CHAPTER -1

INTRODUCTION
“You can tell the condition of a nation by looking at the state of its Woman”
Jawaharlal Nehru

During pregnancy, a miracle unfolds inside the expecting mother. The baby’s
growing, the body’s changing, and hormones are surging, But there are plenty of
things which can be done to make the journey as safe and enjoyable as possible
and to prepare for what’s yet to come.

Pregnancy is a time of great physical and emotional change for woman. Everything
from the size of her belly to the speed at which her heart beats will change over the
nine months leading up to childbirth. During pregnancy, body produces more
blood to support he growth fo baby. If mother is not getting enough iron or certain
other nutrients, body might not be able to produce the amount of red blood cells it
needs to make this additional blood. It’s normal to have mild anemia when
pregnant. But there may be more serve anemia from low iron or vitamin levels or
from other reasons.

Anemia is one of the most commonly encountered medical disorders during

pregnancy. In developing counties it is a cause of serious concern as, besides many
other adverse effects on the mother and the feuts it contributes significantly high
maternal mortality. According to united Nation Deceleration 1977, anemia is a
major public health problem that needs total elimination. It is estimated that
globally two billion people suffer from anemia or iron deficiency.
NEED FOR THE STUDY
Anemia is a reduction in the oxygen-carrying capacity of blood; this may be
caused by a decrees in red blood cell (RBC) production, or reduction in
hemoglobin (Hb) content of blood, or a combination of both, It is often by the
decrees in Hemoglobin levels below the normal range of 13.5g/dll(men),
11.5g/dll(women) & 11 g/dll (children)

According to standard liad down by WHO, Anemia in pregnancy is present when

the Hemoglobin concentration in the peripheral blood is 11g/dl or less. However,
because of prevailing socio-economic deprivation in the developing countries, the
level is brought down to 10gm/dl. Adopting this lower level, the incidence of
anemia in pregnancy ranges widely from 40-80% in the tropics compared to 10-
20% in developed countries.
According to WHO (2005) in the world 5,29,000 woman die every year as a result
of pregnancy and child birth, a global ratio of 400 maternal death per 100,000 live
births. According to SRS report for the year 2003, the maternal mortality rate in
India was 301 deaths per 100,000 live births. According to ICMR report,
Prevalence of anemia among pregnant women in India are like, normal 12.5%,
mild 40.8%, moderate 33/6% & severe 13.1% in the year 1993.

The district nutrition survey (1999-2000), reported that prevalence of hemoglobin

less than 11gm/dll was 61 %, 79%, 84% in the District of Himachal Pradesh, Uttar
Pradesh, Bihar, respectively. The National data suggested that, the prevalence of
Nutritional anemia in Pregnancy is high in India.

Some important factors have strongly influenced anemia during pregnancy, such
as, faulty dietary habit which includes deficiency of iron in diet and reduce the
absorption of iron, faulty absorption mechanism of the body (because of
Malnutrition), repeated pregnancy at short interval, etc. As a result, anemia during
pregnancy remains a significant. Social;, economical & health care problem in
developing countries, like in India.

Anemia is responsible for 25 % of maternal death either directly or indirectly

though several complications, like Ante partum hemorrhage, Abortion, Heart
failure, Preterm labour, etc during pregnancy, Uterine inertia, Post-partum
hemorrhage, Preterm labour, shock during labour and puerperal sepsis sub
involution, etc during puerperium, Also the complication may affect the newborn
as, IUGR, low-birth weight baby. So, it is essential to prevent those complications.
During the community posting of my session I conducted a mini project work on
Estimation of Heamoglobin level among antental mothers. For the completion of
this project, I selected District Hospital Shri Hospital, MGM Hospital, Katni City.
Aim was to promote well being of Antenatal mothers and also to emphasis on
health problems such as Anemia in pregnancy.

During Hemoglobin estimation I found 20 cases suffering from anemia in both the
setting. In both the settings the antenatal clients were enrolled in the health centre.
Some clients were underweight and anemic. I also found & were malnourished, 2
suffered from vo mating and were suffering from moderate and mild anemia.
Hemoglobin estimation is an integral part of Antenatal Period. Health services
provided in health centers promote physical mental social health of antenatal
mothers.
The objectives of the project were Promotion of positive health of antenatal
mothers Prevention of discuses awakening of health consciousness Provision of
healthily environment. For fulfillment of these objectives, Hemoglobin estimation
was done and conducted as many health checks up as possible among the antenatal
mothers in rural and urban community. Goal was accomplished and in this way
results were useful

After accomplishing my project it was found that many antenatal mothers were
suffering fro mild and moderate anemia, clients were tole to modify their dietary
pattern and take care of themselves, I advised them to take nutritious diet, told
them about primary health centers and their facilities near the community and gave
them health education and made them aware about the prevalent diseases and their
precautions, So in this way , did what was be possible on my prth for the good
health of antenatal mothers and thus achieved the goals and objectives of the
minarets of Hemoglobin Estimation in Antenatal Mothers”

