothers knew that

tiredness and weakness are the symptoms of anaemia and 57 (54.28%) of mothers

knew that pallor of the face, eyes, lips, tongue and nails are the important signs of

anaemia; only 11 (10.47%) of mothers were aware that palpitation and breathing

difficulty are the signs of anaemia.

43
 Abbreviations

Graph - 6

Distribution of mothers according to knowledge on signs and symptoms of anaemia

44
 Abbreviations

TABLE NO. 5A
Distribution of mothers according to knowledge on sources of iron rich foods
N = 105

S. No Diet Frequency (f) Percentage (%)

1 Well balanced diet prevents anaemia 88 83.80
2 Green leafy vegetables, cabbage and 76 72.38
sprouted grams are rich in iron
3 Avoidance of Ragi and Jaggery 53 50.47
4 Meat, fish, liver and eggs contain rich 73 69.52
source of iron
5 Avoidance of Potato during pregnancy 40 38.09
6 Dates & dry grapes contains rich source 78 74.28
of iron
7 Absorption iron and citrus fruits 19 18.09
8 Interference of Tea and coffee with iron 18 17.14
9 Avoid iron tablets with milk 46 43.80
10 Consuming meals lastly whatever is left 85 80.95
over
11 Fasting during pregnancy 74 70.47

The above table describes that 88 (83.80%) of mothers responded correctly

that well balanced diet prevents anaemia, whereas 85 (80.95%) of mothers
responded correctly that pregnant mothers “should not eat last in the family”, and
also 78 (74.28%) of them responded correctly that “dates and dry grapes” are rich
sources of iron. 76 (72.38%) of mothers responded correctly that “green leafy
vegetables, cabbage and sprouted grains are rich in iron, 73 (69.52%) of mothers
responded correctly that “meat, fish, liver and eggs are rich in iron”, whereas 53
(50.47%) of mothers knew that “ragi and jaggery should not to be avoided during
pregnancy”. Forty-six (43.80%) of mothers had knowledge that iron tablets are not
to be taken with milk or any hot drinks. Forty (38.09%) of mothers knew that
potato should not be avoided during pregnancy.
Only 18 (17.14%) of the mothers were aware that tea and coffee inhibits
absorption of iron. Nineteen (18.09%) of the mothers were aware that orange and
lemon juice promotes absorption of iron.

45
 Abbreviations

TABLE NO. 5B

Distribution of mothers according to knowledge on personal hygiene

N = 105

S. No PERSONAL HYGIENE Frequency (f) Percentage (%)

1 Nails must be kept clean and short 103 98.09

2 Washing hands with mud after 50 47.61

defecation is good

3 Wearing of chappals for open fields 94 89.52

From the above table, the items revealed that majority 103 (98.09%) of

mothers knew that nails must be always kept clean and short. where as 94

(89.52%) of mothers responded that foot wear should be used while walking in

open fields and only 50 (47. 61%) of mothers were aware that using mud for

washing hands after defection is a wrong practice.

46
 Abbreviations

TABLE NO. 5C
Distribution of mothers according to knowledge on treatment
N = 105

S. No Treatment Frequency (f) Percentage (%)

1 Regular medical check up is necessary 102 97.14

2 Daily intake of iron and folic acid tablet is 44 41.90

not necessary

3 Iron and folic acid tablet leads to big 15 14.28

babies

4 Iron and folic acid tablet leads to 48 45.71

constipation

5 Adequate treatment is necessary to 92 87.61

eradicate Hookworm

From the above table the items revealed that majority 102 (97.14%) of

mothers had knowledge that regular medical check up during pregnancy is

necessary; 92 (87.61%) mothers knew that to prevent anaemia, adequate treatment is

necessary to eradicate Hookworm infestation and malaria, whereas 44 (41.90%) of

mothers that knew regular intake of iron and folic acid tablet is necessary during

pregnancy, only 15 (14.28%) of mothers were aware that intake of iron and folic acid

tablet does not leads to big babies.

47
 Abbreviations

SECTION III
PRACTICES REGARDING PREVENTION OF ANAEMIA

TABLE NO. 6A
Distribution of mothers according to practices regarding diet
N = 105

BENEFICIAL NON- BENEFICIAL

S.
DIET PRACTICES PRACTICES
No
F % F %
1 Pregnancy imposes extra energy 93 88.57 12 11.42
and nutrients
2 Change in normal dietary pattern 58 55.23 47 44.76
3 Following strict meal schedule 76 72.38 29 27.61
4 Consuming meals lastly whatever 100 95.23 5 4.76
is left over
5 Continued fasting during 100 95.23 5 4.76
pregnancy
6 Eating special food preparations 22 20.95 83 79.04
during fasting
7 Avoidance of hot foods 34 32.38 71 67.61
8 Following pica practices 94 89.52 11 10.47
9 Including of meat, fish, eggs 44 41.90 61 58.09
10 Intake of green leafy vegetables 63 60.00 42 40.00
and sprouted grams
11 Washing vegetables before cutting 103 98.09 2 1.90
12 Including seasonal fruits and dry 98 93.33 7 6.66
fruits
13 Drinking of eight to ten glasses of 60 57.14 45 42.85
water
14 Including fibre rich diet and fruits 57 54.28 48 45.71
15 Eating Ragi and jaggery 64 60.95 41 39.04

