RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BENGALURU.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / : / MRS.PREETHI.M1ST YEAR M.Sc NURSING
GOVERNMENT COLLEGE OF NURSING. FORT, BENGALURU-02
2. / NAME OF THE INSTITUTION / : / GOVERNMENT COLLEGE OF NURSING. FORT, BENGALURU-02
3. / COURSE OF STUDY & SUBJECT / : / M.Sc NURSING
COMMUNITY HEALTH NURSING
4. / DATE OF ADMISSION / : / 29-07-2013
5. / TITLE OF THE TOPIC / : / EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING ADVERSE EFFECTS OF ALCOHOL CONSUMPTION ON CONCEPTION AMONG ADOLESCENTS AT SELECTED URBAN P U COLLEGES, BENGALURU.
6. BRIEF RESUME OF THE INTENDED WORK
“It takes only one drink to get me drunk. The trouble is, I can’t remember if it’s the thirteenth or the fourteenth”. - George Burns
INTRODUCTION
Adolescent is transitional period between childhood and adulthood marked by profound and significant physical, physiological, sexual and psychosocial changes. The adolescent period is from 10 to 19 years. During this period the child does not have defined role, neither considered as a child nor as an adult. 1
Adolescence is a period of relatively good health in spite of the storms and stresses of rapid physical growth, physiological changes, sexual and emotional growth and developments. The adolescents who are properly prepared for the physical and emotional changes, who are relatively stable and enduring social background, who are secure in their feelings of self esteem, self independence and who have some aspirations and goals for the future will be more likely to have developments in a constructive way and can achieve mature identity.1
Globally adolescents account for one fifth of the population i.e. more than one billion. Four out of five adolescents livein developing countries. According to population Bureau in 1996, 30% of the total population was that of adolescents (284.02 million). Due to gradual decrease in the growth rate of the overall population, there is little increase in the number of adolescents in population projections till the years 2016(Population Projection 1996-2016).1 According to Indian Census 2011 adolescents accounts for about 1,100,215,890 i. e about 9.7% of the total population.2
Problem which is encountered during adolescents are related to their growth and development and include physical, sexual, mental and emotional health problems. More specifically among them is alcohol drug and tobacco abuse. 1
Alcoholism is worldwide social and medical problem. Over the past 30 to 40 years, alcohol consumption has increased in quantity and frequency. The age at which people start drinking has also declined.The population group at great risk is those undergoing rapid socio-economic and cultural changes;they view alcohol as a symbol of prestige and social status. The consequences of alcohol abuse results in serious medical, psychological and sociological problems.3
The incidence of infertility is high and expected to increase and intake of alcohol is a possible casual factor for infertility as consumption of alcohol is widespread and increasing in many countries including India. The concentration of sulphate steroid has been found to be lower in alcoholic women leads to higher rates of menstrual disorder, including amenorrhea, dysmenorrhoea and irregular menstrual periods, miscarriage, placenta abruption, preterm deliveries, stillbirth and also fetal alcohol syndrome.4
Alcohol doesnot cause problems only after you are pregnant. It can make women less fertile too. It is not just female fertility that’s affected by alcohol. Excessive alcohol lowers testosterone levels and sperm quality and quantity in men. It can also reduce libido and cause impotence. If a man drinks heavily it can really reduce a couple’s chances of conceiving. If drinking is reduced the effects can be quickly reversed.4
