1. health and fitness

IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 01-06
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Dietary habits during the postpartum period among a sample of
lactating women in Sudan
Eshraga Abdallah Ali Elneim
Department: Nutrition and Food Science University of Hail, Saudi Arabia
Abstract: Period and the beginning of the end of the third stage of labor until 42 days after the birth, a critical
period if that many deaths occur in this period, infected mother to many diseases. The device needs this time to
nutritional care and aim of this study was to determine the pattern of daily food intake and dietary habits of
practice in this period of women attending of Singa city maternal and child care centers at the end of the period
of confinement to vaccinate their children. The study was conducted on 165 women . And applied the
questionnaire was filled out by the interview. The results showed that the pattern of food consumption during
the postnatal period focusing on eating meat and eggs 53.33%, fish and chicken 73.93% and not eating fruits
and vegetables and high energy snacks like porridge ring 30.30% and 57.57 % and 29.94% date milk porridge
with butter and your favorite foods 72.84% lamb Soup, 64.84% bird meat soup 72.84% tea ring with milk
90.90% alhargl grass with milk 90.90% hot milk with butter 57.57% and 75.75% prefer not to eat your
vegetables and gain prominent causes of weight during this The period of appearance of the social bottom line
results that good food in content of protein, carbohydrate ,vitamins by frequency high power foods can cause
obesity, which causes many health problems for women, and one of the most important recommendations of the
moderation in eating food that contains sugar and animal fat, and increase physical activity to burn excess
calories daily.
Keywords: food habits, Postpartum, lactating women, Sudan
I. Introduction:
Postpartum maternal health care influences the health of both the mothers and their children greatly.
Like prenatal care, the postpartum health care that is typically provided during the six-week period after
childbirth is very important to the mothers' health.1 In developing countries, over 60% of maternal deaths occur
during the postpartum period. A great number of postpartum complications can be avoided. Physical as well as
psycho-social problems can be detected early via an effective postpartum care. Effective postpartum care is
essential to maximize survival of mothers and new born regardless of where a woman delivers. Ironically, in
developing countries, about 70% of women do not receive any postpartum care.] 2 [ .
In general, Western postpartum practices are based on the biomedical model, where by the role of the
woman is less important than that of the physician. In contrast, the traditional non-Western perspective
emphasizes that birth is part of a holistic and personal system, involving moral values, physical aspects, social
relations, and relation to the environment. Postpartum health beliefs and practices among non-Western cultures
are each distinct, but have many similarities . As such, it is important to increase one's intake of foods
containing these nutrients to prevent risk of deficiencies. It is also important during these periods of the life span
to not consume too much of each nutrient to reduce risk for levels of intake that may be harmful. Although
meeting these increased nutrient requirements can and perhaps should be achieved by the consumption of
appropriate amounts of foods in a balanced and varied diet, the use of dietary supplements may be beneficial in
some situations ] 3 [.
Although the postpartum period serves as a critical time for weight-management interventions because
weight retention and weight gain can be significant (4;5), few researchers have studied dietary behaviors
characteristic to the postpartum period and strategies to effectively promote weight control among, exclusively
breastfeeding (EB), mixed feeding (MF), or formula feeding (FF), overweight and obese women. Thus,
examination of dietary behaviors and compliance with dietary guidelines would help determine nutritional
characteristics and concerns specific to this group.
Gestational weight gain, pre-pregnancy weight, age, race, income and parity are also related to weight
retention among postpartum women] 6,7 [ reported predominantly white postpartum women consumed
adequate dairy servings, but vegetable intake was not sufficient. Two studies have reported a higher
consumption of fruits and vegetables and a lower fat intake among lactating women as compared to formula
feeding women ] 9,10 [.
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Dietary habits during the postpartum period among a sample of lactating women in Sudan
II. Materials And Methods:
Been using a sample of lactating women attending the maternal and child care centers at the end of the
period of pre-trial detention to vaccinate children in city singe (in Sudan) sample included 165 women were
mobilized questionnaire by interview which contained social and economic factors and the pattern of food
consumption habits and foods avoided during the postpartum period and analysis of questionnaire to find the
frequencies and percentages using the statistical program spss:
III. Results And Discussion
Results
Table 1 Socio-demographic characteristics of mothers (n=165)
Characteristic
age groups
)15-20 )eyers
)20-25 ) eyers
)25-30 ) eyers
More than 30 eyers
Level of education
No formal schooling
Primary
Secondary
Tertiary
Employment
Government
Private
Self-employed
Homemaker
Household income
Less than 1000
1000-2000 pounds
more than 2000 pounds
Frequency
Percentage
25
44
80
16
15.15%
26.66%
48.48%
9.69%
25
35
61
34
15.15%
21.21%
36.96%
20.60%
30
20
13
102
18.18%
12.12%
7.87%
61.81%
83
42
40
50.30%
25.45%
24.24%
Table 1 shows the socio-economic characteristics of respondents found 48, 48% of the women in the age group
(25-30 years) and the lowest was aged 30 years and above 9% and educational level of the Secretary-General
15, 15% ,primary 21, 21% were higher secondary education 36, 96% and higher education 20, 60%, and a large
proportion of women homemakers 61, 81 ,18.18% workers in the government and 12% private and family
income was above 50, 30% less than 1,000 pounds a month and 25, 45% income category (1000-2000) pounds
in the month, and 24, 24% more than 2000 pounds .
