A study to assess the knowledge of primi gravida mothers regarding

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					         RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
                              KARNATAKA.

    PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1      NAME OF THE CANDIDATE AND    Ms. ARUNA ASURI
       ADDRESS
                                    GOLDFINCH COLLEGE OF NURSING

                                    NO: 150/24, KODIGEHALLI MAIN ROAD

                                    MARUTHINAGAR

                                    BANGALORE-560092

2      NAME OF THE INSTITUTION      GOLDFINCH COLLEGE OF NURSING

                                    MARUTHINAGAR

                                    BANGALORE-560092

3      COURSE OF STUDY AND          M.SC NURSING
       SUBJECT
                                    OBSTETRICS AND GYNAECOLOGICAL

                                    NURSING


4      DATE OF ADMISSION TO         30.06.2011
       COURSE




    5. TITLE OF THE TOPIC

         “A STUDY TO ASSESS THE KNOWLEDGE OF PRIMI GRAVIDA MOTHERS

         REGARDING ANTE-NATAL DIET AND EXERCISES AMONG THOSE WHO

         ATTEND ANTE-NATAL OPD IN A SELECTED HOSPITAL AT BANGALORE.”
6.0 BRIEF RESUME OF INTENDED WORK

INTRODUCTION

         Antenatal Period is a very crucial period for both mother and lotus. To get healthy baby from a

healthy mother, diet during pregnancy is plays a very important role. For E.g : if a tree is well nourished

with water, it guide plenty of fruits like that only, when mother is provided with good nutritious diet

during her pregnancy, it will end up in delivery of a healthy baby.


        Adolescents comprise 20% of the world’s total population. Out of 1.2 billion adolescents

worldwide, about 85% line in developing countries. In India there are 190 million adolescents

comprising 21% of total Indians population. Adolescents’ pregnancies constitute 10-15% of total

pregnancies in India.


         Pregnant Woman need more essential nutrients has other woman. From the beginning of 2nd

trimester until delivery, your body needs additional 300 calories each day to support the growth of your

baby. Pregnancy period is most stressful period in women’s life. During pregnancy, many changes that

takes place in maternal body. About 910 of portions are deposited on the fetus and maternal tissues. The

balanced diet is required to maintain growth of fetus, placenta and maternal tissues.


          As per WHO 75% of diet should consist of cereals. Fat and refined sugar Should provide 15%

energy. Diet should include proteins, fats, CHO, minerals, vitamins and essential fatty acids. The energy

Should Come from 75% of cereals, 15% fat, 5% refined sugar, diet Should include 50-60% CHO, 400-

500 calories 20-40% Fat use mixed cereals, pulses, vegetables and fruits. Total weight gain during

pregnancy is 11-12 kg. Iron requirement is 300mg/day calcium requirement is 1.0-1.2 gm., Vitamin- A

requirement is 1100 IU and Vitamin-C requirement is 40mg/ day.
          Poor nutrient during pregnancy is well Known to contribute to adverse pregnancy outcome.

Although this is the first study that has looked superficially at the relationship between maternal

micronutrients and pregnancy complications in adolescents.


         Mother who eats unhealthy diet during pregnancy may be putting their children at risk of

developing long term, irreversible health issues including obesity, raised levels of cholesterol & blood

sugar. So, mother should take proper nutritious diet during pregnancy in order to prevent material & fetal

complications & to promote delivery of a healthy baby.


         There is a big problem of malnutrition during pregnancy in developing countries like India, it

is very important that the lady & her family members especially husband should understand the

importance of good balanced diet for pregnant lady and her child.


         The practice of Antenatal exercise during first pregnancy has been shown to reduce the

incidence of stress incontinence of urine both during pregnancy as well as in the postpartum period [1-2].

It has been recommended as part of the National Institute for Health and Clinical Excellence (NICE)

guidelines for the management of urinary incontinence in women [3] the guideline advocates eight

contractions performed three times every day. There is no information however on patient awareness of

such recommendation or the extent to which they comply with it.