From the above table items related to diet revealed that majority 10 0

(95.23%) of mothers were taking food before consumption of family members and

100 (95.23%) mothers were not fasting on any day during pregnancy. Ninety-eight

48
 Abbreviations

(93.33%) mothers were taking seasonal fruits and dry fruits during pregnancy.

Ninety four (89.52%) mothers gave no history of pica. Ninety-three (88.57%) of

mothers were aware that pregnancy needs extra energy and nutrients. Seventy-six

(72.38%) of mothers were practicing strict meal schedule. Sixty-four (60.95%) of

mothers were using ragi and jaggery in their diet. Sixty three (60%) of mothers

were using, green leafy vegetables and sprouted grams regularly. 60 (57.14%) of

mothers were drinking 8-10 glasses of water per day, 58 (55.23%) of mothers

changed their normal dietary pattern due to pregnancy and 57 (54.28%) of mothers

were taking fibre rich diet and fruits regularly. Only 22 (20.95%) of mothers were

taking special food preparations during fasting, 34 (32.38%) of mothers did not

consume hot foods during pregnancy and 44 (41.90%) of mothers were eating

meat, fish and eggs during pregnancy.

49
 Abbreviations

Graph - 7
Distribution of mothers according to practices regarding diet

50
 Abbreviations

TABLE NO. 6B

Distribution of mothers according to hygienic practices

N = 105

S. HYGIENE BENEFICIAL NON- BENEFICIAL

No PRACTICES PRACTICES
F % F %
1 Practicing open-air defecation 52 49.52 53 50.47

2 Wearing of chappals 63 60.00 42 40.00

3 Hand washing after defecation 70 66.66 35 33.33

4 Nail care once in a week 58 55.23 47 44.76

From the above table, items related to hygiene describes that majority 70

(66.66%) of the mothers were washing the hands with soap after defecation and

majority 63 (60%) of the mothers were using chappals when going for open air

defecation, only 52 (49.52%) of mothers were practicing open air defecation, 58

(55.23%) mothers were cutting their nails once in a week.

51
 Abbreviations

Graph - 8

Distribution of mothers according to hygienic practices

52
 Abbreviations

TABLE NO. 6C

Distribution of mothers according to practices regarding treatment

N = 105

S. No Treatment BENEFICIAL NON- BENEFICIAL

PRACTICES PRACTICES
F % F %
1 Seeking medical help during 104 99.04 1 0.95
pregnancy
2 Periodical deworming 35 33.33 70 66.66
3 Iron requirement for the 97 92.38 8 7.61
growth of the baby
4 Regular in take of iron 58 55.23 47 44.76
supplements

From the above table items related to treatment depicts that maximum 104

(99.04%) of the mothers seek medical help during pregnancy. Ninety-seven

(92.38%) of mothers were taking iron supplements for the growth of the baby and

58 (55.23%) of the mothers were taking regular iron supplements. Only 35

(33.33%) of the mothers took medications for deworming.

Table No. 7 :

Mean and standard deviation of practices scores regarding prevention of anaemia

among registered pregnant mothers

N=105

Mean Standard deviation (SD)

15.22 4.82

The table No 7 shows the mean and SD of practices scores. Mean 15.22, SD 4.82.

53
 Abbreviations

Graph - 9
Distribution of mothers according to practices regarding treatment

54
 Abbreviations

ASSOCIATION BETWEEN KNOWLEDGE AND SELECTED

VARIABLES
TABLE NO. 8A

Association between knowledge and age N = 105

Knowledge
Age Total
Poor Average Good
15-19 6 10 5 21
20-24 9 40 7 56
25-30 1 22 1 24
31 yrs and above 0 4 0 4
Total 16 76 13 105

P = 0.015 χ2 = 12.355 df = 4

χ2 calculated value shows that there is statistically significant association

between age of the mothers and level of knowledge at p<0.005.

TABLE NO. 8B

Association between knowledge and Women’s Education : N = 105

Knowledge
Women’s education Total
Poor Average Good
No formal education 13 22 0 35

Primary education 2 14 0 16

Secondary education 1 25 4 30

Higher secondary education 0 9 3 12

Graduate 0 6 6 12

Total 16 76 13 105
P = 0.000 χ2 = 20.586 df = 2

χ2 calculated value shows that there is statistically significant association

between mothers educational status and level of knowledge at p<0.005.