6.1 NEED FOR STUDY.
The World Health Organization (WHO) estimates that 60 to 80 million couples worldwide currently suffer from infertility. Infertility varies across regions of the world and is estimated to affect 8 to 12 per cent of couples worldwide. Underlying these numbers exists a core group of couples, estimated to be 3 to 5 per centwho are infertile due to unknown or unpreventable conditions. A prevalence of infertility above this level suggests preventable or treatable causes.The WHO estimates the overall prevalence of primary infertility in India to be between 2.2. Estimates of fertility vary widely among Indian states, Andra Pradesh, Tamil Nadu, Kerala, Punjab and Himachal Pradesh is 1.6, Delhi, Maharashtra and Karnataka is1.7, registered as low fertility rate below the crucial 2.1. These states accounted for 50.4% of India’s population in 2011.5
An experimental study was conducted regarding presence of anti-sperm antibody in semen and blood serum may impair fertility. Sample size was 64 male and the study conducted at Mediwave Fertility research centre and semen bank in Mysore. The finding of the study revealed that among 64 samples 38(59.3%) showed positive response for ASA (anti-sperm antibody) in their blood serum. In this study ejaculatory dysfunction showed 100% positive response for ASA. The study concludes that one of the causative factors for this condition is alcohol consumption and the prevalence probably increases with increase in client’s age.6
An experimental study was conducted regarding specific impact of alcohol and smoking on semen quality of male. The sample size was 100 alcoholic and 100 smokers at andrology laboratory Uttharkand, India. The findings show that teratozoospermia was present in 72% of heavy alcoholics, 63% moderate alcoholics. Oligispermia was present in 64% of heavy alcoholics. Thus study concludes that heavy alcoholics showed defects in sperm count and morphology and motility. Hence males should abstain from alcoholism to avoid infertility.7
A cohort study was conducted to investigate the prevalence, predictors and perinatal outcomes associated with the pre-conceptional alcohol consumption among 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007 at Ireland. The results shows that 81% of women who reported alcohol consumption during the pre-conceptional period,71% reported low intake, 9.9% moderate intake and 0.2%high intake. High consumption was associated with very preterm birth (<32 weeks gestation) even after controlling for socio-demographic factors. Only three cases of Fetal Alcohol Syndrome were recorded(0.05 per 1000 total birth), one each in the low, moderate and high consumption groups.Thestudy concludes that there is a need for improved detection and management of alcohol misuse in pregnancy and for early intervention in order to minimize the risk to the developing fetus. The study recommends that further research is required specifically addressing the effects of low alcohol intake in pregnancy before it can be considered safe and also Public health campaigns need to educate and change attitudes towards pregnancy and promote healthy lifestyle choice in women of child bearing age.8
A descriptive study was conducted to identify the pattern of Alcohol use in early Adolescence and relate these to hazardous and harmful alcohol use at age 16. A sample size of 7100 adolescents was taken in UK andanalyzed repeated measures of alcohol use. The study revealed that the Heterogeneity in drinking frequency and consumptioncould each be captured with three classes corresponding to low,medium and high levels.In total,14.2% were classified as high-frequency and 8.9% as high consumption alcohol users. About 16.29% were drinking hazardously at age 16. Socio-demographic factors, maternal substance use and the young person’s use of tobacco and cannabis were associated with class membership. The study concludes that the pattern of alcohol exposure in early adolescence were strongly associated with later alcohol use. The study recommends that there is need to alter the drinking pattern in middle adolescence has potential to reduce harmful use in later adolescence.9
An experimental study was conducted on unconfounded effects of moderately increased prenatal alcohol exposure on cognitive/educational performance. A sample of mother-offspring pairs participating in the Avon Longitudinal Study of Parents and Children (ALSPAC).Both conventional observational analyses and Mendelian randomization technique was used. The findings shows that moderate drinking before and during early pregnancy were compared with women reporting lighter drinking and their children had higher key stage 2 and IQ score. Children whose mother’s genotype predisposes to lower consumption or abstinence during early pregnancy had higher KS2 scores than children of mother with heavier drinking. The study concludes thatbetter offspring cognitive/educational outcome observed in association with prenatal alcohol exposure.10
A prospective observational study was conducted regarding effects of alcohol and caffeine on conception among 124 women. The finding of the study shows that >50% reduction in conception among alcohol consumer. Caffeine consumption enhanced the negative effect of alcohol. 26.9 pregnancies per 100 menstrual cycle among women was abstained from alcohol and consumed one cup of coffee and 10.5 per 100 menstrual cycle among those who consumed alcohol and more than 1 cup of coffee per day was reported. The study concludes that there are negative effects of alcohol consumption on the ability to conceive and the investigator suggests that those who are planning to conceive should abstain from consuming alcohol. 11
A cross-sectional study was conducted to investigate social, demographic and environmental factors that may raise the risk of Saturday night drinking and binge drinking among 845 Italian underage school students by means of an anonymous, self-test questionnaire. The study revealed that students of older age classes, male sex, returning home after midnight, belong to group with little respect for the rules. Spending time in bars or discos coincides with two-fold or four-fold increase, respectively, in the risk of alcohol consumption. The findings show that certain environmental and social risk factors are associated with underage drinking. The most important role for preventing young people’s exposure to these factors lies with the family, because only parents can exert the necessary control and provide a barrier against potentially harmful situation. 12
The problems which are faced by the adolescents are mainly associated with life-style and socio-economic conditions of people. These are becoming more prevalent in adolescents mainly because of their risk taking behavior. More over the emotional control of family, the moral control of school and the social control of community are declining. Information explosion and communication across cultural boundaries through mass media have lot of influence on behavior pattern of adolescents all over the world. In India, the prevalence of alcohol and drug abuse which is generally low in early adolescence aged 12 and 13 rises steeply in the late teenage and is highest during the early 20’s. The influence of western culture is more in India.2
After considering the above facts, the researcher feels that there is need for further evaluation of Knowledge level of Adolescence regarding the Adverse Effects of Alcohol Consumption on Conception and modifying their behavioral pattern by creating awareness through a Planned Teaching Programme.
