INTRODUCTION:

Child birth is one of the most marvelous and memorable segment in a woman’s life. It does not really matter if the child is the first, second or third one. Each experience is unique and calls for a celebration.

Congenital malformation is defined as “a permanent change produced by an intrinsic abnormality of development in a body structure during prenatal life”¹. The Reported prevalence of major congenital malformations in different population around the world has shown considerable variation and ranges from less than 1% to up to 8%. Taboo (2012) highlighted that the actual numbers of children with congenital anomalies vary from country to country; it was reported to be as low as 1.07% in Japan and as high as 4.3% in Taiwan. Congenital anomalies account for 2% in England, 1.49% in South Africa and 3.65% in India. The reason for the regional difference of congenital anomalies might be attributed to the many factors, such as: maternal risk factors, environmental exposures, ecological, economical, and ethnic and other factors.^[1]

The causes of congenital anomalies are divided into four broad categories, genetics, environmental, multifactorial and unknown. A genetic cause is considered to be responsible in as many as 10–30% of all congenital anomalies, environmental factors in 5–10%, multifactorial inheritance in 20–35% and unknown causes were responsible for 30–45% of cases Shawky and Sadik, (2011).^[2] Avoiding exposure to hazardous environmental substances, improving vaccination coverage and strengthening education to health staff and other interested in promoting congenital malformations greatly help in reduction of congenital malformations (Disease Control Priorities Project, 2008).^[3]

Child is very special for their parents, the expectations start from the conception till the baby delivered. When they see their baby is born with congenital malformations at that point, their all expectations and hopes are ruined off.

Due to occurrence of congenital malformations, the number of unhealthy population may increase that will create overburden on the health facilities as they will be more dependent. Also, government will also need to spend more money and other sources to care for these children with congenital malformations. If there will be more congenital malformations in the newborn, the healthy manpower will be less. So, the investigators found a great need to undertake this research.

PROBLEM STATEMENT:

A descriptive study to assess the knowledge and attitude regarding congenital malformations among the married women in selected rural area of Ludhiana, Punjab.

OBJECTIVES :

1. To assess the knowledge regarding congenital malformations among married women.

2. To assess the attitude regarding congenital malformations among married women.

3. To find out the co-relation between knowledge and attitude regarding congenital malformations among married women.

4. To find out the relationship of knowledge regarding congenital malformations with selected demographic variables such as age of woman, educational status, occupation, monthly family income, source of information and family history of congenital malformations.

5. To find out relationship of attitude regarding congenital malformations with selected demographic variables such as age of woman, educational status, occupation, monthly family income, source of information, number of children and family history of congenital malformations.

6. To prepare and distribute the pamphlets regarding congenital malformations.

ASSUMPTIONS:

-Married women have inadequate knowledge regarding congenital malformations

-Married women have negative attitude regarding congenital malformations.

STUDY SETTING:

The study was carried out among the married women of village Sarabha, Ludhiana.

REVIEW OF LITERATURE:

Marwah Sheeba, Sharma Sushmita, Kaur Harpreet, Gupta Monika (2012)conducted a prospective study to analyze the frequency, distribution and patterns of congenital malformations among babies born in a teaching hospital in Punjab. The incidence of congenital malformations was determined in 1554 consecutive deliveries conducted at Gian Sagar Medical College, Banur. The diagnosis of congenital malformations was based on prenatal ultrasound or clinical evaluation of newborn by the neonatologist. Various risk factors associated with occurrence of congenital malformations were studied. The incidence of congenital malformations was 4.44 % (n=69). Out of babies born with congenital malformations 71.01% were still born and major defects were present in 68.11%. Central nervous system and uro-genital system were most commonly involved while 8.6% babies had multiple effects of radiation exposure and antenatal infections. ^[4]

Aniekan I. Peter, Moses B. Ekong, Theresa B. Ekanem, Idorenyin U. Umoh (2015)conducted a descriptive cross-sectional study to know the attitude and knowledge of women visiting an antenatal clinic in Uyo, Nigeria on congenital anomaly. Using structured questionnaire with a sample population consisting of 600 pregnant women was interviewed. The attitude of respondents towards children with birth defect was that of pity (47.7%), resentment (4.7%), wanting to help (40.5%). In addition to this 513 (87.7%) will feel bad if they had a child with birth defects. Their knowledge of causes of congenital anomally was good. Most respondents 88.5% believed that congenital anomaly is a big burden to parents. More public enlightment was advocated to help parents prevent/cope better with the consequences of having children with congenital anomalies.^[5]

DEFINITION OF TERMS:

“Knowledge refers to response of married women to questions dealing with congenital malformations. “Attitude refers to tendency to respond positively or negatively towards certain ideas, persons, situations related to congenital malformations. “Congenital malformations” refers to structural abnormalities due to faulty development present in baby at birth and involve any different parts of body, including the brain, heart, bones and intestinal tract. “Married women” refers to female partner in a continuing marital relationship.

