“A STUDY TO ASSESS THE KNOWLEDGE REGARDING CORD BLOOD

BANKING AMONG UNDERGRADUATE STUDENTS OF HEALTH

SCIENCE INSTITUTIONS, HUBBALLI WITH VIEW TO DEVELOP
INFORMATION GUIDE”.

By

MR JONAH.

Dissertation
Submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES, BANGALORE, KARNATAKA.

In partial fulfillment
of the requirement of the degree of

MASTER OF SCIENCE
IN
MEDICAL SURGICAL NURSING
Under the guidance of

Dr. SANJAY. M. PEERAPUR M.Sc (N) Ph.D

PRINCIPAL, HEAD OF DEPARTMENT MEDICAL SURGICAL
NURSING,
KLES’ INSTITUTE OF NURSING SCIENCES,
VIDYANAGAR, HUBBALLI-31, KARNATAKA, INDIA.

OCT 2017
 7. LIST OF ABREVATIONS

1. AABB : American Association for Blood Banks.

2. CCB : Cord Blood Banking

3. FDA :Food and Drug Administration

4. GVHD :Graft-versus-host disease.

5. HLA :Human Leukocyte Antigen Matching

6. HSCs : Hematopoietic stem cells

7. MDSs :Myelodysplastic syndromes

8. NPCBB :National Public Cord Blood Bank

9. PBSCs : Peripheral blood stem cells

10. SE d : Standard error of difference

11. SD : Standard Deviation

12. X : Mean

VIII
 8. LIST OF TABLES

Sl.No Particulars Page

No
1 Frequency and percentage distribution of subjects according to 29
their socio demographic variables

2 Mean, Median, Mode, Standard deviation and range of 40-41

knowledge score of subject regarding cord blood banking.

3 Frequency and percentage distribution of knowledge scores of 49

subjects regarding cord blood banking

4 Association between knowledge scores of subjects and selected socio

demographic variables 50

.
 9. LIST OF FIGURES
Sl.No particulars Page no

1 Doughnut chart representing percentage distribution of 43

subjects according to their gender.
2 Bar graph showing frequency distribution adolescents 43
according to age
3 Bargraph representing percentage distribution of subjects 44
according to religion..
4 Cylindrical graph representing percentage distribution of 44
subjects according to their type of family
5 Pie diagramrepresenting percentage distribution of subjects 45
according to their course.
6 Conical graph representing percentage distribution of 45
subjects according to their family income.
7 Bar diagram representing percentage distribution of 46
subjects according to source of information.
8 The Doughnut chart represents percentage distribution of 46
subjects according to registration for cord blood banking.

9 Bar graph representing percentage of Mean, Median, 47

Mode, Standard deviation and range of knowledge score of
subject regarding cord blood banking.
10 Doughnut graph representing Frequency and percentage 48
distribution of knowledge scores of subjects regarding cord
blood banking
 LIST OF FIGURES
Figure no particulars
Page no

1 Conceptual framework based onModified 16

LudwigVonBertalanffy’s General System theory.

2 Schematic representation of research process 30

 Health is the most important aspect of life which needs to be maintained at any time

in a person’s life at any cost. Health is not simply the absence of illness. Actual health is the

will to overcome every form of adversity and use even the worst of circumstances as a

springboard for new growth and development.

Stem cell research is one of the most important controversial topics of science today.

The ability of stem cells to self-renew and give rise to subsequent generations with variable

degrees of differentiation capacities, offers significant potential for generation of tissues that

can potentially replace diseased and damaged areas in the body, with minimal risk of

rejection and side effects.

The Cord blood is one of the richest and non controversial sources of stem cells. The

blood that remains in the blood vessels of the placenta and the portion of the umbilical cord

that remains attached to it, after a baby and the umbilical cord is cut, is called cord blood.

Umbilical cord blood transplant is desirable and alternative therapeutic treatment with long

term benefits used over the past years for both malignant and non-malignant hematologic and

other diseases as an alternative therapy.

Cord blood banking is a major break through in regenerative medical

research.The scientists believe that research in this area holds promise for the treatment of

many devastating disease of humankind. Hence, The discovery of stem cells has led to a

revolution in modern medicine. Cord blood will play a growing role in both basic research

and medical use in the future.1

STATEMENT OF THE PROBLEM

“A study to assess the knowledge regarding Cord Blood Banking among

Undergraduate Students of Health Science Institutions, Hubballi with view to develop

Information Guide Sheet.”

IX
OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge regarding cord blood banking among

Undergraduate students of Health Science Institutions.

2. To find an association between knowledge and their selected socio-demographic

variables.

3. To develop information guidesheet regarding cord blood banking.

Methodology:

A Descriptive design approach was utilized to achieve the overall and

comprehensive purpose. Samplesize of 100 was selected using Non- probability –

Convenience sampling technique. Data was collected from Final Year B.sc. nursing students

of K.L.E.SInstitution Of Nursing Sciences, Hubballi and Final Year B. Pharmacy students of

KLEU college of Pharmacy, by means of structured knowledge questionnaire.The reliability

of knowledge questionnaire was r = 0.853 The data was gathered from 03.05.2017 and

04.05.2017and analysis is done using descriptive and inferential statistics in terms of

frequency, percentage, mean, median, mode, standard deviation and Chi-square test.

Results:

The overall knowledge score of 100 students was 97 (97%) had average

knowledge, 01 (01%) had poor knowledge and02 (02%) good knowledge in test.

Probability values of chi square contingency table revealed that the knowledge scores

and socio demographic variables were not dependent .

Conclusion:

The study concludes that Informational guide sheet was effective to improve and

update the knowledge of Students towards Cord Blood Banking.

Key words : Students, Informational guide sheet ,Cord Blood Banking

CHAPTER 1 INTRODUCTION

12. INTRODUCTION

“A STUDY TO ASSESS THE KNOWLEDGE REGARDING CORD BLOOD

BANKING AMONG UNDERGRADUATE STUDENTS OF HEALTH SCIENCE

INSTITUTIONS, HUBBALLI WITH VIEW TO DEVELOP INFORMATION

GUIDE”.

“ Your unconditional love and your child’s cord blood – a potential lifeline for the

future.” - Maria Robinson.

Health is now considered to be one of our most important values. Many people, in

particular in modern times, have regarded health as one of the most precious values in life.

Health as longevity, should, they think, be protected and enhanced as much as possible. Thus,

the art and science of medicine has received a crucial place in the modern, both Western and

Eastern, society. 2

One of the greatest dramas in the world of living things is that which takes place in

pregnancy and birth. Pregnancy forms a bond between mother and offspring that, in humans

at least lasts throughout life. Human body is made up of many systems, each of these perform

different functions to maintain homeostasis. For constant working all these systems needs

oxygen which is supplied by blood. This blood supply vital oxygen and nutrients to different

parts of body. 3

Stem cells are a part of the hematopoietic system or the system that is responsible for

the production of various mature blood cells present in the body Stem cells are the foundation

cells for every organ and tissue in our bodies. In addition, in many tissues they serve as a sort

of internal repair system, dividing essentially without limit to replenish other cells as long as

the person or animal is still alive. When a stem cell divides, each new cell has the potential

1
leather to remain a stem cell or become another type of cell with a more specialized function,

such as a muscle cell, a red blood cell, or a brain cell. Stem cell transplantation has

traditionally been performed utilizing bone marrow or peripheral blood as a source of

hematopiotic stem cells, Stem cells are distinguished from other cell types by two important

characteristics. First, they are unspecialized cells capable of renewing themselves through

cell division. 4

The average Umbilical cord is the vital direct interlink between mother and fetus,

which is always depicted as the relationship of an emotional bonding of motherhood, which

is a beautiful experience for a women. Umbilical cord is approximately 50-70 cm long and 2

cm in diameter, and is known to mediate the feto-placental circulation. 5

The cord blood banking is a process which involves blood collecting from the

umbilical cord and placenta after the baby is delivered out. The collected cord blood is frozen

and stored at a cord blood bank for future use. After a baby is born and the umbilical cord is

cut, some blood remains in the blood vessels of the placenta and the portion of the umbilical

cord that remains attached to it. After birth blood is collected which is called umbilical cord

blood. 6

A Child is emotionally, physically bond to mother from the period of conception. The

fetus receives its nutrition for survival from mother through the umbilical cord. The placenta

which is attached to uterus supplies the essential nutrients to fetus for its growth and

development. Umbilical cord acts as a bridge between both mother and fetus. 7

Scientists have provided evidence that the umbilical cord contains blood that is

enriched with stem cells, known as hematopoietic (blood-forming) stem cells. According to

Melinda Beck from the Wall Street Journal, ―two tablespoons of umbilical cord blood

contains about one billion stem cells, compared to 140 billion red blood cells in two

tablespoons. Although small in number compared to red blood cells, these stem cells may be
used to cure genetic diseases, blood disorders, and certain cancers. One of the limitations

inherent in the cord blood is its limited number of hematopoietic stem cells. Thus it has been

primarily used for paediatric patients. 8

Nowadays, Umbilical cord blood transplantation is increasingly considered as an

alternative source to bone marrow for patients who find an unmatched donor. Umbilical cord

blood transplant is desirable and alternative therapeutic treatment with long term benefits.

Umbilical cord blood transplantation has been increasingly used over the past years for both

malignant and non-malignant hematologic diseases. 9

More than 45 diseases have now been treated using cord blood cells. These include

malignant diseases like leukemia, lymphoma, neuroblastoma and retinoblastoma, and several

other non-malignant diseases as well. 10

In India, there are approximately 72000 births daily, which results in discarding

72000 umbilical cords a day. The storage of stem cell rich blood derived from these umbilical

cords can prove to be the best possible insurance against life threatening diseases. 11

The Viacord reports that “To date, 30,000 transplants have been performed using

these amazing healing cells, to treat people for over 80 medical conditions but it only takes

one happy ending to understand why cord blood is so special”. According to National

Marrow Donor Program, World-wide, there were 2000 cord blood transplants in the year

2006. There have been over 15,000 cord blood transplants worldwide through 2009. 12

Recently, more than 300000 frozen cord blood units have been established in many

parts of the world in order to ensure the safety, efficacy and facilitate cord blood

transplantation. 13

There are now about 100 cord blood banks worldwide. More than 400,000 cord blood

stem cell units were banked at the Cord Blood Registry for use of over 120,000 clients

including hospitals and other medical centres worldwide. 14

 In India about 25,000 cord blood units had been preserved over the last three years.

With more than 80,000 births per day or 26 million births a year, India is poised to be the

largest source for umbilical cord blood in the world. The first clinically documented use of

cord stem cells was in the successful treatment of a six-year-old boy afflicted by

Fanconi’sanemia by Dr.Elaine Gluckmen in 1988, in Paris. 15

A study reports that 37%of patients had no knowledge regarding umbilical cord blood

banking, 2.6% of patients had good knowledge the patients are poorly informed about

umbilical cord blood banking and there are expecting information from the health care

professionals. 16

There are now about 100 cord blood banks worldwide. More than 400,000 cord blood

stem cell units were banked at the Cord Blood Registry for use of over 120,000 clients

including hospitals and other medical centres worldwide. 17

The role of nurse in this field is continually expanding and changing in order to offer

appropriate guidance for pregnant women. They are a trusted source of information for most

patients. Nurses have a unique opportunity to help and educate expectant parents about their

options regarding cord blood stem cell preservation. Families should be educated about their

options at least three months before delivery so they can make an informed decision about

their baby’s cord blood stem cells. 18

The nurse needs to be informed about the practice and indications for cord blood

banking and be able to direct the patients for making appropriate options. Research is

underway that could tip the balance of whether and where to donate. For one, researchers are

working on ways to do more with less cord blood so that the smallest amount of baby cord

blood could be used for transplants of full-grown adults one day. This could encourage

parents to save their child's cord blood, Just as crucially, research is advancing on treating
many common diseases with cord blood. Families that have their cord blood in storage have

raw material ready for these therapies. 19

NEED FOR THE STUDY

“Take, if you must, this little bag of dreams, Unloose the cord, and they will wrap

you round.”