Anemia in Pregnancy is a serious proble to day all over the world and mistily I the
developing countries like in India. It can be prevented by the adequate dietary
requirements. The woman in pregnancy have double demand of the nutrients like,
the recommended amount of iron they need cash day increases during pregnancy
from about18mg perk day to 27mg per day. Most pregnant woman get this amount
from eating foods that contains iron. Folic acid and Vit B 2 but due to lack of
education about dietary daily requirement some mother are till suffering

1.3 PROBLEM STATEMENT

to assess the effectiveness Studied teaching programming knowledge regarding

anemia during pregnancy among anemic antenatal mothers in selected hospital of
Katni City
OBJECTIVIES
1. Assess the Hemoglobin level of anemic antenatal mothers.
2. Assess the pre test knowledge score amount antenatal mothers on Anemia
during pregnancy
3. Assess the post test knowledge score among antenatal mothers on Anemia
during pregnancy.
 4. Assess the effectiveness of Structure teaching programs on Anemia during
pregnancy among Antenatal Mothers.
5. Associate the pretest knowledge score with selected demographic variables.

1.5 ASSUMPTIONS:
It is assumed that
Structure teaching program. Will improve antenatal mother's knowledge on anemia
and level of Hemoglobin during pregnancy.

1.6 RESEARCH HYPOTHESES

Hl There will be significant difference in the mean pre test and post test knowledge
score regarding anemia during pregnancy among Antenatal Mothers.
H2 There will be significant association between Pre test knowledge score with
selected demographic variables.

1.7 OPERATIONAL DEFINITION

1. Assess: In the study it refers to the measurement of knowledge regarding

anemia during pregnancy by using appropriated tool developed by the
investigator.
2. 2 Effectiveness: Ink the study, kit refers to the extent to which structure
teaching programmer succeeds in to antenatal mothers regarding anemia
during.
3. Structure Teaching Programmer In this study, it refers to making use of a
avails which includes introduction definition causes, sign and symptoms and
management of Anemia during pregnancy.
4. Anemia: In the study Anemia refers to the low level of Hemoglobin in the
Blood ranging less that 10gm\dl among antenatal mothers.
5. Anemic: In the study. Anemic refers ot the antenatal mothers who have low
level of Hemoglobin in the Blood ranging less that 10gm\dl.
6. Antenatal Mothers: Refers to women who continues a normal pregnancy till
38 weeks of time duration
1.8 DELIMITATIONS
The study is delimited to the antenatal mothers who are note present during
the period of data collection.
Limited time of 1 month will be available for data collection
Study is limited to 60 samples.
9. CONCEPTUAL THEORITICAL FRAMEWORK
10.Conceptual framework is base on modified Imogene M. King
 CHAPTER II

REVIEW OFL LITERATURE

A literature review is a written summary of the existing knowledge on research

problems. The task of reviewing research literature involve the identification,
selection critical analysis and written description of existing information
(Polit kans Handler 2003)

2.1.1. E.O.Ugwn etal (2015) Conducted a study and aim was to determine the
average HCT (hematocrit) prevalence, and pattern of ; anemia as well the arm
preferences for blood sample collection among pregnant women ink Enugu, South
East Nigeria, Subjects and Methods: HCT was determined using venous blood of
200 antenatal women at the University ofl Nigeria Teaching Hospital UNTH
Enugu Nigeria . Questionnaires were used to assess participants arm preference for
blood sample collection for clinical investigations. Data analysis was descriptive
and inferential at 95# confidence level. Results Participants mean HCT was 33.3
(3.7) The average HCT kin second trimester 33.3#(3.76) was significantly lower
than that of third trimester (34.6)(3.4) P=0/01) Prevalence of anemia was 28.0#
(56\200) and a majority (94.6#) 53,56) of anemic women belong to the mild
category. Only parity groups had a significant association with anemia ink
pregnancy (P.= 0/04) None of the participants reported being asked about her arm
preference during blood collection for routine antenatal investigations’ One
hundred and five (52.5%) women expressed preference for either left(34.5)
69\200) or right arm (18.0% 36]200) for blood sample collection Conclusion The
average HCT among pregnant women at the UNTH Enugu Nigeria was within
normal range and the prevalence of anemia was relatively low. The majority of
women expressed a preference for either right or left arum for blood sample
collection for clinical investigations and would with their choices sought for and
respected.
2.1.2. Francis Soumyamol & Nayak Sabitha (2013) Conducted a study to
assess the maternal hemoglobin level and its association with pregnancy outcome
among mother The study design adopted was descriptive design, 100 antenatal
mothers were selected by purposive sapling. The demographic Performa were
collected fro the women by interview and Apgar scoring system, New Ballard
score and infant meter used for assessing the pregnancy outcome. Date obtained
ink these areas were analyzed by descriptive and inferential statistics, a statistics. A
Significant relation was found between maternal hemoglobin level and pregnancy
outcome such as type of delivery (0.039 P.0.05) and birth weight (001,P 0.05) and
a significant association was found between maternal hemoglobin and
selected demographic variables as income (037p)and BMI (039-0.05) The findings
of the study revealed that there is a association between maternal hemoglobin level
and pregnancy outcome