6.2 REVIEW OF LITERATURE.
Review of literature is key step to Nursing Research. It involves a systematic identification,location,and summary of written materials that containing information on research problems. It conveys the readers about the work already done andthe knowledge and ideas that have been already established on a particular topic of research.13
A descriptive study conducted on alcohol consumption during pregnancy is one potential risk factor for Spontaneous abortion (SAb). 302 African- American mothers were selected by prospective sampling method. Analysis was done with semi-structured interview technique. The study revealed that there is a fetal risk among pregnant women due to alcohol consumption. The investigator suggest that an effective intervention that reduces the risk-level alcohol consumption and protect from pregnancy loss.14
A descriptive study was conducted regarding changes in patterns of women’s alcohol use, pre-conception, pre-pregnancy and post-pregnancy recognition time period and to describe characteristics of women consuming any alcohol and that binge drinking during pre and post-post pregnancy recognition period. Computer assisted telephone interview technique was used with 1042 women who had recently delivered a baby in urban Alberta, Canada. The data analysis was done by Chi-square test. The finding of the study shows that 18% of women reported alcohol consumption pre-conceptionally, 50% pre-pregnancy recognition and 18% post-pregnancy recognition. Binge drinking was reported 35%, 11% and 0% for pre-conception, pre-pregnancy and post-pregnancy recognition respectively. The study concludes that pre-conception and “well-women” counseling strategies would be improve by increasing emphasis on the risk of alcohol use during periods when pregnancy can occur. 15
A cross-sectional survey conducted to examine the women’s alcohol consumption and risk for Alcohol-Exposed pregnancies among 648 pregnant and non-pregnant women of childbearing age at 7 public women’s clinic in two locations: St. Petersburg (SPB) and the Nizhny Novgorod region (NNR) in Russia. A face-to-face structured interview technique was used. The result shows that 89% of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past three months. 47% in NNR and 28% in SPB reported binge at least monthly. 32% of women in SPB and 54% in NNR were at – risk for AEP. There was significant decline in drinking after pregnancy. 20% of pregnant women reported consuming alcohol and 6% in SBP reported binge drinking. The study concludes that Russian women substantially reduced drinking after pregnancy recognition compared to pre-pregnancy period. The study recommends the pre-conception period presents a risk window and preventive opportunities are more at this level.16
A cross-sectional survey was conducted on the knowledge and attitude of women of childbearing age regarding alcohol consumption during pregnancy and its effects on fetus among 1103 Australian women aged 18 to 45 years. Samples were randomly selected via computer assisted telephone interview technique. The result shows that 61.5% had heard about effects of alcohol on the fetus and 55.3% had heard of fetal Alcohol Syndrome. Although 92.7% agreed alcohol can affect unborn child, 16.2% did not agree that the disabilities could be lifelong. About 80.2% of women agreed that pregnant women should not drink alcohol and 79.2% reported having negative feeling towards pregnant women drinking alcohol. The study reveals that there was a disjunction between knowledge and attitude towards alcohol consumption in pregnancy. The study recommends that Public Health campaigns, national policy and guidelines are required to influence the women’s alcohol behavior in pregnancy and effective prevention strategies.17
A descriptive and longitudinal study was conducted on pregnant women’s compliance with 2009 Australian alcohol guidelines. Cross-sectional analysis of prospective data from 1973-1978 was collected among women aged 30-36 years who were pregnant at the 2009 survey and had data on alcohol use were included. The study results in 72%of pregnant women did not comply with the 2009 alcohol guidelines and 82% drank less than seven drinks per week. In other models the odds of complying were lower for women who consumed alcohol before pregnancy at least weekly or binged and were higher for those who abstained prior to pregnancy. The study concludes that most pregnant women did not comply with alcohol guidelines promoting abstinence. Prior alcohol behavior was the strongest predictor of compliance during pregnancy, suggesting alcohol use should be addressed in women of childbearing age. The study recommends that there is a need to determine why so many pregnant women are not complying with the current alcohol guidelines. Further research is needed to understand the pathway that exists between policymakers and pregnant women to determine why there is such a low rate of compliance with alcohol guidelines.18