RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU

KARNATAKA

SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Mrs. Sreena Baby

First year MSc nursing

Obstetrics and gynecological nursing

Year 2010-2011

BRITE COLLEGE OF NURSING

BENGALURU

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU

KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME AND ADDRESS OF THE CANDIDATE / Mrs. SREENA BABY
FIRST YEAR MSc NURSING
BRITE COLLEGE OF NURSING
SY.NO: 69, B W S S B COLONY
CHIKKAGOLLARAHATTI
BENGALURU-91
2 / NAME AND ADDRESS OF THE COLLEGE / BRITE COLLEGE OF NURSING
SY. NO: 69, B W S S B COLONY
CHIKKAGOLLARAHATTI
BENGALURU-91
3 / COURCE OF STUDY AND SUBJECT / FIRST YEAR MSc NURSING
OBSTETRICS AND GYNECOLOGICAL NURSING
4 / DATE OF ADMISSION / 01-10-2010
5 / TITLE OF THE TOPIC / A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING PREVENTION OF AIDS/HIV AMONG ANTENATAL MOTHERS IN A SELECTED HOSPITAL AT BENGALURU.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“ Anybody can get AIDS, but everybody can prevent it ”

Acquired Immuno Deficiency Syndrome (AIDS) is now a worldwide problem.As it dangerously sweeps the world, it cuts across the boundaries of nationality, age, sex and education and spares no one. India’s first known HIV infection was diagnosed in a female sex worker in Chennai in February 1986. It is highly probable that HIV had been circulating for some years before that, since screening during 1986-1987 found as many as 3%-4% of sex workers infected in Vellore and Madurai.1

According to estimates from the UNAIDS Global Report 2010 around 30.8 million adults and 2.5 million children were living with HIV at the end of 2009. India has the world’s third-largest population suffering from HIV/AIDS.2

National AIDS Control Organization (NACO) added an extension component to the intervention to reduce vertical transmission of the disease from mother-to-child by actively motivating the antenatal mother’s group for HIV-testing and institutional deliveries.21

Karnataka is one of the worst affected Indian state by HIV as indicated by sexually transmitted disease IDU (Injective Drug User) and ANC (Antenatal Clinics) with 2.4 percent sero prevalence. There is emerging evidence that the HIV epidemic is now becoming established in the rural population as well as urban.1

The transmission of HIV from an infected mother to her child can be reduced to less than two percent by intensive interventions in the antenatal, intranatal and postnatal periods. To achieve this low rate, primary prevention of HIV infection in parents-to-be, early identification of seropositivity in pregnant women, prevention of unwanted pregnancies, prevention of mother-to-child transmission of HIV by appropriate antiretroviral therapy, special interventions in maternal management during labour, appropriate care and follow up of the newborn, all play an important role.3 Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS.4 AIDS leads infant death within two years of acquisition of the infection.5

Nationwide surveillance of HIV/AIDS from 1989 through 1996 in Bangladesh included several risk groups such as professional blood donors, patients with STDs, pregnant women at antenatal clinics, commercial sex workers (CSWs), long distance truck drivers, sailors and non-residents. The population was enrolled by convenience sampling after taking informed consent. Among 70,676 persons tested, 80 (1.13 per 1000) were HIV positive. Frequent movement of people from Bangladesh to India, is one of the possible sources of spread of the cases.6

6.1. NEED FOR THE STUDY

HIV/AIDS is alarmingly increasing both in the developed and developing countries. It is now a global problem. In most Asian countries the infection rate is less than 0.5 percent.7Globally, an estimated 33.3 million people live with the virus, and 2.6 million were newly infected in 2009. In the WHO South-East Asia Region, 3.5 million people are living with HIV/AIDS, largely in India, Indonesia, Myanmar, Nepal and Thailand. In 2009, there were an estimated 220000 new HIV infections in the region and 230000 people died of AIDS related illnesses.19

As per the HIV estimations 2010, India is estimated to have 23.9 lakh people infected with HIV in 2009 at an estimated adult HIV prevalence of 0.31%.Adult HIV prevalence among men is 0.36%, while among women, it is 0.25%. Each day at least 16000 individuals become infected with the HIV/AIDS.20

In Bagalkot in Karnataka a community based HIV prevalence was initiated 99 percent of the 9171 household enumerated in rural areas and 98 percent of the 211 households in the urban were completed. There were 9 deaths per 1000 population. AIDS is reported as a trading cause of death 17 percent of deaths in the age group of 15-49.1

In Karnataka total estimated target population between 15-49 years in a year 2003 in both males and females are 18771422. Among them females are 9159708. A workshop conducted on HIV and AIDS concludes that 1945239 (21.24%) attended the camp. Among them total number of HIV/AIDS cases referred to treating units are 428200.1

HIV prevalence at antenatal clinics in Karnataka has been over 1% for some years. A 2005-2006 survey found that 0.69% of the general population was infected. The average HIV prevalence among female sex workers in Karnataka was 18% in 2005.

