PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
DISSERTATION PROPOSAL
“A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE ON PREVENTION OF URINARY TRACT INFECTION DURING MENSTRUATION AMONG 3RD YEAR AND 4TH YEAR B.SC NURSING STUDENTS OF SHRIDEVI COLLEGE OF NURSING TUMKUR”.
SUBMITTED BY:
MRS .SALMATH
1ST YEAR M.SC NURSING,
OBSTETRICS AND GYNAECOLOGICAL NURSING,
SHRIDEVI COLLEGE OF NURSING, TUMKUR
2010-2012
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MRS.SALMATH .IST YEAR M.SC NURSING,
OBSTETRICS AND GYNAECOLOGICAL
NURSING
2. / NAME OF THE INSTITUTION / SHRIDEVI COLLEGE OF NURSING
3. / COURSE OF THE STUDY AND SUBJECT / IST YEAR M.SC NURSING, OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION / 1-10-2010
5. / TITLE OF THE STUDY / “A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE ON PREVENTION OF URINARY TRACT INFECTION DURING MENSTRUATION AMONG 3RD YEAR AND 4TH YEAR B.SC NURSING STUDENTS OF SHRIDEVI COLLEGE OF NURSING TUMKUR”.
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
Female puberty is one thing that makes a teenager pretty tough. It’s the part of your life where you’ll grow from being a little girl to an adult. This involves your body and mind going through some dramatic changes at a dizzying speed. And yet this chain of events can be summed up in single word puberty. A girl hitting puberty will eventually develop a stage called menstruation.1
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile female humans. Overt menstruation (where there is blood flow from the uterus through the vagina) occurs in humans. The word "menstruation" is etymologically related to "moon". The terms "menstruation" and "menses" are derived from the Latin mensis (month), which in turn relates to the Greek mene (moon) and to the roots of the English words month and moon.2
India's population of 1.17 billion (estimate for July, 2009) is approximately one-sixth of the world's population. Nearly half of the Indian women are mostly neglected especially relating to their gender specific needs. On an average a woman spends 2100 days of her life menstruating but accessibility and affordability of menstruation products is largely absent, which restricts women’s mobility and affects the development of adolescent girls.3
Personal hygiene is the practice of keeping the body well-groomed and clean. The requirements for maintaining hygiene are somewhat different for women and men. Women's personal hygiene is more complex in that special care must be taken to prevent problems associated with the menstrual period such as urinary tract infections. Understanding the nature of women's personal hygiene problems allows you to detect symptoms sooner and maintain optimal cleanliness.4
Up until now, poor menstrual hygiene in developing countries has been an insufficiently acknowledged problem. In several cultures there are (cultural and or religious) taboos concerning blood, menstruating girls and women and menstrual hygiene. The lack of attention to this issue is striking. Approximately 50% of the world’s population knows from their own experience how important good menstrual hygiene is to be able to function optimally during the menstruation period. Yet this is hardly realised by in particular politicians, programmers and policy makers. This is also surprising in view of the explicit relation of this issue to water and sanitation and the distribution of all kinds of diseases, which can be reduced considerably by good hygiene.5
Urinarytract infections are common infections of the urinary tract, which consists of the kidneys, ureters, bladder, urethra and the prostate gland. Urinary tract infections are the result of an invasion of bacteria or other microorganisms into the urinary tract.
Normally, urine and all of the organs and structures of the urinary tract are sterile and contain no microorganisms. However, infectious microorganisms can get into the urinary tract from outside the body through the urethra and cause urinary tract infections. 6
The poor knowledge about menstrual hygiene in Indian rural areas caused the adolescent girls to use gunny bags, sand, ash and even plastics at the risk of infections.7 The best place to translate the plans concerning menstrual hygiene is in the context of educational institutions.6
The knowledge should always begin from the basic level. Student nurses should have adequate knowledge to improve their menstrual care and prevention of urinary tract infections.
