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Effectiveness of educational intervention programme regarding practices on birth preparedness among primigravida women

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Author: 
Supriya Chinchpure, Dr. Alka Deshpande, Dr. Prabha Dasila and Dr. Sripriya Gopalkrishnan
Abstract: 

Introduction: Birth preparedness is a key component of globally accepted safe motherhood programmes & is widely promoted. Birth preparedness helps ensure that women can reach professional delivery care when, Labour begins. Each year, worldwide, approximately 8 million women suffer from pregnancy-related complications more than half a million women die from these complications. Maternal mortality refers to deaths due to complications from pregnancy or childbirth. (Chinmaya Kumar Mohapatra and Hiranmaya Nanda, 2015) The issue was given prominence in MDG goal 5 to improve maternal health, with one of its bold targets the reduction of the MMR by three quarters between 1990 & 2015. Out of the 2, 73,500 global maternal deaths in 2011, India accounts for 50,648 around 19% of the global burden. (The Federation Of Obstetric & Gynecological Societies Of India, 2015) Majority of these deaths could be prevented through proven, effective, and affordable actions. Apart from medical causes, there are numerous interrelated socio-cultural factors which delay care-seeking and contribute to these deaths. Care-seeking is delayed because of the delay in (a) identifying the complication, (b) deciding to seek care, (c) identifying and reaching a health facility, and (d) receiving adequate and appropriate treatment at the health facility (Tabassum Barnagarwala, 2014) Medical causes are often taken care of, if the mother identifies the complication & approaches the health facility at the earliest, but majority of them fail to do so.
Objectives of the study:
• To explore about practices of pregnant women on preparation for delivery & obstetrical emergencies in study and control group.
• To identify association of demographic variables with practices on birth preparedness in study and control group.
• To correlate practices on birth preparedness with outcome of pregnancy in study and control group
Research methodology:
Study approach adopted for study was evaluative, study design was experimental (RCT) two group pre test post test design. Study was conducted in selected urban health center. Simple random sampling was used to select the groups.
Results:
Major findings:
Section 1: Analysis of Demographic variables
Distribution of demographic variables in study and control group shows that, majority of the participants in study (53.14 % & 42.85%) and control group (46.85% & 44%) are less than 25 yrs of age, (87%) in study group & (88%) in control group were found to be Hindu by religion, (49%) from study group and 104 (59%) from control group had completed secondary education, 167 (94%) from study group & 167 (95%) from control group were housewife, (47%) in study group and (45%) in control group were found with monthly income ranging between Rs 10,000 to 15,000/month & (57%) from study group and (55%) from control group had nuclear family. Sources of information wise distribution of participants in study and control group describes, majority of participants 154 (87%) from study group identified electronic media as their basic source of information for birth preparedness & (77.71%) from control group identified family as their source of information for birth preparedness.
Section 2: Analysis of self reported Practices on preparation for delivery & obstetrical emergencies
Description of score based on item wise analysis of practices on preparation for delivery & obstetrical emergencies illucates that, majority of participants were not practicing on preparation of delivery in study & control group before intervention, whereas after intervention increase in practice score in study group was seen but no change in control group practice score. Thus we reject Null hypothesis and accept research hypothesis. Distribution of overall practice score on preparation for delivery & obstetrical emergencies in study & control group table describes, practice score among study group in pre test was poor and it increased to good in post test, whereas Practice score among control group in pre test and post test was average. Comparison of overall practice score on birth preparedness in study and control group shows a significant difference pre test, post test score between study and control group as P<0.0001. Thus we reject null hypothesis and accept research hypothesis. Association of Practice Score with demographic variables among study group shows association with education, type of family & occupation. & in control group shows association with religion, education and occupation.
Section 3: Analysis of labor preparedness with outcome of pregnancy
Distribution of labor preparedness with outcome of pregnancy in study and control group illustrates that majority of participants in study group had planned for health facility (99.38%), transportation (93.83%) , birth companion (95%) and arranged for blood donor (91.97%) whereas only (20.37%) of participants identified danger signs and only (4.94%) sought care in obstetric emergency. In control group (38.27%) of participants had a birth companion during delivery, (45.06%) sought care in obstetric emergency, (12.96%) had planned transportation, (11.73%) planned health facility only (3.70%) identified warning signs and (3.09%) had arranged blood donor. On comparison of outcome in study and control group it showed highly significant difference on all elements of birth preparedness. Thus we reject null hypothesis and accept research hypothesis.
Highly statistical significant association was found between post test practice score and outcome of pregnancy (primary) in study group i.e. identification of danger signs, birth companion & care seeking in obstetric emergency as P<0.005 and rest were not statistically significant as P>0.05. Thus we reject null hypothesis and accept research hypothesis. No association was found between post test practice score and outcome of pregnancy in control group as P>0.05. Thus we accept null hypothesis and reject research hypothesis.
Section 4: Analysis of birth preparedness with mode of delivery
In mode of delivery wise distribution of participants in Study and control group shows slight difference but not statistical significance (borderline). In comparison of pre and post test practice score according to mode of delivery in Study & control group does not shows a significant difference as P>0.05.
Section 5: Analysis of labor preparedness with maternal condition on delivery
Distribution of participants based on mother condition on delivery in study and control group illucates that, majority 59.87% of mother’s condition was normal & 40.12% of mother’s condition was complicated in study group, whereas 58.64% of mother’s condition was complicated & 41.35% of mother’s condition was normal in control group. And on comparison of mother’s condition on delivery wise distribution of participants in Study and control group shows a significant difference as P<0.001. In comparison of maternal complication of participants in study and control group, found to be significant in complications like decreased fetal movement in study group as P<0.05 but not statistical significant and does not show any significance with other complications as P>0.05. In Comparison of pre and post test mean practice score according to maternal complication in Study & control group does not show any significant difference as P>0.05.
Section 6: Analysis of labor preparedness with fetal condition on delivery
Distribution of participants based on fetal condition on delivery study and control group illustrates that, majority 91.97% of fetal condition was normal & 8% of fetal condition was complicated in study group, whereas 33.95% of fetal condition was complicated & 62.34% of fetal condition was normal in control group. And on comparison of fetal condition on delivery wise distribution of participants in study and control group shows a significant difference as P<0.0001. Distribution of participants based on fetal findings at the time of delivery in study and control group showed that Low APGAR, Prematurity, NICU on delivery was statistically significantly in study group than control group. LBW, IUGR was not statistical significant in study group than control group. In Comparison of pre and post test practice score according to fetal complication in Study & control group does not show any significant difference as P>0.05.
Conclusion: Education has always played a vital role in behavioral change. Educational intervention programme was found to be effective as results of the study suggest there was significant increase in practice score among study group as compared to control group. On correlating birth preparedness with outcome of pregnancy showed a highly significant difference in practice score among study group as compared to control group. Association of demographic variables with birth preparedness showed significant association with education, type of family and monthly income among study and control group.

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               Prof. Dr. ISMAIL YILDIRIM

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