During 2009, some 2.6 million people became infected with HIV, including an estimated 370,000 children. Most of these children are babies born to women with HIV, who acquire the virus during pregnancy, labour or delivery, or through breast milk. Drugs are available to minimize the dangers of mother-to-child HIV transmission, but these are still often not reaching the places where they are most needed.

The year also saw 1.8 million deaths from AIDS-related causes. The number of deaths probably peaked around 2004, and due to the expansion of antiretroviral therapy, declined by 19 percent between 2004 and 2009. By the end of 2009, the epidemic had left behind 16.6 million AIDS orphans, defined as those aged under 18 who have lost one or both parents to AIDS.2

6.2. REVIEW OF LITERATURE

Review of literature is a systematic identification, local, or scrutiny and summary of written materials that contain information on research problems.8

Review of literature is an essential step in the research project. It involves the systematic identification, location, scrutiny and summary of the written material that contains information on a research problem.

Review of literature for the present study has been organized under the following headings.

  1. Literature related to knowledge regarding HIV/AIDS
  2. Literature related to prevention of HIV/AIDS

Literature related to knowledge on HIV/AIDS

SamakhyaMahila (2002) a study on vulnerabilities of young women on HIV in Bellary district of Karnataka was conducted. It was done among unmarried females and married females. Women were much less aware of this issues compare to men both in the rural and urban areas. The literacy rate is 36%.75% of total labour force depends on agriculture the most accessed source of information is the local health workers and doctors. The usual age at marriage is lower than 18 years for females. They answer the question as performing pooja in water cures HIV/AIDS. Thus the study reveals that there is lack of awareness about HIV. Among married females 37% while unmarried females 26%. On the whole there is low level of knowledge in married females.9

Tadesse E, Mulla A S (2004) conducted a cross sectional qualitative study on knowledge and perceptions of antenatal women towards prevention of mother to child transmission HIV/AIDS in Blantyre, Malawi, 126 consecutive pregnant women attending antenatal clinics. The study result found that knowledge about HIV/AIDS was high but misconceptions especially regarding causative agents, mode of transmission, signs and symptoms, complication and prevention of HIV/AIDS.10

Singh S, Fukuda H, Ingle G K, Tatara K (2002) carried out a study on knowledge, the perceived risks of infection and source of information about HIV/AIDS among pregnant women in an urban population of Delhi. Large proportion of study subjects were illiterate (44.5%) and least was graduate or more (3.5%). Subjects mainly belonged to middle (46.1%) and lower socio-economic status (53.8%). The study revealed that only 45% subjects responded correctly that AIDS was not transmitted by mosquito bite. More educated had higher correct knowledge on modes of transmission compared to illiterate and less educated. Among various groups of educational status, the relationship of correct knowledge on modes of transmission was statistically significant. Mass media was a source of information on HIV/AIDS among 86.3% out of which television was most the popular source (74.6%) large proportion of subjects (48.6%) had preference to get information on AIDS from doctors.11

Brown H, Vallabhaneni S, Solomon S, Mothi S, McGarvey S, et al (2002) carried out a study on knowledge of women prenatal HIV testing and treatment among pregnant women in Southern India. Objective of the study was to assess the knowledge of antenatal mother regarding prenatal HIV testing and antiretroviral prophylaxis preventing perinatal HIV testing. Oral interviews were conducted on 666 women seeking prenatal care at 9 medical facilities in Chennai and Mysore, India. The study result revealed that seventy-eight percent were aware of the risk of perinatal HIV transmission and 36% knew that intervention could reduce the chances of such transmission. Eighty-six percent would agree to undergo prenatal HIV testing but only two hundred twelve percentages of all respondents would have to decide. Of those women who would not agree to testing, 21% would agree if testing were compulsory. Finally, the study concluded that considering its widespread acceptability, prenatal voluntary counseling and testing may be an affordable method of HIV prevention for that population.12

Singh MB, Chaudhary RC, Halidiya KR (1997) a study was carried out on knowledge of pregnant women regarding AIDS in a semi arid area of Rajasthan. A total of 792 pregnant women from three hospitals of Jaipur were surveyed to assess knowledge of AIDS. The study result found that the level of knowledge was significantly higher in pregnant women from upper income group than low income group (P <0.05). The misconceptions regarding various aspects of AIDS viz. signs and symptoms and mode of transmission and prevention and opinion towards AIDS patients, indicate that there is a strong need of AIDS education programme targeted at pregnant women.13