6.1 Need for the study
As 1 in 5 adult women experience UTI at some point, it is an exceedingly common, clinically apparent, worldwide patient problem. Approximately 25-40% of women in the United States aged 20-40 years have had a UTI. UTI accounts for over 6 million patient visits to physicians per year in the United States. 8
Bladder infections are most common in young women with 10% of women getting an infection yearly and 60% having an infection at some point in their life. Pyelonephritis occurs between 18–29 times less frequently.
According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, urinary tract infection accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations.
According to statistics from 1990, the prevalence of urinary tract infections in pre-school and school girls was 1% to 3%, nearly 30-fold higher than that in boys.[23] Also, the statistics from the same year show that approximately 5% of girls will develop at least one urinary tract infection in their school years.
In what concerns the symptoms of the condition, bacteriuria appears to increase in prevalence with age in women, still being 50 times greater than the one in males. It is estimated that bacteriuria will be experienced by 20 to 50% of older women and 5 to 20% of older men.2
Urinary tract infection is an important cause of morbidity and mortality in Indian subjects, affecting all age groups across the life span9. Urinary tract infections or UTI have become very common especially among females
compared to their male counterpart. Women tend to get urinary tract infections more often than men because bacteria can reach the bladder more easily in women. The urethra is shorter in women than in men, so bacteria have a shorter distance to travel. The urethra is also located near the rectum in women. Bacteria from the rectum can easily travel up the urethra and cause infections.
Possible signs of a urinary tract infection are:
• A burning sensation when you urinate
• Feeling like you needs to urinate more
often than usual.
• Feeling the urge to urinate but not being
able to.
• Leaking a little urine.
• Cloudy, dark, smelly or bloody urine.
During menstruation the PH of the vagina changes and there is more chance of
infection. Blood is an excellent medium for germs to grow; hence urinary infections
are more common in menstruating teens. Menstrual hygiene is very important in this
age. In order to prevent urinary tract infection the sanitary pads should be changed frequently in about every four hours. If clothes are used as pads it should be washed thoroughly, dried in the sun, iron to destroy the fungus and kept in a clean box so that it can be re-used. Holding urine is another bad habit of the teens. Whenever they feel like passing urine they have to do
it otherwise urinary infection will set in. Oestrogen which have kept them young
at heart and kept their vagina lubricated starts coming down. In effect senile vaginites and urithrities set in. Senile Urithrities can produce stricture urethra and chronic retention of urine causing recurrent urinary infection.
Clean running water and a private place to dispose sanitary pads are very
essential in schools and colleges, so that these teens do not hold urination until they
reach back home.
Although Menstrual Hygiene is an issue that every girl and woman has to deal with in her life, there is lack of information on the process of menstruation, the physical and psychological changes associated with puberty and proper requirements for managing menstruation. The taboos surrounding this issue in that society prevents girls and women from articulating their needs and the problems of poor menstrual hygiene and management have been ignored or misunderstood. Good menstrual hygiene is crucial for the health, education, and dignity of girls and women. This is an important sanitation issue which has long been in the closet and there was a long standing need to openly discuss it.10
There were various steps undertaken by the Indian government to ensure menstrual hygiene
Ø In the Budget 2011 the government has cut down the excise duty to 1% on baby & clinical diapers and sanitary napkins.
Ø Astudy conducted by AC Nielsen called “Sanitation protection: Every Women’s Health Right”, provides in depth analysis of the prevalent unhygienic practices and their effect on women’s health. The survey covers 1033 women in the menstrual age and 151 gynaecologists who studied them.
Ø The Union Health and Family Welfare Ministry on approved a scheme for providing highly subsidised sanitary napkins to adolescent girls in the rural areas to promote menstrual hygiene. The scheme, to be launched in 150 districts across the country in the first phase, will cost Rs. 150 crore for the current financial year.
Ø The centre has decided to distribute six sanitary napkins at the cost of Rs.6/- in rural areas to adolescent girls in order to provide adequate knowledge in rural area and thereby alleviating reproductive and urinary tract infections. The scheme is named as ‘Free days’ and it is being carried out by National Rural Heath Mission Board. The distribution will be carried out by community health workers and they will be awarded with Rs.1/-per pack when sold and they will be given with one free packet of the sanitary napkin every month.
