the dietary practices of antenatal mothers

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THE DIETARY PRACTICES OF ANTENATAL MOTHERS WITH ANAEMIA AND OTHER NORMAL ANTENATAL MOTHERS IN INDIA k.Jaya raj Kumar Dept of pharmaceutics Rao’s college of pharmacy Nellore ,A.P India

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INTRODUCTION Nutrition is an area that requires special attention during pregnancy, particularly during the second and third trimesters. The foetus needs nutrients and energy to build new tissue and the women needs nutrients to build her blood volume and maternal stores. There is an increased demand for energy and for almost energy nutrient type. Most nutrient requirements can be met through careful attention to diet, although there are several nutrients including iron that require supplementation during pregnancy. Most minerals can be obtained from a varied diet without Supplementation even during pregnancy.

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INTRODUCTION (contd..) It is important for pregnant women to get sufficient amounts of minerals to prevent deficiency in the growing foetus and maternal stores. Iron is necessary for the formation of haemoglobin; therefore, it is essential to the oxygen carrying capacity of the blood. If a women’s diet is iron deficient during pregnancy her red blood cell volume will increase by only 18% whereas adequate supplementation of iron results in a 30% increase in red blood cell volume.

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Chapter I Cont. . . NEED OF THE STUDY Nutritional status and the nutritional intake of the mother during pregnancy have profound effect on the growth of the foetus. If the mother’s intake of nutrient is not sufficient that limits the supply of nutrients to the foetus this can lead to foetal malnutrition. In India anaemia is a relatively common complication of pregnancy. Pregnant women need iron to support, their enlarged blood volume and to provide for placental and foetal needs. In an adequate diet the daily iron content is 10-15mg of which 10-20%, is absorbed, so other sources of iron are needed to fulfil the needs of pregnancy.

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Chapter I Cont. . . NEED OF THE STUDY (contd..) The best dietary sources of iron are meat, fish and poultry and vegetarians can obtain iron from plant foods such as legumes, dark green leafy vegetables. Iron-fortified cereals and whole grain breeds and cereals, but the iron is not as well absorbed as iron from meats. Eggs are also a valuable source for those who include them (Rath. 2007).

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STATEMENT OF THE PROBLEM A comparative study to assess the dietary practices of antenatal mothers with anaemia and with other antenatal mothers in a selected hospital. Chapter I Cont. . .

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OBJECTIVES To assess the dietary practices of antenatal mothers in a selected hospital. To assess the dietary practices of antenatal mothers with anaemia in a selected hospital. To compare the dietary practices between antenatal mothers with anaemia and other antenatal mothers in a selected hospital. To prepare a booklet on diet during pregnancy. Chapter I Cont. . .

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OPERATIONAL DEFINITIONS Chapter I Cont. . . Assess Refers to estimation of the dietary practices of the antenatal women by using the prepared format and measured by verbal statement of the women.

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Dietary practice Refer to food items taken by the antenatal mothers during pregnancy. Antenatal The time of pregnancy from the first day of last menstrual period to the onset of labour. In this study it refers from 20 weeks of pregnancy to term. Anaemia A reduction in the quantity of the oxygen carrying pigment Hb level in the blood during pregnancy. In this study anaemia refers to Hb level below 10gm%. Chapter I Cont. . .

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Chapter I Cont. . . LIMITATIONS * 50 – Samples of normal antenatal mothers in group I * 50 – Samples of antenatal mothers with anaemia in group II * The study is limited to antenatal mothers with anaemia and other antenatal mothers. * Study is limited to antenatal mothers who are attending antenatal OPD in RMMCH Chidambaram.

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ASSUMPTIONS Chapter I Cont. . . Antenatal mothers may have less knowledge about diet during antenatal period. Antenatal mothers may be interested to know about diet for anaemia.

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Chapter I Cont. . .

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CHAPTER IIREVIEW OF LITERATURE 1. Studies on dietary intake Interventional studies on dietary intake. Group survey studies on dietary intake.

