Mrs. Lovera Sureshms. G. SHANTHI

Submitted to:Submitted by:

Mrs. Lovera SureshMs. G. SHANTHI

Head of the Department1st year M. Sc. Nursing

Paediatriac NursingDept. of Maternity Nursing

2007-2009

Sarvodaya College of Nursing,Sarvodaya College of Nursing, Bangalore – 560 079 Bangalore – 560 079

RAJIV GANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA BANGALORE

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE & ADDRESS / Ms. Shanthi.G
1st year M.Sc.,(Nursing)
Sarvodaya College Of Nursing
#11|2,Agrahara Dasarahalli
Magadi Main Road ,
Bangalore-560079
2. / NAME OF THE INSTITUTION / SarvodayaCollege Of Nursing,Vijayanagar , Bangalore-560040
3. / COURSE OF STUDY AND SUBJECT / First year M.Sc.,(Nursing)
Obstetrics and Gynecological Nursing
4. / DATE OF ADMISSION OF COURSE / 06-10-2007
5. / TITLE OF THE STUDY / “A Study to Assess The Knowledge and Attitude Regarding Infertility Among Women in a Selected Rural Community , Bangalore with a view to develop an information booklet ”
6. / BRIEF RESUME OF THE INTENDED WORK
6.1 Introduction
6.2 Need for the Study
6.3 Statement of the problem
6.4 Objectives of the study
6.5 Operational definitions
6.6 Assumption
6.7 (1)Inclusion &(2)exclusion criteria
6.8 Review of related literature / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / MATERIALS AND METHODS
7.1 Source of Data
Data will be collected from women in the reproductive age of 15-45.
7.2 Methods of Data Collection –Structured interview method.
7.3 Does the study require anyinvestigation or intervention to be conducted on the patient or other human beings or animals.
No
7.4 Has ethical clearance has been obtained from your institution.
Yes.

RAJIV GANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA BANGALORE

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6.1INTRODUCTION

“A baby is a well spring of pleasure

A messenger of peace and love

A resting place for innocence on earth

A link between angels and men”

-Martin Frquhar

It is the dream of every married couple to have a child which will bring happiness and joy into their life. Most people assume they can have children when they choose after twenty or thirty years of assuming that they will have children when wanted and spending time and energy trying to get pregnant, they feel frustrated when they find that to have a baby when wanted is not so simple.1

The WHO (1992) defines infertility is the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular unprotected intercourse (WHO).4

Infertility is a global health issue, affecting approximately 8-10% of couplesworldwide. In India one out of six couples suffer from inability to procreate while infertility is estimated to have around 7% among Indian women in past 3 years according to organon fertility survey.1

Women from rural population are likely to be illiterate and employed in the agriculture. The cause of infertility can rest in the women or the men, or can be from unknown factors or a combination of factors. Infertility does not have a single cause because successful pregnancy is a multi step chain of events. But in India, infertility has devasting consequence for women because the blame for infertility is squarely late only on the women. It results as a threat to the women’s identity and may influence their self concept in terms of their inability to conceive, but 40% of couple infertility is due to the male. The most common cause of male infertility are impaired sperm count, undesended testicles, testosterone deficiency, blockage of epididymis, retrograde ejaculation. The cause of female infertility includes polycystic ovarian syndrome, hormonal imbalance, fallopian block, hereditary, fibroids, early menopause and pelvic adhesions.2

Through ongoing research in the fields of pregnancy induction there are many ways to treat infertility, it has allowed couples to bear healthy children successfully. In Bangalore, there are super specialty hospitals and infertility clinic mainly for the mothers and new born, the aim is to provide best possible care at par with the world’s standards, infertility clinics includes the Gunashela Surgical and maternity hospital, hope infertility clinic and research foundation and BACC (Bangalore Assisted Conception Centre). The first infertility clinic in the country to be designated ISO was set up in the team of healthy child for healthy couple. Today it is one of the best equipped and most advanced infertility centers in India offering tertiary care facilities under the stewardship of Dr. Kamini Rao. Reproduction is the most important event in women’s life. Committed to make motherhood a reality for every women.2

