INTRODUCTION:

Anemia is a National nutritional problem with significant impact on the health and productivity of the population. The country registers 540 maternal deaths per 1, 00,000 live births, higher than what it was a century ago in some of the today's advanced Nations. In rural India the figure is even higher at 619 according to facts and figures brought out by the United Nations Children's Fund. Iron deficiency Anemia, particularly in its severe form during pregnancy, is the major factor contributing to maternal morbidity and mortality as well as low birth weight. Studies show that about 70% of pregnant woman have Hb level lower than 9 gram /dl. Anemia is defined as reduction in circulating hemoglobin mass below the critical level one normal hemoglobin (Hb) concentration in the body is between 12-14 grams % therefore any hemoglobin level below 11gm in pregnancy should be considered as anemia. However in India and most of the other developing countries the lower limit is often accepted as 10 grams %.WHO has accepted up to 11garms % as the normal pregnancy level in pregnancy. The investigator during her posting observed the limited knowledge of pregnant women regarding the prevention of anemia, quite ignorant about their health and diet during child bearing period. The investigator during her past experience observed that there is increased number of pregnant women visited to the antenatal clinics had complaints of tiredness, giddiness, fatigue general malaise, inability to work efficiently, pallorand shortness of breath. Most of them were diagnosed to be anemia. The investigator discussed these problems with the Nurses in charge of the clinic and they expressed that though they were distributing iron and folic acid tablets to mothers they were not taking the supplement to the whole course and discontinuing and also not taking the diet which is rich in iron and folic acid. The reasons given by the antenatal mothers are that if they use haematinics the baby will be dark, the baby will be big and the delivery will become difficult, there will be vomiting sensation, they may abort and they should not take any tablets during pregnancy. All the above said reasons are not true scientifically and show that lack of current information and no proper health education regarding iron and folic acid supplementation and diet. This being the major problem among most of the primi mothers, henceforth the investigator personally felt that there is a need for above studies and statistics and was inspired in selection of this dissertation.

OBJECTIVES:

1. Assess the knowledge of pregnant women regarding anemia.

2. Associate the knowledge of pregnant women regarding anemia with specific demographic variables i.e. age. Duration of marriage, Educational status, Type of family, Family income, Dietary habit, Gravida, Duration of pregnancy (Trimester), Source of information, Residence/Area, Degree of anemia.

3. Identify the deficit areas of knowledge of pregnant women regarding anemia with a view to develop guidelines on knowledge of anemia.

HYPOTHESIS:

H_{1 –}There will be a significant association between knowledge score and demographic variables

METHODOLOGY:

The present study is a descriptive study with non experimental design. Total 100 pregnant women were selected through purposive sampling. A structured interview schedule has been conducted. Descriptive and statistical analysis was carried out.

RESULTS:

1. Level of knowledge of pregnant women regarding Anemia

Figure 1 Shows the frequency and percentage distribution of level of knowledge of pregnant women regarding Anaemia. 8% of Pregnant women obtained Excellent score (> 80%), 57% of Pregnant women got Good score (61%-80%), 30% of Pregnant women obtained Average score (41%-60%), 5% of Pregnant women obtained poor score (21%-40%) and not even single Pregnant women score (below 20%) and mean knowledge score of Pregnant women regarding Anaemia was 20.49 and Mean percentage of knowledge score of pregnant women regarding Anaemia was 68.30%. Thus, it is inferred that maximum of Pregnant women had Good knowledge regarding to Anaemia followed by least of them had Poor knowledge.

