GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

SYNOPSIS

FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. NAME OF THE CANDIDATE MRS: BABITHA MATHEW

AND ADDRESS Koshys college of nursing
Sy.No 31/1
Hennur-Bagalur Road
Kadusonnappanahalli,
Kannur P.O,
Bengaluru – 562149
2. NAME OF THE INSTITUTE KOSHYS COLLEGE OF NURSING
Bengaluru

3. COURSE OF THE STUDY Obstetrics and Gynecological Nursing

Ist year M.Sc Nursing
4. DATE OF ADMISSION TO 16.06.2009
COURSE

5. TITLE OF THE TOPIC A STUDY TO ASSESS THE

KNOWLEDGE AND PRACTICE OF
PREGNANT WOMEN REGARDING
ANTENATAL CARE IN SELECTED
CLINIC, BENGALURU.

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 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Healthy Mothers and Children’s are the real wealth of Societies.”

(WHO)

Pregnancy and Child birth are special events in women`s lives and indeed in the lives of their

families. This can be a time of great hope and joyful anticipation. The primary aim of antenatal

care is to achieve, at the end of pregnancy, a healthy mother and healthy baby. The quality of care

is more important than the quantity. Pregnancy requires specialized care generally agreed to

preventive activity.

Antenatal care is the systemic medical supervision of women during pregnancy. Its aim is to preserve

the physiological aspect of pregnancy and labour and to prevent or detect, as early as possible, all that is

pathological. Early diagnosis during pregnancy can prevent maternal ill-health, injury, maternal

mortality, foetal death, infant mortality and morbidity. Hence, the earlier in pregnancy a woman comes

under the supervision of an obstetrician, the better. (Sheila Haldipu 2004)

Antenatal care refers to pregnancy related health care provided by a doctor or a health worker in medical

facility or at home. Antenatal care should monitor a pregnancy for signs of complication detect and treat

pre-existing and concurrent problems of pregnancy. It should also provide advice and counseling or

preventive care, diet during pregnancy, delivery care, postnatal care and related issues. An antenatal care

is necessary for ensuring a healthy mother and baby at the end of gestation. The antenatal period is a

time of physical and psychological preparation of birth and parenthood. Becoming a parent is a time of

intense learning both for parents and for those close to them. (Dutta)

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Promotion of maternal and child health has been one of the most important components of the family

Welfare Programme of the Government of India and the National Population Policy – 2000. One of the

most important component of antenatal care is to offer information and advice to women about

pregnancy related complication and possible curative measures for early detection and management of

complications. Antenatal care can also play a critical role in preparing a woman and her family for birth

by establishing confidence between the woman and her health care provider and by individualizing

promotional health messages. Antenatal care is considered essential for health of both the mother and

the child, it is important to analyze the possible factors contributing to its utilization. (N. C. Saxena

2005)

The lest of any civilization is the measure of consideration and care, which it gives to its weaker sections. In any

community, women are especially vulnerable during pregnancy. The maternal mortality ratio (MMR) in India

is very high the data given by the registrar general of India for 1998 estimate that MMR to be around

407 per 100,000 live births. (WHO 2005)

Reducing MMR to less than 100 per 100,000 live birth is a commitment enshrined in the national

population 2000. India is committed to reducing MMR to less than 100 per 100,000 by the year 2010

from the current 407 / 100,000 live births (SRS, RGI,1998)

Maternal care includes care during pregnancy and should begin from the early stages of pregnancy.

Women can success antenatal care service either by visiting a health center where such services are

available or from health workers during their domiciliary visits. One of the most important components

of antenatal care is to offer information and advice to women about pregnancy related complication and

possible curative measures for early detection and management of complication. Antenatal care can also

play a critical role in preparing a woman and her family for birth by establishing confidence between the
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woman and her health care provider and by individualizing promotional health messages. (Balwan S

Dhillon 2006)

Effective antenatal care can improve the health of the mother and give her a chance to deliver a healthy

baby. Regular monitoring during pregnancy can help detect the complication at an early stage before

they become life – threatening emergency. However, one must realize that even the most effective

scanning tools currently available, one cannot predict which will develop pregnancy related

complication. Hence, every pregnant women needs special care. (Manchanda 2005)

NEED OF STUDY

The knowledge of pregnant women regarding antenatal care and their compliance to it is of paramount

importance in preventing maternal and infant mortality rate and morbidity. The Indian society is made of large

number of socio–culturally diverse groups. Their views of antenatal care and the health care system in general,

may be different. The disparity of their knowledge and practice has to be assessed for improving the delivery of

such services to these groups.