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Research approach (Quantitative approach) Setting of the Study (Antenatal OPD in selected hospital) Target Population (All antenatal mothers) Accessible Population (Antenatal mothers attending antenatal OPD) Research Design (Survey method) CHAPTER III SCHEMATIC REPRESENTATION

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Sampling Technique (Convenience sampling technique) Sample Size (50 – antenatal mothers with anemia) (50 – normal antenatal mothers) Chapter III Cont. . . Data Collection (Dietary practices of antenatal mothers) Data analysis (Statistical analysis and interpretation of collected data) Report Findings and Conclusion

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CRITERIA FOR SAMPLE SELECTION GROUP I Inclusion Criteria Antenatal Mothers Who are in the age group of 20-40 years. Both primi and multi gravidae Who are willing to participate in the study Who knows to read and write Tamil Who are with gestational age above 20 weeks Whose Hb level in < 10gm

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GROUP II Antenatal Mothers Who are in the age group of 20-40 years. Both primi and multi gravidae Who are willing to participate in the study Who knows to read and write Tamil Who are with gestational age above 20 weeks Whose Hb level in > 10gm Exclusion Criteria For Both groups With associated medical, surgical and cardiac conditions Any high risk conditions

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SETTING Chapter III Cont. . . Antenatal OPD in RMMCH, Chidambaram, was selected as my research setting. The rational for this selection was availability of adequate sample, & co-operation from nursing & others hospital members. This hospital is 1200 bedded & is a baby friendly hospital which has adequate infrastructure. The study was to conducted in antenatal OPD of this hospital.

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SAMPLE Chapter III Cont. . . Antenatal mothers with anemia & others Antenatal mothers attending OPD in RMMCH, Chidambaram.

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SAMPLE SIZE Chapter III Cont. . . Sample comprised 100 Antenatal mothers. First group consists of 50 antenatal mothers with anemia & 50 antenatal mothers with Hb above 10gm%. SAMPLING TECHNIQUE The researcher adopted convenience sampling technique in this study which is a type of non probability sampling method in which the researcher selected participants according to the convenience of the researcher. All the available sample who fulfilled the inclusion criteria were selected.

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DEVELOPMENT OF THE TOOL Chapter III Cont. . . The research instrument was developed by doing extensive literature review and expert opinion from the guide.

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DESCRIPTION OF THE INSTRUMENT Chapter III Cont. . . The tool used for data collection was semi structured interview schedule. It was organized in to 3 parts. Part I Assessed the name, age, religion, residence, education, and occupation, monthly income, type of job, type of family, dietary pattern, resent Hb level by Using 11 semi structured questions.

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DESCRIPTION OF THE INSTRUMENT Chapter III Cont. . . Part II Assessed the obstetrical variables such as duration of married life, details about previous abortion / delivery, Mode of delivery and number of deliveries using 5 semi structured questions.

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Chapter III Cont. . . Part III Assessed the Dietary practices of antenatal mothers with 8 semi structured questions such as common food items taken & avoided during pregnancy, medicinal food, commercial preparation, and supplementation to prevent anemia, problems in taking food, vomiting during & throughout the pregnancy.

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Chapter III Cont. . . CONTENT VALIDITY Content validity was obtained from three experts in the nursing department. Their suggestions were incorporated and the tool was finalized.

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Chapter III Cont. . . PILOT STUDY Ethical clearance was obtained from institutional human ethical committee. Permission was also obtained from the Medical superintendent, RMMCH, Chidambaram. Pilot study was conducted in antenatal OPD, RMMCH for a period of two weeks from 16-11-09 to 28-11-09.During pilot study the practicability, feasibility & reliability of the tool was assessed. Based upon the study result a few modifications were made.

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Chapter III Cont. . . RELIABILITY Reliability refers to the accuracy & consistency of measuring tool. The reliability of the tool was ascertained by test, retest method for practice.

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DATA COLLECTION PROCEDURE Chapter III Cont. . . Formal permission was obtained from medical superintendent of RMMCH. The data collection was done from 13.12.2009 to 13.01.2010. The mothers who fulfilled the inclusion criteria were selected by using the convenience sampling technique. The subjects were contacted individually and explained the purpose of the study. Written consent was obtained. The investigator spent minimum of 20 minutes to interview one mother. Three to four mothers were interviewed per day in antenatal OPD. All mothers co operated well.

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CHAPTER IVANALYSIS & FINDINGS Section – I : Frequency and percentage distribution of demographic variables of mothers in both groups. Section – II: Frequency and percentage distribution of obstetrical variables of mothers in both groups. Section – III : Frequency and percentage distribution of Dietary practices of Antenatal mothers during pregnancy in both groups Section – IV : Frequency and percentage distribution of food items avoided during pregnancy in both groups.

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Section – V : Frequency and percentage distribution of special diet taken by vegetarian mothers to prevent anaemia in both group. Section – VI : Frequency and percentage distribution of special diet take by non vegetarian mother to prevent anaemia in both group. Section – VII : Frequency and percentage distribution of special preparation taken by both groups. Chapter IV Cont. . .

