http://doi.org/10.33698/NRF0081- Jyoti Sarin, Lily Podder, Right Kumari, N.Sujata
Abstract : A study was undertaken to determine the prevalence of anemia among registered antenatal mothers in MMIMS & R antenatal OPD with a view to develop and evaluate a planned health education programme on prevention and management of anemia in pregnancy in terms of knowledge and practice of antenatal mothers. The conceptual framework adopted for the study was based on System Model. The study was conducted in two phases. A survey approach was adopted for Phase-I of the study and an experimental research approach was adopted for Phase-II of the present study with pretest-post-test control group design. The sample comprised of 100 antenatal mothers for Phase I of the study and for Phase II 30 antenatal mothers were there in each experimental and control group. The findings of the study in phase-I shows that two third of the antenatal mother (68%) belonged to the age group of 21-25 years and half of the mothers (54%) had period of gestation between 25 to 32 weeks. Regarding hemoglobin level 49% of antenatal mothers had hemoglobin level between 8.1 to 10 gm% that is they were mildly anemic and 51% of the mother encountered minor problems during pregnancy among which nausea and vomiting was the most common. The significant findings of the study in phase II show that the mean post-test knowledge scores were significantly higher than the mean pretest knowledge score of antenatal mothers in experimental group, The subjects after implementation of planned health education programme improved practices which was significant. Thus the findings of the study reveal that the planned health education programme was effective in terms of enhancing the knowledge as well as improving the practice of antenatal mothers regarding prevention and management of anemia in pregnancy.
Key words :
Planned health education programme, Knowledge, Practice, Effectiveness, Anemia in pregnancy, Antenatal OPD, Hemoglobin, status
Correspondence at : Jyoti Sarin,
Principal , M.M.C.O.N, Mullana, Ambala
Introduction
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The occurrence of anemia as a major public health problem throughout the world is widely recognized. In developing countries, the prevalence of anemia among pregnant women averages 56%, ranging between 35-100% among different regions of the world1. According to WHO estimation 500 million women in the world are iron deficient. In India 13 million out of 22 million pregnant women suffer from anemia; where as the incidence of anemia ranges between 20-30% in the middle income group. It is much higher in the lower income group that is 60% in urban women and 70% in rural women. In India, the incidence of anemia among expectant mothers is alarmingly high. Nutritional anemia is a serious problem in pregnancy which affect 60 – 70 % pregnant women with Hb level less than 10gm%, 15 to 30 % of all maternal deaths are due to anemia2 Maternal anemia was found to be significantly associated with more frequent preterm birth and increased low birth weight new born.
MortalityFigure – 1: Major causes of Maternal Severe anemia in pregnancy may have adverse effects for the new born and should be treated or prevented early in pregnancy.3 Anemia contributes directly to 20% of maternal deaths and is a contributory factor in another 20% of maternal deaths following obstetrical hemorrhage, obstructed labor, sepsis and other causes.4 (fig. 1)
Reduction in infant and maternal mortality is a priority goal for all the nations and also for both WHO and UNICEF. ICMR 2004 reported that in India approximately 52% of women have some degree of anemia and 40% women in every subgroup of population are anemic. Anemia is a serious concern for women because it can be an underlying cause of maternal and infant morbidity and mortality. There is also an increasing risk of premature delivery and birth of low birth weight babies due to anemia in pregnancy. The prevalence of anemia is found high in schedule tribe women and poor women.5
The extent of maternal mortality is an indicator of disparity and inequity in access to appropriate health care and nutrition services throughout a lifetime, particularly during pregnancy and child-birth. National Population Policy 2000 and National Health Policy 2002 aimed at reducing the Maternal Mortality Rate to 100 per 100,000 live birthst/ rom the current level of MMR of 400 to 500.6 Therefore anemia is the potentially lethal complication of pregnancy leading to large number of maternal and fetal loses but it is preventable and curable disease. No women must enter into labour in an anemic state especially when prevention is easy and complications are hazardous. So to have a healthy mother and a healthy baby we should prevent and treat anemia in pregnancy in the early period.
