RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

“A STUDY TO ASSESS EFEFCTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE AMONG ANTENATAL MOTHERS REGARDING IRON DEFICIENCY ANAEMIA IN SELECTED HOSPITALS TUMKUR”

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

LATHA.K

IST YEAR M.Sc NURSING

OBSTETRIC AND GYNAECOLOGICAL NURSING

2011-2012

BHARATHI COLLEGE OF NURSING

4TH CROSS, K. R. EXTENSION

TUMKUR

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA FOR THE REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / MISS LATHA K.
1 YEAR M.SC NURSING BHARATHI COLLEGE OF NURSING , 4TH CROSS, K.R. EXTENSION , TUMKUR
2 / NAME OF THE INSTITUTION / BHARATHI COLLEGE OF NURSING 4TH CROSS, K.R. EXTENSION , TUMKUR
3 / COURSE STUDY AND SUBJECT / 1 YEAR M.SC. OBSTETRIC AND GYNAECOLOGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 22-11-2011
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS EFEFCTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE AMONG ANTENATAL MOTHERS REGARDING IRON DEFICIENCY ANAEMIA IN SELECTED HOSPITALS TUMKUR”


INTRODUCITON

Cheerfulness is the best promoter of health and is as friendly to the mind as to the body

Joseph Addision

Cheerfulness during pregnancy makes the child to be healthy “Anemia makes the mother joyless”

Anemia is defined as low hemoglobin concentration resulting in a decrease in oxygen carrying capacity or blood according to WHO, Hb level of 11g5 is considered as anemia during pregnancy. Anemia is caused by many factors such as nutritional deficiency, (iron deficiency topic acid deficiency, protein efficiency, vit . A deficiency) blood loss, genetic causes, pregnancy, worm interaction etc.1

Pregnancy causes mainly nutritional anemia, during pregnancy many physiological changes occur is the cardio vascular system. The plasma volume is increased and the blood cells are also increased but comparative to the plasma volume the blood cells are not increased which causes hemodilution. Due to hem dilution physiological anemia occurs as well as during pregnancy the mother requires 60mg of iron / day to meet the require on this requirement she develops iron deficiency anemia. 2

Material iron deficiency anemia is associated with increased weight or size of the placenta, a condition that may pose a risk for later high blood pressure in the offspring pregnant women with los hemoglobin levels the iron bearing component in the blood) have an elevated risk for pre- tern or low birth weight infants (However, iron , supplement does not appear to have any effect on these complications) pregnancy is also associated with fluid retention, which in turn may produce high volumes at plasma (the fluid component of blood) This can dilute red bloods cells, which may lead to anemia. After delivery, heavy bleeding , which occurs in 5% to 10% women who have given birth can cause symptoms at anema.3

The need for bringing down material mortality rate significantly & improving material health in general has been strongly stress in the national population policy 2000.. this policy recommends a holistic strategy for bringing about total interjector co- ordination at the grass root level and involving the NGOs, civil societal panchayti Raj institutions and women’ Group in bringing down material mortality ratio and infant mortality rate . 4

In the last decades , the life expectancy of the population in India has shown remarkable improvement from 41 at birth in 1961 to the present day of 65 years. Yet, over a 100, 000 women in India continue to die of pregnancy related causes every year, the material mortality Ratio in India is 407 per 1000,000 live births. The major causes for the these deaths have been identified as hemorrhage (both ante & post partum), toxemia (Hypertension during pregnancy), anemia, obstructed lab our, puerperal sepsis ( infections after delivery) and unsafe abortion. 5

Material mortality is a cause of great concern. However reliable estimates or maternal mortality are not available. Any interventions to check it will only be effective It we know reasonably accurate data on material mortality. An expert group has been constituted in the department of family welfare, which is working into the modalities of carrying out a survey for collection of data on maternal mortality. A pilot survey for this has already been completed.6

Pregnancy and child birth are special events in women lives and indeed , in the lives of their families . this can be a time of great hope and joyful anticipation. It can be a time of tear suffering and even death. Women burdened with ill health will not be able to function as sole or primary care providers for the children their basic human right to health and development. 7

Pregnancy makes considerable nutritional demands on the mother , as a consequence anemia is very common, particularly when consecutive pregnancies are not well spaced. The presence of anemia increases morbidity in pregnant, the risk of infection, the hazards of post partum hemorrhage, anemia is one of the most common problems of pregnancy. As estimated 20% to 60% of women will be anemic at some time during pregnancy. 8

The total requirement for a typical pregnancy with a single fetus is approximately 1000 mg. unfortunately, most women do not have iron stores that equal this amount. Material health, nutrition & education are important for the survival and well being of women and are the key determinates of the health and well being of the fetus. 9

2. Need for the study

In the year 2002 , the world health organization day was observed as would anemia day” In our country, anemia during pregnancy is one of the major causes of maternal mortality and morbidity. World health organizations (2002) study on maternal deaths showed that worldwide 64.4% who died had hemoglobin less than 5 gm% Anemia was the direct cause of death in 10-15% cases but was an associated cause in 80-85% cases. Many maternal deaths due to hemorrhage sepsis and cardiac failure . pregnancy anemia is a major public health problem in many other developing countries . many women start their pregnancy in an anemic state. National family health service (1998-99) has shown anemia in 54% of rural women and 46% of urban women in child bearing age . 10

Desai V.S.Status in India , diets which Are predominantly vegetarian & lacking in animal proteins, rich in pytates and low in ascorbic acid contents , the bioavailability of iron is poor this coupled with poor iron absorption contributed to widespread prevalence at own deficiency anemia”.11

Material health care has been a part of the family welfare programme since it inception. Intermissions were identified and vertical schemes namely the national nutritional anemia control programme iron deficiency anemia is a global public health problem that attects women in all stages of the reproductive cycle.12

In spite of improved M.M.R. and I.M.R. due to advances in medicine and care, our statistical show high incidence of complications due to anemia . This could be prevented by providing planning teaching programme early detection in preventing anemia and its complications.