- William Butler Yeats

Health is the most important aspect of life which needs to be maintaining at

any time a person’s life at any cost. In a life time of a human being, there are some important

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

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

and life style. 20

Most parents start getting ready for the arrival of a baby as soon as the

woman`s pregnancy is confirmed. Biologically, life begins at the moment of conception.

Birth is merely a break in the pattern of growth and development that has been going on for

nine months. 21 On the day of birth of baby, parents will probably be overcome with visions

of the future with their child`s first smiles, steps and life milestones. Their child ever

becoming seriously ill will probably be the last thing on their mind. But some parents do

consider the possibility that a serious illness might someday affect their child and they make

a choice on the day their baby is born that might impact the future health of that child or even

their other children by deciding to bank their newborn's cord blood. 22

Umbilical cord is vital direct interline between mother and fetus which is

always depicted as the relationship of emotional bonding of motherhood, which is a beautiful

experience for a women. When mother gives birth, the blood that remains in the placenta and

umbilical cord, it is referred as Cord blood. This particular blood contains numerous

hematopoietic stem cells that have the ability to differentiate into other cells and the ability to
self-degenerate. The collection and storage of blood and stem cells from Baby’s Umbilical

cord after the Birth for future transplantation is called Cord Blood Banking. 23

Hematopoietic stem cells also have the ability to generate brain cells, skeletal

muscle cells, cardiac muscle cells and liver cells. Mesenchymal cells can create cartilage,
24
bone, muscle, tendon, ligament and fat. Cord blood stem cells are the major source of

hematopoietic stem cells and mostly used to regenerate a patient’s blood and immune system

that have been weakened or damaged by radiation or chemotherapy. 25

There have been over 15,000 cord blood transplants worldwide through 2009.

In the United States, more than one half of all stem cell transplants from unrelated donors in

children now use cord blood. In Japan, this is true for adults as well. This program has

provided cord blood units for transplantation to over 3,500 recipients to date, about one

fourth of all cord blood transplants from unrelated donors. 26

A study reported that among 443 antenatal mothers.70%of antenatal mothers

had them poor or very poor knowledge about Cord Blood Banking,68% wanted to receive

information about Cord Blood Banking from Health Professionals and 70%wanted from

Prenatal Classes. 27

Cord blood banking was an alien concept till a few years ago in India but it is

rapidly becoming popular now. There are two types of banking facilities for storing the cord

blood cells of baby, Public Donor Banks and Private Banks. In 2005 there were less than 25

banks worldwide and now there are over 500 banks around the world with an umbilical cord

blood bank now established in almost every major country." As of 2011, there were three

public banks and seven private cord blood banks in India, but the numbers are on the rise. 28

As a use of cord blood transplantation is become a common practice, the

number cord blood banks contain to be increased in the world, cord life is considered as the

largest network of stem cell banks. The first cord blood repository in India was established by
Reliant Life Sciences, which in-cooperated in 2001, the first strictly private blood bank in

Indian is life science, and is located in Chennai. India’s first public cord blood bank is Jeevan

Blood Bank and Research Centre (Chennai). The various Private Cord Blood Banks found

across India are Life Cell India (Chennai, Mumbai, Hyderabad, Bangalore, Ludhiana,

Ahmedabad, Delhi & Cochin), Asia Cryo-Cell Private Limited (Chennai & Bangalore),

Reliance Life Sciences Pvt. Ltd. (Mumbai), Cryo Banks International (Patna) and Rotary

Narayana Tissue Bank and Stem Cell Research Center (Bangalore). 29

In the last 10 yr, umbilical cord blood has been shown to be therapeutically

useful for rescuing In patients with bone marrow-related deficits and inborn errors of

metabolism. Umbilical cord blood offers advantages over bone marrow because cord blood

does not require perfect human leukocyte antigen (HLA) tissue matching, has less incidence

of graft vs host disease, and may be used allogenically. More recently cord blood has also

been used as a stem cell source for patient without a donor and more than 2000 Cord blood

Haematopoietic Stem Cell Transplants are performed annually to date, more than 35,000

patients worldwide have received an UCB transplant. In India, more than 1000 cord blood

transfusions were done in children and adults for various indications, in an apparently safe

and efficient manner. Indications for Cord Blood Transplant are Acute Myelogenous

,Leukemia, Juvenile CML, Thalassemia, Sickle cell disease.

Recent studies have shown that cord blood as unique advantages over

traditional bone marrow transplantation, particularly in children and can be lifesaving in rare

cases where a suitable bone marrow donor cannot be found and or approximately 50% of

patients requiring a bone marrow transplant will not find a suitable donor within a critical

period. However studies have shown than cord blood stem cells can also be used for siblings

and other members of your family who have a matching tissue type. Siblings have up in a 75

% chance of capability and cord blood may even be a match for parents and grandparents. 30
 Storage of the stem cells derived from umbilical cord blood means one can preserve

and use genetically matched stem cells on hand, in case the child or someone else in the

family suffers from a treatable blood disorder or needs a bone marrow transplant. There is a

25% genetic match between the siblings and parents, which proves to be the most important

prospect for expectant couples to bank their child’s cord blood. 31

Recent advances in science have demonstrated that umbilical cord blood is a

rich source of stem cells, making a valuable tissue resource in the clinical field of stem cell

therapy and transplantation. In spite of many benefits of the stem cells obtained from

umbilical cord blood, the umbilical cord was considered medical waste and disposed of

following delivery along with the placenta due to the lack of knowledge about its benefits and

uses. In addition, from the investigators’ clinical experience, they found that there was poor

knowledge and negative attitude regarding cord blood collection and stem cells among

undergraduate students. Hence it is imperative to raise the students' knowledge about recent

issues of cord blood collection and stem cells. So the researcher felt the need to conduct a

study regarding knowledge and attitude regarding cord blood collection and its utilization by

that creating awareness among undergraduate students.

 CONCEPTUAL FRAMEWORK BASED ON MODIFIED LUDWIG VON
BERTALANFFY'S GENERAL SYSTEM THEORY

INPUT THROUGH
OUTPUT
SOCIODEMOGRA PUT
PHIC LEVEL OF
KNOWLED
VARIABLES:-
• Age
GE
• Gender
• Religion ASSESSMENT • Good
• Types of Family • Average
• Course of Study Structured • Poor
• Family Income knowledge
• Source of questionnaire to
Information assess the
• CCB Member knowledge
Registration regarding Cord
TARGET Blood Banking
POPULATION

Undergraduate
students of Health
Science Institutions
FEEDBACK
Not included in study
OBJECTIVES

13. OBJECTIVES OF THE STUDY

STATEMENT OF THE PROBLEM

“A study to assess the knowledge regarding Cord Blood Banking among

Undergraduate Students of Health Science Institutions, Hubballi with view to develop

Information Guide Sheet. ”

OBJECTIVE OF THE STUDY

1. To assess the level of knowledge regarding cord blood banking among Undergraduate

students of Health Science Institutions.

2. To find an association between knowledge and their selected socio-demographic

variables.

3. To develop information guide sheet regarding cord blood banking.

OPERATIONAL DEFINITIONS

 Knowledge: refers to appropriate response given by undergraduates on knowledge

regarding cord blood banking through structured knowledge questionaire.

 Cord Blood Banking:refers to collection and storage of blood and stem cells from

baby’s umbilical cord after the birth for future transplantation.

 Undergraduate students: refers to final year students from B.Sc Nursing and B.

Pharmacy studing at selected institutions of Hubballi.

 Health Science Institutions: refers to Nursing and Pharmacy institutions, Hubballi.

 Information Guidesheet: refers to material and instruction regarding Cord Blood

Banking which is prepared by investigator.

 Socio-demographic Variables: refers to age, gender, religion, area of residence, type

of family, and sources of information.

11
HYPOTHESIS

H1: There will be statistical association between knowledge scores of undergraduate

students and their selected socio-demographic variables at 0.05 level of significance.

ASSUMPTIONS

 Undergraduate students have some knowledge regarding cord blood banking

and its importance.
 Information Guidesheet provides knowledge regarding cord blood banking.
DELIMITATIONS

 The study is delimited to undergratuade students who are studing in selected

health sciences instutions of Hubballi.
PROJECTED OUTCOMES

 The findings of the study will throw light on knowledge of undergraduate

students of selected health sciences institutions regarding of cord blood
banking.
 Finding of the study will support the further use of Information guidesheet as
a source of knowledge for undergraduate students.

CONCEPTUAL FRAME WORK

Writing a framework requires that the investigator exercises creativity in

identifying concepts and specifying the relationship. The concept that forms the basis

of the study is clarified so that others will be able to understand the study from the

same frame of reference is as the investigator. 32

A conceptual Framework is a discussion of the relationship of concepts that

underline the study problem and support the rational reason for conducting the study.

The conceptual framework used in this study is based on modified Ludwig

Von BertalanIfy’s General System Theory. According to the general system theory a
OBJECTIVES

system consists of a set of interaction components within a boundary that filter the

type and rate of exchange with the environment.

The system consists of three components namely input, throughput and output

input.

INPUT

 Input is any form of energy, information, material or human that enters into a system

through its boundaries. In this study the input refers to the patients undergoing cord

blood banking with their background factors like age, sex , family income, type of

family, course, frequence of attending cord blood banking, source of information and

associated factors.

THROUGHPUT:

 Throughput through put is the process that occurs in between the input and output

processes which enables the input to be transferred as output in such a way that it can

be readily used by the system. The throughput in this study refers to the structured

knowledge questionnaire schedule to assess the knowledge regarding cord blood

banking.

OUTPUT:

 In this study output refers to the level of knowledge of the patients such as good,

average, poor.

13
 14. REVIEW OF LITERATURE

The creation of literature review is one of the most difficult and important task faced

by scientists. It requires the culmination of many skills including library research, logical

arrangement of information and scientific writing. The purpose of the literature review may

be many fold but usually it is the first step in the process of doing research. The role of a

good literature review is to find and present the pretinent work from the primary literature in

a logica, organized manner and to bring the reader as up to date as possible. The relevant

literature reviews have been organized and presented under the following headings.33

The literature review related to the present study is organized and presented under

the following headings:

Section I : Literature related to Knowledge regarding cord blood banking.

Section II : Literature related to general information regarding cord

banking.

Section III : Literature related to advantages of cord blood banking.