55
 Abbreviations

TABLE NO. 8C

Association between knowledge and Family income N = 105

Knowledge
Family income Total
Poor Average Good

Below 2000/month 2 21 0 23

Rs. 2001-3000/month 11 28 2 41

Rs. 3001-4000/month 3 21 4 28

Rs. 4001-5000/month 0 5 7 12

Rs. 5001 and above 0 1 0 1

Total 16 76 13 105

P = 0.000 χ2 = 19.047 df = 4

χ2 calculated value shows that there is statistically significant association

between mothers family income and level of knowledge at p<0.005.

TABLE NO. 8D

Association between knowledge and Gravid status of mothers obstetric score

N = 105

Knowledge
Gravida Total
Poor Average Good
Primigravida 2 27 4 33
Multigravida 14 49 9 72
Total 16 76 13 105

P = 0.196 χ2 = 3.254 df = 2

χ2 calculated value shows that there is no statistically significant

association between mothers gravid status and level of knowledge at p<0.005.

56
 Abbreviations

ASSOCIATION BETWEEN PRACTICES AND SELECTED VARIABLES

TABLE NO. 9A

Association between practices and age N = 105

Practices
Age Total
Beneficial Non-beneficial
15-19 5 16 21
20-24 15 41 56
25-30 8 16 24
31 yrs and above 0 04 4
Total 28 77 105

P = 0.932 χ2 = 0.140 df = 2

χ2 calculated value shows that there is no statistically significant

association between age in years of the mothers and practices at p<0.005.

TABLE NO. 9B
Association between practices and women’s education
N = 105

Practices
Women’s education Total
Beneficial Non-beneficial
No formal education 2 33 35
Primary education 1 15 16
Secondary education 15 15 30
Higher secondary education 8 04 12
Graduate 2 10 12
Total 28 77 105
P = 0.000 χ = 22.381
2
df = 3

χ2 calculated value shows that there is statistically significant association

between mothers educational status and practices at p<0.005.

57
 Abbreviations

TABLE NO. 9C

Association between practices and family income

N = 105

Practices
Family income Total
Beneficial Non-beneficial

Below 2000/month 2 21 23

Rs. 2001-3000/month 5 36 41

Rs. 3001-4000/month 14 14 28

Rs. 4001-5000/month 7 05 12

Rs. 5001 and above 0 01 01

Total 28 77 105

P = 0.000 χ2 = 20.828 df = 2

χ2 calculated value shows that there is statistically significant association

between mothers family income and practices at p<0.005.

TABLE NO. 9D
Association between practices and gravid status of mothers obstetric score :
N = 105

Practices
Gravid status Total
Beneficial Non-beneficial
Primigravida 12 21 33
Multigravida 16 56 72
Total 28 77 105
P = 0.120 χ2 = 2.314 df = 1

χ2 calculated value shows that there is no statistically significant

association between mothers gravid status and practices at p<0.005.

58
 Abbreviations

ASSOCIATION BETWEEN KNOWLEDGE AND PRACTICES

TABLE NO. 10

Association between knowledge and practices regarding prevention of anaemia

among registered pregnant mothers

N=105

Practices
S. Knowledge Total
No Beneficial Non-beneficial
1 Poor 0 16 16
2 Average 16 60 76
3 Good 12 01 13
Total 28 77 105

P = 0.000 χ2 = 28.972 df = 1

χ2 calculated value shows that there is statistically significant association

between level of knowledge and practices at p < 0.005 level of significance. This

clearly shows that women having good knowledge tend to show inclination

towards beneficial practices than women with poor and average knowledge.

59
 Abbreviations

CHAPTER V

Major Findings, Discussion, Summary, Conclusion,

Implications, Limitations & Recommendations

Major Findings

Findings are as follows :

¾ Majority of mothers (53.33%) were between the age group of 20-24 years. ¾

Most of the mothers (33.33%) had no formal education.

¾ Majority of the mothers (61.61%) belonged to Hindu religion.

¾ Majority of the mothers (55.23%) were from nuclear family.

¾ Maximum of the mothers (95.23%) were housewives.

¾ Data regarding income status showed that majority of the families income

(39.04%) ranged between Rs. 200/- 3000 per month.

¾ Data regarding diet showed that most of the mothers (73.33%) were taking

mixed diet.

¾ Most of the mothers (56.19%) were registered during 1st trimester.

¾ Regarding gravid status, majority of the mothers (68.57%) were

multigravida.

¾ Data regarding birth spacing between previous pregnancies shows that

majority of the mothers (46.66%) had the range between 2-3 years.

¾ According to WHO classification the haemoglobin of the mothers shows

that majority (50.47%) of them had mild anaemia.