2.1.3 Husain Shahida etal (2013) conducted a study to determine the

prevalence and risk factors of anemia among pregnant women receiving antenatal
care at Aziz Bhatti Shaheed Hospital Gujarat. The attending doctor filled a
Performa at the first antenatal visit and blood sample was also drawn for complete
blood counts. Resulted Out of 560 women studied 419(74.8%) women were
anemia, Anemic, was more prevalent in multigravidac Anaemiawas more prevalent
in multigravidac (77.6%) that ink primigravidae (69.3) Regarding severity
699%mild 26.7%)moderate and 3.3% cases were of severe anemia respectively.
The severity increased with increasing parity. The prevalence also increased with
decreasing birth intervals (P=0001) and late booking anemia was morel common
among uneducated (78.6%) or those educated up to primary (72.7) Intake of
meat\chicken less than 2 times week (p=001) and pICA (p=000020 Anemia was
more common among uneducated (78.6%) or the educated up to primary
(72.7%) Intake of meat \chicken less than 2times\week (p=0.01) and PICA
(p=0.0050 were also the risk factors for anemia developed in pregnancy.
Conclusions The prevalence of anemia in antenatal care attendees of ABSH is very
high. Frequent child birth with lack of birth spacing, latke booking low educational
status and poor dietary habits are the major risk factors that need urgent attention
of health care providers.

2.1.4 Ali Mohammed etal (2013) conducted a descriptive cross sectional

study was conducted from August 2011 to February 2012. The data was collected
by a direct
Interview from pregnant women in their 3rd trimester attending primary health
care entres the hemoglobin level of 11 gm\dl was considered anemic. Results. The
total sample size was 400 pregnant women their ages ranged from 15 to 44 years
(mean A standard deviation of 26.68 = 5.917 year) The overall prevalence of
anemia was 55.5% with highest rate among the age group of ^20 year and ^40
years Overcrowding index poor dietary habit multiparty, low consumption of iron
foliate supplements, the absence of specialist doctor and monthly screening for
anemia week significantly associated with prevalence of anemia, Conclusion There
is a high prevalence of anemia among pregnant women in Erbil city all the cases
are of mild and moderate severity which is associated with any factors like over
crowding poor dietary habit gravidity lack of qualified staff shortage of iron-foliate
supplements and poor counseling.
2.1.5. Obse etat (2013) conducted a cross section study from june to august
2011 on 374 pregnant women, Mothers who came for ANC during the study
period and who met the inclusion criteria were interviewed and a capillary blood
sample was taken Hemoglobin level laws determined by using HemoCue
Photometer, and interviewer administered questionnaire was used to collect data
Data were cleaned, coded and fed into SPSS version 16.0 for analysis, RESULT.
the mean hemoglobin concentration was 12.05A=1.5 g\dl and prevalence of
anemia was 36.6% Family sizes (COR=2,67 , CI(1.65,4,32) third trimester
(COR=1,45 CI (1,11,2.23) meat consumption ^lx/wk ( COR=3.47, CI ( 1.58, 7.64)
and pica (COR=2.33, CI(1.53,2,23) meat consumption ^1x’wk (COR =2.67, CI(
1.65,4.32) third trimester (COR=1.45 CI (1.11.2,23) meat consumption
^1wk(COR=3.47,CI(1,58, 7.64) and pica (COR = 2.33, CI (1.52,3.58) were
significantly associated with anemia . Having five or more children (AOR=5.2,
CI(1.52, 3.58) were significantly associated with anemia. Having five or more
children (AOR=2.33, CI(1.52, 3.58) were significantly associated with anemia .
Having five or more children (AOR=6.7 CI(2.49,17.89) intake of tea always after
meal (AOR=12.83 CI( 45-28.9) and recurrence of illness during pregnancy (
AOR=7.3 CI( 2.12 – 25-39) were factors associated with anemia .
CONCLUSION: This study showed that anemia is a moderate public health
problem less frequently meat and vegetable consumption parity are risk factors for
anemia. Therefore reducing parity taking balanced diet and use of mosquito nets
during pregnancy are recommended.