SECTION-I

Across-sectional study to assess the knowledge regarding stem cells and its

transplantation among students from various colleges & women from ANC clinic in Indore

study conducted on 80 undergraduate medical students & 80 non-medical students and 40

Antenatal mothers. The study tool for data collection in the form of a Structured

Questionnaire was designed. The study Results reaveled that 45% medicos and 31.25% non

medicos were aware of the terminology stem cell while only 10% Antenatal mothers knew

about it. Monetary Reason was the major factor which prevented 77.5% mothers from opting

for stem cell preservation while12.5% Antenatal mothers never thought of it, 7.5% Antenatal

mothers did not opt because of social stigma and 2.5% due to Ethical consideration. The

study Concluded that Students from streams other than Medicine and antenatal mothers
CHAPTER 2 REVIEW OF LITERATURE

should be educated about the advances being made in Medical Science and a brief

introduction about the newer modalities of treatments, to increase people participation and

achieving a Holistic Approach towards Health Care.34

A descriptive study was conducted to assess nurses knowledge about Umbilical Cord

Blood Banking (UCCB) and its barriers among 150 nurses in Health Hospital, Assiut

University Hospitals, Egypt.Result of the study revealed that Nurses' Knowledge about

UCBB are lacking, inadequate knowledge represented 79.7% and they identified from their

point of view that the costs of the umbilical cord blood banks, policies and procedures are

barriers of conducting such new technology in their hospitals. The Study concluded that,

Nurses level of knowledge on UCBB is inadequate and this indicates the necessity of creation

of educational programs and continual training with the use of UCBB. Also nurses must be

equipped to know the approved standards and understanding UCBB.35

A Quasi-experimental study was conducted to evaluate the effectiveness of an

educational intervention on 53 maternity nurses knowledge and attitude regarding cord blood

collection and stem cells at two settings; labor unit in obstetrics department at Benha

University Hospital and Maternity Hospital at Zagazig University Hospital, Egypt.The results

of the study revealed that 88.7% of nurses had poor knowledge before intervention. However,

90.6% and 81.2% of them had good knowledge immediately and after three months of

intervention respectively. As well as, only 1.9% of the studied nurses had positive attitude

toward cord blood collection and stem cells before intervention. Meanwhile, immediately and

after three months of intervention the positive attitude changed to 66.0% and 69.8%

respectively. The study concluded that the implementation of an educational intervention was

effective and significantly improved nurses knowledge and attitude towards cord blood

collection and stem cells.36

13
 An exploratory descriptive study was conductedin two antenatal outpatient clinics to

determine pregnant women's knowledge and attitudes towards stem cells and cord blood

banking in Istanbul, Turkey. The sample consisted of 334 pregnant women during routine

prenatal visits and data was collected in interviews by using an interview form.The pregnant

women who stated that they were thinking aboutstorage of cord blood were doing so for the

following reasons because it might be necessary in the future (48.9%) because they might

regret not having performed it in the future (10.2%) because it was good to store what would

have been thrown out (9.8%) because it is beneficial (22.1%) because it would be insurance

for the health of their child (8.1%) and, in case a problem developed, because they had

married a relative (5.9%). Results of the study reveled that majority of the participants had a

lack of knowledge about stem cells and cord blood banking and wanted more information.

Before pregnancy, they received some information through the media (newspaper, Internet,

television, etc.) but unintentionally. It was determined that they wanted information before

becoming pregnant, more from their obstetrician but also from nurses and midwives. The

majority also wanted to store their infants cord blood and stated that they would be more

likely to choose a public cord blood bank. The study concluded that those giving ante-natal

and perinatal care need to offer accurate and scientific counselling services on this subject to

parents.37

A standardized survey was conducted among 5120 mothers on factors that influence a

mother's willingness to preserve Umbilical Cord blood (UCB) during 2011 to 2013 at China.

The results of the study showed that first-time mothers showed a greater willingness to

preserve their UCB (73.3%) compared to those having their second (48.9%) or third child

(40.3%). Mothers who were employed at Government Agencies and Organizations were

more willing to preserve their UCB (87.3%) than those employed at factories (62.0%), and

those who were unemployed (27.3%). Mothers holding master's or college degrees were
CHAPTER 2 REVIEW OF LITERATURE

more willing to preserve their UCB (72.5% and 71.1%, respectively) than mothers with high

school diplomas (48.7%) or those who only went to preliminary school or middle school

(40.7%). The two strongest factors that influenced an unwillingness to preserve UCB were

the high cost and concerns regarding the safety of the preservation.The study concluded that

the government, clinicians and UCB banks should combine efforts to take measures, such as

increasing public knowledge of the importance of UCB preservation and decreasing the high

cost for its storage will most likely increase the frequency of UCB preservation which will

further benefit stem cell research and therapy.38

A survey was conducted to assess the knowledge and preference of blood donors and

of pregnant women on donating umbilical cord blood to a public bank or storing it in a

private bank at the "Sapienza" University of Romes. Two types of anonymous questionnaires

were prepared: one type was administered to 1,000 blood donors while the other type was

distributed to 300 pregnant women. The study results revealed that most blood donors as well

as the majority of pregnant women had some general knowledge about UCB (89% and 93%,

respectively) and were aware of the possibility of donating it (82% and 95%). However, the

level of knowledge regarding current therapeutic use resulted generally low, only (10%)

among informed blood donors and (31%) among informed pregnant women gave a correct

answer. The survey also revealed a preference for voluntary donation both among blood

donors (76%) and among pregnant woman (55%). Indeed, a minority of blood donors (6.5%)

and of pregnant women (9%) would opt to store UCB for private use. The study concluded

that information about UCB donation and preservation should be carefully given by

professionals and institutions. 39

15
 SECTION II

Literature related to general information regarding cord blood banking.

A Discriptive study was conducted to assess Health professionals knowledge and

attitudetowards the umblical cord blood donation in Greece.The sample consisted of 109

Health Professionals from 3 provincial hospitals and 2 other hospitals the data was collected

using sturcture questionnaire. The study results revealed that among the health Professionals

23.9% were physicians, 34.9% were midwives, and 34.8% were nurses. The 15.6%

participants declared to be quite or well informed on the collection methods and the usage of

Umbilical Cord Blood. The vast majority of the participants (89%), declared that a well-

organized program on a continual training is very essential. 93.5% of the participants

declared that in the last 5 years received no or very little training regarding the collection,

storing and transplantation of Umbilical Cord Blood.The study concluded that health

professionals are considered by the public as the most credible source of information about

Umbilical Cord Blood, their level of knowledge on the usage and storing of Umbilical Cord

Blood is inadequate. The present study indicates the necessity of creation or reinforcing of

effective programs of continual training with the use of technology.40

A study was conducted to assess pregnant women’s awareness of cord blood stem

cells and their attitude regarding banking options among 1620 pregnancy in women. France,

Germany, Italy, UK. The study result showed that, total of 79% of pregnant women had little

awareness of cord blood banking 59% of women had heard of the therapeutic benefits of cord

blood, of which 21% received information from midwives and obstetricians, 89% of

respondents would opt to store CBUs. Among them 76% would choose to donate CBUs to a

public bank to benefit any patient in need of a cord blood transplant, 12%, a private bank.

The study concluded that strong preference for public banking in all five countries. Attitudes

of pregnant women are not a obstacle to the rapid expansion of allogenic banking in these EU
countries. Banking do not appear to be correlated with household income. The extent of

commercial marketing of cord blood banks in mass media highlights the importance for

obstetric providers to play a central role in raising women’s awareness early during their

pregnancy with evidence based medical information about banking options.41

A descriptive study was conducted to examine pregnant women's knowledge and

attitudes regard to collection, testing and banking of cord blood stem cells The questionnaire

was distributed to 650 women attending antenatal clinics at a regional women's hospital. The

study results reveled that more than half of the women (70% to74%) reported poor or very

poor knowledge about cord blood banking and (68%) thought that physicians should talk to

pregnant women about the collection of cord blood.66% wanted to receive information about

this topic from health care professionals or prenatal classes (70%). 86% would elect to store

cord blood in a public bank and 14% would elect private banking, indicating that this would

be a good investment or that they would feel guilty if the blood had not been stored.

Additional acceptable uses for cord blood included research (67%) and gene therapy (39%).

The study concluded that Most of the women in this study supported the donation of cord

blood to public cord blood banks for potential transplantation and research.42

A Cross-sectional survey was conducted on maternal understanding of commercial

cord blood storage for their offspring among pregnant women in Hong Kong. The study

results reveled that the knowledge about the use of self-stored umbilical cord blood (UCB)

stem cells and attitude towards CCBB. Out of the 2,000 women recruited, 1 866 (93.3%)

completed the questionnaire. The majority (78.2%) had no idea that there was the chance of

using self-stored stem cells. Moreover, most of the respondents were unclear about which

diseases other than leukemia are amenable to treatment with UCB stem cells in general. Only

20.3% of women knew that stem cells are available from the Red Cross in case their children

need hematopoietic cell transplantation. The study concluded that inadequate knowledge on
UCB stem cell banking and its applications among most of our pregnant women. The

government and clinicians should combine efforts to provide accurate information on

utilization of UCB stem cells during antenatal care.43

A study was conducted to determine patients knowledge of umbilical cord

blood banking (UCBB).A questionnaire was administered in Part 1 (patients with familiarity

with the term UCBB) and part 2(patients with any awareness of UCBB). The study results

reveled that 425 patients completed the survey, 37% had no knowledge of UCBB. Older

patients and those with higher degrees of education were more aware of UCBB, and the

greatest disparity of knowledge was noted among Native American patients (p < 0.001). Of

patients indicating familiarity with UCBB, 2.6% felt extremely knowledgeable, while 74%

felt minimally informed. 50% percent of the patients were misinformed that UCBB was only

for the child that I will deliver. The studyconcludedthat 71% percent of patients were not

planning UCBB, with expense and insufficient knowledge as the primary reasons cited. Only

14% of patients were educated about UCBB by their nurse or obstetrician, although 90% of

patients expected their obstetrician to answer their questions on UCBB.44

A descriptive study was conducted to assess the knowledge & attitude regarding

umbilical cord blood stem cells banking among antenatal women was conducted in Civil

Hospital, Amritsar (Punjab). The investigator selected 325 antenatal women who fulfilled the

inclusion criteria by using purposive sampling technique. The study results reveledthat

maximum (49.5%) antenatal women had below average knowledge, followed by 39% had

average knowledge and only 11.3% had good knowledge regarding umbilical cord blood

stem cells banking. As per attitude towards umbilical cord blood stem cells banking,

maximum number of antenatal women (72.6%) had negative attitude whereas remaining

(27.3%) had positive attitude regarding umbilical cord blood stem cells banking. As per

relationship, there was a positive correlation between the knowledge and attitude regarding
umbilical cord blood stem cells banking among antenatal women (r = 0.747, p<0.01).This

means that as knowledge of antenatal women regarding umbilical cord blood stem cells

banking increases, there is improvement in attitude for the same likewise & vice-versa. The

study Concluded that Maximum antenatal women had below average knowledge & negative

attitude towards umbilical cord blood stem cells banking.45

A study was conducted to explore beliefs and attitude toward umbilical cord blood

donation among 250 Hispanic and non-Hispanic black women was conducted at the antenatal

wards in Spain. The study results revealed that majority, 49.5% antenatal mothers had below

average knowledge and 72.6% had negative attitude towards umbilical cord blood stem cells

banking. It is harvesting and use, and the steps and conditions necessary to donate were

primary barriers to donation There was positive relationship between knowledge and attitude

regarding umbilical cord blood stem cells banking among antenatal women i.e. (r=0.747)

which was significant at p<0.01 The study concluded that 70% had lack of basic information

& have negative attitude regarding umbilical cord blood,.This means that as knowledge of

antenatal women regarding umbilical cord blood stem cells banking increases, there is

improvement in attitude for the same likewise & Vice-versa.46

The study was conducted to determine Greeks opinion about umbilical cord blood,

identify the reasons for the lack of motivation to donate umbilical cord blood and allow

experts to establish better recruitment campaigns to enrich the donor pool. The

studyResultsrevealed that48 % of respondents knew about umbilical cord blood and had full

knowledge about what storage/donation offers. Media (35%) and doctors (25%) were the

main source of information. The information from the state was considered either inadequate

or non-existent by 85% of the responders. 95% of the people questioned would like further

information regarding umbilical cord blood transplantation and umbilical cord blood

storage/donation. Six percent of the respondents who had children and were in favour of
umbilical cord blood transplantation, had stored/donated UCB. With regards to future

decisions, 84% of the sample would store/donate umbilical cord blood, of whom 57% would

keep the umbilical cord blood in a private bank. The studyconcluded that Greek citizens

receive information about umbilical cord blood from both the state and advertising campaigns

by the Ministry of Health and Social Solidarity. A kind of cooperation between all hospitals

and public umbilical cord blood banks would be advisable in order to facilitate access to

umbilical cord blood donations.47

A quantitative survey was conducted for selecting 100 staff nurses working in

selected hospital at Mangaluru to assess the Knowledge Regarding Cord blood banking

among Staff Nurses. The study revealed that 48% of staff nurses were of age group 26-30

years and most of the staff nurses were females (82%) and only 18% were male nurses

Maximum of staff nurses participated in the study were GNM’s (58%).Results also showed

that majority of staff nurses (61%) belongs to Christian religion with maximum of 1-5 years

of clinical experience. Most of the staff nurses (89%) had no previous information regarding

stem cell therapy. Most (11%) of them had media as their source of informationThe study

concluded that The present study was aimed to assess the knowledge regarding umbilical

cord blood stem cell therapy among staff nurses in selected hospitals at Mangaluruwith the

view to develop self-instructional module. The concluded that, majority of staff nurses are

having poor knowledge regarding umbilical cord stem cell therapy. Thus there is a great need

to educate staff nurses regarding umbilical cord stem cell therapy.48

SECTION III

Literature related to advantages of cord blood banking.