60
 Abbreviations

To summarize the study, following are major findings :

1. 49.14% of the mothers had knowledge regarding disease aspects of

anaemia, 33.64% had knowledge regarding cause whereas 48.19% had

knowledge about signs and symptoms.

2. Knowledge regarding prevention anaemia showed that 56.27% of the

mothers had knowledge regarding diet, 78.04% had knowledge regarding

personal hygiene, whereas 57.33% had knowledge about treatment.

3. Practices regarding prevention of anaemia showed that 67.67% of the

mothers were taking care of diet, 57.85%, of the mothers maintained

adequate personal hygiene, 70.00% of mothers seeked medical help.

4. There is statistically significant association between age in years of the

mothers and level of knowledge at P<0.005 level of significance.

5. There is statistically significant association between mothers educational

status and level of knowledge at P<0.005 level of significance.

6. There is statistically significant association between mothers family

income and level of knowledge at P<0.005 level of significance.

7. There is statistically significant association between women’s education

and practices at P<0.005 level of significance.

8. There is statistically significant association between family income of the

mothers and practices at p < 0.005 level of significance.

Looking into above facts (Ho) hypothesis is accepted since value of

calculated χ2 (28-972) shows that there is significant association between

knowledge and practices at the level of p < 0.005. This clearly shows that women

having good knowledge tend to show inclination towards beneficial practices than

women with poor and average knowledge.

61
 Abbreviations

Discussion

This chapter deals with the discussion and summary of the study and the

conclusions drawn. Nursing implications of the study are also given for the

different aspects like nursing education, nursing practice. It classifies the

limitations of the study and suggests recommendation for the future research.

The study was undertaken with the main purpose of assessing the level of

knowledge and identify the practices regarding prevention of anaemia among

registered pregnant mothers attending antenatal clinics. To achieve the set

objectives of the study, a total of 105 mothers were studied. In order to get the

projected results, the study focused its attention on registered pregnant mothers

attending antenatal clinics in K.L.E.S Hospital and MRC Belgaum. Samples were

selected as per planned sampling criteria and structured interview schedule with

the following headings used to elicit the responses

1. Knowledge regarding anaemia and knowledge regarding prevention of

anaemia.

2. Practices regarding prevention of anaemia.

SECTION I

Ia. Findings related to sociodemographic data :

Table : 1A represents the distribution of mothers according to socio

demographic and baseline data. Majority of the mothers (53.33%) were in the age

group of 20-24 years and only (3.80%) were in the age group of 30 years and

above. Similar findings were found in a study done by Edda’ma Mahmoud R.

62
 Abbreviations

(1995) which showed that associated risk factors with anaemia in pregnancy were

increasing with age. The range of anaemia in the following age groups was for 20

years 27.6%; 20-24 years 55.4%; 25-29 years 51%; and 30 years and above

47.2%.49 Regarding their educational status, (33.33%) of the mothers had no

formal education while (11.42%) were graduates. This indicates that literacy level of

women in India has not improved (32.38%) of husbands had secondary

education and only (5.71%) did not have any education. This shows that husbands are

always more educated than wives

It was observed that majority of mothers (67.61%) were Hindus and

(1.90%) belonged to other religion. It was also seen from the above table that

(55.23%) of the mothers belonged to Nuclear Family; only (44.76%) belonged to

Joint Family. One of the reason for disintegration of the family from joint to

nuclear may be due to unemployment. Most of the rural families are shifting to the

urban areas for the sake of jobs. It was also seen that majority of the mothers

(95.23%) were housewives and (1.90%) were professionals. Further from the

economic point of view, the family income indicated that majority of the families

(39.04%) income ranges were between Rs. 2001-3000 per month and (0.95%)

ranges were between Rs. 5001 and above per month. Hence to balance income, the

mothers were not able to lead a healthy life style.

It was also observed that majority of the mothers (73.33%) were taking

mixed diet, only (26.66%) of the mothers were taking vegetarian diet. Similar

findings supports the study done by Griffiths and Bentely 2001. They founded that

Disparities in women’s nutrition status were primarily related to women’s access to

resources and income.13

63
 Abbreviations

Ib. Findings related to base line data :

Regarding registration majority of the mothers (56.19%) were registered

during 1st trimester, only (9.52%) were registered during 3 rd trimester. It was

observed that majority (68.57%) of the mothers were multigravida’s where as

(only 31.42%) were primigravida’s. This indicates that multigravida mothers had

awareness regarding registration. Regarding birth spacing between previous

pregnancies, majority (46.66%) of the mothers ranges were between 2-3 years,

only (6.66%) had <3 years of gap between 2 pregnancies. According to WHO

classification, the haemoglobin level of the mothers shows that majority (50.47%)

of them had mild anaemia, only (2.85%) had severe anaemia. Similar findings

were found in a study done by Gies.S Barbin B.J Yassin M.A and Cuevas, L.E

(2003), where 10.4% of mothers had mild anaemia 4.2% had moderate anaemia

(0.3%) had severe anaemic.36

SECTION II

Findings related to knowledge regarding anaemia and its prevention of

anaemia :

Table No. 4a depicts that 95 (90.47%) of mothers knew that pregnancy

creates large demand of iron. Only 31 (29.52%) of mothers were aware of what is

anaemia and 31 (29.52%) of mothers knew the normal value of haemoglobin. This

clearly shows that majority of mothers had poor knowledge regarding disease

aspects of anaemia.