METHODOLOGY:

A Descriptive study design was used to achieve set objectives. The study was conducted on 200 married women of age 21-45 years of village Sarabha. The married women were administered structured questionnaire and three point Likert scale to assess their knowledge and attitude respectively. Dependent variables were knowledge and attitude regarding congenital malformations. Independent variables were age of mother, education, occupation, family income, source of information, number of children and family history of congenital malformations. A self structured questionnaire was developed on the congenital malformations to assess the knowledge and attitude of married women.

Inclusion Criteria:

Married Women:

-Whose age was 21-45 years

-who were willing to participate and were present at the time of study

The tool i.e. structured questionnaire was used in the present study. The tool consisted of the following sections:

Section A:

Socio Demographic data

Section B:

Knowledge questionnaire of congenital malformations consisting of 22 multiple choice questions. Each correct response was given score of one and wrong responses zero. The total score of knowledge questionnaire was 22.

Section C:

Likert five point scale to assess attitude regarding congenital malformations consisting of 20 statements was used. Out of which ten statements were negative and ten statements were positive. If the respondents agree to positive statement score of 5 was given. Maximum score of Likert scale was 100.

The data collection was carried out in the month of April 2015. The purposive sampling technique was used to select the sample of married women from village Sahauli. Researchers spent 10-15 minutes with each married women to collect their responses regarding congenital malformations. The data was analysed using descriptive and inferential statistics. The data nalysed was presented using tables and diagrams.

Validity and reliability:

xperts’ opinions were sought from the experts in the field of obstetrics and gynaecology, nursing education and nursing research.

Ethical considerations: the study was carried out with the permission from the authorities of the selected village of Sahauli, Ludhiana. Informed written consent was obtained from the married women. Measures were taken to maintain the confidentiality of the data and the married women.

The collected data was arranged and tabulated to process the findings. Descriptive and inferential statistics such as frequency, mean, standard deviation, percentage, ANOVA were used to analyze the data.

Table 1. Frequency and percentage distribution of sample characteristics:

Demographic variables

1) Age (in years)

a) 21-25

b) 26-30

c) 31-35

d) 36-40

e) 41-45

30.5

21.5

2) Education

a) Illiterate

b) Primary

c) Matriculation

d) Senior secondary and above

25.5

44.5

3) Occupation

a) Housewife

b) Service

c) Self employed

d) Labourer

72.5

2.5

4) Monthly family income (in Rs)

a) ≤ 5000

b) 5001-8000

c) 8001-10000

d) ≥10001

20.5

34.5

5) Source of information

a) Tv/radio

b) Newspaper/magazines

c) Health personnel

d) Family and friends

65.5

2.5

6) Family history of history of congenital malformations

a) Yes

b) No

7) Number of children

a) 1

b) 2

c) 3

d) ≥4

14.5

3.5

Table 2: frequency and percentage distribution of married women according to level of knowledge regarding congenital malformations N=200

Level of knowledge	score	n(%)
Good	16-22	9(4.5)
Average	8-15	126(63)
Poor	0-7	65(32.5)

Table 3: Frequency and percentage distribution of married women according to attitude

Level of attitude	score	n(%)
Positive	≥50	126(63)
Negative	<50	74(37)

Table 4: Correlation of knowledge and attitude regarding congenital malformations among married women

relationship	mean	SD	correlation
Attitude	56.36	5.30	0.645
Knowledge	9.42	2.17

Table 5: Relationship of knowledge regarding congenital malformations among married women with selected demographic variables

Sample characteristics

Frequency

Knowledge score

Mean ±

F/T

p value

1. Age (in years)

a) 21-25

b) 26-30

c) 31-35

d) 36-40

e) 41-45

9±2.12

9.74±2.20

11.98±2.44

5.02±1.58

11±2.34

4.37**

2. Education

a) Illiterate

b) Primary

c) Matriculation

d) Senior secondary and above

9.7±2.2

8.8±2.09

9.3±2.15

10.2±2.25

4.88**

3. Monthly family income (in Rs)

a) ≤ 5000

b) 5001-8000

c) 8001-10000

d) ≥10001

8.22±2.02

8.73±2.08

9.82±2.21

10.38±2.27

4.60**

4. Source of information

a) Tv/radio

b) Newspaper/magazines

c) Health personnel

d) Family and friends

131

9.94±2.23

8.98±2.11

7.28±1.90

6±1.73

5.88**

5. Family history of history of congenital malformations

a) Yes

b) No

186

7.7±1.96

9.5±2.17

2.25*

Table 1 reveals that maximum i.e. 30.5% of married women belong to age group of 31-35 years. 44.5% were matric pass, majority i.e. 72.5% of married women were housewives, 34.5% of married women had family income Rs. 8000 - 10000/-, 65.5% of women got information from TV/radio, 93% women had no any history of congenital malformations and 58% women had two children.