Ø Menstrual Hygiene: Sharing Simple Facts is a guidance booklet on Menstrual Hygiene Management (MHM) is intended for adolescent girls and young women. Issues associated with menstruation are never discussed openly and the silence surrounding menstruation burdens young girls by keeping them ignorant of this biological function. Even after the attainment of menarche, very little information is given to young girls about the physiological processes involved and the hygienic practices to be followed. 11
The investigator while working as staff nurse has come across a number of adolescence being admitted with urinary tract infections due to improper menstrual practices. After analyzing the body of research and various research projects on the investigator has concluded the adolescents are having limited knowledge in various areas of menstrual hygiene. So the information regarding urinary tract infections and menstrual hygiene need to be inculcated from the basic B.Sc level and decided to carry out a comparative study among 3rd year and 4th year B.Sc nursing students.
6.2 Review of Literature
Dr. R. Kousalya Devi presented an article stated that many were uncomfortable when menstrual hygiene was discussed in public. Menstrual hygiene was not only a problem of individuals but also a social and human rights issue. In rural areas, use of sanitary napkins was still considered a luxury, she said. “Waste and dirty clothes were being used as napkins and this resulted in reproductive and urinary tract infections. Effective propagation of napkins would improve menstrual hygiene,” she added. The Gandhi gram trust had established five units in different parts of the country, particularly in the north-eastern states With considerable achievements in sanitary napkin manufacturing technology, the Gandhi gram Trust has started transferring its technology to other parts of the country to improve menstrual hygiene among rural women.12
An article by Kounteya Sinha reported in New Delhi that the Union health ministry's has announced the one-rupee sanitary napkin —ambitious scheme to improve menstrual hygiene among adolescent girls will be launched in July. The scheme was announced around a year ago, and supposedly enjoys the blessing of Congress president Sonia Gandhi. The ministry plans to arm 1.5 core girls with sanitary napkins to protect them from most common urinary tract infections. The target group in the 10-19 age bracket is spread across 152 districts in 20 states. The girls, who mostly come from below poverty line (BPL) families, will be sold a pack of six napkins for Rs 1 a piece. At a conservative estimate, only 20% of girls in this age group can afford a sanitary napkin .13
A cross-sectional study was conducted to explore the menstrual practices among 1275 female adolescents of urban Karachi, Pakistan from April to October 2006 by using interviews. Menstruation is a normal physiological process that is managed differently according to various social and cultural understandings. Data was entered and analyzed in Epi Info Version 9 and SPSS Version 10. Descriptive findings showed that 50% of the girls lacked an understanding of the origin of menstrual blood and those with a prior knowledge of menarche had gained it primarily through conversations with their mothers. Many reported having fear at the first experience of bleeding. Nearly 50% of the participants reported that they did not take baths during menstruation. In univariate analysis, factors of using unhygienic material, using washcloths, and not drying under sun were found to be significant in the Chi square test among those going and not going to schools. This study concludes that there are unhygienic practices and misconceptions among girls requiring action by health care professionals.14
A study was conducted to examine the knowledge and practices of adolescent school girls in Kano, Nigeria around menstruation and menstrual hygiene. Data was collected quantitatively and analyzed using Epi info version 3.2.05. The mean age of the students was 14.4 +/- 1.2 years; majority was in their mid adolescence. The students attained menarche at 12.9 +/- 0.8 years. Majority had fair knowledge of menstruation, although deficient in specific knowledge areas. Most of them used sanitary pads as absorbent during their last menses; changed menstrual dressings about 1-5 times per day; and three-quarter increased the frequency of bathing. Institutionalizing sexuality education in Nigerian schools; developing and disseminating sensitive adolescent reproductive health massages targeted at both parents and their adolescent children; and improving access of the adolescents to youth friendly services are veritable means of meeting the adolescent reproductive health needs in Nigeria.15