2.1.6 Fujimori E et al(2011) conducted a cross sectional study to compare

prevalence of anemia and hemoglobin (HB) levels in Brazilian pregnant women
before and after flour fortification with liron. The Subjects were 12,119 pregnant
woman before and after flour fortification with iron. The subjects were 12,119
pregnant woman distributed in two group: before fortification and after
fortification) Statically analysis was carried out using chi-squared tests, Student's
tests, and logistic regression with a significance level of 5% the results indicated
that prevalence of anemia fell from 25% to 20% after fortification (p<0.001) and
the logistic regression analysis showed that group, geographic region, marital
status, trimester of pregnancy, initial nutritional status, and prior pregnancy were
associated with anemia (p<0.05) The study concluded that prevalence of anemia
decreased after fortification.

New
2.1.7 Reveiz L etal (2011) conducted a study to assesws the effects of different
treatments for lanaemia in pregnancy attributed tol iron deficiency (defined as
haemoglobin less that 11 g|l or other equivalent parameters ) on matemrnal and
neonatal morbidityand majortality. The samples were 3.198women. There sults
revealed that the oral liron in pregnancy showed a reduction in the incidence
oflanaemia (results revealed that the oral iron in pregnancy showed a reduction in
thein cideence of anaemia (ruskkratio 0.38.95% confidance kintervall 0.26 to 0.55
d) . The study concluded that despite the high incidence and burden of discase
associated with this condition. Daily oraliron treatment impoves hematological
indices land large, good qualify trials, assessing clinical outcomes (including
advaerse effects ) as well as the effects of treatmenht by severity of anaemia are
required.

2.1.8 Godwin I Kumari k.s. (2009) conducted al study in Kerala to assess the
prevalence of iron deficiency anaemia ammong young mothersl and their children
of pre school.The pre schoolers and women of child bearing age are affected
mostly. lThe study was communitylbased to assess the extent ofl anaemia among
mothers and children and find out lits associationwith the age , genderand
thequality oflife3 index of the subjects. lPreschoolers ink the age group of l3-5
year (N=376) and their klmother l(N=3340)belonging tolowlsocio leconomicstatus
lwere selecte,questionnaire method laws adopted the haemolobin levels lwere
measured using cyanmetha haemoglobin method.l Thefindings showed that pre
schoolers and mothers mostly had mild and moderate anaemia. Statistical analysis
indicated a significant association between blood haemoglobin level &
qualityoflife index (p=0.019) and age oflmothers ( p=0.012) .Among preschool
children there was a significant association of haemoglobink levelwith gender,
socio economic status (p=0.034) and area of dresidence. lCorrelation between
haemoglobin level loflmother and achildren wasfound tolbepositive. Preschoolers
were mostlylmildly (54.25%) orl moderately anaemic (41.75%) Among mothers,
mild anaemia (67.7%) and moderate anaemia (126.8%) dwere common.

2.1.9 Bharati Premananda etal (2008) conducted a study tol investigate

theseverityand distribution of anaemia among non pregnant
andpregnantwomenaged15-49 years inlkudrbanand rurall sectors of 26 states ink
Indiaandits association with certain
@@
economic andlbiosociall factors. lA nationalsurvey was conducted lto lcollectdate
onl haemoglobin height weight andcertainkleconomicand biosocial factors of
72660and 5619 pregnant lwomen. lNon pregnant lwomen age less that 25 years are
the most affected by anemia. Womens education land standard of living linkl the
houseolds have a vitall role lin reducinganaemia Urban and well lnourished
womenalsolsuffer less froml anaemia. The severity kof anaemia is klhigher among
pregnant that non pregnant women. effosdrs must be made toeducate dwomenand
enhance their level of leconomic status so that the prevalence of anaemia can be
reduced substantially,

2.1.10 Leblance CP, Rioux FM (2007) conducted a study toinvestigate the

prevalence of Anaemia and irondificiencyAnaemia (IDA) in healthy low income
pregnant women in Canada. The samples were 31 Antenatal mothers participationg
inklthe early childhood initiatives ECI programme. The results revealed that
among the 31 antenatall mothers six (19.04%) were Anaemic and five (16.1%^)
suffered from IDA (Hb-110g\L and SF-10 micro g\L The studyconcluded that the
prevalence of Anhaemia in low income group antenatal mothers are comparably
hight to that of privileged women and effectivestrategies are needed tol prevent
IDA invulnerable goups.

2.1.11 Cyril CD (2007) conducted a retrospectivestudy of 530 ndormall pregnant

women was conducted to assess the prevalence ofanemia among pregnant women
in south Eastern Nigeria, Data on age paritydate of lregistration andHaemoglobin
concentration were obtainedand analysed, 214 womenh wereanaemic with Hb-
11g\dl. lThel majority 90.7% of these anaemic patients were mildly anaemic,
whereas 9.3% dwere dmoderately anaemic. There dwasno case of severeanaemia
with Hb-7g]dt . The prevalence of anaemia was sigfificantly higher inthose who
registered for antenatal care in thelast trimesterthat in thosewhoregisteredin the
first andthesecondtrimesters.Pre conception care
includingironandfolicacidsuppplementation is advocated toreducethe problem.
22.1.12 Toteja GS et at (2006) conducted to assess the status of anaemia
among 6,923 pregnant womenand 4337 adolescent girlsfrom 16districtsof 11 states
ofIndia.l A twostage random sampling method wasused Anaemia wasdiagnosed by
estimatingthe haemoglobinconcentration linlthe blood with theuseof theindirect
cyanmethemoglobin method. The results showed that 84.9% of pregnant
lwomenwereanaemic13.1% had severeanaemia and60.1% had moderate anaemia.
Among adolescent girls the overall prevalence of anaemiawas 90.1% with 7.1%
having severe anaemia. The study concluded