2. Association of the level of knowledge with selected demographic variables

Table 1:About the demographic variables. n=100

S.NO.	Variables	Mean Percentage	Chi Square(X2)	df	p-value	Significant/ Non Significant
1	Age in years 18-21	58.96	14.1609	9	0.1166	Significant
	22-25	69.00
	26-29	70.83
	>30	75.55
2	Duration Marriage
	0-2YRS	65.34	7.8490	9	0.5494	Non Signifcant
	3-5YRS	69.20
	6-8YRS	69.43
	> 8yrs	73.80
3	Educational Status
	Illeterate	55.13	32.2010	9	0.0007	Significant
	Primary edu	66.06
	Seconday edu	70.34
	Graduate or more	71.80
4.	Type of Family
	Joint	68.60	34.6799	6	0.0000	Significant
	Nuclear	66.71
	Extended	83.00
5	Family Income
	Upto 3000 RS	62.5	24.0038	9	0.0042	Significant
	3001-6000RS	68.19
	6001-9000RS	69.06
	Above 9000RS	71.52
6	Dietary Habit		11.5991	3	0.0087	Significant
	Veg	67.5
	Non-veg	70.2
7.	Gravida
	Primi	66.87	1.6326	3	0.6520	Non Significant
	Multi	69.67	1.6326	3	0.6520	Non Significant
8	Duration of Pregnancy
	First three months	66.90 68.70 68.83	3.7669	6	0.7081	Nonsignificant
	Mid three months
	Last three months
9	Source of Information					Significant
	Relatives	72.08	6.3787	9	0.7015
	Family memb,friends	67.36
	Mass media	65.88
	Health workers	73.00
10	Residence/Area
	Urban	70.50	4.3630	3	0.2247	Non Significant
	Rural	66.35	4.3630	3	0.2247	Non Significant
11	Degree of Anaemia
	Normal	72.96	30.7815	6	0.0000	Significant
	Mild	70.00
	Moderate	62.71
	Severe	0.00

According Table 1, the age of pregnant women, depicts that maximum of pregnant women (50%) were in the age group of 22-25 years followed by minimum (6%) in the age group of above 30 years..As regard to years of marriage (42%) of pregnant women were with 2-5 years, while only (7%) were with above 8 years of duration. Regarding educational status, maximum (48%) of subjects were up to secondary and lesser number (11%) were illiterate. Maximum number (63%) of subjects belongs to Nuclear family and minimum number number (6%) belongs to extended family. As per monthly family income is concern, (35%) respondents belong to 3001-6000 Rs. income group and minimum (16%) were from below 3000 Rs group. Regarding dietary habits, maximum (71%) of subjects were vegetarian. According to Gravida, greater number (51%) of them were multi gravida. About duration of pregnancy, greater number of subjects (40%) were of third trimester and lessor number (26%) of them were of first trimester. As per the source of information, maximum respondence (47%) gained information from mass media (T.V, Radio, magazine) and least (10%) gained information from health team workers. About residence, maximum (54%) of subject belong to rural area. According to Kuppuswamy social classification regarding degree of anaemia, maximum (38%) subjects were having moderate anaemia (Hb 6.1-8 gm/dl) followed by minimum (26%) were having mild anaemia (8.1-10gm/dl).

3. According to mean knowledge score of anaemia with demographical variables

The highest mean knowledge score and percentage 22.66 (75.55%) of Pregnant women were age group of > 30 years, followed lowest 17.69 (58.96%) mean knowledge score and percentage of pregnant women in age group of 18-21 years. The difference in mean knowledge score was tested and found statically Non-significant at 0.05 level (p-value 0.1166).

The maximum mean knowledge score and percentage 22.14 (73.80%) was found in Pregnant women having above 8 years of duration of marriage while minimum mean knowledge score and percentage of 19.60(65.34%) in 0-2 years of duration of marriage. The difference in the mean knowledge score of pregnant women according to duration of marriage was tested and found statistically non-significant at 0.05 level (p-Value 0.5494).

The mean knowledge score of pregnant women was highest 21.54(71.80%) among those with educational status of graduate or above and illiterate obtained lowest mean knowledge score i.e 16.54 (55.13 %).The difference in the mean knowledge score of pregnant women according to education status was tested and found statistically highly significant at 0.05 level ( p-Value 0.0007)

The maximum mean knowledge score and percentage 25.00 (83.00%) was found in pregnant women who belonged to extended family and the minimum mean knowledge score and percentage 20.01 (20.58%) of pregnant women who belonged to nuclear family. The difference in the mean knowledge score of pregnant women according to type of family was tested and found statistically highly significant at 0.05 level (p-value 0.0000).