Materials and Methods
The study was carried out in two phases. The survey approach was found to be consistent with the purpose of phase I of the present study in order to furnish a factual description of existing status of anemia among antenatal mothers in the Maharishi Markendeshvar Institute of Medical Sciences & Research, Mullana, Ambala, Haryana (MIMS&R) antenatal OPD. The experimental approach was considered to be appropriate for phase II of the present study in order to evaluate the effectiveness of planned health education programme on prevention and management of anemia in pregnancy among antenatal mothers. The research design selected for phase II of the present study was a “Pretest, Posttest Control Group Design”. The sample selection was done by purposive sampling technique in Phase I and simple random sampling in Phase II. In phase I of the study a total of 100 mothers were selected. And for phase II a total of sixty mothers were selected as sample (Thirty mothers in each group)
The summary of the data collection tools and techniques is depicted below in Table 1.
Table – 1 : Summary of data collection tools and techniques
| Tool | Purpose | Data collection technique |
| ¨ Structured record analysis performa | To collect the data regarding age, gestational age, parity, Hb level and problems encountered during pregnancy among antenatal mothers registered
in the OPD. |
Record analysis |
| ¨ Structured knowledge interview schedule | ||
| Section – I Demographic data and obstetrical data |
To collect background data and the obstetrical data. |
Interviewing |
| Section – II
interview schedule |
To assess the knowledge of antenatal mothers regarding prevention and management of anemia in pregnancy. | |
| ¨ Structured practice interview schedule. | To assess the practices of antenatal mothers regarding prevention and management of anemia in pregnancy. | Interviewing |
Research Hypotheses
H1 The mean post-test knowledge score of antenatal mothers who were exposed to planned health education programme on prevention and management of anemia in pregnancy will be significantly higher than those who were not exposed as measured by structured knowledge interview schedule at 0.05 level of significance.
H2 The mean post-test practice score of antenatal mothers who were exposed to planned health education programme on prevention and management of anemia in pregnancy will be significantly higher than those who were not exposed as measured by structured practice interview schedule at 0.05 level of significance.
Null Hypotheses
H01 There will be no significant difference between the mean post-test knowledge scores of antenatal mothers in experimental and control group regarding prevention and management of anemia in pregnancy as measured by structured knowledge interview schedule at 0.05 level of significance.
H02 There will be no significant difference between the mean post-test practice scores of antenatal mothers in experimental and control group regarding prevention and management of anemia in pregnancy as measured by structured practice interview schedule at 0.05 level of significance.
Results
Findings related to age, gestational age, parity, Hb level and problems encountered during pregnancy among antenatal \ mothers registered in the MMIMS&R antenatal OPD.
Two Third of the antenatal mothers (68%) were in the age group of 21-25 years, followed by 21 % of antenatal mothers in the age group of 26-30 years and 10% of the antenatal mothers in the age group of below 20 years. Regarding period of gestation 54% of the antenatal mothers were between 25- 32 weeks of gestational period followed by 42% having more than 32 weeks period of gestation. As regard to Hb level of the antenatal mother only three out of 1 00 antenatal mothers had hemoglobin level between 6.1 to 8 gm% Le. they were moderately anemic and 49% of the antenatal mothers had hemoglobin level between 8.1 to 10 gm% i.e. they had mild anemia. Forty eight percent of the antenatal mothers had hemoglobin level 10.1 gm% and above i.e. their hemoglobin level were within normal limits. Forty nine percent of the antenatal mothers did not encounter any health problems during pregnancy and 51% of the antenatal mother had encountered various health problems among which headache and nausea were more common (29%). Personal data and the obstetrical data: Half of antenatal mothers in the experimental group and 43.33% of antenatal mothers in control group were in the age group of 20-25 years. Two Third of the antenatal mothers (66.67%) in the experimental and 60% in the control group were Hindus. Forty percent of the antenatal mothers in experimental group were having secondary education and 16.67% of the antenatal mothers were having higher secondary education whereas in control group 50% of the antenatal mothers were having secondary education. Most of (96. 67%) antenatal mothers in experimental group and control group 90% were house wives. Two third of antenatal mothers (66.67%) in experimental group and 50 % in control group were from joint family. Seventy percent of antenatal mothers in experimental group and 63.33% in control group were in the per capita income range of Rupees 1501- 3000 per month. Majority of the antenatal mother in experimental (83.33%) and control group (86.67%) had service type of sanitary facility. Two third of antenatal mothers in experimental (70%) and control (66.67%) group were vegetarian and 66.67% antenatal mothers in both groups usually have 3 meals and 2 snacks per day. Sixty percent of antenatal mothers in experimental group and 70% of antenatal mothers in control group had clean and shor t nails. More than half (56.67%) of antenatal mothers in experimental group and 50% in control group receive information regarding health from their relatives.