##3##
that any intervention strategyforthis populationlmuswt address not only the
jproblem of irondeficiency, butalsoldificiencies oflother micronutrients, such as
B12 and folic acid and other possible causallfactors.

2.1.13 Agarwal K.N. etal (2006) conducted a study todeterminetheprevalencej of

Anaemia kinlk pregnant women, Tkhe subjects dwere 1248 pregnantl women from
7 states Himachal Pradesh Haryana, Assam, Orissa, Kerala, Tamill Nadul in South
and Madhya Pradesh. The results showed that t a totalofl84 percent pregnantand
92.2 percent lactating women were anaemiacd with severe anemia ink 9.2 and k7.3
perecent respectively ; 39.2 and 27.3 percent in Madhya Pradesh 14.4 and 8.6 per
cent inkl Assam and 8.5 and 13.4 percent in Haryana t had severe anaemia inkl
pregnancy andlactation, respectively. Around 51 per cent womeninl pregnancy and
lactation had moderate degree of anaemia (Hb 7.0-9.9 g\dld) In Kerala l57.8
percent pregnant women were anaemic dwith 2.9 percent having severe anaemia.
lTheldpresent findings showed thqat the interstate fifferences particularly infertility
women deduction nutrition status and occupation availability of antenatal services
and iron folate tablests lare possible factors responsible for differences in
pdrevalence of anaemia.
2.1.14 Parra BE etal (2005) conducted a study to assess effectivencess of
lnutritional education I and ironsupplementation on preventionof anaemia during
pregnancy among antenatal mother oflColumbmia The samples were 42 pregnant
women subjected to la nutritionalleducation programme along with administration
lof a suppliement consisting of 60mg elementaliron 400 micro folic acid, and 70mg
vitamin c. The results revealed that 94./4% of dwomen did not show Anaemia at
the end of pregnancy. The study conclude that nutritional leducation and iron
supplementation are effective on prevention of lanaemia .

2.1.115 Ronnenberg AG etat (2004) conducted a prospective cohosrt study

among 405 chinese women to lexamine the relation between preconception
anaemia, iron deficiency and pregnancy outcome. lHaemoglobin level laws
measured before pregnancy and the pregnancy outcome was assessed. Study
revealed that both mild and moderate anaemia were signfificantly lassociated with
lower birth weight with 132 and 192 g respectively. The risk of low birth weight
and fetal growth drestrictiond were significantly greater among women with
moderate anaemia compared with non anaaemic kcontrols. The study concluded
that preconception anaemia was associated with increased risk of adverse
pregnancy outcome.

2.1.16 Gadallah M etal (2002) conducted a cross sectional study to determine the
prevalence of Anaemia and tol assess the feect of iron supplementationkl and
nutritional educationall programme. The subjects were 100 pregrnant women
attending the antenatal clinics in two primary health care units. Data dwas
collected by lstructured questionnaires and haemoblobin analysis was done during
the first vist, after one month land four months Chi square and paired t taest were
applied lto test the relationship among study variables. The results lsuggested that
after 3 months of lnutrition education programme and iron supplementation lthe
prevalence declined down lto 32 % form 55% before l;programme. The study
concluded lthat Anaemia is still lhigh among pregnant women and integrated
interventions programme should be considered prior to conception.

2.1.17 Ministry of Health and Family Welfare Government of India ( 2007-

2004) conducted a survey to lasses the prevalence of Anaemia among children,
adolescent girls and pregnant women in Madhya Pradesh. A Random sampling
wasused tol select 17 thosasnd children, 12 thousand adolescent girls and 1,000,
Pregnant women and of the age of 0-7 years , 96 percent of children havae some
level of lanaemia, 42 pecent are mildly anaemic, 50 percent are moderately
anaemic and 4 percent are severly lanaemic. In adolescent rirls. 20 percent of them
are mildly anaemic, 45 percent are moderately anaemic and 33 percent are having
severeaqnaemia, Among dpregnant women aged 15-44 years, 42 percent have mild
anaemia, 51 percent have moderate anaemia and 3 percent have severs anaaemia.