The highest mean knowledge score i.e 21.45 (71.52%) was found in pregnant women who belonged to (Rs >9000 /-month) income group while the lowest mean knowledge score 18.75(62.5%) was found in pregnant women who belonged to (Rs up to 3000/-) income group. The difference in the mean knowledge score of pregnant women according to family income was tested and found statistically significant at 0.05 level ( p-value 0.0042).

The mean knowledge score of pregnant women was more 21.06 (70.2%) among non vegetarian while it was 20.25 (67.5%) in vegetarian, their difference was found statistically significant at 0.05 level (p-value 0.0087).

The mean knowledge score and percentage was found to be more i.e 20.9 (69.67 %) in multigavida followed by mean knowledge score and percentage 20.06 (66.87%) in primigravida. The difference in the mean knowledge score of pregnant women according to gravida was tested and found statistically non-significant at 0.05 level (p-value 0.6520).

The pregnant women belonging to 3^rd trimester had maximum mean knowledge score i.e 20.65 (68.83 %) and least 20.07(66.90 %) in women with first trimester. The difference in the mean knowledge score of pregnant women according to duration of pregnancy was tested and found statistically non-significant at 0.05 level (p-value 0.7081).

The maximum mean knowledge score 21.90 (73.00 %) was obtained by women who gained information from health worker and lowest mean knowledge score of 19.76 (65.88%) of those who gained information from mass media..The difference in the mean knowledge score of pregnant women according to source of information was tested and found statistically non- significant 0.05 level ( p-value 0.7015).

The maximum mean knowledge score 21.17 (70.50 %) was found in pregnant women related to urban area followed by mean knowledge score 19.90 (66.35 %) of pregnant women who belong to rural area, their difference was found statistically non-signicant at 0.05 level (p-value 0.2247).

The maximum mean knowledge score of pregnant women 21.88 (72.96%)belonged to those with normal level of Hb ( i.e >_ 10.1-12gn/dl) and minimum mean knowledge score of pregnant women 18.81 (62.71%) among those who were having moderate degree of anaemia (i.e Hb- 6.1-8gmgm/dl) . the difference in the mean knowledge score was tested statistically and found statically significant at 0.05 level (p-value 0.0000) level

Fig. 2. Deficit area of knowledge of pregnant women regarding anemia

Related to identification of deficit area the mean and mean percentage of knowledge score of pregnant women regarding introduction and definition was maximum 7.64 (76.40%) with rank 1 and followed by mean knowledge score regarding causes and sign and symptoms 3.60 (72.00%) with rank 2, complication 2.51 (62.75%) with rank 3 and minimum 6.73 (61.18%) with rank 4 belongs to prevention and control and mean knowledge score of pregnant women regarding anaemia was 20.48 and mean percentage of knowledge score of pregnant women regarding anaemia was 68.3%.

DISCUSSION:

The present study was conducted to assess the knowledge regarding anaemia among pregnant women. The non-experimental, descriptive method with Purposive sampling technique was used to select the sample. The data was collected from 100 pregnant women by using a structured interview schedule. The findings of the study have been discussed with reference to the objectives and assumption and with the findings of the other studies. The data is organized, analyzed and presented in four sections.

Section – A: Demographic profile of pregnant women

Section – B: Knowledge of pregnant women regarding anaemia.

Section - C: Association of demographic variables with levels of knowledge of pregnant women regarding anaemia

Section - D: Identification of deficit area of knowledge score of pregnant women regarding anaemia

Section A: Demographic Profile of Pregnant women

The characteristics of the demographic variables described in terms of their frequency and percentage of distribution which showed that 50% were in the age group of 22-25 years, 42% were with 2-5 years, 48% of subjects were upto secondary ,63% of subjects belongs to Nuclear family, 35% had family income between 3001-6000 Rs. 71% of subjects were vegetarian, 51% were multi gravida, 40% were in third trimester ,47% gained information from mass media (T.V, Radio, magazine) ,54% of subject belong to rural area and (38%) subjects were having moderate anaemia (Hb 6.1-8 gm/dl))

Section B: Knowledge Score of Pregnant women regarding Anaemia.