Adequate teaching on anemia can be provided when the patient visits ANC O.PD and / or is admitted in the maternity ward by nursing staff specialized in obstetries nursing or midwife with the help of health education and counseling seminar by using videos, CDs questionnaire, informative booklets etc.

In today’s world , iron deficiency anemia is the most common from at nutritional deficiency affecting the women, particularly who are subjected to numerous stress attesting their health and well being. Globally , 48% of the pregnant and 33.3% of non – pregnant women of reproductive age group suffers from IDA. 13

Iron deficiency anima during pregnancy is notoriously responsible for intrauterine growth retardation pre- term labor, intra – uterine death, birth of very low birth weight internal who die soon after leading to high parental morbidity, bleeding during delivery it is responsible for 30% of maternal deaths during child birth . 14

It is also contributory factor to the other major reported causes of maternal death, such as hemorrhage (24%) and sepsis (8%) (world health organization/ voluntary health association of India, 2000) according to the world health organization (2001) According to the world health organization . (2001) anemia has been implicated as contributing in up to 40% of maternal deaths in third world countries . 15

During pregnancy the maternal plasma volume gradually expands by 50% or an increase of approximately 1200 ml by them. The total 50% or an increase of approximately 300 ml. this relative hem dilution produces a fall in Hb concentration . these changes are considered to represent a physiological alteration of pregnancy necessary for the development of the tutus. Fetal outcomes appear with an increased incidence of low birth weight and preterm birth in mothers have either a very low or very high Hb concentration. 16

Regarding the dietary pattern, the lack of dietary knowledge and the lack of knowledge about anemia consequences leads to many complications during pregnancy . Anemia vitamin A and iodine deficiency existed as public health problems in the adolescent pregnant mothers and 46% of the pregnant mothers out of 151 selected for the study were found anemic. Abel R.et.al,. (2001), vellore, reported that among 845 pregnant women understudy, the prevalence of anemia (Hb<gr/dl) was 56,6%, 70.2% and 69.85% respectively among the first trimester the among the second and third trimester women, which was less than the recommended value of 11g/ dl. Iron deficiency was significantly more among the third s trimester women than first.

The adverse effect of anemia in maternal and total outcomes are associated with adverse material outcome such as puerperal sepsis , ante- partum hemorrhage, postpartum hemorrhage and maternal mortality is common and it is also responsible for increased incidence or premature births, low birth weight babies and high prenatal mortality.11

The researcher recommended preventive nutritional supplementation throughout the reproductive life style which focuses mainly on iron and folic acid. The researcher round out that supplement of 40 mg. ferrous iron/ day from 18 weeks of gestation appears adequate to prevent iron deficiency in 90% of the women and iron deficiency in 95% of the woman during pregnancy and post partum. 19

According to the WHO estimates, the prevalence of nutritional anemia in Indi is 50-80% in women and 70-90% in pregnant women (Gupta , 2003) Indrani T.K. (2003) reported the incidence of anemia to be 40 to 80% with HB below 10 gm/% an 10-20% which severe anemia in western parts of the country , National health programmes in India (2005) reported the prevalence of nutritional anemia in India 88% for adolescent girls and 85% for pregnant women . Based on the findings , the authors advocated that optimum dose of iron should be 120 mg. instead of 60 mg. as is currently being in the national nutrimental anemia prophylaxis programme. 20

National health programmes in India (2005) reported that national nutritional Anemia prophylaxis programme which is now a part of RCH- II program prophylactic treatment for expected and nursing mothers are given one tablet containing 00 mg elementary iron and 0.5 mg folic acid. Nutrition education to improve dietary intakes in family for receiving needed macro/ micro nutrients as protein, iron and vitamins like folic acid , B. Complex etc. for hemoglobin synthesis is important . The Tamil Nadu integrated Nutrition project was started in 1980 targeting at 6-36 months old children and pregnant and lactating women. The objective was to reduce anemia from about 55% to about 20% through nutritional services, Health services, communication and monitoring and evaluation. The projects were assisted by world Bank and with the goal or universalization of ICDS. All the TINIP blocks were converted into ICDS. 22

Further , it also felt that the compact disc can bemused by anyone and anywhere it is standardized hence, the investigator was interested in preparing the CD and testing it for its usefulness in improving the self learning by the antenatal mothers on prevention of anemia.

3. REVIEW OF LITERATURE

A literature review is a written summary of the state of existing knowledge on a research problem. The talk of reviewing research literature involves the identification, selection , critical analysis and written description of existing information on a topic. 23 (polit and Hungler, 2003)

Review of literature involves the selection of available documents on the topic , which contain information, idea data and evidence wirtten from a particular stand point to fulfill certain aims or express certain views on the nature of the topic an how it is to be investigated and the effective evaluation of these documents in relation to the research being proposed . 24 (Hart, 1998)

The review of literature is related to

1)  Prevalence of anemia during pregnancy

2)  Effects of iron deficiency anemia during pregnancy

Ø  Related to mother

Ø  Related to fetus

3) Knowledge of mother on prevention of anemia

4) Importance of education in the prevention of iron deficiency anemia

5) Nurses role in prevention and control of anemia.