A Cross sectional survey was conducted to assess the knowledge, awareness and

perception of medical students in Malaysia towards stem cells and SCR.Thestudy Results

revealed that majority of the participants were female (56.7%) and Chinese (62.4%). Most of
the students were aware of stem cells, although 78% mentioned that their knowledge was not

obtained from their medical studies. Most respondents were aware of umbilical cord stem

cells (81.5%) as compared to 24.8% awareness of fetal stem cells. The support for the use of

embryonic as well as adult stem cells had increased from the initial support of 49.7% using

stem cells for research purposes to 67.5% when they were asked to view SCR as a potential

therapy for diseases. The study concluded that medical students were aware of stem cell

concept but the exposure to this topic is still limited in their medical curriculum. A moderate

level of knowledge was observed.49

A cross sectional study was conducted to determine Turkish mothers knowledge level

and attitudes about cord blood and cordblood banking. The study was conducted at five

primary healthcare centers in Erzurum city center. The research was made in collaboration

with 322 mothers between ages 18 and 49 that came to the healthcare centers. The study

Resultsreveled the 29.8% of mothers knew about cord blood and stem cells and that they

were used for medical treatment. 75.4% of mothers did not know about cord blood banks and

21.1% learned about these issues from the internet or other mass media. It was also found that

knowledge level of mothers increased and their attitudes got better in accordance with their

educational status (p<0.001). The study Concluded that the most participants of the study did

not have enough knowledge about either stem cells or cord blood banking.50

A study was conducted on attitudes of Swiss public umbilical cord blood donors

toward private and public banking.A standardized questionnaire was sent to the most recent

621 public UCB donors including items regarding satisfaction with recruitment process, The

study results revealed that Of the questionnaires, 48% were returned, and 16% were lost due

to mail contact. Of our donors, 95% would donate to the public bank again. As much as 35%

of them were convinced that public banking was useful. Whereas 27% had never heard about

private UCB banking, 34% discussed both options. Nearly 70% of donors opted for public
banking due to altruism and the high costs of private banking. Of our public UCB donors,

81% stated that they did not need a re-consent before UCB release for stem cell

transplantation. In case of sample rejection, 53.5% wanted to know details about the

particular research project. A total of 9% would not consent. The study concluded that

Almost all donors would choose public banking again due to altruism and the high costs of

private banking. Shortly after donation, mail contact with former UCB donors was difficult. 51

A study was conducted to assess procedures and outcomes in Antenatal clinics and

reference hospitals in Zurichall deliveries in Switzerland took place in hospital.between 1989

and 1992. In that 489 women opting for home delivery and 385 opting for hospital delivery

The study Resultsreveledthat All women were followed up from their first antenatal visit till

three months after delivery. Referrals during pregnancy 37 and labour 70, and 17

miscarriages resulted in 369 births occurring at home and 486 in hospital. During delivery the

home birth group needed significantly less medication and fewer interventions whereas no

differences were found in durations of labour, occurrence of severe perineal lesions, and

maternal blood loss. Perinatal death was recorded in one planned hospital delivery and one

planned home delivery (overall perinatal mortality 2.3/1000). The study Concluded

thatHealthy low risk women who wish to deliver at home have no increased risk either to

themselves or to their babies.There was no difference between home and hospital delivered

babies in birth weight, gestational age, or clinical condition. Apgar scores were slightly

higher and umbilical cord pH lower in home births, but these differences may have been due

to differences in clamping and the time of transportation.52

A Cross sectional study was done on women who attend antenatal clinic at the Benue

State University TeachingWillingness to Donate Umbilical Cord Blood by Pregnant Women

inMakurdi, North-Central NigeriaHospital were used for this study. A total of 250 structured

questionnaires were distributed, out of which204 were found fit for analysis. The study
results reaveled that the respondents were aged 19 to 44 years, with a meanage of 29.1 years.

Tiv tribe made up the largest number (72.5%). Majority (44.1%) was Civilservants, 91.2%

were Christians, 99.0% were married and 74.6% had tertiary education. Thirty-eightpercent

(38.2%) were having their first pregnancy while the rest were either having their 2nd, 3rd, 4th

ormore pregnancies. On willingness to donate umbilical cord blood, 83 (40.8%) of the

women were willingto donate their placenta after delivery. Eight-four percent of these

women said they will be doing so inorder for the hospital to help them discard their placenta.

The reasons for not donating placenta by theunwilling women included, preference to bury

placenta at home (56.9%), protection of child’s destiny(20%), obedience to their husband’s

wish (9.6%), cultural reasons (8.5%) and religious reasons (5.0%).Willingness to donate cord

blood was noted to be significantly affected by the number of pregnancies.Women with first

pregnancy were less willing to donate their placentas compared to women with highernumber

of pregnancies. (p=0.004). The study results Concludes that the willingness to donate

placenta after delivery by women in Makurdi is fair. Preferenceto bury placenta at home was

the major impediment to donation of placenta by pregnant women inMakurdi.53

An explorative questionnaire based survey was carried out in the areasof Mumbai,

India The participants of the surveywere of varied age groups. Total number of

543individuals participated, out of which 177 weremales and 366 were femalesthe study

reavledthat out of total populationapproximately 48% of the population was notaware of

UCB banking that the institutions carryingout UCB Banking.From the 3rd and 4th questions,

it wasobserved that above 89% of the studied populationare willing to do UCB Banking for

their new-born.From the studied population about 96% of thepopulation agreed for active

participation ofgovernment and private bodies such as hospitals inUCB Banking. The study

concluded that the overall awareness about theUCB Banking was very poor among the
studiedpopulation. Out of the total populationapproximately 48% of the people were aware

ofUCB Banking and the associated institutions.54

A Cross sectional study was conducted to assess the knowledge and attitude of 56

nurses enrolled from the Labour room and Maternity ward of the facility revalidated and

tested self developed knowledge question and attitude scale where used to collect data

regarding stem cells and UCB. The study results reaveled that most of the nurses had good

knowledge 42.86% and neutral attitude 78.6% with a mean knowledge and the attitude score

of 16.84% and 53.75% respectively none of the nurses received any pre service or inservice

education regarding stem cells UCB and however 17 nurses assisted witnessed UCB and all

this nurses way from the Labour room all of the nurses Express that they want to have more

information regarding stem cells majority 62.5% of the nurses have heard about UCB and

reported other Healthcare workers 74.28 as their knowledge resource there was a positive

correlation between knowledge and attitude scores of the nurses or is equals to 0.532 nurses

who witnessed a sister UCB be at significantly greater knowledge about UCB The study

concluded that they have a significant better knowledge and those who did not hear about

UCB attitude scores of the nurses were significantly associated with a professional education

status nurses have good knowledge and neutral attitude regarding stem cells and UCB they

want to have more information.55

The study was conducted to determine the relationship between the maternal age at

delivery and selected properties of the cord blood stem cells Bank in Warsaw. The study

included 50 pregnant women aged between 18 and 38 years in which spontaneous labors or

elective cesarean sections were performed. Umbilical cord blood was collected immediately

after the women were delivered of newborns. The samples were analyzed in the Polish Stem

Cells Bank in Warsaw. The study Results revealed that highest mean WBC level (p < 0.05)

was observed in the umbilical blood collected from patients aged 35 years and more.
Similarly, the highest mean cell viability was observed in the umbilical cord blood collected

from patients aged 35 and more. There were no statistically significant correlations between

the CD34+ cells count and mean cell viability in the umbilical cord blood and the maternal

age. With the significance level at p < 0.001, the females after spontaneous labor revealed a

visibly higher WBC level than patients after a cesarean section. The study concluded that the

higher mean WBC concentration (24.95 thousand/μl) was observed in the umbilical cord

blood of patients aged 35 and more after spontaneous labors. In the same group, the

umbilical cord blood was also characterized by the highest mean cell viability (98.72%). The

number of nucleated cells in the umbilical cord blood collected in the perinatal period

increases together with the maternal age.56

A study was conducted for banking, characterizing, and distributing placental blood.

Placental blood was stored under liquid nitrogen and selected for specific patients on the

basis of Human Leucocyte Antigen type and leukocyte content. The study Results revealed

that cumulative rates of engraftment among the recipients, according to actuarial analysis,

were 81 percent by day 42 for neutrophils (median time to engraftment, 28 days) and 85

percent by day 180 for platelets (median, day 90). The speed of myeloid engraftment was

associated primarily with the leukocyte content of the graft, whereas transplantation-related

events were associated with the patient's underlying disease and age, the number of

leukocytes in the graft, the degree of Human Leucocyte Antigen disparity, and the

transplantation center. The study concludes that the engraftment, age, Human Leucocyte

Antigen disparity, and center were the primary predictors of outcome, Placental blood is a

useful source of allogeneic hematopoietic stem cells for bone marrow reconstitution.57

A Comparative study was conducted to compare the co expression of Umbilical Cord

Blood, CD45(+)/CD34(+) cells in preterm and full-term neonates. The study included 25

Preterm i.e.29-36 weeks gestation and 25 Full-Term i.e. 37-41weeks of gestation neonates
delivered at Ain Shams University, Maternity Hospital .The study results reveals that the

absolute CD45(+)/CD34(+) count did not differ between Preterm and Full-Term infants Z = -

0.485, p = 0.63. There was no correlation between absolute cell count and Gestational Age (r

= 0.013, p = 0.9) for all 50 neonates. The study results concluded that the absolute cell count

is not affected by gestational age and did not relate to morbidity scores in the studied Preterm

infants.27 wide-scale work will be needed to study CD45(+)/CD34(+) count in hUCB in sick

PT neonates.58

A prospective open study was conducted to assess knowledge through a structured,

anonymous questionnaire at the University of Basel Women's Hospital pregnancy outpatient

clinic. The study results reveled that from 300 questionnaires handed out to pregnant women

of different ethnic background attending our outpatient clinic, 250 (83%) were returned, and

245 could be evaluated for final analysis. Only 40% indicated that they did know what

usually happens to the placenta after birth. In contrast, the vast majority (95%) supported the

idea of umbilical cord blood for banking and later use for stem cell transplantation. Similarly,

93% stated that they would agree to donate the cord blood from their own child for this

purpose. The study concluded that there is no statistically significant differences could be

identified either between women with or without previous knowledge or of different ethnic

background study shows the high acceptance of umbilical cord blood donation for banking

and stem cell transplantation purposes in pregnant women, irrespective of previous

knowledge.59
CHAPTER 3 RESEARCH METHODOLOGY

RESEARCH METHODOLOGY

Research methodology refers to the master plan specifying the methods and procedure

for collecting and analysing the needed information in a research study.48

Research methodology in the present study includes the following: research approach,

research design, research setting, population, sample selection and sampling techniques, the

exclusion and the inclusion criteria, development and description of knowledge

questionnaire. Information Guide Sheet, content validity, and development of informational

booklet, pilot study, procedure of data collection and a plan for data analysis.