Table No 4b reveals that 91 (86.66%) of mothers knew that faulty dietary

habits causes anaemia. Only 18 (17.14%) were aware that obesity in pregnancy

and also haemorroids causes anaemia. The findings of the study supports the study

64
 Abbreviations

supports the study done by Kilemann (2000), Amin (2000) hypothesized that

findings in women with low BMI (<18.5 kg M2) would have a higher risk of

anaemia compared to women of normal or overweight.48

This clearly shows that majority of mothers had poor knowledge regarding

causes of anaemia..

Table No. 4c shows that majority 84 (80%) of the mothers had good

knowledge that tiredness and weakness were the symptoms of anaemia. Only 11

(10.47%) of mothers were aware that palpitation and breathing difficulty are the

signs of anaemia.

The findings of the study supports the study done by Gies. S. Brabin B.J.

Yassin M.A and Cuevas L.E. (2003). The reported complaints and their

frequencies shows that breathlessness was reported more frequently by pregnant

anaemic women, while dizziness was reported by 117 women. Anaemic pregnant

women stopped walking more frequently than that of non-anaemic women (76.5%

vs 56% P=0.19). As Swollen face (16.7% vs 3.1% P=0.02) and perceived paleness

or change of skin colour (22.2% vs 9.9% P=0.11) were more frequently reported

by women with Hb level <10g/dl. The over all mean knowledge for signs and

symptoms were 50.6 (48.19%). This depicts that majority of mothers had poor

knowledge regarding signs and symptoms of anaemia.36

Table 5a describes that 88 (83.80%) of mothers responded correctly that

well balanced diet prevents anaemia. Only 18 (17.14%) of the mothers were aware

that tea and coffee habits absorption of Iron. Nineteen (18.09%) of the mothers

were aware that orange and lemon juice promotes absorption of Iron. The findings

of the study supports the study done by New Castle Tyne (2001) explained that

awareness of the link between anaemia and diet may be low. In a national lifestyle

surveys, less than 1% of respondents mentioned anaemia as a problem related to

65
 Abbreviations

diet. They also found that anaemia tended to be more common in those who rarely or

never ate meat.47 This clearly shows that majority of mothers had average

knowledge regarding diet.

In Table 5b it was found that majority of the mothers had good knowledge

regarding personal hygiene.

Table 5c describes with knowledge regarding treatment. whereas 44

(41.90%) of mothers knew that regular. Intake of iron folic acid tablet is necessary

during pregnancy. The findings of the study supports the study done by Verma,

M. Chhatwal, J. and Varughese, P. V. (1995) shows that there was a significant

rise in knowledge for the need for Hematinics tablets during pregnancy in both

control and intervention groups but only the intervention group showed a

significant rise in the knowledge of the purpose of taking tablets. 38 It is evident

that majority of the mothers had average knowledge regarding treatment.

SECTION III

Findings related to practices regarding prevention of anaemia :

Table 6a depicts items related to practices of diet revealed that majority

100 (95.23%) of mothers were taking food before consumption of family members

and Ninety-four (89.52%) mothers gave no history of pica. The findings of the

study supports the study done by Manocha S, Aneeta A.M Puram R.K. (1992).

It explained that women in all the three villages of Haryana developed craving for

citrus foods, raw mango, guava, tomato red chillies and pickles of all kinds. A few

craved for sweets, aversion towards certain foods like pulses, chapattis, fried foods

during pregnancy is noticeable drawing inedible substances like chullah ash,

chullah mud and clay is found to be common in 26%, 46% and 16% of the

66
 Abbreviations

respondents respectively. Women were found to be very causal about their foods

intakes.35

Table 6b describes that majority 63 (60%) of the mothers were using

chappals while going for open air defecation. The findings of the study contradicts

the study done by Tanjua D Karmarkar V, Sampathkumar S Jayalakshmi and

Abel R (1998). In this study data collected as to the practice of wearing slippers

while going out, founded that, only 4.0% tribal women were wearing slippers

regularly while 64.0% were wearing occasionally and 32.0% were not wearing at

all. This may increase the chances of getting hookworm infestation there by

causing anaemia.37

Table 6c items related to practices regarding treatment depicts that ninety-

seven (92.38%) of mothers were taking iron supplements for the growth of the

baby and 58 (55.23%) of the mothers were taking regular iron supplements. Only

35 (33.33%) of the mothers took medications for deworming. Similar findings

supported the study done by Dr. Chandra C. P (2004) found that, 74 (59.68%)