2.1.18 Levy A etal (2005) A retrospective study was done to determine the
effects of severe antenatalmateral anaemia on pregnancy joutcome. 2 groups of
pregnant women 111 pregnant anaemic women with Hb - 8g]dl and 111 non
anaemic pregnant women with HB 110g} were compared. Results showed that
inanacmic group iron deficiencywas the most commoncause of anaemia with
92.7%Maternal anemic group iron deficiency was the most commonsuse of
anaemial with 92.7% Maternal anaemia wassignificantly associated with modre
requent preterm birth with 29.2% in anaemic and 9.2% in non anaemic cases. The
study concluded that preterm birth and low birth weightare commonlinlmild to
moderat eaaemia. Severe anaemia in pregnancy may have sever adverse effects for
the mother and the new born and should be identified and treated as soon as ;
possible.

2.1.19 Abel l R etal (2001) conducted a study in rural vellore districtto assess the
drevalence of lanaemiak and iron deficiencyin three trimesters. A ultistage
sampling technique was used to select 845 pregnat women froml two blocks in
vellore district. Haematological measurement of haemoglobinwas done. The
prevalence of lanaemia with lHdB -11dl was 56.6% , 70.2% and 69.5%
respectively lamongthe first second and third trimesterwome. The high prevalence
of anaemia in each trime sterink pregnancy indicated the need for iron
supplementation las early aspossible.

2.1.20 Kaur AM etal l(2001) conducted a study on effects of health education on

knowledge, attitudes and practices about Anaemia among rural women in
Chandigarh. All the 60 married women in the age group of l20 to 45 years were
selected for the study . The study revealed that socio economic and demographic
chracteistics of both the intervention and demographic characteristics of both the
intervention and control groups were similar, all women in the intervention group
could specify at leaset one correct cause of Anaemia and identified signs and
symptoms of Anaemia whereas 73.3% and 46.6% women inthecontrol group did
not specify the cause signs and symptoms of Anaemia respectively and the
knowledge about methods of Anaemia prevention was significatly higher in
intervention group compared with control group did not specify the cause, signs
and symptoms of Anaemia respectively (P-0.001) and the knowledge about
methods of Anaemia prevention was significantly higher in intervention group
compared with control group The results concluded that there was significant
change in knowledge and attitude of women whore received healt education.

2.121. Verhoeff F H etal (1999) conducted a study to analyses the

determinants of Anaemia in pregnant women in rural Malaw area. The subjects
were 4104 pregnant women attending the antenatal- care facilities of two hospitals
in a rurall area. The results revealed that Mean (S.D) haemoglobin (HB)
concentration was significantly lower in the primigravidae 8.7 (1.67) g}dl and
thevariables associated with an increased risk for moderately severe anaemia were
iron deficiency (RR=4:2 CdI =3.0-6.0) and malaria parasitaemia (RR=1.9d:
CI=1.3-2.7) ) The study lconcluded that lilliteracy andpoor nutritional status were
significantly associatedwith increased risk of anemia and the basis of Anaemia
preventionin this population of pregnant women was found to be malaria control
and haematinic supplementation.
 CHAPTER III

RESEARCH METHODOLOLGY

CHAPTER III

RESEARCH METHODOLOGY

This chapter deals with methodololgy used by the researcher, to lassess the effectiveness of
structure teaching programme on knowledge regareding Anaemia during pregnancy among
antenatal mothers in selected Hospital of Katni City. This chapter deals with Research approach
Research design Setting of the study Population Sample Sampling technique Development of
tool land structure teaching proggramme Pilot study date gathering process tool and technique
and the plan of date analysis adopted by the investigator.

3.2 RESEARCHAPPROACH
Research approach refers to the researchers overall plan for obtaining answer to the research
question and testing the hypothesis. (According to Hungler)
In this study Quantitative evaluative approach is used.

3.3. RESEARCH DESIGN

The research designis the back bone or the structure of the study. It provide s a frame
work that supports the study and holds it together. (Polit and Hungler 1995) stated that a
research design incorporate the most important methodological decision that a researcher makes
in conducting are search study.

In the present study, the investigator selected Pre experimental one group pre test post test design
to observe the effectiveness of video teaching programmme among antenatal mothers regarding
anemia during pregnancy.

01…………………. x………………………………………02

X Structure teaching programmme regarding anemia during pregnancy.

02 Post test knowledge score.

3.4 RESEARCH VARIABLES
Veriables lare the condition or characteristics which the experimenter manipulates,
controls or observe (Polit & Hungler 1999)
Independent Variable: The independent variable is the condition or characteristics
that the investigator manipulates or control in his or her attempt to ascertain their
relationship to observed phenomena ( Basaavanthapa 2005)

In this study the independent variable is Structure teaching program

Dependent variable: The variables that are used to describe or measure the problem
under the study are called dependent variable.
In the study the dependent variable is knowledge on Anemia during pregnancy
among antenatal mothers.
3.5 SETTING
Setting s are the most specific places where data collection occurs ( Polit &
Hundler 1999) This study is being conducted in selected Hospital of Katni city).