Research approach

The research approach helps the researcher to understand the method for collecting

data and analysing it. It also suggests the possible conclusions to be drawn from the data.48

In view of the nature of the problem selected and the objectives to be accomplished,

an descriptiveapproach was considered appropriate for the present study.

Research design

The research design is a blueprint for conducting the study that maximizes

control over factors that can interfere with the validity of the findings. It is an overall plan

investigator used to obtain valid answers to research questions.

The selection of design depends upon the purpose of study, reasearchapporach and

variables to be studied. The reaseach design selected for the study is Descriptive survey

design.

28
Research setting

Setting refers to the area or physical location where the study is being conducted.The

present study was conducted in K L E Society's Institute Of Nursing Sciences, Hubballi and

KLE University's College Of Pharmacy - Hubballi.

Population

Population refers to the aggregation of all the units in which a researcher is interested.

In others words, population is a set of people or entities to which the results of a research can

be generalized.

Target population

It refers to the population that the researcher wishes to study and make

generalizations.48In the current research study, the target population comprise B.sc. Nursing

and B. Pharmacy students of K.L.E. Society’s Institutions, Hubballi.

Sample

A subset of population selected to participate in a research study is known as

sample.48 In the present study, the sample consists of Final Year B.sc nursing students of K L

E Society's of Institute Nursing Sciences, Hubballi and Final year B.Pharmacy students of

KLE University's College of Pharmacy Hubballi.

Sample size

The sample size for the study was 100.

Sampling technique

The researcher in the present study selected target population through Non-

probability – Convenience sampling technique.

Criteria for selection of samples

The criteria for selection of samples in this study involves:-

Inclusion Criteria :Undergraduate Students who are:
 Willing to participate in the survey.
 Present during data collection.
Exclusion Criteria :Undergraduate Students who are:
 Sick at the time of data collection.
Selection and development of the tool
Based on the objectives of the study, a structured knowledge questionnaire regarding cord

blood banking was prepared by the researcher for the present study.

The following steps were carried out during the preparation of the tool:

1. Literature review on knowledge regarding cord blood banking.

2. Discussion with the experts in the field of nursing.

3. Informal discussion with the teachers.

4. Preparation of the blueprint

5. Preparation of first draft of tool

6. Validity of the tool by experts

7. Reliability check of the tool

8. Final draft of the tool.

Description of the tool

The tool selected for the studywas a structured knowledge questionnaire which comprised

three sections. They were:

Section I : Socio demographic data containing 8 items

This part consists of 8 items for obtaining information about socio demographic

variables such as age, gender, religion, family income, course of study, source of information,

Have you had close family member or friend went to cord blood banking .

Section II : Structured Knowledge Questionnaire which contains 27 items:

 This part consists of 52 items for obtaining level of knowledge among Undergraduate

Students regarding Cord Blood banking. Each correct answer carries 1 mark and incorrect

answer 0 marks.

Part A: Definition of blood, composition, functions and color.

Part B:Cord Blood and Cord Blood banking

Validity of the tool

Tool was validated by the experts in the field of Medical Surgical Nursing and other

health care professionals andthe members of the research committee of KLES Institute of

Nursing Sciences, Hubballi. The experts were requested to review and verify the items on

knowledge questionnaire. There is a consensus among the experts regarding the items.

Hence, the minor mistakes which needed correction were corrected and incorporated as per

the directions of the research committee and the suggestions given by validators.

Reliability of the tool

The tool was tested for reliability on five students during pilot study by using split

half method,and applying Karl Pearson’s Correlation Coefficient formula. Hence the tools

were found to be reliable.

Pilot study

Administrative approval for a pilot study was obtained from the Principal, Sheraya

College of Nursing, Hubballi. The pilot study was conducted on 03.05.2017 to 04.05.2017.

The purposes of the pilot study were:

1. To evaluate the tool constructed

2. To find out the feasibility of conducting the final study

3. To determine the method of statistical analysis

 The investigator selected tensamples using non- probability convenience sampling

technique. The datawas collected by using structured knowledge questionnaire. The data was

collected and analysed using descriptive and inferential statistics.

Procedure of data collection

The research investigator had taken formal permission from the Principals of K.L.E.

Institution Of Nursing Sciences, Hubballi and KLEU College of Pharmacy Hubballi. The

main study was conducted on 03.05.2017 to 04.05.2017 at respective K.L.E. Institution Of

Nursing Sciences, Hubballi among Undergraduate Students Health Science Institutions,

Hubballi

The method used for data collection is as follows:

1. The investigator introduced himself and explained the purpose of study among

Undergraduate Students of K.L.E. Hubballi.

2. The consent was obtained from the participants.

3. The data was collected by using structured knowledge questionnaire The collected

data was tabulated and analyzed.

Data analyses plan

The data obtained were analyzed in terms of the objectives of the study using

descriptive and inferential statistics. The plan of the data analysis was developed under the

excellent direction of the experts in the field of nursing and statistics. The plan of the data

analysis was as follows:

1. Organization of the data on the master sheet

2. Tabulation of the data in terms of frequency, percentage, mean, standard

deviation and range to describe the data.

3. Classify the knowledge scores as follows:

 Good knowledge -- ( X + SD) and above

 Average knowledge -- ( X - SD) to ( X + SD)

 Poor knowledge -- ( X - SD) and below

[Note: X – Mean, SD – Standard deviation]

4. Inferential statistics used to draw the following conclusions

 Chi–square test to find out association between the knowledge and

their selected socio demographic variables.

 Karl Pearson’s Coefficient of Correlation to measure the degree of correlation

between knowledge.

This chapter on research methodology has thus described about the various

activities planned and carried out by the research investigator during the course of

his dissertation.
 SCHEMATIC REPRESENTATION OF THE RESEARCH PROCESS

SETTING POLULATI SAMPLE

ON SIZE
To assess the
level of K. L. E
knowledge Society’s
regarding Institute of Undergraduat
cord blood Nursing e students of
banking Sciences, Health 100 Samples
among Hubballi and Science
Undergraduat KLEU college Institutions
e students of of Pharmacy,
Health Hubballi.
Science
Institutions.

STATISTICS METHOD OF DATA INSTRUME

OF ANALYSIS COLLATION NT
&
INTEPRATIONS
Structured
• Descriptive Assess the Knowledge
Statistics knowledge by questionnaire
• Inferential structured . related Cord
statistics Knowledge Blood
questionnaire. Banking
SAMPLE SIZE OF ESTIMATION

16. SAMPLE SIZE OF ESTIMATION

SOURCES OF DATA
Primary Source: Undergraduate B.Sc Nursing and B. Pharmacy Students.
Secondary Source:Students Records maintained in the Health Sciences Instutitions.
Research Approach: Descriptive.
Research Design: Descriptive Survey.
Research Settings: KLE’S Institute of Nursing and KLEU’S Institute of Pharmacy,
Hubballi.
Sample:Final Year Undergraduate Bsc Nursing and B Pharmacy Students.
Sample Size:100.
Inclusion Criteria:Undergraduate Students who are:
 Willing to participate in the survey.
 Present during data collection.
Exclusion Criteria:Undergraduate Students who are:
Sick at the time of data collection.

34
 ANALYSIS AND INTERPRETATION OF DATA

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

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

can be discussed.

Analysis is the categorizing, ordering, manipulating and summarizing of data to

obtain answers to the research questions. The interpretation of tabulated data can bring light

to the real meaning and effectiveness of the findings

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge regarding cord blood banking among Undergraduate
students of Health Science Institutions.
2. To find an association between knowledge and their selected socio-demographic
variables.
3. To develop information guidesheet regarding cord blood banking.
HYPOTHESIS
H1: There will be statistical association between knowledge scores of undergraduate
students and their selected socio-demographic variables at 0.05 level of significance.
PRESENTATION OF THE DATA

The data is presented under the following sections:

SectionI : Distribution of sample characteristics according to socio demographic

variables.

Section II : Analysis and interpretation of Knowledge scores of Undergraduate students

regarding cord blood banking.

Section III : Analysis and interpretation of data to find out an association between

knowledge and their selected socio-demographic variables

CHAPTER IV ANALYSIS AND INTERPRETATION OF DATA

SECTION I: Distribution of sample characteristics according to socio demographic

variables

Table No 1: Frequency and percentage distribution of subjects according to their socio

demographic variables

n=100

Sl
No Demographic variables Frequency (f) Percentage (%)
1. Gender
a) Male 35 35
b) Female 65 65
2. Age in years
a) 15-20 00 00
b) 21-25 85 85
c) 26-30 15 15
3. Religion
a) Hindu 65 65
b) Muslim 06 06
c) Christian 23 23
d) Others 06 06
4. Type of family
a) Nuclear 60 60
b) Joint 40 40
c) Extended 00 00
5. Course of study
a) Nursing 50 50
b) Pharmacy 50 50
6. Family income/month in rupees
a) <10000 00 00
b) 10,000-25,000 80 80
c) 25,000-50,000 20 20

35
 d) 50,000 and above 00 00
7. Source of information
a) Mass media 60 60
b) Self reading 20 20
c) Health personnel 10 10
d) Academic 10 10

8. Have you had a family member or friend

went to cord blood banking?
a) Yes 00 00
b) No 100 100

Table No 2. Revels that

 Majority of the subjects 35(35%) were females and 65(65%) were males.
 Majority of age 85(85%) belonged to the age group of 21-25 and 15 (15%)
belonged to 26-30.
 Majority of religion 65(80%) belonged to Hindu, 10(10%) to muslim Christians
23(23%) and 10 (10%) to others.
 The maximum, number of subjects 60(60%) were from nuclear family and
remaining 40(40%) from joint family.
 Majority had an income between 10,000 to 25000 80(80%) and 20(20%) 25,000
to 50,000.
 Majority of belonged to nursing 50(50%) and pharmacy 50(50%)
 The maximum received information from mass media 60(60%) ,rest 20(20%)
from self Health personnel,10(10%). and academic ,10(10%)
 Majority 10(100%) of members had not went to cord blood banking
 \
GRAPHICAL REPRESENTATION OF SOCIO-DEMOGRAPHIC VARIABLE:

Gender

35% Male
Female

65%

Graph1:The Doughnut chart represents percentage distribution of subjects according

to gender

Age in Years

85%

90%
80%
70%
15-20 years
60% 21-25 years
50% 26-30 years
40%
15%
30%
20% 0%
10%
0%
15-20 years 21-25 years 26-30 years

Graph 2: The Bar graph represents percentage distribution of subjects according to age
 Religion

100%
80%
65%
60%
40% Hindu
20%
Muslim
0% 23%
Christian Others
6% 6%

HinduMuslimChristianOthers

Graph 3: The bar chart represents percentage distribution of subjects according to

religion

Type of Family

Extended 0%

Joint 40%

Nuclear 60%

0% 20% 40% 60% 80% 100%

Graph 4: The bar graph represents percentage distribution of subjects according to

type of family
 COURSE OF STUDY

50%

50%

NursingPharmacy

Graph 5:The pie graph represents percentage distribution of subjects according to

course of study

Family income/month in rupees

100%
90%
80%
70%
60% < 10,000
50% 10000-25000
40% 25000-50000
30% > 50,000
20%
10%
0%

Graph 6:The conical graph represents percentage distribution of subjects according

to family income
 Source of information

100%
80% 60%
60%
Mass media Self reading
40%
Health personnel
20%
20% Academic
0% 10% 10%

Mass mediaSelf readingAcademic

Graph 7:The bar diagram represents percentage distribution of subjects according

source of information.

Registration for Cord Blood Banking

Yes 0%

No
100%

YesNo

Graph8:The Doughnut chart represents percentage distribution of subjects according

to registration for cord blood banking.
 SECTION II: Analysis and interpretation of knowledge scores of undergrauates
students of K.L.E. Society’s Institutions who have participated in the study regarding
cord blood banking
Table No 2: Mean, Median, Mode, Standard deviation and range of knowledge score of
subject regarding cord blood banking.

n=100

Area of Standard
analysis Mean Median Mode deviation Range
Test 24.88 26 23 10.528 22
Table No 2: Reveals that
Test mean knowledge scores were 24, Median were 26, Mode were 23, Standard deviation
were10.528 and Range were 22.