Women are the bearers and nurtures of the next generation. Birth is as ancient as life itself and as natural process as breathing.3

6.2 NEED FOR STUDY

Motherhood is the ultimate dream in a women life. To be able to experience this wonderful feeling, one has to be endowed with the female reproductive organ. If a woman lacks any of these organs her dream will remain unfulfilled.3

So infertility can happen to any age group between 15-45 years, to any person and no one thinks it will happen to them.3

Prevalence of infertility affects approximately 8-10% world wide, in India infertility rate estimated to be 6-7%. The population of infertile couples in India is 15 million compared to six million in the USA according to organon fertility survey.6

Infertility has been relatively neglected as a health problem in South Asia, but these figures are more significant in a country like India where children are accepted as an integral part of the cultural and social fabric.6

A global review of infertility from the world fertility survey, the estimated rates in south Asia are 4% - Bangladesh,6% - Nepal, 5% - Pakistan, 4% -Srilanka, and 7% - India.6

Infertility risk increases with reproductive age group between 15-45 years are 4.1% of 15-24 years old, 31.1% of 25-35 years old, 21.4% of 35-44 years old.6

Kumar D, conducted a study on prevalence of female fertility in sidhi district of Madhya Pradesh in Central India. The objective of the study was to determine the prevalence of infertility in two tribal groups. The data were collected from 1305 people through structured interview schedule in April 2002. The results they found that the infertility was significantly higher among Khairwars than non Khairwars.6

Some causes of infertility are pelvic inflammatory disease, sexually transmitted disease, ovulatory dysfunction, hormonal imbalance, uterine fibroids, endometriosis, pelvic adhesions and polycystic ovarian disease there are easily correctable, but a diagnosis is needed before treatment. Before making a decision regarding the kind of treatment the client should be given proper information and guidance. Arming oneself with information, resources and support can make them a better infertility patient.

Prakash Trivedi, conducted a study on fibroids major cause of infertility among Indian women, he studied 2,142 women and found that who are red meat eaters or overweight and have hypertension tend to get fibroids. Researcher came to an conclusion that fibroids which are responsible for infertility can be operated and increase the chance of pregnancy.7

From the experience the researcher felt that infertility can be treated with proper guidance and treatment, and every couple can have fruitful life.Infertility is not merely a health problem, it is a matter of social injustice and Inequality for the rural population, as they are having high levels of child and maternal mortality and morbidity arising from poor nutrition, economically disadvantage, socially undeveloped and have low levels of literacy.Knowledge is virtue and knowledge is power therefore the more learned a person is the more she is educated. Knowledge is gained by educating oneself. It is not necessary to undergo formal education, although it is the most commonly used method to gain knowledge.7

6.3 STATEMENT OF THE PROBLEM:

“A Study To Assess The Knowledge And Attitude Regarding Infertility Among Women in a Selected Rural Community at Bangalore with a view to develop an information booklet.”

6.4 OBJECTIVES OF THE STUDY:

1) To assess the knowledge and attitude of women regarding infertility.

2) To find out the correlationbetween knowledge and attitude of women

regarding infertility.

3) To determine the association between the knowledge and attitude among

women regarding infertility in selected variables.

4) To provide information booklet.

6.5OPERATIONAL DEFINITIONS:

1)KNOWLEDGE: Refers to awareness of information given by mothers on items of knowledge regarding infertility as assessed by the proper response to items of the knowledge questionnaire.

2)ATTITUDE : Refers to the opinion of women regarding infertility as assessed by the proper response to items of the attitude questionnaire.

3)WOMEN :It refers to females in the age group of 15-45 years.

4)INFERTILITY: Refers to a woman’s inability to conceive and give birth to a living child with regular unprotected intercourse after one year.

5)INFORMATION BOOKLET:Itis a list of information which includes definitions, causes, diagnosis and treatment of infertility.

6.6ASSUMPTION

Women may have some level of knowledge and indifferent opinion about infertility.