The first objective of the study was to assess the knowledge of pregnant women regarding Anaemia

The findings of the study revealed that the knowledge score of pregnant women regarding Anaemia was 20.49 and Mean percentage of knowledge score of pregnant women regarding Anaemia was 68.30% (SD-5.3686).

These findings are better then those of the study conducted by Shah B.K and Baig L.A(2001) , who found that pregnant women knowledge score regarding anaemia was less i.e 56% in anaemic women and 43% in normal women.

Aggarwal A (2003) in his study found that 52% pregnant women had shown gaps in the knowledge regarding anaemia.

Kalimbira, et, al (2009) showed that 96.6% of the women were aware of anaemia. Thus, it is inferred that maximum of Pregnant women had Good knowledge regarding to Anaemia followed by least of them had Poor knowledge.

Section C: Association of Demographic Variables with levels of Knowledge of Pregnant women regarding Anaemia

The second objective of the study was to associate the knowledge of pregnant women regarding anaemia with specific demographic variables i.e. age. Duration of marriage, Educational status, Type of family, Family income, Dietary habit, Gravida, Duration of pregnancy (Trimester), Source of information, Residence/Area, Degree of anaemia.

Association of demographic variables with level of knowledge was done by using Chi- Square Test. Although there was no statistical significant association found between level of knowledge and demographic variables such as age, Duration of marriage, Gravida, duration of pregnancy, source of information and residence/area. There was a significant association found between level of knowledge and educational status, Type of family, family income, Dietary habits and Degree of anaemia at 0.05 level. This indicates that the level of knowledge of pregnant women varies according to age, Duration of marriage, Gravida, Duration of pregnancy, source of information and residence/area.

Findings related with age: The highest mean knowledge score and percentage 22.66 (75.55%) of Pregnant women were age group of > 30 years, followed by lowest 17.69 (58.96%) mean knowledge score percentage of pregnant women in age group of 18-21 years. The difference in knowledge score was tested and found statically Non-significant at 0.05 level (p-value 0.1166).

The findings were also supported by Cyril C. Dim. et, al. (2007) who concluded that their was no significant relationship between age and knowledge score of pregnant women regarding anaemia.

The findings was in conformity with the findings of study conducted by Gautam V.P, et.al (2002) who concluded that age of pregnant women was not associated with the knowledge regarding anaemia.

Findings related with duration of marriage:- The maximum mean knowledge score and percentage 22.14 (73.80%) was found in Pregnant women having above 8 years of duration of marriage while minimum mean knowledge score and percentage of 19.60 (65.34%) in 0-2 years of duration of marriage.The difference in the mean knowledge score of pregnant women according to duration of marriage was tested and found statistically non-significant at 0.05 level ( p-Value 0.5494).

The findings of Shah B.K and Baig L.A (2001) revealed that there was not significant relationship between duration of marriage and knowledge of pregnant women

Findings related with Educational status: The mean knowledge score of pregnant women was highest 21.54 (71.80%) among those with educational status of graduate or above and illiterate obtained lowest mean knowledge score i.e 16.54 (55.13 %) only. The difference in the mean knowledge score of pregnant women according to education status was tested and found statistically highly significant at 0.05 level (p-Value 0.0007)

On the contrary to the above findings, Thangaleela T. and Vijaylakshmi P. (1994) found that education had a significant association with the knowledge of pregnant and hence education had inpact on knowledge score. Also, another study by Shah B.K and Baig L.A (2001) found that there was highly significant relationship between education and knowledge of pregnant women regarding causes, prevention and control of anaemia in pregnant women.

Findings related with type of family: The maximum mean knowledge score and percentage 25.00 (83.00%) was found in pregnant women who belonged to extended family and the minimum mean knowledge score and percentage 20.01 (20.58%) of pregnant women who belonged to nuclear family. The difference in the mean knowledge score of pregnant women according to type of family was tested and found statistically highly significant at 0.05 level (p-value 0.0000).

The study by Gautam V. P, et.al (2002) revealed that pregnant women who belongs to nuclear family were having more prevalence of severe anaemia due to inadequate knowledge. These findings supported that there is significant association between knowledge regarding anaemia and type of family.