30

25

20

15

10

0
Mean Median Mode Standard deviation Range

Graph No 9: Bar graph Showing Mean, Median, Mode, Standard deviation and range
of knowledge score of subject regarding cord blood banking.

Table No 3: Frequency and percentage distribution of knowledge scores of subjects

regarding cord blood banking

n = 100
 Knowledge Pretest
score Frequency Percentage
Good
(35.4and 02 02%
above)
Average
(14.32-35.4) 97 97%
Poor
(below14.32) 01 01%
Table No 3: Reveals that in test majority 97(97%) had average knowledge regarding
cord blood bank 2 (2%) had good knowledge and 1 (1%) had poor knowledge

Good (>35.4)

Average (14.32 to
35.4) Poor(<14.32)

Graph 10: Doughnut graph showing Frequency and percentage distribution of

knowledge scores of subjects regarding cord blood banking

SECTION I1I: Analysis and interpretation of knowledge scores of undergrauates

students of K.L.E. Society’s Institutions who have participated in the study regarding
cord blood banking
Table No 4: Association between knowledge scores of subjects and selected socio
demographic variables
n=100
SL.No. Demographic Chi square Df
Good Average Poor
variables Cal tab
1) Gender

a) Male 1 34 0 1.279 5.99 2

b) Female 1 62 2

2) Age in years

a) 15-20 0 00 0 2.7136 9.49 4

b) 21-25 2 82 1

c) 26-30 3 8 4

3) Religion

a) Hindu 6 55 4 2.26 12.59 6

b) Muslim 1 4 1

c) Christians 3 18 2

d) Others 1 5 0

4) Type of family

a) Nuclear 1 58 1 1.56 9.49 4

b) Joint 2 88 0
c) Extended 0 0 0
5) Course of study

a) Nursing 1 49 0 1.01 5.99 2

b) Pharmacy 1 48 1

6) Family income/month
 a) <10,000 0 0 0 6.46 12.59 6
b) 10,000-25,000 8 67 5
c) 25,000-50,000 06 12 2

d) >50,000 0 0 0

7) Source of information

a) Mass media 2 57 1 2.643 12.59 6

b) Self reading 2 16 2

c) Health 3 4 3
personnel
d) Academic 2 5 3

8) Have you had a family

member or friend went
to cord blood banking?
a) Yes 0 0 0 1.9163 5.99 2

b) No 6 82 12

Table No: 4 Reveals that

 The calculated chi- square value is 1.279, is less than tabulated chi- square value 5.99

hence H1.1 is not accepted

 The calculated chi- square value is 2.713, is less than tabulated chi- square value 9.49

hence H1.2is not accepted

 The calculated chi- square value is 2.267, is less than tabulated chi- square value

12.59 hence H1.3 is not accepted

 The calculated chi- square value is 1.56, is less than tabulated chi- square value 9.49

hence H1.4 is not accepted

 The calculated chi- square value is 1.01, is less than tabulated chi- square value 5.99

hence H1.5 is not accepted

 The calculated chi- square value 6.46 is less than tabulated chi- square value 12.59

hence H1.6 is not accepted

 The calculated chi- square value is 2.643, is less than tabulated chi- square value

12.59 hence H1.7 is not accepted

 The calculated chi- square value is1.9163 is less than tabulated chi- square value 5.99

H1.8 is not accepted.

CHAPTER V DISCUSSION

18. DISCUSSION
The study was under taken” to assess the knowledge regarding Cord Blood Banking

among Undergraduate Students of Health Science Institutions, Hubballi with view to develop

Information Guide Sheet. ”

The findings of the study are discussed under following

headings; The study findings are related to:

Findings related to the selected demographic variables of students.

1) Findings related to the selected demographic variables of students.

In the present study, the sample size of 100 was chosento assess the knowledge

regarding Cord Blood Banking among Undergraduate Students.

In this study majority of samples 35 (35%) were males and 65 (65%) females, this is

supported by a study conducted by Jordan.H.Perlowwho observed that 137 (32.3%) were

males and 288 (67.7%) were females. Majority of the subjects 46 (92%) belonged to Hindu

religion; whereas 03 (6%) and 01 (02%) belonged to Christian and others religion

respectively. These findings are contradicted through a study conducted by

Jordan.H.Perlow369 (97%) were Muslims, 8 (2%) were Christians and 4 (1%) Hindus.34

In this study, maximum 20 (40%) belonged to age group of 40-50 years. These

findings are contradicted through a study conducted by Jordan.H.Perlowwere maximum

belonged to age group of 18-20 years. Majority of subjects were married 46 (92%) and 4

(8%) single, this is supported by a study conducted by Ann j. Alphonsewhere 233 (57.1%)

were married and 175 (42.9%) single.34

The findings were supported by a study conducted by Ann j. Alphonsewho observed

that103 (53.4%) were males and 90 (46.6%) females. In terms of religion 46 (92%) were

Hindus.Majority of subjects were 165(85.5%) married and 28 (14.5%) single, 135 (69.9%)

received information from mass media38.

46
 The findings were also supported by a study conducted by Ms. Elizabeth Mathewwho

observed that majority of samples 316 (71.8%) males and 124 (28.2%) females. In terms of

religion majority 348 (71.8%) were Hindu. Maximum subjects 53% received information

from mass media, 34.1% from health personnel and 13% from friends. 50

2) Findings related to gain in level of knowledge scores of students regarding cord

blood banking.

In present the mean knowledge score was 24.88.The findings were similar to the

finding of the study was done by. Miss Redid Purnimma, Ms.Nongmeikapam Monika, Ms.

Elizabeth Mathew,MsReetuHanglem , MrMahanteshSarabani, Ann j. Alphonse Where

knowledge of patients on cord blood banking reveals that mean knowledge score was 31.0

percent.

3) Findings related to association between test knowledge scores regarding cord

blood banking and socio demographic variables

The association between the knowledge scores and the socio demographic variables

was computed by using Chi- Square test revealed that there was no association between test

knowledge scores and there selected socio demographic variables at 0.05 level of

significance. These findings were supported with a study conducted by Miss Redid Purnima

where there was no significant association between knowledge level and there socio

demographic variables at 0.05 level of significance52.

CHAPTER V CONCLUSION

CONCLUSION

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

1. The overall knowledge regarding cord blood banking scores among Undergraduate

Students were average, therefore the finding reveal varying degree of all knowledge

in different aspects of cord blood banking

2. There is a need for improvement in the level of knowledge regarding cord blood

banking among Undergraduate Students

IMPLICATIONS:

The findings of the present study have implications in the area of nursing education,

nursing practice, nursing administration and nursing research.

Nursing Education:

The educational background of nursing personnel should equip him/her with the

knowledge necessary to function as a health educator. Findings of the study can be used by

the nurse educator to highlight the importance of the informational guide sheet regarding cord

blood banking. The informational guide sheet can be used as reference materials by nurse

educators regarding cord blood banking. The nurse educator should periodically organize

special training program for students on cord blood banking. Nurse educators must conduct

workshops, seminars for students and also patient’s relatives in the hospital.

Nursing Practice:

This study will enable nurse educators to become aware of importance of teaching

Informational guide sheet, as an effective means. Nurse educators can extend and expand

their role in different settings especially in schools, industry and home care setting. Nurse

educators’ role is to extend the health care services to the community. Nurse educators should

provide a package of services in preventive, curative and rehabilitative services for

promotion, maintenance and restoration of health. Nursing supervisors and nurse educators

48
can utilize the self instructional module as a reference material to teach the nurses in the

hospitals as in service education programmes. The nurse must conduct mass awareness

programmes regarding cord blood banking in people. Learning material like wall hangings,

posters, charts can be made available in the community and hospital regarding organ

donation.

Nursing Administration:

The nurse as an administrator should take interest in providing information on

effectiveness of various methods of teaching regarding cord blood banking. They can also

plan and organize teaching program for students in order to enhance their knowledge and

keep them aware regarding cord blood banking, which is a general issue, so that students

themselves will be aware and reduce the gap between demand and supply. The informational

guidesheet as a tool can be utilized during training programs for students.

Nursing Research:

The study findings can be effectively utilized by the nursing researchers to conduct

further studies and improving the body of knowledge in nursing and general population.

Based on the present findings, nurse professional and post graduate student nurse can conduct

research on the effectiveness of information Guide Sheet on knowledge among

Undergraduate Students of Health Science Institutions and other subjects. It is necessary that

the nursing personnel should have the knowledge regarding the research. The tool, lesson

plan and A.V. aids used for the present study can be utilized or modified on the similar kind

of study. Research provides nurses the credibility to influence decision–making, policy and

protocol formulation regarding cord blood banking. Findings of the study suggest that

educators and teachers should encourage nurses to read, discuss and conduct research studies.

So as to enable the nurses to make evidence based decision rather than intuitive decision. The
findings of the present study can be published in journals, internet and other useful media as a

review for further research study on similar topic.

LIMITATIONS:

The study is limited to:

 100 students

 Undergraduate Students of Health Science Institutions Students,Hubballi.

The tool used for the data collection was not standardized. It was designed by the

investigator himself for the purpose of present study based on the objectives of the study

which was validated by experts.

RECOMMENDATIONS:

Keeping in view the findings of the present study, the following recommendations were

made:

1. A similar study that can be done on large and wider sample size and for a longer

period of time would be more pertinent in making broad generalizations.

2. An experimental study can be conducted for assessing the knowledge on cord blood

banking.

3. A descriptive study can be conducted to assess knowledge, attitude and practices

towards cord blood banking..

4. A similar study can be replicated in different setting.

In this chapter, the investigator has tried to rationalize his findings with other studies.

The overall study is undertaken to assess the knowledge among Undergraduate Students of

Health Science Institutions, Hubballi with view to regarding Cord Blood Banking develop

Information Guide Sheet. ” enhancing in nursing education, practice, administration and

research.Information Guide Sheetwas effective in enhancing and upgrading the knowledge of

students. This chapter can thus guide the new learner to make an in depth study about this

topic and compare their findings through it.

 CHAPTER V SUMMARY

19. SUMMARY

This chapter presents the summary of the study. The primary aim of the present study

is to to assess the knowledge regarding Cord Blood Banking among Undergraduate Students

Health Science Institutions, Hubballi with view to develop Information Guide Sheet. ”

The present study was aimed to achieve the following objectives:

1) To assess the level of knowledge regarding cord blood banking among

Undergraduatestudents of Health Science Institutions.

2) To find an association between knowledge and their selected socio-demographic

variables.

3) To develop information guidesheet regarding cord blood banking.

The study attempted to examine the following research hypotheses:

H1: Therewill be statistical association between knowledge scores of undergraduate

students and their selected socio-demographic variables at 0.05levelof significance.

The conceptual framework adopted for this study was based on Ludwig Von

Bertalaniffy’s General System Theory.Review of literature is organized and presented.

The research design selected for the study was Descriptive study. The sample

comprised a total of 100 samples. Non- probability -Convenience sampling technique was

adopted.The tool used for data collection was structured knowledge questionnaire.

TheInformational guidesheet consists of various aspects of cord blood banking.

The content validity of the tool and Informational guidesheet were evaluated by 5

experts and also validated by the research committee of K. L. E Society’s Institute of Nursing

Sciences, Hubballi.

47
 The pilot study was conducted among 10 studentsof K. L. E Society’s Health Science

Institutions,Hubballi.The tool was tested for reliability on 10 samples during pilot study by

using split half method and applying Spearman Brown Prophecy formula co-efficient

formula. Correlation coefficient for knowledge questionnaire.r = (0.853). This indicates the

tool is reliable.