A study can also help us to compare the levels of knowledge and practice of primigravida and multiparas. This

helps us to assess the stress given to preventive obstetric care with in the health care system as well as the

dissemination of knowledge in the community. Such a study could also potentially help us find the source of

knowledge of those who have it and to intensify the use propaganda through such media.

Poor utilization of services reflects cultural and socio – economic constraints as well as perceptions regarding

accessibility of facilities and quality of care. Nearly 64.00% of women who did not utilize antenatal services

consider it unnecessary reflecting both the traditional notion that child bearing is not an event worthy of medical

attention.
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The purpose of the study is to identify the knowledge and practices of pregnant women regarding different

aspects of antenatal care such as diet, antenatal checkups, immunization, adequate sleep and rest, exercise,

hygiene, breast care, breastfeeding the health problems and complications of pregnancy to make

recommendations to enhance the knowledge and practices of antenatal care by improving the delivery of

antenatal services( both quality and quantity ) if they are less; and to continue with the present antenatal service

rendering status if the knowledge and practices are adequate.

A study conducted at Safdarjang Hospital New Delhi by ICMR revealed that as 42.6% of perinatal death could

be attributed to preventable causes which are directly or indirectly related to maternal disease, complications of

pregnancy and methods of delivery (Daftary & Mehta 1984)

A sample of 310 mothers belonging to low Socio economic class from an antenatal clinic of an urban health

center and another sample of 180 mothers belonging to high Socio-economic class attending nearly nursing

home clinic were studied and classified into 3 groups based on risk. Two third were classified as low risk, 5% as

hybrisk and the rest as moderate risk. (Murthy,Goswame & Narayan, 1990)

A study conducted to Niger Dela in sub terliary Hospital in 2005 concluded that late looking for antenatal care

common and unrelated to age, level of education, social class, previous fetal loss and previous obstetric

complications. This show that the only factor involved was the dissemination of knowledge.

Thus the investigator felt the needs to explore this area and to assess the knowledge and practice of mothers

regarding antenatal care. The aim of the investigator is to find out any association between knowledge and

practice of pregnant women regarding antenatal care in selected demographic variables (age, family income,

types of family, education status.)

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6.2 Review of Literature

A review of literature is an essential aspect of scientific study. It involves the systematic identification, location,

scrutiny and summary of written materials that contains information on a research problem. It broadens the views

of the investigator regarding the problem under investigation, helps in focusing on the issues specifically

concerning the study.

Polit and Hungler (1996) Review of literature is defined as a broad comprehensive, in – depth, systematic and

critical review of scholarly publications, unpublished scholarly print materials, audiovisual materials and

personal communications.

Few studies have been done in the field of breast feeding and antenatal care. The investigator has made an

attempt to explore studies, publications and reports relevant to the study.

Review of literature is done for the present study and presents in the following headings.

Studies and Literature related to knowledge and practice of antenatal care among antenatal mothers.

 Antenatal care

 Maternal health status

 Pregnancy and risk

Antenatal care

Nahla A Kishk (2009) conducted a comparative study to assess the Knowledge and Practices towards ANC

between rural and urban women in Alexandira a cross sectional, community – based house to house survey was

conducted in Alexandria using cluster – sampling technique 30 clusters from urban areas and 30 cluster from

rural areas. Concerning maternal practices the current study revealed rural/ urban disparities as significantly

higher proportions of urban women had proper practices during antenatal period in their last pregnancy as

regards utilization earlier initiation and frequent visits of antenatal care.

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Susila. C (2008) performed a study to assess the level of self motivation of primigravidre mothers towards

antenatal care at Sree Ramachandra Hospital and Research institute Chennai, among 100 mothers only 8% of the

mothers were with high level of self motivation towards receiving or following the antenatal care and she finds

that there is a responsibility for the nurses to increase the level self motivation among antenatal mothers.