pregnant women took IFA tablets and 50 (40.32%) did not take. Among 74 who

received IFA tablets, only 52 (70.27%) pregnant women took the tablets regularly

and remaining 22 (29.73%) took the tablets irregularly. The various causes for not

taking of IFA tablets by the pregnant women in our study were : no antenatal care

in to (20.00%) diarrhoea among 10 (20.00%) vomiting in 9 (18.00%) gastritis

among 5 (10.00%) cause body heat in 4 (8.00%) and in 3 (6.00%) each due to

head ache, constipation, fetus will grow big leading to difficult labour and bitter

taste. The over all mean practices was 73.50 (70.00%).34

67
 Abbreviations

Findings related to knowledge and selected variables :

There is statistically significant association between age in years of the

mothers and level of knowledge at P<0.005 level of significance. Hence the

research hypothesis is accepted.

There is statistically significant association between mothers educational

status and level of knowledge at P<0.005 level of significance. Hence the research

hypothesis is accepted.

There is statistically significant association between mothers family income

and level of knowledge at P<0.005 level of significance. Hence the research

hypothesis is accepted.

There is no statistically significant association between gravid status of

mothers obstetric score and level of knowledge at P<0.005 level of significance.

Hence the research hypothesis is rejected.

Findings related to practices and selected variables :

There is no statistically significant association between age in years of

mothers and practices at P<0.005 level of significance. Hence the research

hypothesis is rejected.

There is statistically significant association between women’s education

and practices at P<0.005 level of significance. Hence the research hypothesis is

accepted.

There is statistically significant association between family income of the

mothers and practices at p < 0.005 level of significance. Hence the research

hypothesis is accepted.

68
 Abbreviations

There is no statistically significant association between gravid status of the

mothers obstetric score and practices at p < 0.005 level of significance. Hence the

research hypothesis is rejected.

Findings related to association between knowledge and practices :

There is statistically significant association between level of knowledge

and practices at p < 0.005 level of significance. This clearly shows that women

having good knowledge tend to show inclination towards beneficial practices than

women with poor and average knowledge.

69
 Abbreviations

SUMMARY
Despite dramatic advances in human health that have occurred during the

20th century; the beginning of 21 st century still has many places in the world with

high maternal mortality rates due to anaemia complications during pregnancy and

puerperium.

A WHO study shows that anaemia prevalence is disportionately high in the

developing countries due to poverty, inadequate diet, certain diseases, lactation

and poor access to health services and lack of awareness regarding anemia and its

prevention.

Pregnant mothers needs to improve their practices on preventive,

promotive and curative aspects to prevent the consequences of anaemia. It is of a

concern that pregnant mothers should equip themselves with adequate knowledge

about the disease aspects and prevention of untoward complications through

beneficial practices.

The present study was conducted with a view to find out levels of

knowledge and practices regarding prevention of anaemia among registered

pregnant mothers.

The conceptual framework for the study was derived from the health

promotion model proposed by Nola J. Pender in the year 1996. The main

component of this framework are individual characteristics and experiences,

activity related affect, commitment of a plan of action.

The tool for the data collection included background proforma knowledge

and practices questionnaire regarding prevention of anaemia.

70
 Abbreviations

The data collection was carried out between 01/09/2005 to 30/09/2005

which included collection of information on socio-demographic and baseline data

structured interview schedule. In this verbal responses were recorded with use of

structured interview schedule at K.L.E.S obstetrics and gynaecological antenatal

OPD.

The subjects studied were 105 registered pregnant mothers.

Findings are as follows :

¾ Majority of mothers (53.33%) were between the age group of 20-24 years. ¾

Most of the mothers (33.33%) had no formal education.

¾ Majority of the mothers (61.61%) belonged to Hindu religion.

¾ Majority of the mothers (55.23%) were from nuclear family.

¾ Maximum of the mothers (95.23%) were housewives.

¾ Data regarding income status showed that majority of the families income

(39.04%) ranged between Rs. 200/- 3000 per month.

¾ Data regarding diet showed that most of the mothers (73.33%) were taking

mixed diet.

¾ Most of the mothers (56.19%) were registered during 1st trimester.

¾ Regarding gravid status, majority of the mothers (68.57%) were

multigravida.

¾ Data regarding birth spacing between previous pregnancies shows that

majority of the mothers (46.66%) had the range between 2-3 years.

¾ According to WHO classification the haemoglobin of the mothers shows

that majority (50.47%) of them had mild anaemia.

71
 Abbreviations

To summarize the study, following are major findings :

1. 49.14% of the mothers had knowledge regarding disease aspects of

anaemia, 33.64% had knowledge regarding cause whereas 48.19%

had knowledge about signs and symptoms.