6.7 (1) INCLUSION CRITERIA:

1)Who are willing to participate

2)Who are available at the time of study

6.7(2) EXCLUSION CRITERIA:

- Who are taking treatment

6.8REVIEW OF LITERATURE

Review of the literature is an integral component of any study or research project. It enhances the depth of the knowledge and inspires a clean insight into the cruse of the problem. Literature review throws light on the studies and their finding reported about the problems under study.

Review of literature following under sub-headings.

Studies related to incidence of Infertility

Vite Vargas JA, Ortiz Nunez DA, Hernandez Marin I, Tovar Rodriquez JM, Ayala AR. Conducted a study on epidemiological analysis of infertility in Mexican population. The objective of the study is to gain knowledge of general characteristics from patients with infertility. Data were collected from 116 infertile patients through descriptive, observational, situational and retrospective indagatory study in 1999. They found that altered ovarian endocrine factor is 82.7%, cervical factor is 80%, maculine factor is 39%, tuboperitonial factor is 29%. The percentage successful pregnancy is 31.88%.8

Larson U, Masenga G, Mlay J. Conducted a study on infertility in community and clinic based samples of couples. The objective of the study is to determine the type and etiology of infertility in a community and clinic based samples. Data were collected from 2019 women aged 20-44 years through cross-sectional survey in a community based setting in Moshi. They found that the percentage of primary infertility was 37.1% and secondary infertility was 62.9% and female factor is 65.9% and male factor is 6.8%, male and female factor is 15.2% and unexplained infertility is 12.1%. they came to a conclusion that etiology of infertility were same in the community and clinic based sample and tubal factor infertility was the commonest cause.9

Singh AJ, Dhaliwal LK. Conducted a study on identification of infertile couples in a rural area of Northern India. The purpose of the study is to identify infertile couples through a three stage screening of the cases were done with the help of the health worker records with the total population of 28839 in 40 villages of PHC, out of 4453 eligible couples in the PHC, 129 (2.9%) were infertile. (46.5% primary infertile and 53% secondary infertility). The study revealed that key informants and existing information structure can be utilized to identify infertility in rural areas.10

Zargar A H, Waxi AI, Masoodi S R, Laway B A, Salahuddin M conducted a study on epidiomological and etiologic aspects of primary infertility. The objective of the study is to assess the magnitude of primary infertility and etiologic aspects, the data were collected from 10063 married couples in Kashmir valley of India. They found that 15% of the couples had primary infertility and 4.6% had unresolved fertility, etiology of infertility in female factor is 57.6% and male factor is 22.4%. They came to a conclusion that primary infertility is as common and distressing problem in India.11

Trent M, Millstein SG, Ellen JM. Conducted a study on gender based differences in fertility believes and knowledge among adolescents and high sexually transmitted disease – prevalence communities. The purpose of the study was to examine gender based differences data were collected from adolescents health study and population based telephone survey. They found that female adolescents are able to identify the chlamydia and pelvic inflammatory diseases are causes fertility than male adolescents. Through this they decided that health education is needed to motivate adolescents to participate in asymptomatic STD screening programme.12

Studies related to Etiological and Epidemiological Risk factors regarding infertility

Kelly – Weeder S, Cox C L. conducted a study on the impact of life style risk factors on female infertility. The objective of the study were to identify the life style factors associated with infertility in women and to offer recommendations to women’s health providers. The data were collected from 824 women between the age of 15 – 45 years through the reexamination of National Survey of Family Growth (NSFG) in 1995. They found that the infertility is directly related to increasing age, a history of ectopic pregnancy, current smoking, obesity and self reported health status. They came to conclusion that women with routine visit can give an appropriate intervention and reinforcing messages on fertility risk.13

Trokoudes KM, Skordis N, Picolos MK. Conducted a study on infertility and thyroid disorders. The objective of the study is thyroid dysfunction affects many organs including the male and female gonads interferes with human reproduction. They found that thyroid auto immunity increase the miscarriage rate and came to an conclusion that awareness of the thyroid status in the infertile couple is crucial because of its significant, frequent and often reversible or preventable effect on infertility.14