N.Gerein, S. Mayhew & M. Lubben, (2003) conducted a study to assess a framework for a new approach to

antenatal care (ANC) is presented to improve maternal health. Based on evaluations of ANC, safe motherhood

programs, gender and social theory it suggests that managers should draw upon existing family and community

support systems and develop partnerships beyond the health service. Policy and program changes are required in

professional mandates for ANC provides oraganisation of ANC services, service protocols, training programs

policy towards TBAs, referral care and service support system.

Adil H Ibnouf (2002) performed a study about utilization of routine antenatal health care services in Khartoum

State, Sudan. Interviews were held among a representative sample of 400 marries women aged 15 – 49 years

from both urban and rural localities was approximately 5 times and application of TT vaccination was 3.7 times

higher in urban women as compared to women in rural areas. A higher quality of care (odds – ratio 5.8) and

shorter walk time (odds ratio 3.1) were significantly associated with more utilization of routine antenatal care

services. Mother education showed a nearly significant positive relationship both with use of routine antenatal

health care services (odds ratio 2.1)

Maternal health status

Padam Singh, R.J.Yadav (2009) conducted a study to assess the status of antenatal care among pregnant

women in India. In that study 89% of the pregnant women availed antenatal visits of which 62% had received

three or more ANC visits. Those receiving the second dose of TT or booster dose were about 78%. About 73% of

the pregnant women received IFA tablets during their pregnancy. About 53% of the pregnant women had full

package proportion of pregnant women who availed full ANC package was lower in rural as compared to urban

areas, lowest for ST followed by SC higher for literate women as compared to illiterate women. The population

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of Institutional deliveries managed by hospitals and health centers was about 41% , it being higher among literate

women and in urban areas. The study revealed that the literacy of women is the key to improve antenatal care of

pregnant women. Hence efforts should be made to have information, Education and Communication (IEC)

activities targeted to educate the mothers especially in rural areas.

C.S.Metgud, S. M.Katti, M. D.Mallapur and A.S.Wantamutte (2009) conducted a study of Utilization

Patterns of Antenatal care among Pregnant women all women (n=130) village in Tanzania who were pregnant at

the start of the study and who became pregnant during the study.

Most of the pregnant women (92.31%) were registered for antenatal care, but only 30.00% of them were

registered in the 1st trimester of pregnancy. As regards to TT immunisation70.77% of the pregnant women as

received two doses or one booster dose iron and folical acid supplementation was taken by 59.68% of the

pregnant women. Nearly 39.52% of the pregnant women were provided with full antenatal care. The main

antenatal care provided for the pregnant women was doctor (64.52%). The study shows early and wide spread of

the antenatal care, but it also reveals that the antenatal visits of occur late in pregnancy.

S. Kiwawa (2008) conducted a study about the use of antenatal care maternity services for the pregnant women

in Lewero Dist in Uganda. A sample size of 769 women in the viewed, among that 417 visiting initially, during

second trimester 242, during third trimester 266. About the use of antenatal services most the woman delivered in

health centers (28.7%), (26.4%) delivered from home, (18.2%) in private maternity homes and (13.8%) in

hospital. About maternity service utilization approximately (59.2%) gave birth with a skilled attendant present

others delivered other by themselves or with help of at relatives, friends and traditional birth attenders.

Pregnancy and risk

Ali Yawar Alam & Akhtar Ali Qureshi (2007) performed a cross sectional survey to access the knowledge and

practice of women utilizing and not utilizing antenatal care facilities during their previous pregnancy among 200

married women in the age range 15-49 years were compared by the calculating odds ratios and 95% confidence

intervals. Studied showed Pallor was significantly lower among women utilizing antenatal care (57%) as

compared to those who were not (77.6%) (O.R.38.95% Cl (. 18-81) p value.02). Tetanus toxoid coverage was

higher among women utilizing antenatal care (92%) compared to those who were not (59.2%) (O.R 10.8 95% Cl

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(4.5-26.2). Knowledge about danger signals in pregnancy and realization of the importance of eating healthy diet

during pregnancy was significantly higher among utilizing antenatal care. The finding reveals that Lesser

prevalence of Anaemia and better tetanuxs toxoid coverage was seen among women attending antenatal care

facilities. Identification of danger signals in pregnancy and recognition of nutritional demands of pregnancy are

better understood by women utilizing antenatal care facilities.