Panda S, Kumar MS, Lokabiraman S, Jayashree K, Sabagopan M C, Solomon S et al (2005) conducted study on risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India. A total 226 injection drug users and their regular sex partners were screened. A semi structured questionnaire was administered and serum was tested for HIV antibody. The study result found that HIV seroprevalence was 30% (68/226) in IUDs and 5 in their regular sex partners (11/226) while in 25% of couples only the male partner was HIV positive, 5% of the couple was concordant for HIV infection. The study concluded that reducing sharing of injection equipment and unsafe tattooing through targeted and environmental interventions, increasing HIV risk perceptions and promoting and environmental interventions, increasing HIV risk perception, and promoting safer sex among IUDs and their sex partners are urgent program needs.14

Literature related to prevention of HIV/AIDS

De Bruyn M, Paxton S (2005) a study on HIV testing of pregnant women-what is needed to protect positive women’s needs and rights?” The study revealed that with increased availability of antiviral therapy, there is an escalating global trend to all pregnant women for HIV in order to stop perinatal transmission. Men must be brought into the testing process through couple counseling and testing programs outside the antenatal care setting. In addition, people living with HIV have unique expertise and are very effective as peer counselors. They have been under-utilized in the health care sector to provide support to newly diagnosed people and to help eliminate AIDS-related shame and stigma.15

Ratnathicam A (2001) conducted a study on AIDS prevention in India. This study revealed that with 3.7 million human immunodeficiency virus (HIV) positive in India, many predict that this nation of 1 billion people will soon see infection rates soar if successful prevention programs are not implemented. India is also at war with poverty, illiteracy, and gender inequality, all of which make the fight against acquired immune deficiency syndrome (AIDS) a more difficult battle. The study finally suggested that India’s AIDS control strategy must take these issues into account in order to design successful programs to prevent infection rates from multiplying rapidly.16

Laiskonis A, Pukente E (2005) conducted study on vaccine for human immunodeficiency virus (HIV) in Kaunas, Ludhiana. The study revealed that since 1980 more than 25 million people have died from acquired immune deficiency syndrome (HIV), which results from infection with human immunodeficiency virus. The study suggests that one and the most effective method to stop the progress of the epidemic is the development of the HIV testing. The vaccine cannot protect fully but the changes of the natural infection course could decrease virulence, distance the stage of AIDS, and retard the spread of the epidemic.17

Painter TM (2001) conducted study on voluntary counseling and testing for couples for HIV/AIDS prevention in Sub-Saharan Africa. The study revealed that most HIV infections in Sub-Saharan Africa occur during heterosexual intercourse between persons in couple relationships. Women who are infected by HIV seropositive partners risk infecting their infants in turn. Increasingly studies point to the value of voluntary HIV counseling and testing (VCT) as a HIV prevention tool. Studies in Africa frequently report that VCT is associated with reduced risk behaviors and lower rates of seroconversion among HIV serodiscordant couples.18

PROBLEM STATEMENT

A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING PREVENTION OF HIV/AIDS AMONG ANTENATAL MOTHERS IN A SELECTED HOSPITAL AT BENGALURU.

6.3. OBJECTIVES

  1. To determine the knowledge of antenatal mothers regarding HIV/AIDS
  2. To find the association between the mean pre-test knowledge with selected demographic variables

6.3.1. HYPOTHESIS

H1 There will be a significant association between the mean knowledge scores of antenatal mothers with selected demographic variables.

6.4. OPERATIONAL DEFINITIONS

Knowledge: Refers to the correct responses of antenatal mothers to the items on the structured questionnaire measured in terms of knowledge score, which is categorized as good, average and poor.

Antenatal mothers: The women who are pregnant and attending the hospital irrespective of their parity and gestational age.

HIV/AIDS: Human Immunodeficiency Virus (HIV) causes an incurable infection that leads ultimately to a terminal disease called Acquired Immunodeficiency Syndrome (AIDS).

6.5. ASSUMPTION

  1. Antenatal mothers may have some knowledge regarding HIV/AIDS.

6.6. LIMITATIONS

Study is limited to antenatal mothers of selected hospital at Bangalore.