3.6 POPULATION
Population is the study consists of Antenatal Mothers who lhave Anaemia during
pregnancy in selected rural lareas of Jabalpur .
3.7 SAMPLE AND SAMPLE SIZE:
A sample is a subset of population selected to participate in a research study l
(Basavanthapa 2006)

In this study the samples include 60 Antenatal mothers in the selected Hospital of
Katni city rural Katni.
3.8 SAMPLING TECHNIQUE
Non Probability Purposive sampling technique will be used .
3.9 SAMPLING SELECTION CRITERIA
The sample frame structured by the researcher include the following criteria
 INCLUSIION CRITERIA
1. All the antenatal mothers who are having anemia
2. Antenatal mothers of all age group
3. Both primigravida and multigravida mothers
4. Antenatal mothers who know English and Hindi
5. Antenatal mothers who know English and Hindi
6. EXCLUSION CRITERIA

1. Antenatal mothers who are not available lat the time of data collection
2. Antenatal mothers who are having other associated diseases with Anemia

3.10 TOOL
Data collection is the procedure and instruments used by the researcher to observe
or measure the key variable in the research problem (Polit & Hungler 1999.)
The tools in this study are
1. Socio demographic Performa
2. Assessment of Hemoglobin status as per who classification
3. Questionnaire for assessing the knowledge regarding anemia during
Pregnancy.
11. DEVELOPMENT OF THE TOOL
The following steps were adopted prior to the development of tools
Review of literature provides adequate content for the tool preparation. Personal experience
of the researcher was an added benefit in the construction of tools. Prior to the
development of the tool the researcher consulted the experts in the field of
obstetrics land Gynecological Nursing Based on the suggestions of the experts
researcher prepared and organizes the item under the respective areas.
First Draft
The first draft was made in English . The first draft was given to 11 experts for their expert
opinion. The opinion of the experts were considered and made the needed changes.
The setting of the research was in Selected Hospital of Katni City)

Second Draft
The second draft was used for the pilot study. The investigator applied the pre test question
on 10 antenatal mothers. The scores were analysed and item analysis was done.
Thus the third draft or final draft was prepared

Third Draft
The third draft was used for the final study
12. PREPARATION OF BLUE PRINT
A blue print was prepared prior to the construction of questionnaire which assessed the
knowledge regarding anemia during Pregnancy.
TABLE NO: 1
BLUE PRINT

S.No. CONTENT AREA QUESTION NUMBER TOTAL NUMBER OF

QUESTION
1 KNOWLEDGE 1,2,3,4,5,7,10,11,14,19,22,27 12
2 UNDERSTANDING 6,8,9,12,15,17,20,23,24,25,29,30 12
3 COMPREHENSION 13,16,18,21,26,28 06
TOTAL 30

13. DESCRIPTION OF TOOLS

14. Section A Socio demographic data
15. Socio demographic profile include age educational status of mothers
type of family socioeconomic status any previous information about anemia
during pregnancy, obstetrical land menstrual history.
1. Section lB WHO classification Anaemia
2. Assess the level of Anaemia by using sahlis method and classifying it is
Mild Moderate and severe.
TABLE NO. 2
WHO CLASSIFICATION OF IRON DEFICIENCY ANEMIA
S.No. CATEGORIES VALUE
1 NORMAL 12-15GM
2 UNDERSTANDING 6,8,9,12,15,17,20,23,24,25,29,30
3 COMPREHENSION 13,16,18,21,26,28
TOTAL

Source : Adapted from WHO l1995 WHO 2000 and WHO 2004
Section C ": Knowledge questionnaire

It consisted of l30 items covering the knowledge regarding anaemia during

pregnancy among antenatal mothers. Each item had four responses in the form of
answers and among the form of responses one correct answers has to be selected
Score on each item refers to poor knowledge average knowledge and good
knowledge
Poor knowledge score was 1-10
Average knowledge score was 11-20
Good knowledge score was 21-030

Scoring was done in accordance of experts in Obstetrics and Gynaecological field.

3.14 SCORING
A score of (1) is assigned to correct response and (0) is assigned to wrong answer
TABLE NO 3
DISTRIBUTION OF KNOWLEDGE SCORE
Maximum Marks -1

3.15 STRUCTURE TEACHING PROGRAMME

The Structure teaching programme was prepared for giving information about
anaemia during pregnancy which dealt with the introduction, incidence, causes,
sign and symptoms and management of Anaemia during pregnancy which included
the medication, diet exercises and do miciliary managemnt and , domiciliary
management and complications to mother and baby if not treated./

3.16 VALIDITY OF TOOl

Validation is a criterion for evaluating the quality of measure of ; instrument
content validity refers ot the degree to which an instrument measures what it is
supposed to measure (Polit & Hungler 1999)

VALIDITY OF TOOl
Validity of content, however , should not depend upon the subjective judgement of
only one specialist. It should be based on careful analysis by sever specialists of
instructional objectivel and of the actuals actual subject matter studies.