Anna & Gunilla (1998) conducted a study to assess the consequences of reduction of the routine programme for

surveillance of normal pregnancy. The study of a total pregnant population comparing utilization of care the

years before and after a new routine antenatal programme was introduced, a reduction of three to four midwife

visits during the second half of pregnancy. All women from the catchment area gave birth in 1990 (n=2008) and

1992 (n=1874) and had attended antenatal care in the area during the second half of their pregnancy were

analyzed for use of potential primary and secondary care, obstetric interventions, pregnancy outcome and

perinatal outcome. The researcher revealed that compliance to the programme improved resulting in a reduction

of only 1.8 visits initiated by staff increased slightly, but extra contacts initiated by the mother remained very

few. There were no significant difference in material outcome or obstetric intervention and the rates of

prematurity, low birthweight, low Apgar score and the need for neonatal interventions were equal both years. The

study shows the reduction of three to four scheduled visits in the traditional antenatal care programme can be

done without increasing demands for extra visits, need for specialist constultions or emergencies or less

favorable outcome.

B.Moller, G.Lindmark (1989) conducted a study of antenatal care at village level in rural in Tanzania among

707 women delivered in the study period. Ninety five percent of the antenatal records were available. Anemia,

malaria and anticipated obstetric problems were the utmost frequent reasons for interventions. Among the

women from the area who were delivered in hospital, 90% had been referred there. No relationship was found

between the number of antenatal visits and the pregnancy outcome, but prenatal mortality was correlated to a low

birth weight. Even with a mean attendance rate of six visits and full coverage by antenatal care maternal and

prenatal mortality remains high.

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STATEMENT OF THE PROBLEM

A Study to assess the knowledge and practice of pregnant women regarding

antenatal care in selected clinic in Bengaluru.

OBJECTIVES OF THE STUDY

The objectives of the study are to:

1. assess the knowledge of pregnant women regarding antenatal care.

2. assess the reported antenatal practices of pregnant women

3. Find out the association between knowledge of pregnant women regarding

antenatal care and selected demographic variables (age, family income, types of family,

Education Status etc.)

4. Find out the association between the reported antenatal practices of pregnant

women and selected demographic variables.

5. Find out the relationship between knowledge and practices of pregnant women.

HYPOTHESES

The Hypothesis will be significant at 0.05 level.

 There will be significant association between the knowledge of pregnant women regarding antenatal care

and selected demographic variables.

 There will be significant association between the reported practices of pregnant women regarding care

and selected demographic variables

 There will be significant relationship between knowledge of pregnant women regarding antenatal care

their practice.

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OPERATION DEFINITIONS

1. Pregnant Women

Pregnant mother refers to women who are pregnant and in the age group between 19 to 35 yrs.

2. Antenatal Care

Care provided to a pregnant mother in those aspects like diet , exercises, adequate sleep and relaxation ,

hygienic practices , understanding complications of pregnancy , immunization antenatal check up , breast feeding

, and breast care.

3. Knowledge

It is the level of understanding of the pregnant women about antenatal care on the basis of the score obtained in

the knowledge questionnaire on various aspects of antenatal care.

4. Practice

It is the degree of antenatal practices followed by the pregnant women on the basis of the score obtained in the

practice questionnaire on the various aspects of antenatal care.

ASSUMPTIONS

The study assumes that:

 All pregnant women will be co-operative and willing to participate in the study.

 Pregnant women having little knowledge regarding antenatal care

 Pregnant women have experience of antenatal practices.