The final study was conducted from 14-6-2017 to 15-6-2017 at KLES University

College of Pharmacy and KLES Institute of nursing science Hubballi. The test was conducted

by using the structured knowledge questionnaire followed by administration of Informational

guidesheet. The data gathered were analyzed and interpreted using descriptive and inferential

statistics. Descriptive statistics like percentage, mean, median, mode, standard deviation and

range the hypothesis at p<0.05 level of significancewere used. Analyzed data was represented

in the form of tables, graphs, etc.

The major findings of the study are as follows

1. Findings related to distribution socio demographic variables of students

 Majority of the subjects 35 (35%) were males and 65 (65%) females.

 In terms of age, maximum 85 (85%) were from the age group of 21-25 years.

 Majority of the subjects 65 (65%) belonged to Hindu religion.

 Majority of subjects 60 (60%) belonged to nuclear family.

 Majority of subjects 50 (50%) were from Nursing and 50(50%) were from Pharmacy.

 Majority of the subjects 80 (80%) had a monthly family income between of Rs 10,

000-24.,000.

 Majority of subjects 60 (60%) received information through mass media.

 Majority 100 (100%) had not went to cord blood banking.

1) Findings related to the assessing the level of knowledge score among subjects

Degarding cord blood banking.

 Itrevealed in test 97 (97%) of subjects had average knowledge, 01 (01%) had poor

knowledge and 02 (02%) had good knowledge regarding cord blood banking.

The over all mean knowledge scores was 24.88, median was 26, mode was 23, range was 22

and standard deviation was 10.528.

2) Findings related to Association between pretest knowledge scores and selected

socio demographic variables.

The computed Chi square value for association between the knowledge scores of

patients of cord blood banking and their socio-demographic variables was found to

significantly associated with knowledge level, course etc.

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fromhttps://link.springer.com/content/pdf/10.1007%2Fs10561-017-9657-y.pdf

55. Stem cell therapy, stem cell treatment, stem cells 21. [Online]. [2009]. [cited 2010

Sept]. Available from: URL:http://www.stemcells21.com.

56. Screnci M, Murgi E, Pirre G, Valente E, Gesuiti P, Corona Fet.al. Donating

umbilical cord blood to a public bank or storing it in a private bank: knowledge

and preference of blood donors and of pregnant women. 2012 Jul; 10(3):331-7.

58. Journal of Biomedical Science.IndiaCD45(+) CD34(+) cells co expression in

preterm and full-term neonates: a pilot study. 2007; 64(4): 157-159.

59. Survek D, IslebeA, Umbilical cord blood transplantation: acceptance of umbilical

cord blood donation by pregnant patient.Schweiz Med Wochenschr. May

2,1998;128(18):689-95.
 INFORMED CONSENT FORM

22. INFORMED CONSENT FORM

Respected Respondent,

I Mr. Jonah Final year M.Sc. Nursing student of KLES’ Institute of Nursing Sciences,
Hubballi.In partial fulfilment of the course requirement, I have to undertake a research
project to be submitted to RGUHS, Bangalore. The title of my project is “A study to assess
the knowledge regarding Cord blood banking among undergraduate students of health
science institutions Hubballi, with a view to develop Information Guide sheet. The
purpose of this study is to determine the knowledge and attitude regarding cord blood
banking among teaching and non teaching faculty of KLES Educational Institutions. You are
requested to participate in this study by responding appropriately to the questionnaire, which
will take about 40-45 minute for you to complete. Your kind co-operation is highly esteemed
and your honest responses are valuable.

I assure you that the information given by you will be kept strictly confidential and
used only for the study purpose. If you are willing to participate in this study please sign the
consent form given below.

Place:

Date: Yours sincerely,

Mr. Jonah.

CONSENT FORM
I have been informed of the purpose of the study and I voluntarily give my consent to participate in this study.

Place: Signature of the Respondent

Date: Name:

62
 PORFORMA

PORFORMA
CRITERIA CHECKLIST FOR EVALUATION OF TOOL REQUESTING
SUGGESSTIONS AND OPINIONS FROM THE EXPERTS.

Dear Madam/Sir,
Kindly go through the tool and give your response in columns given in the criterion table
against each question. Please give your expert comments on the items you agree by tick
mark()Or disagree by marking (X) which will help in modification of the tool.

Structured Knowledge Questionnaire

Organized
Content S. No Relevant Measurable Clarity Remarks
Appropriately
Part I: Socio-demographic data
1
2
3
Socio – 4
demographic 5
Data
6
7
8
Part II: Knowledge Questionnaire
Section A: Items on Anatomy and Physiology of Blood.
1
2
3
4
5
6
7
8
Section A 9
10
11
12
13
14
15
16

64
 Organized
Content S. No Relevant Measurable Clarity Remarks
Appropriately
Section B: Items on cord blood and cord blood banking
17
18
19
20
21
22
23
24
25
26
27
28
29
Section B 30
31
32
33
34
35
36
37
38
39
40
41
42
 Organized
Content S. No Relevant Measurable Clarity Remarks
Appropriately
Section C: Items on cord blood and cord blood banking
43

44
45
46
47
48
Section C 49
50
51
52
53
54

Signature :

Name of the expert :

Designation :
 CERTIFICATE FOR VALIDATION

This is to certify that the,

• Tool : Structured knowledge questionnaire.

• Information Guide Sheet on Cord Blood Banking

Constructed by Ms. Jonah Studying in final year M.Sc (Nursing) at KLES

Institute of Nursing Sciences Hubballi to be used in his study titled “A study to

assess the knowledge regarding Cord blood banking among undergraduate

students of health science institutions, Hubballi with a view to develop

information guide sheet.", has been validated by me.

Signature :

Name :

Designation :

Address :
 LETTER REQUESTING THE OPINION AND SUGGESTIONS FROM EXPERTS ON
CONTENT VALIDITY OF THE TOOL AND INFORMATIONAL BOOKLET.
From,
Mr. Jonah
II Year M. Sc. Nursing
K.L.E.S Institute of Nursing Sciences,
Vidyanagar, Hubballi - 31

To,

Forwarded through Principal

KLES Institute of Nursing Sciences, Hubli

Respected Madam/Sir,
Subject: Requesting for the content validation of the research tool.
I, Mr. Jonah, II year M. Sc. Nursing student of K.L.E.S Institute of Nursing Sciences,
have undertaken a research study on “A study to assess the knowledge regarding cord
blood banking among undergraduate students of health science institutions, Hubballi
with a view develop information guide sheet”.
Objectives of the study
• To assess the level of knowledge regarding cord blood banking among undergraduate
students of health science institutions.
• To find out an association between knowledge and their selected socio-demographic
variables.
• To develop information guide sheet regarding cord blood banking
To achieve the above mentioned objectives, I request you to kindly validate my tool for its
accuracy, appropriateness and relevancy.
Herewith I am enclosing:
• Blueprint
• Tool
• Criteria checklists for evaluation of tool.
I request you to kindly go through the content and give your expert and valuable
suggestions in the columns given and mark () if you agree. Your expert opinion and
kind cooperation will be highly appreciated and gratefully acknowledged.
Thanking you in anticipation,

Yours sincerely,
Place:
Date: Mr. Jonah
 ANNEXURE III

LIST OF VALIDATORS
1. Mr. A.C. Prabhuswamy

Principal,

Fortis Institute of Nursing,

YelchennahalliVillage, Bangalore.

2. Mrs.Venu .A. S.

Asst, Professor,

Dept. of pedS.S. Institute of Nursing Sciences.Davangere.

3 Prof. SonaliJadhav

Principal M,S .Ramaiah Institute of Nursing Education and Research.

M,S .Ramaiahnagara MSRIT. PostBanglore,

4 Mrs. Janet Mathias.

Asst.Professor,

Department of MSNS

J.S.S College of nursing 1st main Sarawathipurum, Mysore

5 Mr .Mansoor M.

Lecturer.dept of

MSN

Kimsvidyanagar

Kims college of Nursing

Hubballi.
 ANNEXURE-V

BLUE PRINT OF THE TOOL

KNOWLE COMPREHEN APPLICAT

CONTENT TOTAL %
DGE SION ION

Items on

anatomy and
1,7,5,6. 2,3,4. _ 7 16.66
physiology of

blood.

Items on cord
10,11,12,14,
blood and 8,9,13,16,17. 11 26.19
15,18._
stem cells.

Items on cord
19,20,22,25, 21,23,24,26,28,2
blood 11 26.19
27. 9._
banking.

Items on
38,39,41,42,43,4
collection and 30,31,32,34,
4,45,46,47,48,49 33 23 30.95
processing, 35,36,37,40.
,50,51,52.
uses.

Total. 23 28 1 52

% 54.8 43 2.4 99.99

 TOOL: STRUCTURED KNOWLEDGE QUESTIONNAIRE.
SECTION - I: SOCIO DEMOGRAPHIC VARIABLES.
INSTRUCTIONS:
CODE NO:

Dear Participant,
Kindly read the questionnaire carefully and tick () mark for the most appropriate answer
given on the right side each item. The information provided by you will be kept confidential.
1. Age in years: .

2. Gender
a. Male []
b. Female []
3. Religion
a. Hindu []
b. Muslim []
c. Christian []
d. Others []
4. Type of family
a. Nuclear Family []
b. Joint Family []
c. Extended Family
5. Monthly Family Income in Rupees
a. < 10,000 []
b. 10,001 – 25,000 []
c. 25,001 – 50,000 []
d. > 51,000 []

6. Course of study
a. Nursing. []
b. Pharmacy. []
7. Source of information regarding cord blood banking through
a. Mass media []
b. Self reading []
 c. Health personnel []
d. Academic education []
8. Have you had a close family member or friend went to cord blood banking?
a. Yes []
b. No []

SECTION – 2: STRUCTURED KNOWLEDGE QUESTIONNAIRE.

PART – 1: ITEMS ON ANATOMY AND PHYSIOLOGY OFBLOOD.
INSTRUCTIONS:
Dear Participant,
 Kindly read the questionnaire carefully
 Select and tick() for the most appropriate answer from the four options given below
each Question.
 Please note that it is important to answer to all questions.
 Each Question Carry one Mark.

1. Blood is a
a. Muscle tissue. []
b. Nervous tissue. []
c. Connective tissue. []
d. Epithelial tissue. []
2. Composition of blood is EXCEPT
a. White blood cells []
b. Macro cells []
c. Red blood cells. []
d. Platelets. []
3. The functions of the blood are
a. Transportation. []
b. Regulation. []
c. Protection. []
d. All the above. []
4. Average total amount of blood in an adult is
a. 5 liters. []
b. 7 liters. []
c. 8liters. []
 d. 9liters. []
5. Blood reaches to all the organs of the body through
a. Respiratory system []
b. G-l system []
c. Urinary system []
d. Circulatorysystem []
6. Shape of red blood cells is
a. Biconcave []
b. Spherical. []
c. Oval []
d. Convex. []
7. Life span of red blood cell is
a. 120 days. []
b. 100days. []
c. 110 days. []
d. 200 days. []
8. Color of blood is red due to
a. Plasma. []
b. Hemoglobin. []
c. Platelets. []
d. WBC. []
9. Normal Hemoglobin level in an adult is.
a. 5 - 9gm% []
b. 9 -13 gm% []
c. 12 -17 gm% []
d. 15 -19gm%. []

10. Diet which increases the Hemoglobin level in the blood is.
a. Vegetables. []
b. Non- Vegetarian. []
c. Milk. []
d. All the above. []
11. The liquid portion of blood is referred to as.
a.Plasma. []
b.Serum. []
 c.Whole blood. []
d. Hematocrit. []
12. Which of the following does not belong with the others.
a. Erythrocyte. []
b. Serum. []
c. Leukocyte. []
d. Platelet. []
13. The most common type of white blood cell is
a. Monocyte. []
b. Basophil. []
c.Neutrophil. []
d. Eosinophil. []
14. An increase in the number of white blood cells is called
a. Anemia. []
b. Leucopenia. []
c. Leukocytosis. []
d. Polycythemia. []
15. The precursor of all lines of blood cells is called as
a. Myeloblast. []
b. Hemocytoblast. []
c. Proerythroblast. []
d. None of the above. []

PART - 2: ITEMS ON CORD BLOOD AND CORD BLOOD BANKING.