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CHAPTER VISUMMARY, CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS MAJOR FINDINGS OF THE STUDY Majority of mothers in group I (56%) and group II (64%) were in the age group of 22-27 years. Majority of mothers in group I (80%) and group II (66%) were hindus. Non of the mothers were illiterate in both group. Majority of the mothers in group I (58%) had primary and middle school education but in group II (56%) mothers had high school education.

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CHAPTER VISUMMARY, CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS MAJOR FINDINGS OF THE STUDY All the mothers in both groups were house makers. Majority of the mothers in both group I (66%) and group II (90%) were have monthly income between 2001-4000 Rupees. Majority of the mothers were in group I belongs to (56%) joint family but in group II (66%) majority of the mothers were in nuclear family. Majority of mothers in both groups (group I 60% and group II 66%) from rural area.

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MAJOR FINDINGS OF THE STUDY (contd..) Majority of the mothers in both groups ( group I 88% and group II 100%) were non vegetarian. Majority of the mothers in both groups received health information through television (group I 92% and group II 66%). Hb lower level in group I 34% (8.2gm%) in group II 36% (10.5gm%) III only higher level. Majority of the mothers were married less than one year in both group (group I 44% and group Ii 645) Majority of the mothers in both groups were primi mothers (group I 58% and group II 60%).

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MAJOR FINDINGS OF THE STUDY (contd..) Mothers in group I had delivery (10%) in 21-30 moths before, where as in group II mothers had delivery in 12- 72 months before (14%). Majority of the mothers in group I (8%) had abortion between 12 to 15 but in majority of the group II (14%) mothers had abortion 24 months before. Majority of the mothers in group I had normal delivery of one child (16%) where as in group II majority of the mothers had caesarean section (40%) delivery of one child.

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MAJOR FINDINGS OF THE STUDY (contd..) All the normal antenatal mothers took extra diet in all trimesters. Majority of the mothers took meals 3 times in I trimester and II and III trimester (II 62%, III 76%) 4 times a day (76%). Majority of the mothers took 2 glasses of milk per day in (I trimesters 50%, II trimester 30%, III trimester 50%). In terms of Ragi majority of the mothers (52%) not taken. In that 48% of the mothers taken one time a week in all trimesters. Majority of the mothers taken Dates (88%) one time daily in all trimesters. Extra supplement of horlicks taken by 76% of the mothers in all trimester.

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MAJOR FINDINGS OF THE STUDY (contd..) In terms of fruits majority of the antenatal mothers (73%) preferred to take any one of this (apple, sappota, pomegranate, grapes) fruits daily. All the mothers took all type of green leafy vegetables in all trimesters. Majority of the mothers not taken ghee(86%), Soya (86%), daily or weekly but majority of the mothers took jaggery (76%) one time a week in all trimesters. Majority of the anemic antenatal mothers not taken extra diet (90%) during pregnancy because of morning sickness in I trimester, but in II and III trimesters took extra diet. In terms of meals 80% of mothers took 2 time only per day in I trimester but in IIand III trimester took meals 3 times (72%) per day.

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MAJOR FINDINGS OF THE STUDY (contd..) Majority of mothers took 2 glasses of milk per day in I and II trimester (52%) III trimester (44%). Majority of mothers not taken ragi (80%) in all trimesters. Majority of the mothers took dates one time only in all trimesters. Most of the mother took nutrition ball (42%) as extra supplement in all trimesters. 73% of the mothers preferred to take apple, sappota, pomegranates, banana and grapes any one of these fruits daily and all the mothers took all type of green leafy vegetables daily in all trimesters. 88% of the mothers not taken ghee and soya daily in all trimesters. 90% of the mothers took jaggery one time a week in all trimesters.

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MAJOR FINDINGS OF THE STUDY (contd..) In terms of food items majority of the antenatal mothers in both group avoided (Group I 100% and Group II 74%) Papaya and pine apple because they believed that it will cause abortion, and mango (group I 34% and group II 10%) may cause heat for the mother and baby and also Chicken (group I 10% and group II 14%). In group II 26% of the mothers avoided fruits because they believed that it may cause cold for baby but group I mothers not avoided any fruits except papaya, pine apple and mango.

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MAJOR FINDINGS OF THE STUDY (contd..) Anaemic and non-anaemic vegetarian mothers mothers were selectively taken apple, sappota, grapes, pomegranate, banana any one of the furits daily during pregnancy. All mothers took all type of green leafy vegetable. Majority (88%) of group I mothers were taken 1-4 glasses but all group II mothers were taken 1-4 glasses of milk. Majority of mothers in both group taken dates 1-3 times a day (group I 72%, Group II 88%). Majority of the mothers in both groups taken weekly 1 time ragi (Group I 10% and Group II 48%).