Table 6: Relationship of attitude regarding congenital malformations among married women with selected demographic variables

Sample characteristics

frequency

Knowledge score

Mean ±SD

F/T

p value

Education

a) Illiterate

b) Primary

c) Matriculation

d) Senior secondary and above

5.5 ±5.26

52.7±5.13

55.6±5.27

62±5.56

4.64**

Occupation

a) Housewife

b) Employed

c) Self employed

d) Laborer

145

56.5±5.3

66.9±5.7

53.9±5.1

54.4±5.2

2.87*

Monthly family income (in Rs)

a) ≤ 5000

b) 5001-8000

c) 8001-10000

d) ≥10001

54.1±5.20

53.5±5.17

54.9±5.24

62.3±5.58

4.09**

Source of information

a) Tv/radio

b) Newspaper/magazines

c) Health personnel

d) Family and friends

57.8±5.3

55.7±5.2

48±4.8

48.2±4.9

3.06*

Table 2 shows that the majority 126 (63%) of married women had average knowledge followed by 65(32.5%) had poor knowledge and only 9 (4.5%) had good knowledge regarding congenital malformations.

Table 3 signifies that more than half 126(63%) of married women had positive attitude followed by 74 (37%) had negative attitude regarding congenital malformations.

Table 4 reveals that there is positive correlation between knowledge and attitude of married women regarding congenital malformations.

Table 5 and 6 indicates that variables like age of woman, educational status, monthly family income, source of information had significant impact on the knowledge and attitude of married women at p < 0.01 level of significance.

RECOMMENDATIONS:

· The study can be replicated on large sample to validate and generalize its findings.

· The study can be conducted in different community setting.

· A comparative study can be conducted to compare knowledge of married women regarding congenital malformations in rural and urban areas.

· A quasi experimental study can be conducted to assess the effectiveness of structured teaching program regarding congenital malformations among married women.

· The records can be maintained in hospital about congenital malformations to find out its incidence and exact causes.

IMPLICATIONS:

The findings of the study will provide baseline data about knowledge and attitude of married women regarding congenital malformations so nurses can impart knowledge regarding various risk factors and improve quality of nursing care by imparting knowledge to mother regarding prevention of congenital malformations in an effort to reduce infant morbidity and mortality rate.. In addition to that the midwifes and community health nurses should provide married women with the information related to free health services like folic acid supplementation and iron tablets that are being provided by the government.

CONCLUSION:

The study revealed that maximum number of married women had average knowledge score regarding congenital malformations and majority of married women had positive attitude regarding congenital malformations. There was positive correlation between knowledge and attitude of women regarding congenital malformations. Also the variables like age of woman, educational status, monthly family income, source of information had significant impact on the knowledge and attitude of married women.

CONFLICT OF INTEREST:

Nil.

FUNDING:

No funding was sought from any government or private organization to undertake this study.

REFERENCES:

1. Taboo Z (2012). Prevalence and risk factors for Congenital Anomalies in Mosul City. The Iraqi Postgraduate Medical Journal. 11 (2). 458-470.

2. Shawky R and Sadik D (2011): Congenital Malformation prevalent among Egyptian children associated risk factors. The Egyptian Journal of Medical Human Genetics. 12 (2). 157-163.

3. Wright S, Corry S, Whibley O, Malik P, Mckinney pand Parslow r(2013). Risk factors for congenital anomaly in multiethnic birth cohort: an analysis of the born in bradford Study. Lancet. 3 July.

4. Marwah Sheeba, Sharma Sushmita, Kaur Harpreet, Gupta Monika. Surveillance of congenital malformations and their possible risk facors in a teaching hospital in Punjab. Interbnational journal of reproduction, contraception, obstetrics and gynaecology 2014.3 (1).162-167.

5. Aniekan I. Peter, Moses B. Ekong, Theresa B. Ekanem, Idorenyin U. Umoh. Attitude and knowledge of pregnant women attending antenatal clinic at St. Luke’s Hospital .IBOM medical journal .2015.(6) .

Received on 07.10.2016 Modified on 19.01.2017

Asian J. Nur. Edu. and Research.2017; 7(3): 379-383.

DOI: 10.5958/2349-2996.2017.00076.3