Studies related to treatment of infertility

Widge A, conducted a study on experience of urban Indian women with invitro fertilization. The objective of the study is the social context of infertility and women’s perception and experiences with IVF. Data were collected from 22 childless women / couples who sought IVF from two major cities – New Delhi and Mumbai. They found that infertility affects women’s status and stigmatization and isolation. They came to a conclusion that in Indian society fertility defines womanhood and motherhood and infertility is stigmatized and women undergo all kinds of treatment to produce a biological child.15

7. Material Methods

7.1 Source of data

Data will be collected from women in a rural community, Bangalore.

7.2Methods of collecting data

1)Research design - Descriptive design.

2)Setting - Rural area.

3)Sampling technique - Purposive Sampling Method.

4)Sample size - 100.

5)Method of data collection - Interview method.

6)Tool for data collection - Structured interview schedule..

7)Duration of the study - 6 Weeks.

8)Method of data analysis and interpretation - The researcher will use appropriate statistical technique for data analysis and present in the form of table and diagrams.

9)Variables - Research variables- Knowledge and Attitude.

- Demographic variables

Age
Age at menarche
Source of information
Education
Occupation

10) Projected outcome:

Women with increase knowledge and positive attitude can cope with the disease condition and its consequences.

8. BIBLIOGRAPHY

Holistic online com (online). 2000 [cited 2007 Aug 10]; Available from URL:
Mayoclinic.com tools for healthier lives [cited on 2008, Feb.12]; Available from
- causes html - 42K.
Fraser Diane M, Cooper Margaret A, Myles Textbook for Midwives. 14th ed. New York; Churchill Livingstone, 2003.
Adele Pillitteri, Maternal and Child Health Nursing, 2nd edition, chapter 6, page 116.
Kumar D. Prevalence of female infertility and its socio-economic factors in tribal communities, 2007 May:8, 7:456. Available from:
Prakash Trivedi. Fibroids major cause of infertility 2008, Feb 7. New Delhi. Available from
Vite Vargas JA, Ortiz DA, Hernandez Marin I, Tovar Rodriquez JM, Ayala AR, epidiological analysis of infertility, 1999, Available from PMID:17081929, pubmed indexed for Medline.
Larsen U, Masenga G, Mlay J. Infertility in a community and clinic based sample of couples. 2006 Jan; 83(1):10-7 Available from PMID:8262584 pubmed-indexed for MEDLINE.
Singh AJ, Dhaliwal LK, Identification of infertile couples in a rural area. 1993. Aug:98:206-8. Available from PMID 15850324 pubmed-indexed for MEDLINE.
Zargar AH, Waxi AI, Masoodi SR, Laway BA, Salahuddin M. Epidemiologic and etiologic aspect of primary infertility. 1997 Oct: 68(4):637-43. Available from PMID:17590841 pubmed-inprocess.
Trent M, Millstein SG, Ellen JM. Gender based differences in fertility belief and knowledge among adolescents, 2006 Mar:38(3):282-7, Available from PMID:16580364 pubmed_indexed for MEDLINE.
Kelly Weeder S, Con CL. Life style risk factors on female infertility, 2006; 44(4): 1–23, Available PMID:17786646 pubmed indexed for medline.
Trokoudes KM, Skordis N, Picolos MK. Infertility and thyroid disorders, 2006 Aug 18(4): 446-51. Available from PMID:16827825 pubmed_indexed for MEDLINE
Widge A. experience of urban Indian women with in vitro fertilization. 2005, Dec: 59(3): 226-33. Available from PMID:1648882 pubmed_indexed for MEDLINE

9. Signature of Candidate:

10. Remarks of the Guide:

11. Name & designation of (in block letters):

11.1 Guide:

11.2 Signature:

11.3 Head of the Department:

11.4 Signature:

12. 12.1 Remarks of the Chairman & Principal :

12.2 Signature: