A Study to Evaluate the effectiveness of Information booklet on knowledge regarding Iron and Folic Acid deficiency among Antenatal mothers in selected rural areas at Udaipur District, Rajasthan

Mr. Pranav Acharya¹, Mr. Dinesh Kumar Sharma^2*, Mr. Dasrath Menariya³

¹Lecturer, JR Institute of Nursing, Sagwara, Rajasthan

²Nursing Tutor, College of Nursing, AIIMS Rishikesh, Uttrakhand

³Asst. Prof., Vedanshi College of Nursing, Udaipur, Rajasthan

*Corresponding Author E-mail: dinosharma740@gmail.com

ABSTRACT:

INTRODUCTION: High fetal demands for iron, render iron deficiency the most common cause of anaemia in pregnancy, with other micronutrient deficiencies contributing less frequently. Folate deficiency anaemia affects 25-50% of pregnant women attending hospital clinic in some areas of India..Present study is aimed to evaluate the effectiveness of information booklet on knowledge regarding Iron and Folic Acid deficiency among antenatal mothers in selected rural areas at Udaipur district Rajasthan. OBJECTIVES: to evauate the effectiveness of information booklet on knowledge regarding iron and folic acid deficiency among antenatal mothers. & to find out the association between pre-test knowledge score regarding iron and folic acid deficiency with selected socio demographic variables. METHOD:The method adopted for the present study was evaluative approach with Pre experimental one group pre and post test Research design as the study aimed at development of an intervention (Information Booklet) for assessing the knowledge of 120 Antenatal Mother at CHC (Badgove), CHC (Sarada) rural areas at Udaipur District. This approach would help the investigator to evaluate the effect of specific intervention that is “Information Booklet” on the variable that is ‘knowledge’ of Iron and Folic Acid efficiency among Antenatal Mother in selected rural area in Udaipur. In this study samples were drawn by using convenant Sampling method. Data was collected by using structured knowledge questionnaire. RESULTS: the mean post-test knowledge score was 17.73 and mean% was 59.1% that was greater than the mean pre-test knowledge score 10.55 and mean% was 35.16% t=23.46 (p=0.05, significant). This indicates that there was difference in pre-test and post-test knowledge score of respondents and Information Booklet was effective in improving the knowledge score of iron and folic acid deficiency among antenatal mother. CONCLUSION: This study concludes that there is improvement in the level of knowledge of Antenatal Mother which indicates that the Information Bookletis effective. The socio-demographic variables of rural area significantly associated with the pre-test knowledge score. The development of antenatal mothers will help the rural area to enhance their knowledge.

KEYWORDS: Evaluate, Effectiveness, Information booklet, antenatal mother, Iron and Folic Acid.

INTRODUCTION:

“Healthy Mothers and Children are the Real Wealth of Societies”.

Pregnancy – the nine months or so for which a woman carries a developing embryo and fetus in her womb – is for most women a time of great happiness and fulfillment. However, during pregnancy, both the woman and her developing child face various health risks. So, it is important that all pregnancies should be monitored by skilled care providers.¹ Anaemia is a common ill-health status in humans although many people neither know what it means and what causes it. The condition is developed when there is a lack of red blood cells which function primarily to carry oxygen to the cells of the body. This condition becomes more pronounced in pregnant women. The demand for absorbed iron increases from 0.8mg/day in early pregnancy to 6.0 mg/day in late pregnancy.²

According to World Health Organization, anaemia in pregnancy is when the hemoglobin concentration in the peripheral blood is 11gm per100ml or less. Hemoglobin level at or below 9gm/dl requires detailed investigation and appropriate treatment. Adopting this lower level, the incidence of anaemia in pregnancy ranges widely from 40-80 % in the tropics compared to 10-20% in the developed countries.³ The Indian Council of Medical Research (ICMR) has categorized anaemia into four categories, depending upon the haemoglobin levels as mild anaemia (10.0-10.9 Hb%), moderate (7.0-10.0 Hb%), severe (<7.0 Hb%) and very severe (<4.0).⁴ In India, the prevalence of anaemia is high because of (i) low dietary intake, poor iron (less than 20 mg /day)and folic acid intake (less than 70 mg/day); (ii) poor bioavailability of iron (3-4% only) in phytate and fibre-rich Indian diet; and (iii) chronic blood loss due to infection such as malaria and hookworm infestations. The hemoglobinopathies, sickle cell disease and thalassemia, represent diverse causes of anaemia of pregnancy, requiring specialized care.⁵ Clinical features of anaemia include history of lassitude, feeling of exhaustion, anorexia, palpitation, dyspnea, giddiness, and swelling of legs. A simple blood test- a complete blood picture gives the necessary indicators for anaemia. Complication of severe anaemia in pregnancy are: pre-eclampsia, occurrence of infections due to diminished resistance causing bone marrow depression, heart failure at 30-32 weeks of pregnancy and preterm labour. Maternal risk during labour includes uterine inertia, hemorrhage, cardiac failure and shock. The puerperium can be complicated with puerperal sepsis, sub involution, failing lactation, puerperal venous thrombosis, and pulmonary embolism. Anaemia can also affect the fetal and neonatal outcome adversely in the form of complications like increased incidence of low birth weight babies, and intrauterine death.⁶ Anaemia is a preventable cause of maternal and neonatal mortality and morbidity. Iron deficiency anemia is a significant public health problem in India. National and regional surveys of anemia indicate that the problem could reach as high as 85% in expectant mothers in population groups.⁷ It has been estimated that iron deficiency costs India about 5% of its gross national product annually. According to a WHO estimation, about 80% of the world’s population likely to be suffering from iron deficiency. Recent analysis highlights the effect of severe anemia in accounting for up to 20% of maternal deaths in developing countries. More than 40% women worldwide are anaemic.⁸. Low iron during pregnancy can cause fatigue, reduced work capacity, cardiovascular stress, lower resistance to infection, iron deficiency--which can lead to anemia Dietary sources of iron-red meat, eggs and poultry, whole-grain and enriched breads and cereals, dried beans (cooked or canned), peas and lentils.⁹. Folic acid deficiency can cause anemia. Anemia is a condition where you have too few RBCs. Anemia can deprive your tissues of oxygen it needs, because red blood cells carry the oxygen.¹⁰

NEED FOR THE STUDY:

“Pregnancy Is Special, Let Us Make It Safe”:

Iron supplementation, nutrition education (to encourage diversified diets), fortification of foodswith iron, and de-worming, done alone or in combination, are all approaches widely applied for controlling iron deficiency anemia during pregnancy. In a review of iron-folic acid (IFA) supplementation during pregnancy, researchers reported a 70% reduction in anemia at term, a 67% reduction in iron deficiency anemia, and a 19% reduction in the incidence of low birth weight. Researchers have identified lower risks of neonatal mortality in infants for mothers who reported taking antenatal iron-folic acid (IFA) supplements during pregnancy compared to those who did not. In Indonesia a 34% reduction in risk of <5 child death was seen when the mother consumed any IFA supplements during pregnancy. This protective effect was greatest for deaths on the first day of life (60% reduction) followed by deaths during 1–30 days of life (31% reduction), and deaths during the rest of the neonatal period (26% reduction). Folic acid and iron in combination was shown to be more effective than iron or folic acid supplementation alone for the treatment both of anemia during pregnancy and of neonatal mortality.¹¹ Just over half (51%) of Indian women (15 to 49 years) are anaemic, according to the just-released Global Nutrition Report 2017. A similar number (53%) were estimated to be anaemic in the fourth National Family Health Survey (NFHS-IV) in 2015-16. ¹²

India Anaemia Problem, 2015-2017(Prevalence In %)

Segment 2015-16 2017

Antenatal mother 53.1% 51.0%

A cross sectional study was conducted to assess the prevalence of anaemia among pregnant women of rural area in Maharashtra. There were 827 pregnant women between the mean age of 22.72+/- 3.25 years were selected from 16 villages. The study result showed that overall prevalence of anaemia was 92.38%. Among the total 827 pregnant women, 39.66% were mildly anemic, 49.09% were moderately anemic, and 3.63% were severely anemic. The study concluded that there is high prevalence of anaemia and it continues to be a major public health problem in rural area.¹³West Bengal has around 70% pregnant women anemic as per National Family Health Survey III, and only around 22.4% pregnant women consume 100 iron and folic acid (IFA) tablets during pregnancy according to the District Level Household Survey (DLHS) III, 2012-2013.¹⁴

STATEMENT OF PROBLEM:

“A study to evaluate the effectiveness of information booklet on knowledge regarding Iron and Folic Acid deficiency among antenatal mothers in selected rural areas at Udaipur district, Rajasthan.”

OBJECTIVES OF THE STUDY:

1. To assess the pretest knowledge score of iron and folic acid deficiency among antenatal mothers.

2. To develop and distribute the information booklet on knowledge regarding iron and folic acid deficiency among antenatal mothers.

3. To assess the post-test knowledge regarding iron and folic acid deficiency among antenatal mothers.

4. To evauate the effectiveness of information booklet on knowledge regarding iron and folic acid deficiency among antenatal mothers.