Findings related to the knowledge scores of the antenatal mothers regarding prevention and management of anemia in pregnancy in experimental and control group.\ The bar graph in Figure- 2 represents the mean pretest and post-test Knowledge score of antenatal mothers in experimental control group. It is evident from the bar graph that the mean post-test knowledge score of experimental group was higher as compared to the mean post-test knowledge scores of the control group.
Figure – 2 : Bar graph comparing the mean pretest and post-test knowledge scores of antenatal mothers between the experimental & control group
Table – 2 : Mean, Mean Difference, Standard Deviation Difference and Standard Error of Mean Difference and,’t’, values of Pretest and Post-test Knowledge Scores of Antenatal Mothers in Control Group and Experimental Group N = 30
| Group | Knowledge Scores | Mean | MeanD | SDD | SEMD | ‘t’ value |
| Control | Pretest | 23.5 | 0.1 | 0.46 | 0.08 | 0.875NS |
| Post-test | 23.4 | |||||
| Experimental | Pretest | 23.6 | 3.2 | 0.692 | 0.126 | 24.841 * |
| Post-test | 26.8 |
NS= not significant at 0.05 level of significance. Df
(58) ‘t’ = 2.04 at 0.05 level of significance.
* Significant at 0.05 level of significance
The data presented in Table- 2 shows that the mean post-test knowledge scores of antenatal mothers in control group was 23.4 and mean pretest knowledge scores was 23.5 with a mean difference of 0.1, which was not found to be statistically significant as evident from ‘t’ value of 0.875 for df 29 at 0.05 level of significance. This shows that the obtained mean difference between the pretest and the post-test knowledge score was by chance and was not a true difference. This indicates that the knowledge level of the antenatal mothers in control group did not significantly change in the post-test.
The data in Table- 2- further shows that the mean post-test knowledge scores of antenatal mothers in experimental group was 26.8 and mean pretest knowledge scores was 23.6 with a mean difference of 3.2, which was found to be statistically significant as evident from ‘t’ value of 24.841 for df 29 at 0.05 level of significance. This shows that the obtained mean difference between the pretest and the post-test knowledge score was a true difference and not by chance. This shows that the antenatal mothers exposed to planned health education programme had higher knowledge in post-test. Thus it can be inferred that the planned health education programme on prevention and management of anemia in pregnancy was effective in increasing the knowledge level of the antenatal mothers regarding the same
Table – 3 : Mean, Mean Difference, and Standard Error of Mean Difference and ‘t’ values of Post-test knowledge Scores of Antenatal Mothers in Experimental and Control Group N = 60
Experimental group 26.8Group Mean MD SE MD ‘t’ value
(n = 30)
3.4 1.003 3.349*
Control group 23.4
n= (30)
* Significant at 0.05 level of significance. Df (58) ‘t’ = 2.00 at 0.05 level of significance.
The data given in Table 3 shows that after the administration of planned health education programme on prevention and management of anemia in pregnancy the mean post-test knowledge scores of antenatal mothers in experimental group was 26.8 and mean post-test knowledge scores in the control group was 23.4 with a mean difference of 3.4, which was found to be statistically significant as evident from ‘t’ value of 3.349 for df 58 at 0.05 level of significance. This shows that the obtained mean difference was a true difference and not by chance. Therefore the researcher rejected the null hypothesis HO1 and accepted the research hypothesis H1. This result indicated that the planned health education programme on prevention and management of anemia in pregnancy was an effective method for increasing the knowledge of the antenatal mothers regarding the same.
