RAJIVGANDHI UNIVERSITY OF HEALTH AND SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
MS. BINCY K.P
M.Sc. NURSING 1ST YEAR,
CHILD HEALTH NURSING,
BATCH 2011-2013
R.R. COLLEGE OF NURSING,
RAJAREDDY LAYOUT
CHIKKABANVARA
BANGALORE -560090.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
PORFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MS. BINCY K.PM.Sc. NURSING 1st YEAR,
R.R COLLEGE OF NURSING
CHIKKABANARA
BANGALORE-560090
2. / NAME OF INSTITUTION / R.R COLLEGE OF NURSING
CHIKKABANAVARA
BANGALORE-560090
3. / COURSE OF THE STUDY AND SUBJECT / M.Sc. NURSING 1st YEAR
CHILD HEALTH NURSING
4. / DATE OF ADMISSION TO THE COURSE / 10.07.2011
5. / TITLE OF THE STUDY / A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PRENATAL AND PERINATAL FACTORS AFFECTING GROWTH & DEVELOPMENT AMONG REPRODUCTIVE AGE GROUP MOTHERS AT SELECTED AREA, BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
A child in its mother's womb is the highest form of all the arts.
No painter could paint anything better than that. ………………
And the moment, the child steps into this Earth,
A masterpiece will be born and
In front of this child mediocre will be the works of art.
The great majority of women have uncomplicated pregnancies and give birth to healthy babies, and for many years it was believed that the baby in the uterus was completely insulated from outside influences. Scientists now know that this is not entirely true. Environmental influences ranging from radioactivity and stress in the outside world to drugs, chemicals, hormones, and viruses in the mother's bloodstream can affect prenatal development.
Growth and development is a complex process that depends on the inherent biological potential as well as various environmental influences including social, emotional and pathological factors1. Important factors affecting child development are as follows —
I. Intrinsic (Biological)factors affecting child development determine the inherent pace, pattern and ultimate potential for growth & development.
- Extrinsic (Organic)factors affecting child development are prime determinants of growth and development in developing countries, which directly facilitate or limit the achievement of inherent growth potential. Important organic factors affecting growth and development include :-
a) Prenatal factors affecting child development involving:-
· Maternal Nutrition: Malnutrition, anemia
· Intrauterine infections
· Maternal diseases: Hypertension, Diabetes
· Teratogens: Drugs, Radiation, Smoking, drugs, alochol
· Placental disorders/insufficiency
· Emotional state of the mother
· Maternal age
b) Obstetrical or perinatal factors affecting child development:
•Gestational Age and Birth Weight
•Complications: Birth asphyxia, Kernicterus2
PRENATAL FACTORS AFFECTING CHILD GROWTH & DEVELOPMENT
Adverse influences during prenatal period will affect the basic structure and form of the body and may have particularly serious permanent effects.
Nutrition is a primary non-genetic factor affecting brain development. The effects of under-nutrition (and malnutrition) on the developing brain are long-lasting, leading to permanent deficits in learning and behaviour. In developing countries, where micronutrient deficiencies are routine, increasing micronutrient intake (by supplementation or increased micronutrient-rich food consumption) is associated with significantly increased birth size and IUGR reduction in women with low pre pregnancy body mass index(BMI).
The international symposium organised by the Danone Institute as a pre-congress satellite of the European Nutrition Societies Congress, in Paris, in July 2007, brought together experts of child nutrition and behaviour. These experts coming from several countries of Europe and North America shared their views on the impact of numerous factors affecting child eating and health in present-day developed societies. Most contributions addressed the obesity epidemics and the problems associated with body weight control.3
Since the placenta cannot filter out extremely small disease carriers, such as viruses, children can be born with venereal diseases that have been transmitted from the mother. The most dangerous infections known to pass from the mother to the fetus and to produce malformations are toxoplasmosis, rubella, cytomegalovirus,and herpesvirus (TORCH); syphilis; and varicella.1
The potential consequences of intake of teratogenic substances are IUGR, fetal malformations, fetal demise, and spontaneous abortion.1
Emotions can temporarily affect the child. The activity level of the foetus is increased when the mother is emotionally upset.
Maternal age also plays significant role in growth of child. Those woman who are below 21, have chances of miscarriage, still births, and foetal malformations. The reason is that the reproductive organs of the female are not fully mature.