         The aim of this audit was to assess patient awareness of and actual practice of pelvic floor

exercises in their first pregnancy. Specific attention was given to source of information and how patient

compliance could be improved.
6.1. NEED FOR THE STUDY

         Diet in pregnancy is very essential to provide delivery of a healthy baby. During this period,

mother has to extra amount of calories. She has to eat for herself and for the baby. The total weight gain

during pregnancy is 11-12 kg. In 2nd & 3rd trimester every week 204 k & in 1st trimester 1-2 kg. Nutrients

for the fetus come from mothers diet, stored nutrients in the mothers bones & tissues & synthesis of

certain nutrients in the placenta. Placenta facilities the transfer of nutrients, hormones & other substances

from mother to fetus


         But many people don’t know about the dietary pattern. Especially in rural areas, they didn’t

even know what were the physiological changes that occur during pregnancy and need for supplementary

nutrition. Because of illiteracy, they take the diet as normal women takes. This amount of food that the

mother took is not sufficient for the growing fetus. This will result in baby born with low birth weight &

mal formations, IUGR etc. Poor nutrient during pregnancy is well known to contribute to adverse

pregnancy outcome. Although this is the first study that has looked superficially at the relationship

between maternal micronutrients and pregnancy complications in adolescents.


          Mother who eats unhealthy diet during pregnancy may be putting their children at risk of

developing long term, irreversible health issues including obesity, raised levels of cholesterol & blood

sugar. So, mother should take proper nutritious diet during pregnancy in order to prevent maternal &

fetal complications & to promote delivery of a healthy baby.


           There is a big problem of malnutrition during pregnancy in developing countries like India, it

is very important that the lady & her family members especially husband should understand the
importance of good balanced diet for pregnant lady and her child. Exercise during pregnancy is usually

beneficial depending on the woman’s state of health conditioning and stage of pregnancy. Exercise

provides a diversion reduces anxiety and tension quiels the mind promotes sleep helps to decrease

constipation and stimulates the appetite all of which are valuable aids to the pregnant women.


          Specific exercise & posture can be helping the pregnant women to adopt the physical changes

her body during the child bearing age. They are as follows: abdominal tightening, pelvic rocking, pelvic

floor exercises, foot & leg exercises, sit or half lie with legs supported, breathing awareness, and client

education.
6.2. REVIEW OF LITERATURE
            A review of literature is an essential aspect of scientific research. One of the major functions

of review of research literature is to ascertain what is already known related to the problem of interest

and this will help in developing a broad conceptual context into which a research problem will fit.

            An intensive review of literature was done by the investigator to lay a broad foundation for

the study and a conceptual framework was developed to proceed with the study. The review of literature

is presented under the following headings as follows:

Section-A: LITERATURE RELATED TO KNOWLEDGE OF ANTE-NATAL DIET AND

EXERCISES


           A study was conducted on the relationship between maternal nutritional status and

spontaneous abortion in National Institute of Nutrition, Andhra Pradesh. The aim is to improve the

nutritional status of promote safe delivery. A case control study was conducted to assess the relationship

between vital status & spontaneous abortion. The result is the incidence of anemia & Riboflavin &

Folate deficiency were similar among cases & controls vitamin A levels are higher in study group to

compare to those in controls. The results suggest that various nutrient deficiencies have no correlation

with the occurrence of spontaneous abortion.


            A study was conducted on growth patterns of Indian fetus in department of obstetrics in

CMC, Vellore. The objective of this study is to determine the patterns of Intra uterine growth & the

gestation at birth of Indian fetus. One hundred & twenty consecutive women who had reliable menstrual

histories, low risk pregnancies & who were booked for delivery at Christian Medical College, Vellore

before 20th week gestation were recruited to the study. The conclusion slowing growth of fetal abdominal
circumstance of the 23 weeks & shorten length of gestation result in the birth of small babies in this ethic

group.

             A study was conducted on nutrient intake of rural women present in Haryana state to know

the relationship between income & education. The daily nutrient intake of 90 pregnant women from

forming & non farming communities in rural villages of Haryana state. As a result of questionnaire &

interviews, nutritional intake for consecutive days was calculated. The protein intake of farming women

was significantly lower & that of farming women. The mean daily intake of thiamine, riboflavin & niacin

of women of both communities are adequate. Through this study we can come to know that income of

present women and their educational states also has influence on the nutrient intake.

              A study was conducted to know the influence of maternal vegetarian diet on essential fatty

acid status on newborn in dept of nutrition, Kings college at Calcutta. The objective is to evaluate

whether a maternal vegetarian diet influences the essential fatty acid status of newborn & whether this is

related to outside of pregnancy. Dietary intake of fatty acid composition of plasma phospholipids were

determined in 24 South Asian vegetarian & 24 white omnivore non-present pre menopausal women

randomly selected from general population. The result is birth weight; HC & Length were lower in

infants born to South Asian vegetarian even after adjusting for maternal HT duration of gestation gender

of infant.

               A cross sectional study was conducted to determine the diet quality & common food

sources of various nutrients of pregnant women. Cross section study of 716 pregnant women attending

the antenatal clinic at the provincial general hospital. Nutrient intake was estimated using the 24 hours

dietary recall method. Result is inadequate nutrient intake was found for energy, folic acid, calcium &

iron etc., adequate intake of protein, fat, PUFA etc. Conclusion the result of this study indicates poor

quality of diet of pregnant women attending the antenatal clinic, low in multiple micro nutrients. So they
concluded that nutrition education should he given for dietary diversification.


Section-B: LITERATURE RELATED TO KNOWLEDGE OF PRIMI GRAVID MOTHERS

REGARDING ANTE-NATAL DIET AND EXERCISES


                A study was conducted to know the effect of pelvis in muscle exercise on transient

incontinence during pregnancy and after birth. The audit also provided insight into the preferences of

pregnant women regarding instructions on pelvic floor exercises. Whilst more participants preferred one-

to-one instructions (29.1%) than instructions in groups (9%), over 60% of participants did not mind

either way. Although more participants preferred instructions from midwives (28.7%) than from

physiotherapists (6.7%) over, 60% did not indicate any per fences. Training midwives to provide

instruction regarding pelvic floor exercises deserves more research and is beyond the scope of this audit

likewise, the provision of specialist physiotherapy service to pregnant women, which will have staffing

and financial implications will need to be evaluated in relation to the likely benefit from it is beyond this

audit.


                A single-blind randomized control trial was made to prevent urinary incontinence during

pregnancy through pelvic floor muscle training. Although over 90% of first time mothers who took part

in this audit were aware of value of pelvic exercises during pregnancy and over 75% of them were happy

with their ability to perform these exercises detailed awareness of the proper technique and actual

performance of these exercises were of less impressive not which standing the limitations of this audit it

has show the importance o customized messages that stress the value of antenatal pelvic floor exercises

for those unaware of this value explain their proper technique for those unaware of the proper technique

and provide simple remainders to perform them for those aware of the value and the technique various

forms of media should be utilized in this approach especially national resources as these are relied upon
most by patients all staff in world in the antenatal care, especially midwives, should stress the importance

of pelvic floor exercises, instruct them about the technique advice them about the consequences of not

performing them. The availability of information prior to pregnancy is important. And the provision of

specialist physiotherapy input for individualized instructions as well as adoption of measures to increase

adherence, in sources of information, health education as well as professional instructions programs or

worth exploring.
6.3. STATEMENT OF THE PROBLEM

       “A study to assess the knowledge of primi gravida mothers regarding ante-natal diet and exercises

among women who attend ante-natal OPD in a selected hospital at Bangalore”

6.4. OBJECTIVES

      To assess the knowledge regarding antenatal diet among primi gravida mothers.


      To assess the knowledge regarding antenatal exercises among primi gravida mothers.


      To associate the knowledge of primi gravida mothers regarding antenatal diet and exercises with

       selected demographic variables.


6.5. RESEARCH HYPOTHESIS

      H1. There will be significant difference in the level of knowledge regarding antenatal diet and

       exercises among primi gravida mothers


      H2. There will be significant association between the level of knowledge regarding antenatal diet

       and exercises with selected demographic variables.


6.6. OPERATIONAL DEFINITIONS

      ASSESS: In my study the word assess refers to the statistical measurement of knowledge

       regarding antenatal diet and exercises among primi gravida mothers.

      KNOWLEDGE: In my study knowledge refers to the awareness or familiarity regarding

       antenatal diet and exercises.
      DIET: The food which is required to maintain growth of fetus, placenta and maternal tissues.


      WOMEN: In my study, women refer to any person belonging to a female gender hailing from

       urban sector of the country towns and smaller cities.


      EXERCISE: During pregnancy the exercises has been shown to reduce the incidence of stress

       incontinence of urine.


6.7. ASSUMPTIONS


1. Primi gravida mothers will have less knowledge regarding antenatal diet and exercises.


2. Primi gravida mothers are not aware of the antenatal diet and exercises.


6.8. DELIMITATIONS

      The study will be delimited to pregnant mothers who attend antenatal clinic of a selected hospital

      The study will be delimited to pregnant mother who can understand either English or Kannada.