Findings related to the practice scores of the antenatal mothers regarding prevention and management of anemia in pregnancy in experimental and control group.
Frequency and percentage distribution of practices of antenatal mothers regarding prevention and management of anemia in pregnancy in experimental and control group was computed The practices of antenatal mothers in the control group remains unchanged in the post test except the practice regarding intake of mixed and freshly cooked food and wearing chappal while going outside the house.
The data in table 4 further shows that in the experimental group 10% of the antenatal mothers were using iron utensils for cooking in post test whereas it was 3.33% in pretest. Regarding intake of mixed and freshly cooked
Table – 4 : Frequency and Percentage Distribution of the Practices of the Antenatal Mothers Regarding Prevention and Management of Anemia in Pregnancy in Experimental and Control Group N=60
| S.
No |
Practice Items
/ statements |
Pretest
F (%) |
Post-test
F (%) |
Pretest
F (%) |
Post-test
F (%) |
| 1
2
3
4
5
6
7 8
9
10 11
12
13
14
15 |
I cook my food in iron utensil usually.
I don’t take mixed and freshly cooked food most of the time. I always wear chappal wherever I go outside the house I usually drain excess water while cooking. If I don’t feel like taking foodthen I should take small and frequent diet. I take iron tablets daily as prescribedby the physician. I take my iron tablets with milk or tea If my stool becomes black then I should stop taking Iron tablets. My daily diet contains more of green leafy vegetables. I take iron tablets in empty Stomach I take two iron tablets together daily I take iron tablets on every alternative day I take my iron tablets with lemon juice daily I include almond, jiggery and dates in my daily diet I take two glasses of milk daily to prevent Anemia |
1 (3.33)
28 (93.33)
27 (90.00)
23 (76.67)
16 (53.3)
30 (100)
30 (100) 30 (100)
5 (16.67)
5 (16.67) 0 0
0 0
0 0
0 0
11 (36.67) |
3 (10.00)
25 (83.3)
30 (100)
27 (90.00)
22 (73.33)
30 (100)
30 (100) 27 (90.00)
25 (83.33)
8 (26.67) 0 0
0 0
0 0
0 0
12 (40) |
0 0
29 (96.67)
25 (83.33)
30 (100)
21 (70)
30 (100)
30 (100) 30 (100)
8 26.67
3 (10.00) 1 (3.33)
1 (3.33)
0 0
0 0
9 (30) |
0 0
27 (90.00)
27 (90.00)
30 (100)
19 (63.33)
30 (100)
30 (100) 30 (100)
7 (23.33)
4 (13.33) 1 (3.33)
1 (3.33)
0 0
0 0
14 (35.78) |
Experimental Group Control Group (n=30) (n=30)
food there is higher percentage of compliance from 6.67% in pretest to 16.67% in post-test. All the antenatal mothers started wearing chappal while going outside of the house in post-test whereas it was 90% in pretest. Majority of the mother i.e. 73.33% reported that they should take a small and frequent diet when they don’t feel like taking food where as it was 53.33% in pretest. 26.67% of the antenatal mother reported to include more green leafy vegetables in daily diet in post- test when it was 16.67% in pretest. The positive health practices such as taking iron tablets as prescribed by the physician, not taking it together or on alternative day were followed by the antenatal mothers in pretest as well as in post-test. The practices with regard to intake of iron tablets with lemon juice and not with milk or tea remain unchanged despite of planned health education programme on prevention and management of anemia in pregnancy.
The bar graph in Figure- 3 depicts the mean pretest and post-test practice score of antenatal mothers between the Experimental & Control group. It is evident from the bar graph that the mean post-test practice score of experimental group were higher as compared to the mean post-test practice scores of the control group.