A study to assess intrauterine growth restriction as a potential risk factor for disease onset in adulthood shows that unfavourable influences in the fetal environment may program metabolic homeostasis in later life affecting blood pressure, glucose tolerance and lipid regulation. Fetal restricted protein supply may impair the development of the kidney and reduce the nephron number, which is involved in blood pressure regulation.4
PERINATAL FACTORS AFFECTING CHILD GROWTH & DEVELOPMENT
Low birth weight (LBW) babies behave differently than term babies during postnatal growth period — while preterm grow faster in late infancy (catch-up growth) than the term babies, small for gestational age (intra uterine growth retardated) babies are unlikely to show significant catch-up growth and have limited growth potential throughout the life. Other perinatal events e.g. asphyxia/injuries, sepsis, kernicterus etc. may also have disastrous effects on subsequent growth and development.5
The aim of this study is to explain that there is relationship between prenatal and perinatal factors such as intrauterine growth retardation, maternal malnutrition, anemia, emotional state on the normal growth and development in early childhood as well as later years in life. Hence this study is taken up to give knowledge to reproductive age group mothers regarding prenatal and perinatal factors affecting growth and development.
6.1NEED OF THE STUDY
Although post-neonatal and child mortality rates have declined dramatically in many developing countries in recent decades, neonatal mortality rates have remained relatively unchanged. Neonatal mortality now accounts for approximately two-thirds of the 8 million deaths in children less than 1 year of age, and nearly four-tenths of all deaths in children less than 5 years of age. Worldwide, 98% of all neonatal deaths occur in developing countries, mostly at home, and largely attributable to infections, birth asphyxia and injuries, and consequences of prematurity, low birth weight and congenital anomalies.6
South Asia is one of the most highly-populated regions of the world with nearly one quarter of the world's population. Although Africa has the highest overall perinatal, neonatal and maternal mortality rates, the greatest number of deaths occurs in Asia, especially the South Asia region.7
Mortality during the first 28 days of life (i.e. perinatal) now accounts for two-thirds of deaths in children less than 1 year of age, and nearly four-tenths of all deaths in children less than 5 years of age.A recent analysis found that the loss of healthy life from newborn deaths represented 8.2% and 13.6% of the burden of disease in Sub-Saharan Africa and South Asia, respectively, or 27 and 53 million years of life lost in those two respective regions alone.8
For every death during the neonatal period, it is estimated that another stillbirth has occurred; when combined with the two-thirds of neonatal deaths that occur during the first week of life, perinatal deaths nearly equal the number of deaths during the entire first year of life.Estimates from the World Bank suggest that perinatal deaths account for approximately 7% of the global burden of disease, exceeding that due to malaria and vaccine-preventable infections combined.9
The relationship between maternal education and perinatal and neonatal mortality is complex but several studies have demonstrated reduced rates of infant and child mortality in association with increased levels of maternal education.10
Infants born to mothers who do not receive prenatal education & cares have nearly a 25% increase in neonatal mortality, and the risk of perinatal mortality is highest in women with very short and very long intervals between pregnancies.11,12
Approximately two-thirds of all neonatal mortality occurs in the first week of life, emphasizing the importance of care, and research to improve care, given in the early postpartum period (i.e., the first week of life). Intrapartum asphyxia is a major cause of perinatal and neonatal morbidity and mortality. An estimated 4 to 9 million cases of birth asphyxia occur each year, accounting for 24% to 61% of all perinatal mortality.13
The number of lives lost in the perinatal and neonatal period exceeds that of any other period in life of a similar duration. Thus, in order to sustain gains in child survival made in recent decades, attention must be focused on reduction of morbidity and mortality in the newborn period. Effective education & awareness can reduce prenatal & perinatal morbidity and mortality rates and will lead to cost-effective, acceptable and sustainable interventions, particularly at the community level, may now hold the greatest potential and promise for improving the survival and health of future generations of children.6
A study regarding the role of selected socio-occupational factors on the development of intrauterine growth retardation (IUGR) in the urban population of Lódź, Poland. The studies have shown that the process of preventing IUGR and its consequences requires more effective activities aimed at increasing the level of health education and stimulating the development of appropriate, health-oriented behaviour.14
Hence the investigator felt that it is very essential to educate mothers in reproductive age regarding prenatal and perinatal factors affecting growth and development.