Findings related with family income: - The highest mean knowledge score i.e 21.45 (71.52%) was found in pregnant women who belonged to (Rs >9000/-month) income group while the lowest mean knowledge score 18.75 (62.5%) was found in pregnant women who belonged to (Rs upto 3000/-) income group. The difference in the mean knowledge score of pregnant women according to family income was tested and found statistically significant at 0.05 level (p-value 0.0042).

The study conducted by Gautam V. P, et.al (2002) concluded significant association between family income and knowledge of pregnant women.

Findings related with Dietary Habit:

Shah B.K and Baig L.A (2001) found that there was highly significant relationship between Dietary habit and knowledge of pregnant women

Findings related with Gravida: The mean knowledge score and percentage was found to be more i.e 20.9 (69.67 %) in multigavida followed by mean knowledge score and percentage 20.06 (66.87%) in primigravida. The difference in the mean knowledge score of pregnant women according to gravida was tested and found statistically non-significant at 0.05 level (p-value 0.6520).

Shah B.K and Baig L.A (2001) also found that there was no significant relationship between gravida and knowledge of pregnant women.

Findings related with duration of pregnancy (Trimester): The pregnant women belonging to 3^rd trimester had maximum mean knowledge score i.e 20.65 (68.83%) and least 20.07 (66.90 %) in women with first trimester. The difference in the mean knowledge score of pregnant women according to duration of pregnancy was tested and found statistically non-significant at 0.05 level (p-value 0.7081).

The study conducted by Shah B.K and Baig L.A (2001) found no relationship between trimester of pregnancy and knowledge level of pregnant women regarding anaemia.

Findings related with source of information:

The difference in the mean knowledge score of pregnant women according to source of information was tested and found statistically non- significant 0.05 level (p-value 0.7015).

Findings related with Residence /Area:

Findings related with Degree of anaemia:

The maximum mean knowledge score of pregnant women 21.88 (72.96%) belonged to those with normal level of Hb (i.e >_ 10.1-12 gm/dl) and minimum mean knowledge score of pregnant women 18.81 (62.71%) among those who were having moderate degree of anaemia (i.e Hb- 6.1-8 gm /dl). The difference in the mean knowledge score was tested statistically and found significant at 0.05 level (p-value 0.0000) level

Thangaleela T. and Vijaylakshmi P. (1994) found that there was significant association between degree of anaemia with the pregnant women knowledge level.

Section D: Identification of deficit area of knowledge score of pregnant women regarding anaemia with a view to develop guidelines on knowledge of anaemia

Related to Guidelines on knowledge on anaemia for pregnant women which were being prepared and attached.

Related to identification of deficit area the mean and mean percentage of knowledge score of pregnant women regarding introduction and definition was maximum 7.64 (76.40 % ) with rank 1 and followed by mean knowledge score regarding causes and sign and symptoms 3.60 (72.00%) with rank 2, complication 2.51 (62.75%) with rank 3 and minimum 6.73 (61.18%) with rank 4 belongs to prevention and control and mean knowledge score of pregnant women regarding anaemia was 20.48 and mean percentage of knowledge score of pregnant women regarding anaemia was 68.3%

The findings of study were better than that conducted by Shah B.K and Baig L.A (2001), whose findings revealed that knowledge of pregnant women regarding causes, sign and symptoms of anaemia was (56.3%) while it was good regarding prevention and control i.e (54.5%) as compaired to findings of present study in that area.

Jessa F and Hampshire A.J. (1999) in their study found that (61.5%) of pregnant women had poor knowledge regarding prevention and control of anaemia.

Kalimbira, et, al (2009) showed that 96.6% of the women were aware of anaemia. with at least 2/3rd knowing its cause, way of prevention and treatment

CONCLUSION:

The finding of the study concludes that the antenatal mothers had moderate knowledge on selected aspects of anemia during pregnancy. The study suggests that the antenatal mother require educational instruction for improving the knowledge

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Received on 04.12.2019 Modified on 31.12.2019

Asian J. Nursing Education and Research. 2020; 10(2):163-170.

DOI: 10.5958/2349-2996.2020.00036.1