2. Knowledge regarding prevention anaemia showed that 56.27% of

the mothers had knowledge regarding diet, 78.04% had knowledge

regarding personal hygiene, whereas 57.33% had knowledge about

treatment.

3. Practices regarding prevention of anaemia showed that 67.67% of

the mothers were taking care of diet, 57.85%, of the mothers

maintained adequate personal hygiene, 70.00% of mothers seeked

medical help.

4. There is statistically significant association between age in years of

the mothers and level of knowledge at P<0.005 level of

significance.

5. There is statistically significant association between mothers

educational status and level of knowledge at P<0.005 level of

significance.

6. There is statistically significant association between mothers family

income and level of knowledge at P<0.005 level of significance.

7. There is statistically significant association between women’s

education and practices at P<0.005 level of significance.

8. There is statistically significant association between family income

of the mothers and practices at p < 0.005 level of significance.

72
 Abbreviations

Looking into above facts (Ho) hypothesis is accepted since value of

calculated χ2 (28-972) shows that there is significant association between

knowledge and practices at the level of p < 0.005. This clearly shows that women

having good knowledge tend to show inclination towards beneficial practices than

women with poor and average knowledge.

73
 Abbreviations

CONCLUSION

Based on the findings of the study, the following conclusions were drawn

1. Knowledge regarding disease aspects, causes and signs and symptoms

was poor.

2. Knowledge regarding prevention of anaemia shows that, knowledge on

dietary aspect was average, personal hygiene was good and treatment was

average.

3. Practices regarding prevention of anaemia shows that dietary practices

were good, Hygiene practices were average and practices regarding

treatment were good.

4. There was a significant relationship between the age in year of the

mothers and level of knowledge.

5. There was a significant relationship between the educational status of the

mothers and level of knowledge.

6. There was a significant relationship between the family income of the

mothers and level of knowledge.

7. There was a significant relationship between the educational status of the

mothers and practices.

8. There was a significant association between family income of the

mothers and practices.

9. There was a significant association between level of knowledge and

practices.

With the help of available knowledge and practices, further intensive health

education can be planned and implemented to motivate the mothers to practices

beneficial practices to prevent anaemia among pregnant mothers.

74
 Abbreviations

IMPLICATIONS OF THE STUDY

The findings of the study has implications on nursing practice, nursing

education and nursing research.

Implication for Nursing practice :

Since the present study revealed that most of the mothers had average

knowledge and few had poor knowledge than who had good, concerted efforts

must be made by nurse to increase more knowledge and created awareness

regarding prevention of anaemia.

The nurses are the link between the consumers and the health care system.

Being in this pivotal role they could plan and design considering the culture,

custom, tradition, present attitudes and practices.

The nurses may disseminate certain ill practices and false beliefs. They can

also demonstrate and re-demonstrate on identification of signs and symptoms,

practices on diet, hygiene, prevention and control of the disease.

Implications for nursing education :

The educational background of a nurse should equip her with the

knowledge that is necessary to function as a health educator. Since health

education is the way to improve knowledge and modify practices, therefore

nursing education should emphasize on :

™ Adequate knowledge about anaemia in pregnancy.

™ The skills to develop and prepare educational materials fitting to the needs.

™ Competency in guidance and counseling of the mothers and their family

members.

75
 Abbreviations

The decision making must be taught to family members. Health personnel

requires knowledge in depth. The education should not provide only knowledge but

it should be practically practiced by the pregnant mothers.

Students and teacher may work together in clinical area to disseminate

knowledge on cause, spread, signs and symptoms and prevention regarding

anaemia and practices.

c. Nursing research :

Based on the findings, the professional and student nurses can conduct

further studies on knowledge and practices regarding prevention of anaemia

among pregnant mothers for the implementation in more broader and easy way to

make the programme people friendly and popular. Further the study will also

motivate the beginning researchers to conduct similar study in large scale.

LIMITATIONS

1. The present study was limited to only 105 pregnant mothers.

2. The study was limited to the samples from out patient departments.

3. The study was limited to registered pregnant mothers attending antenatal

clinics.

4. No broad generalization could be made due to limited area of setting and

limited sample size.

76
 Abbreviations

RECOMMENDATIONS

1. A similar study can be conducted in a broader area in order to draw

generalization.

2. A similar study can be conducted in different settings and in different

social economic strata.

3. A study can be conducted on attitude of registered pregnant mothers

regarding prevention of anaemia attending antenatal clinics.

4. A study can be conducted on a large sample of the same problem and a

control group can be kept for comparison of the result.

77
 Abbreviations

CHAPTER VI

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38. Verma-M, Chhatwal J. P Varughese. P.V. Antenatal period an educationa

opportunity. Indian pediatrics. 32, 1995 : 171-177.