6.2 REVIEW OF LITERATURE
Review of literature is a critical summary of research on a topic of interest, generally prepared to put a research problem in context or to identify gaps and weakness in prior studies so as to justify a new investigation (Polit and Hungler, 1989, pg-397)
The researcher presents the review of literature which helps to study the problem in depth. It also serves as a valuable guide to understand what has been done and what is still unknown and tested. The present study is to assess the effectiveness of structured teaching programme on prenatal and perinatal factors affecting growth and development among reproductive age group mothers.
The related literature are organized and presented under the following headings:-
· Study related to prenatal factors affecting growth and development of child
· Study related to perinatal factors affecting growth and development of child.
REVIEW RELATED TO PRENATAL FACTORS AFFECTING GROWTH & DEVELOPMENT
K.S. Negi et al (2006) conducted a longitudinal study to determine the epidemiological factors influencing low birth weight. The prominent factors associated with low birth weight (LBW) such as maternal age, parity, obstetric and maternal anthropometry were studied in a rural community of district Dehradun. The average birth weight of all newborns was 2.67± 0.42 kg and 23.84% of newborns were low birth weight. Rouse Hill Town Centre(RHTC) caters to a population of 11,278 and the prevailing antenatal registration rate at rouse hill town hill (RHTC) was found to be 82.2%. The incidence of LBW was 23.8%, while the mean birth weight of all 172 newborns was 2.67 Kg (with SD ± 0.42 kg). It is to be noted that there was no new born with birth weight less than 1.5 Kg and only 5% new born were with birth weight more than 3.4 Kg. The study concluded that birth weight is a reliable index of intra uterine growth retardation (IUGR) and a major factor determining child survival, future physical growth and mental development.15
Gardener et al (1999) conducted a study to assess prenatal and perinatal factors in relation to Multiple sclerosis (MS). The sample included 723 confirmed MS cases, including 383 with diagnosis after reporting prenatal and perinatal factors. Few associations were observed. These included an increased risk among women whose mothers reported late initiation of prenatal care (after the first trimester) (27 cases; rate ratio = 1.6 [95% confidence interval = 1.0-2.4]), diabetes during pregnancy (2 cases; 10 [2.5-42]), and maternal pre-pregnancy overweight/obesity (20 cases; 1.7 [1.0-2.7]). Results also suggested a possible increase in incident multiple sclerosis (MS) risk among women with prenatal diethylstilbestrol exposure. The study concluded that prenatal factors play an important role in the causation of multiple sclerosis.16
Sushma Malik et al (1997) conducted a study to assess the influence of some of the maternal bio-social factors on the variance of birth weight of the infants in Mumbai. A total of 984 consecutive live births delivered at an urban hospital were analysed. The rate of low birth weight (LBW) was 28.3% and preterm accounted for 3.2%. The study concluded that a strong correlation existed between birth weight and maternal height, weight, age, antenatal clinic visit (ANC) visits and risk status at pregnancy. A short, malnourished, young, unregistered or primiparous mother was associated with a higher rate of low birth weight.17
R. Frisancho et al (1973) conducted a study to assess the influence of Maternal Nutritional Status on Prenatal Growth in a Peruvian Urban Population. The study included a total sample of 4,952 mothers and their neonates attended at the Maternity Hospital of Lima; who gave birth at the hospital between July and December, 1973. The result stated that although fat mothers have fatter newborns, they do not necessarily have longer newborns when compared to lean mothers. Born of more muscular mothers have significantly (p < 0.01) greater muscle area than those of less muscular mothers. The more muscular mothers also have significantly (p < 0.01) longer newborns except in the 30 to 34-year age group. Among female newborns, those of more muscular mothers have significantly (p < 0.01) greater muscle area than those of less muscular mothers.18
Anja C. Huizink et al (1969) conducted a study to assess the effects of prenatal stress on infant development separately from the effects on temperament. The results shows that, mental development scores at 8 months-old infants were negatively correlated with unadaptability (r= -.19, p<.05) and positively correlated with test-affectivity and goal-directedness (r= .37, p<.005 and r=.34, p<.005, respectively). Motor development scores (PDI) of 8-months-old infants were not related to maternal reports of infant temperament, but were positively correlated with test affectivity (r= .30, p<.005).The study concluded that increased maternal prenatal stress seems to be associated with temperamental variation of young infants and may be a risk factor for psychopathology later in life.18