6.9. PROJECTED OUTCOME


      The study would reveal the statistical level of knowledge among primi gravida mothers from a

       selected hospital
7.0. MATERIALS AND METHODS


   7.1 SOURCE OF DATA :

       Antenatal mothers who attend the antenatal OPD in a selected hospital in Bangalore.


       7.1.1 RESEARCH DESIGN & APPROACH :

       The research design adopted for the study is descriptive design. The research approach adopted

for the study is quantitative approach.


       7.1.2 SETTING :


       The study will be conducted in a selected hospital in Bangalore.


       7.1.3    POPULATION :

       Antenatal mothers who attend the antenatal OPD of a selected hospital


   7.2 METHODS OF DATA COLLECTION

   7.2.1. SAMPLING TECHNIQUE:


      Simple random technique will be used by the researcher in the study.


   7.2.2 VARIABLES UNDER STUDY :


          Attribute variables : Age , Occupation, Socio-Economic status, education & status etc.,

          Dependent variable: Knowledge regarding antenatal diet & exercises of the primi gravida
            mothers.




   7.2.3 SAMPLE SIZE :


         100 antenatal mothers who attend the antenatal OPD of a selected hospital


   7.2.4 DURATION OF STUDY : The data will be collected for a period of 4 weeks.


   7.2.5 INCLUSIVE CRITERIA :


            Mothers who attend the antenatal OPD of a selected hospital

            Women between the reproductive age group of 18 -45 years.

   7.2.6 EXCLUSIVE CRITERIA :


            Women who cannot read either Kannada or English.

   7.2.7 INSTRUMENT NEED TO BE USED :


         Structured knowledge questionnaire will be used to assess the level of knowledge regarding

antenatal diet & exercises of primi gravida mothers.


   7.2.8 METHOD OF DATA COLLECTION: Prior to actual data collection, permission will be

obtained from the selected hospital at Bangalore. Written consent will be obtained from the study

participants. Adequate care will be taken for protecting the subject from potential risk.


    7.2.9 DELIMITATIONS :


      The study will be delimited to pregnant mothers who attend antenatal clinic of a selected hospital
      The study will be delimited to pregnant mother who can understand either English or Kannada.




  7.2.10 PLAN FOR DATA ANALYSIS :


           The data will be analyzed by using descriptive statistics and inferential statistical method.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED ON

PATIENTS OR OTHER HUMAN ORANIMALS :


           Yes the study will be conducted among antenatal mothers from a selected hospital at

            Bangalore.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM THE INSTITUTION IN CASE OF

7.3?

            Yes
7.5. ETHICAL COMMITTEE:



                             A study to assess the knowledge of primi gravida mothers

       Title of the topic    regarding ante-natal diet and exercises among those who attend

                             ante-natal OPD in a selected hospital at Bangalore



    Name of the candidate    Ms. Aruna Asuri


    Course and the subject   MSc in Obstetrics and Gynecological Nursing


      Name of the guide      Prof. (Mrs). Julie Justin


      Ethical committee      Approved
8.0 LIST OF REFERENCES

  1. D.C. Dutta, text book of obstetrics 6th edition, 2004 new central book agency private limited,

     page no. 100-102.


  2. Molly Rom & N. Geetha Jaypee, & text book of nutrition for nurses, medical publishes private

     limited new Delhi, page no. 89-91.


  3. Vijay D.Joshi, Hand book of nutrition & duties vora publication, 4th edition page no. 213-216.


  4. M.Swaminathan, hand book of food & nutrition fifty edition 1986, page no.189-192.


  5. http:/ / w.w.w health encyclopedia.com


  6. http:/ / w.w.w Biomed Central.com


  7. http:/ / w.w.w Inmedica.com/journals


  8. http:/ / w.w.w nature.coms


  9. http:/ / w.w.w google.com
9    Signature of the candidate




                                  This study will be helpful for the antenatal
10   Remarks of the guide
                                  mothers to know about antenatal diet and

                                  exercises




     Name and designation of


     11.1 Guide                   Prof. (Mrs). Julie Justin
11



     11.2 Signature


     11.3 Co-Guide(if any)                                 -
     11.4 Signature                                    -




     11.5 Head of Department   Prof. (Mrs). Julie Justin




     11.6 Signature


                               It enhances the knowledge of antenatal mothers
     12.1 Remarks of the
                               regarding antenatal exercises and dietary pattern.
     Principal

12

     12.2 Signature

				
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