7. MATERIALS AND METHODS

7.1. Sources of data:Antenatal mother who is attending the selected hospital, Bengaluru

7.1.1. Research approach: Descriptive approach

7.1.2. Research design: Descriptive design

7.1.3. Setting: Selected hospital, Bangalore

7.1.4. Sample size: 80 antenatal mothers who is attending the hospital, Bangalore

7.1.5. Inclusion criteria

  • Antenatal mothers who are attending the selected hospital, Bangalore
  • Antenatal mothers who are willing to participate in the study
  • Antenatal mothers who are able to read and write English or Kannada

7.1.6. Exclusion criteria

  • Antenatal mothers who are not attending at the time of data collection
  • Antenatal mothers those who underwent similar type of intervention recently

7.2. Method of collection of data

7.2.1. Sampling technique:Convenient sampling

7.2.2. Tool of research: Structured questionnaire will be constructed in two parts

  1. Part I : Demographic data
  2. Part II : Knowledge based questionnaire regarding HIV/AIDS

7.2.3. Collection of data: The investigator collects data from hospitals

  1. Investigator introduces himself to subject and notifies about his objectives, and steps of study and takes written consent
  2. Selection of subjects (antenatal mothers)
  3. Assess the antenatal mothers for knowledge regarding HIV/AIDS using structured knowledge questionnaire

Assess the gain in knowledge of antenatal mothers regarding HIV/AIDS using some structured questionnaire.

7.2.4. Method of data analysis and presentation

  1. In the present study descriptive and inferential statistics will be used to analyze the data
  2. The analyzed data will be presented by using tables and graphs

7.3. Does the study require any investigation to be conducted on patients or other human or animals? If so please describe briefly?

Yes, in the study will be updated from sample. So permission will be taken.

7.4. Has ethical clearance has been obtained from your institution?

  1. Yes, consent will be obtained from concerned authority.
  2. Privacy, confidentiality and anonymity will be guarded.
  3. Scientific objectivity of the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCE

  1. Government of Karnataka, Department of health and family welfare Training Of Trainees (TOT) workshop on STO issues in HIV/AIDS. St. Johns Medical College. Bangalore 2003 March. Page no: 1-13
  2. Patton G et al. Global patterns of mortality in young people: a systematic analysis of population health data, 12th September 2009.P. 374
  3. Godbole S, Mehendule S. HIV/AIDS Epidemic in India. Indian J Med Res. 2005 Apr; 121(4): 356-68
  4. Goldenberg RL, Andrews WW, Ywan AC, St Luis ME. Sexually Transmitted Diseases during pregnancy. Women’s Health 1997; 24(5): 23-41
  5. Hawkins, Bourne, Shaw S. Text book of gynaecology. 12th ed. New Delhi: BI Churchill Livingston Pvt. Ltd; 1999. P. 106-114
  6. Islam M, Mira AK, Mion AH, Vamund SH. HIV/AIDS in Bangladesh: a national surveillance. Int J STD AIDS. 1999 Jul; 10(7): 471-74
  7. Dutta DC. Text book of gynaecology. 3rd ed. Calcutta. New central book agency; 2002. P.135-143
  8. SumangalaSheela. Study to assess the knowledge and attitude of women in child bearing age with regard to selected sexually transmitted diseases in selected areas of Raichur. 2003 March. P. 1-103
  9. SamakhyaMahila- Karnataka. Vulnerabilities of young women to STIs/HIV in Bellary District. Karnataka. 2002 January. P.1-58
  10. Tadesse E, Mulla AS. Knowledge and perception of antenatal women towards prevention of mother to child transmission of HIV/AIDS Malawi. Cent Att J Med. 2004 Mar-apr; 50(3-4): P.29-32
  11. Singh S, Fukuda H, Ingle GK, Tatare K. Knowledge and perceived risks of injection and sources of information about sexually transmitted disease (HIV/AIDS) among pregnant women. Delhi. J Commu Dis. 2002 Mar; 34(1): 23-34
  12. Brown H, Vallabhaneni S, Solomon S et al. Knowledge of women prenatal HIV testing and treatment among pregnant women in Southern India. Int J STD AIDS 2002 Jun; 12(6):390-94
  13. Singh MB, Chaudhary RC, halidiya KR. Knowledge of pregnant women regarding AIDS in a semi arid area of Rajasthan. J Commun Dis 1997 Jun;29(2): 139-44
  14. Panda S, Kumar MS, Lokabiraman S et al. Risk factors for HIV infection drug users. India. J acquire Immune DeficSyndr. 2005 May 1; 39(1): 9-15
  15. De Bruyn M, Paxton S. HIV testing of pregnant women Sex Health 2005; 2(3): 143
  16. Ratnathicam A. AIDS in India. AIDS patient care STDs 2001 May; 15(5): 255-61
  17. Laiskonis A, Pukente E. Vaccine for human Immuno deficiency virus (HIV) medicine. Medicine 2005; 41(2): 93-99
  18. Painter TM.Voluntary counseling and testing for couples: HIV/AIDS prevention in Africa. Socsci Med. 2001 Dec; 53(11): 1397-411
  19. Nightingale Nursing Times. Vol-6. No-10. January 2011: Page no. 5
  20. Gary Hopkins, Dr. PH, William A Wittla. Herald of Health. December 2008: page no. 4
  21. RanganadhaRao, DR. PV. Health action. August 2008: page no. 4-6