16. The Average length of the Umbilical Cord is ranges from

a. 10 to 30 cm. []
b. 30 to 50 cm. []
c. 40 to 70 cm. []
d. 60 to 90 cm. []
17. Cord blood means the blood that remains in
a. Umbilical cord following birth. []
b. Placenta following birth. []
c. Uterus following birth. []
 d. Both a and b. []
18. Cord blood is collected through
a. Umbilical artery. []
b. Umbilical vein []
c. Carotid artery []
d. Jugular vein. []
19. Umbilical cord blood can provide a rich source of []
a. Protein. []
b. DNA. []
c. Stem cells. []
d. Minerals. []
20. Blood-forming stem cells in cord blood can develop into

a. White blood cells. []

b. Red blood cells. []
c. Platelets. []
d. All of the above. []
21. The cells that are banked from a baby’s cord blood are
a. Red blood cells. []
b. Platelets. []
c. Stem cells. []
d. White blood cells.
22. Cord Blood Stem Cells are
a. Perfect match for nerve cells. []
b. Multiplying thebody with no control. []
c. Develop into various types of cells in the body. []
d. All of the above. []
23. The stem cells can be used by
a. Anyone among HLA compatibility. []
b. No One among HLA compatibility. []
c. Only matching family. []
d. No matching family. []
24.Stem cells that differentiate into only one type of cell are described as
a. Pluripotent. []
b. Multipotent. []
 c. Totipotent. []
d. Punipotent. []
25. Stem cells are found in the
a. Bone marrow. []
b. Spleen. []
c. Adrenal glands. []
d. All of above. []
26. Cord blood collection
a. Is painful procedure that require general anesthesia. []
b. Is safe, painless and takes less than 5 minutes to complete. []
c. Is collected during the Amniocentesis test between 15-20 weeks. [ ]
d. It is collected during first stage of labour. []
27.Cord blood collection is done within
a.10 minutes of birth. []
b. 20 minutes of birth. []
c. 30 minutes of birth. []
d. 40 minutes of birth. []
28. Average amount of blood collected for cord blood banking is
a. 55 ml. []
b. 65 ml. []
c. 75 ml. []
d. 85 ml. []
29. Cord blood is stored "cryogenically means that
a. It's kept in test tubes. []
b. It's stored at body temperature. []
c. It's frozen []
d. It’s stored in warm temperature. []
30.The Cord Blood can be stored successfully for
a. 5 years. []
b. 10 years. []
c. 15 years. []
d. More than 20 years. []
31. Temperature at which stem cells can be Stored are
a. -156 c. []
b. -196 c. []
 c. -206 c. []
d. -306 c. []
32. The Number of cells are collected through cord blood banking is

a. 100 to 400 cells. []

b. 200 to 600 cells. []
c. 300 to 800 cells. []
d. 400 to 1000 cells. []
33. The Cord blood needed for the transplant for every pound of body weight is
a.1.0 ml. []
b.1.3 ml. []
c. 1.6 ml. []
d. 1.9 ml. []
34. The Cord that can be collected through
a. Blood Bank. []
b. Any Hospital. []
c. Home birth. []
d. All the above. []
35. Cord blood is stored for long periods in
a. Liquid nitrogen tanks. []
b. Oxygen tanks. []
c. Carbon dioxide tanks. []
d. Hydrogen tanks. []
36. The Cord Blood is tested for all EXCEPT
a. Virology tests. []
b. Bacteriology tests. []
c. Hematology tests. []
d. Biochemistry tests. []
37. The Factors which are important when choosing a Cord Blood Banking is
a. With a very fast average time from collection to processing []
b. With lab facilities that are FDA registered and AABB accredited. [ ]
c. Both a & b. []
d. None of the above. []
38. The Process in collection of cord blood banking includes
a. Role and informed consent. []
 b. Collection and cryopreservation. []
c. Retrieval for transplant. []
d. All the above []
39. Following should be stronglyconsider by the cord blood services are
a. Family with genetic diseases. []
b. Couple suffering from infertility. []
c. Children with ethnic background. []
d. All of the above. []
40. Among these is not a cord blood bank
a. Cryosave. []
b. Cryo life. []
c. Jeevan blood bank. []
d.Stem cell bank. []
41.The Advantages of cord blood banking are
a. Connected in advance tested, stored and frozen. []
b. Transplants do not require a perfect match. []
c. Transplants are associated with lower risk of viral infections. []
d. All the above. []
42. The Disadvantage of adult stem cells over embryonic stem cells are
a. They are much smallerand therefore difficult to maneuver []
b. They grow too fast. []
c. There is no disadvantage; the two types of cells are identical. []
d. They are difficult to locate. []
43. Donating cord blood may harm
a. Baby. []
b. Mother. []
c. Both baby and mother []
d. Nobody []
44. The most common use of cord blood is

a. In place of a blood transfusion. []

b. To replenish a weakened immune system as a result of illness. []
c. To treat anemia. []
d. To treat infection. []
45. Method of Cord Blood collection is
 a. In utero method. []
b. Ex utero method. []
c. Both a and b. []
d. None of above. []
46. Allergenic transplants means.
a. Donor stem cells. []
b. Own stem cells. []
c. Mother stem cells. []
d. None of above. []
47. Autologous transplant means
a. Using patients on stem cells. []
b. Using stem cells of relatives. []
c. Using stem cells of animals. []
d. Using stem cells of birds. []
48. Diseases that can be treated using umbilical cord blood stem cells are

a. Leukemia’s. []
b. Inherited platelets. []
c. Hematopoietic stem cells disorders. []
d. All the above []
49. Delayed cord clamping is done after an average period of.
a. 10 to 140 seconds. []
b. 20 to 160 seconds. []
c. 30to 180 seconds. []
d. 40 to 200 seconds. []
50.Cord blood banking is Contra Indicated in EXCEPT
a.Twins. []
b. Congenital anomaly babies. []
c. Premature babies. []
d. Term babies. []
51. The First Cord blood transplant performed in
a. October 1988. []
b. November 1999. []
c. July 1979. []
d. August 1969. []
 52. The number of diseases that are FDA approved for routine treatment
with cord blood stem cells are

a. Below 20 []
b. Exactly 40 []
c. Less than 60. []
d. More than 80. []

STRUCTURED KNOWLEDGE QUESTIONNAIRE – ANSWER KEYS

The questionnaire consists of 54 items .There are four alternate answers from which the
participants had to choose one best alternate answer. A score value 1(One) will be allotted for
each correct response given.

SL. No. ANSWERS SCORE

1 c 1
2 b 1
3 d 1
4 a 1
5 b 1
6 d 1
7 c 1
8 a 1
9 b 1
10 c 1
11 d 1
12 a 1
13 b 1
14 c 1
15 c 1
16 a 1
17 b 1
18 a 1
19 b 1
20 a 1
21 d 1
22 c 1
23 c 1
24 d 1
25 a 1
26 a 1
27 d 1
28 b 1
29 a 1
30 c 1
31 c 1
32 d 1
33 b 1
34 c 1
35 d 1
36 d 1
37 a 1
38 d 1
39 c 1
40 d 1
41 d 1
42 d 1
43 d 1
44 b 1
45 d 1
46 b 1
47 c 1
48 a 1
49 a 1
50 d 1
51 c 1
52 d 1
53 a 1
54 d 1
Annexures
 Chapter-1

Introduction
 Chapter-2

Review of literature
Chapter-3

Research
Methodology
 Chapter-4

Analysis
&
Interpretation
 Chapter-5

Discussion, Summary
& Conclusion
 Chapter-6

Bibliography
 CONCEPTUAL FRAMEWORK BASED ON MODIFIED LUDWIG VON
BERTALANFFY'S GENERAL SYSTEM THEORY

INPUT THROUGH
OUTPUT
SOCIODEMOGRA PUT
PHIC LEVEL OF
KNOWLED
VARIABLES:-
• Age
GE
• Gender
• Religion ASSESSMENT • Good
• Types of Family • Average
• Course of Study Structured • Poor
• Family Income knowledge
• Source of questionnaire to
Information assess the
• CCB Member knowledge
Registration regarding Cord
TARGET Blood Banking
POPULATION

Undergraduate
students of Health
Science Institutions
FEEDBACK
Not included in study
 SCHEMATIC REPRESENTATION OF THE RESEARCH PROCESS

SETTING POLULATI SAMPLE

ON SIZE
To assess the
level of K. L. E
knowledge Society’s
regarding Institute of Undergraduat
cord blood Nursing e students of
banking Sciences, Health 100 Samples
among Hubballi and Science
Undergraduat KLEU college Institutions
e students of of Pharmacy,
Health Hubballi.
Science
Institutions.

STATISTICS METHOD OF DATA INSTRUME

OF ANALYSIS COLLATION NT
&
INTEPRATIONS
Structured
• Descriptive Assess the Knowledge
Statistics knowledge by questionnaire
• Inferential structured . related Cord
statistics Knowledge Blood
questionnaire. Banking
 CORD BLOOD BANKING

INFORMATION GUIDE
SHEET

Mr. Jonah
Final Year M.Sc Nursing.
K. L. E.S Institution’s of nursing sciences, Hubballi
INTRODUCTION
Cord blood banking is a process of collecting the blood from your baby’s
umbilical cord in a simple safe and painless procedure that usually takes less
than 5 minutes which is done right after birth. Once umbilical cord is cut the
collected blood sample is then sent to the laboratory undergoing processing and
then frozen in Cryogenic storage tanks for long term preservation of 25 years
and more.

How does cord blood banking work

1. Read and sign the agreement storage and consent document.
2. Pay the initial deposit.
3. The collection kit will be handed to you after the initial payment.
4. Once the delivery date blood is collected from your baby’s umbilical cord
5. Sample is shift to the lab for testing processing and storage.
6. After 2 to 6 weeks you will receive a certificate providing your sample
results.
The benefits of saving your baby’s cord blood.
Cord blood is a rich source of unique stem cells that can be transform into many
types of stem cells. Cord blood is 100% match to your babies and there is one
is 1:4 chance of perfect match to siblings. Collection of cord blood is simple
painless on only takes a few minutes.
The future use of Cord blood is strictly reserved for your family use only. It can
possibly be match for another family member as well.
How to donate
If you are 18 years of age, in fairy good health and I recside in a community
where cord blood donation is available, you may be able to donate your baby’s
cord blood or you may look for participating hospitals near you got. Cord blood
donation is still in its experimental stages and rapidly growing because of this
not all hospitals are prepared to receive a donation at this time by approximately
your 34th week of pregnancy contact Cord blood bankthe blood bank will ask
you to
1. Fill out a consent form agreeing to donate your baby’s got blood.
2. Fill out a health history form to confirm you meet health eligibility
guidelines.
3. Give a small blood sample for infectious disease testing.
These steps are usually completed before the birth of the baby when the baby is
born the umbilical cord is collected process and store for future use.

Facts and Information of Cord blood registry

There are two options for saving the babies cord blood Family bank- which
saves the cord blood only for your baby and family to use. Public bank -which
save the babies cord blood for public use, not a related individuals.

CONCLUSION.
The promise and potential of UCB already demonstrated inresearch and the
need for further development of these currenttherapeutic uses, as well as of
other potential uses ofstem cells contained in UCB, weigh strongly in favour of
the active pursuit of UCB research to bring its promise to fruition.