DELIMITATIONS

This study is delimited to:

 Mothers who have consumption is conformed until 40 weeks of gestation

 Pregnant women who are able to read and write English & Kannada

 Study duration is limited to 5 weeks

 Subjects are selected from a selected antenatal clinic in Bengaluru

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MATERIALS AND METHODS

Sources of Data

Antenatal mothers from antenatal clinic in Bengaluru

Methods of Data collection

Research method - Non –Experimental method

Research design - Descriptive study

Sampling method - Convenient sampling

Sample size - 70 antenatal mothers

Setting of the study - Selected antenatal clinic in Bengaluru

Criteria for selection of samples

Population will be pregnant women attending antenatal in clinics

Inclusion criteria

This study includes antenatal mothers

 From antenatal clinic in Bengaluru

 Antenatal mothers willing to participate in the study

 Antenatal mothers who are between the age group 19-35 yrs

 Who are available at the time of data collection

 Able to read and write kannada

Exclusion criteria

Pregnant women who are

 Mothers who are not available at the time of data collection

 Not willing to participate in the study

 Not able to read and write English & Kannada

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Data Collection tool

A structural questionnaire can be used to assess the knowledge and practices regarding antenatal care among

antenatal mothers. Content validity of the tool can be ascertained in consultation with guide and experts from

various fields like medicine nursing and statistics.

Prior to the study, written per mission can be obtained authorities. Further consent can be taken from samples

regarding their willingness to participate in the study. The data will be collected by the investigator herself.

Data Analysis , method

The collected data will be analyzed by using

 The knowledge questionnaire is scored on the basis of the answer key with each correct answer receiving

one point

 The least appropriate or incorrect answers receive no points

 The maximum core that can be achieved is 50 and the minimum score is zero grading

 The samples are divided in to three categories based upon the point score as follows excellent > 80% ,

Average 60-80% , Poor < 60%

Does the study any require any investigation or intervention to be conducted on patients or other human

or animals?

Yes , only structured questionnaire will be used

Has Ethical clearance been obtained?

Yes a) A written permission from the concerned authority will be obtained prior to the

study

b) Consent will be taken from subjects before conducting the study

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REFERENCES

Books

 D.C. Dutta (2006) Text book of obstetrics 2nd edition sunders Publication New Delhi.

 Diane M. Fraser A. Cooper (2003) Text Book of midwives church hill livingstone Newyork

 Annamma Jacob (2004) comprehensive text book of midwifery 2nd edition. R.M. Brothers New Delhi

Padubiri 2004 A text book of obstrics Elsever publication New Delhi

 F. Grey Cunningham Kenneth J.Leveno Steven L.Bloom (1997) Williams Obstrics 4th Edition M C Graw

Levis Medical publications Division New Delhi

Journals

 Susila C (2008) “level of self motivation among primiparae mothers towards antenatal care” Journal of

clinical nursing, Education, Training and career Development: Volume 3 Number1,Januvary;p:7-9

 Blondel B,Pusch D,Schmidit E “some characteristics of antenatal care in 13 European Countries” Br:J

Obset Gynaecol,1985 jan:92(6);565-568 (pubmed)

 Ali Yawar Alam,Akhal Ali Quresi “comparatative study of knowledge and practice among antenatal care

facilities utilizing and non-utilising women” perinatal (2007) December 6:18059464

 Adil H Ibnouf,Johannes A Maarse “utilization of antenatal care services for women in their reproductive

age”Journal of Egypt Public Health Associaton 2002;77(5-6); 479-98; 17216974

 Nahala A Kishk “knowledge and practice of women towards antenatal care;rural urban comparison”.Arch

Gynecol/obstet 2009 sep 2;19727783

 Kathryn S Panaretlo “sustainable antenatal care services in an urban community”MJA 2007;187(18-22)

 Hassan Ali “knowledge and practice among Antenatal care facilities” J Pak med Association 2005 Feb ;

55(2) p;53-56

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 Maternal health Division Department of Family Welfare Ministry of Health & Family Welfare

Government of India “Guidelines for Antenatal care” 2005 April (1-22)

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 SIGNATURE OF THE CANDIDATE
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This study will identify the antenatal
10 REMARKS OF THE GUIDE
practices of antenatal mothers

Mrs. Ahitha. V
11 NAME AND DESIGNATION

GUIDE

SIGNATURE

HEAD OF THE DEPARTMENT Mrs. Ahitha. V

SIGNATURE

12 REMARKS OF THE PRINCIPAL Antenatal mother can practice what she

learns which enhances safe motherhood

SIGNATURE
and safe baby.

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