5. To find out the association between pre-test knowledge score regarding iron and folic acid deficiency with selected socio demographic variables.

OPERATIONAL DEFINITION:

1. Assessment: In this study it refers to organized systematic and continuous process of collecting data about pre-test and post test knowledge from antenatal mothers regarding. Iron and Folic Acid deficiency.

2. Effectiveness: In this study it refers to gain in knowledge as by significant difference in pre and post test knowledge scores.

3. Information booklet: In this study it refers to a small thin book with paper covers, typically giving information on iron and folic acid deficiency among antenatal mother.

4. Knowledge: In this study it refers to the correct responses of antenatal to the items listed in the information booklet regarding meaning, causes, signs and symptoms, effects and prevention of Iron and Folic Acid efficiency.

5. Iron and folic acid deficiency: In this study Iron refers to one of the minerals & Folic Acid refers to one of the water-soluble vitamin Iron and Folic Acid deficiency refers to nutritional disorder caused by deficiency of Iron and Folic Acid.

6. Antenantal mother: In this study it refers to the mother from conception to 36 weeks.

Assumption:

The study assumes that:

· Antenantal mother will have some knowledge regarding iron and folic acid deficiency.

· Some demographic variable will have influence on knowledge of antenantal mother regarding iron and folic acid deficiency.

Hypothesis:

H₁: There will be significant difference between pre –test and post-test knowledge scores of the antenantal mother regarding iron and folic acid deficiency.

H₂: There will be significant association between pre-test knowledge scores and selected socio demographic variables.

VARIABLES OF THE STUDY:

1. Dependent variable:

It refers to the presumed effect. It is the condition or characteristics those appear or disappear as a result of an independent variable. In this study dependent variable is knowledge of antenatal mother regarding iron and folic acid deficiency.

2. Independent variable:

It refers to the presumed causes. It is the condition or characteristics manipulated by the researcher. In this study independent variable is information booklet regarding knowledge of iron and folic acid deficiency among antenatal mother.

3. Demographic variable

The demographic variable confound the relationship between the independent and dependent variable and that need to be controlled either through building in research design or through statistical procedure.

In this study the selected socio demographic variables are Age in years, educational qualification, occupation ,personal habits, nutritional habits, disease condition, regarding previous knowledge, source of information.

SAMPLING CRITERIA:

Inclusion criteria:

1. Antenatal mothers Belonging to the rural areas at Udaipur district.

2. Antenatal mothers Able to understand Hindi and mewari.

Exclusion criteria:

1. Willing to participate in this study.

2. Not available at the time of data collection

RESEARCH METHODOLOGY:

RESEARCH APPROACH- Evaluative research approach

RESEARCH DESIGN- Pre experimental one group pre and post test design

RESEARCH SETTING- CHC (Badgove), CHC (Sarada) rural areas at Udaipur district

POPULATION- Antenatal mothers come in selected rural areas at Udaipur district.

SAMPLING TECHNIQUE- Convenent sampling technique

SAMPLE- Antenatal mothers

SAMPLE SIZE- 120

DATA COLLECTION INSTRUMENT- Structured Knowledge Questionnarie

RESULT:

The Table-1 showed that the mean post-test knowledge score was 17.73 and mean% was 59.1% that was greater than the mean pre-test knowledge score 10.55 and mean% was 35.16% t=23.46 (p=0.05, significant). This indicates that there was difference in pre-test and post-test knowledge score of respondents and Information Booklet was effective in improving the knowledge score of iron and folic acid deficiency among antenatal mother. This indicates that there was significant difference between the pre-test and post-test knowledge score hence there research hypothesis H₁ is a proved.

LIMITATIONS OF THE STUDY:

Ÿ The study was limited to the assessment of knowledge of iron and folic acid deficiency among antenatal mothers .The study was limited to antenatal mothers whose educational stream was no formal education, secondary, senior secondary, diploma and equalant

Ÿ The sample was limited to 120.

Ÿ The data were collected by using convenient sampling method.

Ÿ No attempt was made to do the follow up to measure the retention of knowledge of antenatal mothers.

Ÿ Use of structured knowledge questionnaire restricts the amount of information that can be collected from the respondents.

RECOMMENDATIONS:

Ÿ A similar study can be under taken with a large sample to generalize the result.

Ÿ ^{A comparative study on knowledge of iron
and folic acid deficiency among antenatal mothers}may be taken up.

Ÿ A similar study can be conducted by using experimental and randomized control group method.

Ÿ A VAT (Video attendant teaching) or STP (Structured Teaching Programme) can be developed based on the knowledge of undergraduate students and the society