Freeman 1968
SECTION A

This section consisted of Delmographic Variables.

The Correction was given in item no 2 as per ethical consideration and the 20 the
item.

SECTION B
This section 0 consisted of WHO Classification of Anaemia to check the level of
Anaemia during pregnancy .
 SECTION
This action consisted of structured questionnaire on Anacmia during pregnancy
there are correctiongiveninitem No.

3. 3.17 CONSTRUCT VALIDITY

Construct validity referes tol the degree to which an instrument measures dwhat it
jislsupposed to measure ( Polit & Hundler, 1999). In this kl;study thekl construct
validity of dHaemoglobinometer for the classification of Anaemia according to
WHO was taken.

18. RELIABILITY OF THE TOOL

Reliabilityofthe research instrument is defined as the extent tolwhich the instruments yieldl
the same dresult klofrepeated measures. It is then concerned dwith consiswtency,
accuracy, precision equivalence and klhodmogeeity (Wood and Hak in 2002 )

19. PILOT STUDY

20. A pilot study is a small preliminary investigation of thethe same generall
character as the major study, which is designed to acquaint the researcher with the
problems that can be corrected in kpdreparation for a larger research study (Treece
& Treece 1999)
1. The purposeof the study wastolfind outl thefeasibility of the study, clarity of
language in too l and finalize the plan for analysis.
The lpilot study wasconducted in Community Healthl centre ofl Patan in the
secondweekkjl ofApril 2016 . The lprior lpermission was taken from the respective
authorities. Data for the pilot study dwere collected from respondents who
lfulfilled lthe inclusivecriteria. The purpose of the study wasexplained tolthe
respondents. Pre test was conducted kand the structure teachink pdrogramme dwas
taken. lAfter onweek kpost test was assessed. The analysis kljof lthe pilot study
dtevealed that objectives of the study would lbe fulfilled. lBased on this
information the investigator proceeded with the actual date collection for the main
study.

3.20 PROCEDURE FORDATA COLLECTION

Written permission dwas obtainedfromthe respective authorities prior to data
collection. The stuldywas carried klout in the same way as that of the pilot study.l
The sample size dwas 60 antenatallmothers from Katni

The actualdate collection period dwas on the last week kof l2018 The investigator
collected data from 60 antenatal mothers.

3.21 PLAN FOR DATA ANALYSIS

Data analysis isthesystematic organization and ksynthesis of lresearch data and the
testing kof lresearch hypothesis using those data (Polit and Hungler 1999.)
The data obtained from 60 antenatalmother having anaemia during pregnancy
would lbe analyzed using the descriptive statistics and inferential statistics.

Socio demographic data would be analyzed using thesescriptive statisties i.e.

frequency andpercentage.

WHO classification of anaemia to lasses the level of anemia data dwould lbe
analyzed usingthedescriptive statistics i.e. frequency and percentage.
Computing t value tol find out lthe significance ofdifference between klthemean of
pre testandpost test knowledge score.

Association between lkpre testknowledge score with demograpahaic varialblelwas

calculated by chi ksquare test.
 CHAPTER IV
ANALYSIS KL
AND
INTERPRETATIONOF DATA

CHAPTER IV
ANALYSIS ANDKLINTERPRETATIONLOF DATA
Analysis lis defined as a Processl oforganization and synthesizing data in such a
way thet research questionkcanlbe answered and hypdothesis accepted ( Poilt and
Hundler 1999)
This chapter deals with theanalysis andinterprectationk ofdata collected dusing
stdructured multiple questionnadries. Data was collectedaboutlthe social
demographic profile lwhoclassificationn of ldAnaemia pre testknowledge were
assessed andafterawarenss programme posttestknowledge were assessed. The
samplesize is kof l60 antenatalmothers. The ldate has been processed and analysed
I n a systematic fashion. lThe data was analysed according to the objective of lthe
study using descriptiveqand inferentaial statistics.

4.2 STATEMENT OF THE PROBLEM

Study to assess the effectiveness of structure teaching programme. on knowledge

regarding anemia during pregnancy among antenatal mothers in selected Hospital
of Katni City

4.3 OBJECTIVES
1 Assess the Hemoglobin level of anemic antenatal mother
2 Assess the pre test knowledge score among antenatal lmothers onAnaemia during
pregnancy.
3. Assess the effectiveness of Structure teaching progrmme on Anaemia during
pregnancy among Antenatal mothers.
4. Assess the post test knowledge scosre among antenatal mother on Anemia
during pregnancy.
5. 5 Associate thepdre test knowledge score with selected demographic
variables.
4.4 RESEARCH HYPOTHESES
H1 There will be significant difference in the mean pre test and post test
knowledge score regarding anaemia during pregnancy among Antnatal lmothers.

H2: There will be significant association between pre test knowledge score with
seselected demographicvariabales.