39. De Silva, W.I.: Towards Safe Motherhood in Sri Lanka: Knowledge,

Attitudes and Practices During the Period of Maternity. The Journal of
family Welfare. Sept 1996. 41(32) : 18-26.

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 Abbreviations

40. Park. K. Preventive and social medicine 17th edition 2002. Jabalpur
Publications.

41. George Julia B. Nursing theories the base for professional nursing practices.
Appleton and large Narwalk.

42. Polit D and Hungler B. Nursing Research Principles and Method 6 th edition,
1991 New York.

43. B. K. Mahajan methods in Biostatistics. 6th edition 1997 Jaypee Brothers

Publication New Delhi.

44. Dr. D. R. Krishnaswami. Methodology of research in Social Sciences.

Himalaya Publication House. Bombay.

45. Dutta DC. Textbook of Obstetrics 6th ed. Calcutta : New Central book
Publishers 2006 ; P. No.: 393-400.

46. Dawn CS. Text book of Obstetrics. Dawn Publications. Bombay.

47. New castle type. British Medical Journal. April 2001; 13(2);44.

48. Kilemann. Amin. Asian Pacific Journal. Sep 2000; 44(1);58.

49. Edda’ma Mahmoud R. The Nursing Journal of India. Nov 1995; XXI(5);8.

83
 Abbreviations

LETTER REQUESTING OPINION AND SUGGESTIONS FROM

EXPERTS

From,
Anitha. M
II nd year M.Sc. Nursing Student
K.L.E.’S Institute of Nursing Sciences
Belgaum-590 010

To,
_______________________________

_______________________________
_______________________________

Sub : Letter requesting opinion and suggestions of experts for

establishing content validity of the tool.

Respected Madam,

I am IInd year M.Sc Nursing student of K.L.E.’S Institute of Nursing

Sciences, Belgaum, in the speciality of Obstetrics and Gynaecological Nursing. As

per the partial fulfillment of the M.Sc Nursing Degree under Rajiv Gandhi University

of Health Sciences, Bangalore, I have selected the following topic for my dissertation

titled.

‘A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICES

REGARDING PREVENTION OF ANAEMIA AMONG REGISTERED

PREGNANT MOTHERS ATTENDING ANTENATAL CLINICS IN

SELECTED HOSPITALS OF BELGAUM’

I request you to kindly go through the instrument and state your expert

opinion and suggestions on the appropriateness of the items prepared and the items

84
 Abbreviations

which need to be modified or deleted, by using the evaluative criteria checklist

enclosed.

Kindly sign the certificate stating you have validated the tool.

I will be very grateful to you, if you could kindly send the same by 30 th June

2005.

Thanking you, with anticipation.

Yours faithfully,
Date :
Place : (Anitha. M.)

Enclosures :

1. Blue Print

2. Tool

3. Scoring key

4. Content validation proforma

5. Certificate of validation

6. Stamped self - addressed envelope

85
 Abbreviations

B. BLUE PRINT FOR STRUCTURED KNOWLEDGE AND

PRACTICE QUESTIONNAIRE

86
 Abbreviations

TOOL FOR DATA COLLECTION

STRUCTURED INTERVIEW SCHEDULE

SECTION I
SOCIO DEMOGRAPHIC AND BASELINE DATA

Code No :

1. Age :

1.1 15-19 yrs

1.2 20-24 yrs

1.3 25-30 yrs

1.4 31 yrs and above

2. Women’s education :

2.1 No formal education

2.2 Primary education

2.3 Secondary education

2.4 Higher secondary education

2.5 Graduate

3. Husband’s education :

3.1 No formal education

3.2 Primary education

3.3 Secondary education

3.4 Higher secondary education

3.5 Graduate

87
 Abbreviations

4. Religion

4.1 Hindu

4.2 Muslim

4.3 Christian

5. Type of family

Nuclear family

Joint family

Extended family

6. Woman’s occupation

6.1 House wife

6.2 Labourer

6.3 Professional

7. Family’s income

7.1 Below Rs. 2000/- month

7.2 Rs. 2001 - 3000/ month

7.3 Rs. 3001 - 4000/ month

7.4 Rs. 4001 - 5000/ month

7.5 Rs. 5001 & above
8. Diet

8.1 Vegetarian

8.2 Non-vegetarian
9. Registered during

9.1 1st trimester

9.2 2nd trimester

9.3 3rd trimester
10. Obstetric score

88
 Abbreviations

11. Menstrual history

11.1 a. Less than 3 days

b. Between 3-5 days

c. More than 5 days

11.2 Amount of blood flow

a. Heavy & regular

b. Heavy & irregular

c. Scanty & regular

d. Scanty & irregular

12. Birth spacing between previous pregnancies

13. Haemoglobin level during 1st visit _____ gm%.