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MAJOR FINDINGS OF THE STUDY (contd..) Anemic and non-anemic non-vegetarian mothers are taken in terms of egg majority of the mothers taken 1-.3 eggs a week (60%) in group I but in group II mothers taken 4-7 eggs per week (48%) all the mothers in both groups taken chicken 1 time a week. Majority of the mothers in both groups taken mutton 1 time in a month (group I 60% group 62%). All mothers in both, groups taken (62%) fish 1-3 times a week. Non of the mothers taken liver in group I but in group II 40% of the mothers taken liver 1 time per month. Non of the mothers in both groups not taken other non vegetarian diet except egg, chicken, mutton, fish, liver. Non-vegetarian mothers consumed these food items for foetus weight gain and increase the blood volume.

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MAJOR FINDINGS OF THE STUDY (contd..) In terms of medicinal food non of the mothers taken any medicinal food. Majority of the mothers (group I 78% and group II 48%) taken some special supplements such as boost, horilicks, nutrition ball, more green leafy vegetables, and dates. Non of the mother prepared any special food to prevent anaemia.

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NURSING EDUCATION Chapter VI Cont. . . Nursing education need to be strengthened to enable nursing students to know about current knowledge on dietary practices among antennal mothers utilize evidence based finding (self instructional module) to promote diet during pregnancy. Nursing curriculum should include more lessons on customs and belief to provide sound knowledge to the nursing students for this will help them provide culturally complementary nursing care to their client.

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NURSING PRACTICE Chapter VI Cont. . . Nurses play an important role in promotive, curative and preventive aspects of health care system. Nurse should be provide booklets on diet to antenatal mothers to prevent anaemia. The nurses working in the hospital should provide health education on continuous basis. They should give planned teaching. Nurses should motivated the mothers to take well balanced diet including Iron rich foods if normal and anaemic.

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NURSING ADMINISTRATION Chapter VI Cont. . . The nursing administration in the hospital should have facilities for education to antenatal mothers such as flash cards, chart, VCD and separate place for education mothers in OPD. They should provide guidelines and modules on diet for anaemia during pregnancy. In-service education must be provided to all nurses to update their knowledge about dietary practices on anaemia during antenatal period. Modules on diet during pregnancy and can be distribute to mothers in antenatal OPD.

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NURSING RESEARCH Chapter VI Cont. . . Generalization of the study results can be made by further replication on large samples. The study can be done in community set up. A comparative study on knowledge regarding diet for anemic during antennal period to be done between rural and urban population. Experimental study can be done on the effect of health education on diet for anaemia including balanced diet for antenatal mothers with a control groups.

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CONCLUSION Chapter VI Cont. . . The present study assessed the dietary practices of antenatal mothers with anaemia and other normal antenatal mothers with semi structured interview questions in antenatal OPD, RMMCH. The finding shows that during 1st trimester Group I mothers not taken extra diet because of vomiting but in Group II all the mothers took extra diet in all trimesters.

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CONCLUSION (contd..) Group I Common food items taken by Group II mothers are 2-times meals, 1-2 glass of milk, I time dates, extra supplement of boost, horlicks, nutrition ball, fruits like apple, sappota, pomegranate, banana, grapes, all type of green leafy vegetables, jaggery daily, but not taken ragi, ghee, soya daily in their diet.

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CONCLUSION (contd..) Group II Common food items taken by Group II mothers are 2-4 meals, 2-4 glasses of milk, I time ragi and dates, extra supplement of boost, horlicks, nutrition ball, daily fruits like apple, sappota, pomegranate, banana, grapes daily, all type of green leafy vegetables daily, jaggery weekly, but ghee, soya not taken daily in their diet, with this diet mothers in both group followed medication supplement advised by doctor.

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CONCLUSION (contd..) Non-vegetarian mothers taken egg, chicken, fish every week frequently, but mutton and liver taken monthly once only in both group mothers avoided some food and fruits such as papaya, and pin apple they believed it may cause abortion, and mango and chicken may cause heat for mothers and foetus. Non anemic mothers avoided fruits they believed that it may cause cold for baby, mothers in both groups no one did worm infestation during their pregnancy.

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RECOMMENDATIONS Chapter VI Cont. . . Home visit can be done by nurse to provide individualized teaching and counseling on diet for anaemia during pregnancy. The mass media can be used to educate the public on the importance of well balanced diet and routine health education on diet for anaemia during antenatal period should be done in a antenatal OPD. Initiation of well balanced diet including iron rich diet can be encouraged in antenatal by educating mothers about a well nutritious diet regarding its benefits. On the basis of the study findings the following recommendations have been made for further study.

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THANK YOU