Figure – 3 : Bar Graph Comparing the Mean Pretest and Post-test Practice Scores of Antenatal Mothers Between the Experimental & Control Group
Table – 5 : Mean, Mean Difference, Standard Deviation Difference and Standard Error of Mean Difference and ‘t’ values of Pretest and Post-test Practice Scores of Antenatal Mothers in Control Group and Experimental Group
N=30
| Group | Practice Scores | Mean | MeanD | SDD | SEMD | ‘t’value |
| Control | Pretest | 5.36 | 0.007 | 0.3042 | 0.0566 | 1.18NS |
| Post-test | 5.43 | |||||
| Experimental | Pretest | 5.33 | 1.83 | 28.72* | 0.3485 | 0.0637 |
| Post-test | 7.16 |
NS=not significant at 0.05 level of significance. Df (29) ‘!‘ = 2.04 at 0.05 level of significance.
* significant at 0.05 limit of significance.
The data presented in Table- 5 shows that the mean post-test practice scores of the antenatal mothers in control group was 5.43 and mean pretest practice scores was 5.36 with a mean difference of 0.07, which was not found to be statistically significant as evident from ‘t’ value of 1.18 for df 29 at 0.05 level of significance. This shows that the obtained mean difference between the pretest and the post-test practice score was by chance and was not a true difference. This indicates that the practices regarding prevention and management of anemia in pregnancy of antenatal mothers in the control group did not significantly improve in the post-test.
The data presented in Table- 5 further shows that the mean post-test practice scores of the antenatal mothers in experimental group was 7.16 whereas the mean pretest practice scores was 5.33 with a mean difference of 1.83, which was found to be statistically significant as evident from ‘t’ value of 28.72 for df 29 at 0.05 level of significance. This shows that the obtained mean difference between the pretest and the post-test practice score was a true difference and not by chance. This shows that the antenatal mothers exposed to planned health education programme had higher practice score in post- test. Thus it can be inferred that the planned health education programme on prevention and management of anemia in pregnancy was effective in improving the practices of the antenatal mothers regarding the same.
Table – 6 : Mean, Mean Difference, and Standard Error of Mean Difference and ‘t’ values of Post-test Practice Scores of Antenatal Mothers in Experimental and Control Group N=60
Group Mean MD SEMD ‘t’ vlue Experimental group 7.16
(n = 30)
1.73 0.4842 3.57*
Control group 5.43
n= (30)
* Significant at O.05 level of significance. Df (58) ‘1’ = 2.00 at 0.05 level of significance.
The data given in Table 6 shows that the mean post-test practice scores of antenatal mothers in experimental group was 7.16 whereas the mean post-test practice scores of antenatal mothers in control group was 5.43 with a mean difference of 1.73, which was found to be statistically significant as evident from ‘t’ value of 3.57 for df 58 at 0.05 level of significance. This shows that the obtained mean difference was a true difference and not by chance. Therefore the researcher rejected the null hypothesis H02 and accepted the research hypothesis H2. This result indicated that the planned health education programme on prevention and management of anemia in pregnancy was an effective method for improving the practice of the antenatal mothers regarding the same.
Conclusion
On the basis of the findi.ngs of the present study the following conclusions are drawn:
- Deficit in knowledge was found regarding prevention and management of anemia in pregnancy in the selected group of antenatal
- Antenatal Mothers who were exposed toplanned health education programme had significantly higher knowledge score than the antenatal mothers who did not exposed to planned health education programme on prevention and management of anemia in
- The planned health education programme was effective in enhancing knowledge of antenatal mothers regarding prevention and management of anemia in
- Deficit in practice was found regarding prevention and management of anemia in pregnancy in the selected group of antenatal
- Antenatal Mothers who were exposed to planned health education programme had significantly higher practice score than the antenatal mothers who did not exposed to planned health education programme on prevention and management of anemia in
- The planned health education programme was effective in improving practice of antenatal mothers regarding prevention and management of anemia in
Therefore it is be concluded that the planned health education programme was effective in terms of enhancing the knowledge as well as improving the practice of antenatal mothers regarding prevention and management of anemia in pregnancy
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6 Gupta Neeru. Maternal Mor tality: Magnitude, Causes and Concerns, Obstetrics and Gynaecology today 2004;9;9:555