Table2 food consumption pattern during the puerperal period daily
Foods
Fruits and vegetables
Milk
Eggs and meat
Fish and chicken
Date porridge
Fenugreek pills porridge
Total deal a day
Once
Twice
Three times
No special diet
Once
Twice
Three times
No special diet
Once
Twice
Three times
No special diet
Once
Twice
Three times
No special diet
Once
Twice
Three times
No special diet
Once
Twice
Three times
No special diet
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Frequency
100
15
50
5
40
120
22
43
88
22
122
43
56
44
50
10
95
35
12
18
Percentage
60.60%
9.09%
30.30%
3.03%
24.24%
72.72%
13.33%
26.06%
53.33%
13.33%
73.93%
26.06%
33.93%
26.66%
30.30%
6.06%
57.57%
21.21%
7.27%
10.90%
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Dietary habits during the postpartum period among a sample of lactating women in Sudan
Millet flour porridge
Alasra fermented flour soup(elnsha)
Once
Twice
Three times
No special diet
Once
Twice
Three times
No special diet
Once
120
30
10
40
44
66
15
54
72.72%
18.18%
6.06%
24.24%
26.66%
40%
9.09%
32.72%
Twice
Three times
No special diet
81
30
49.09%
18.18%
Rice with milk
Style food consumed during the puerperal period per day found that vegetables and fruits consumed once per
day at 60.60% 9.09% address twice and lack of eating three times a day and 30.30% on .3.03% on daily food
dairy once and 24.24% twice and the highest was three times 72.84 years%. Eating eggs and meat 53.33% three
times a day, 26.06% twice, and 13.33% once and 13.33% non-custom in daily consumption. the consumption of
fish and chicken once a day 73.93% and twice 26.06%. Date porridge eaten once 33.93% and twice 26.66%30.30% three times a day.
And porridge ring consumed once per day 57.57% and twice 21.21% and three times 7.27% and 10.9%
not allocated in the daily diet. Alasra soup and fermented with sugar ( elnsha) is consumed once per day
26.66% twice a day 26.66% and three times 40% 9.09% is considered a special diet in this period. And
consumption of rice with milk once a day 32.72% and twice 49.09% to 18.18% is not considered a special food
diet daily.
Table 3 Food are avoided during the postpartum period and why
Avoid food
Onion-garlic-onion-radish
Spices (chili powder and black
)pepper
Legumes
yes
Frequency
143
Percentage
86.66%
NO
22
13.33%
yes
165
100%
NO
-
-
yes
95
57.57%
NO
70
42.42%
59
35.75%
69
41.81%
32
19.39%
15
9.09%
the reasons
Undesirable effect to fetus
Repealed and flatulence
Food beliefs
no apparent reason
Foods to avoid during the puerperal period was onion and radish 87.62% 13.33% don't avoid it. Chili chili each
sample to avoid eating legumes 57.57%, 100%, not avoid 42.42 percent. Reasons for avoidance (not addressed):
undesirable effect on fetus 35.75% intestinal flatulence 41.81%, 19.39% eating habits view 9.09 per cent, there
is no reason to avoid these foods during the puerperal period.
Table 4 food consumption during the first day of birth
Diet
Foods rich in protein
foods rich Energy there is no special diet
Frequency
100
45
20
Percentage
60.60%
27.27%
12.12%
The Joule shows the foods consumed on the first day of the birth and the protein-rich foods 60.60% Foods rich
in energy for 27.27% there is no Private dining on the first day 12.12%
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Dietary habits during the postpartum period among a sample of lactating women in Sudan
Table 5 favorite foods during the postpartum period and the reasons
Favorite foods
Frequency
Percentage
NO
107
58
64.84%
35.15%
yes
Hot drinks
Lamb soup
Bird meat soup
yes
120
72.72%
NO
45
27.27%
Milk with fenugreek tea
yes
150
90.90%
milk with the butter
NO
yes
NO
15
95
70
9.09%
57.57%
42.42%
90.90%
milk with herbs alharg
yes
150
NO
10
6.06%
Vegetables and fruits
yes
50
30.30%
NO
110
66.66%
Pasta, porridge
Yes
40
24.24%
125
75.75%
40
-.
24.24%
105
20
63.63%
12.12%
NO
Undesirable effect to fetus
the reasons
Prevent bulges, abdominal pain
Food beliefs
Help increase weight
no apparent reason
The table shows your favorite foods during the postpartum period and was eating Hot drinks
like soup lamb 64.84% prefer to eat while 35.15 percent prefer the soup birds favorite 72.84 years% 27.27%
does not prefer. Fenugreek tea with milk is the preferred 90.90% and 15.9% no preference. hot milk with the
butter animal 57.57%, 42.42% prefer not. milk 85.72% alhargl with Herb prefer eating and 6.06% prefer not.
favorite vegetables and fruits for 30.30% and 66.66% do they prefer her favorite pastry 24.24% and 75.75
percent disfavored women. and reasons for preferring these foods were available at: 24.24% and 57.3% help in
weight gain and there are reasons behind this preference 12.12% foods..
IV.
Discussion
The postpartum period is a very special phase in the life of a woman. Her body needs to heal and
recover from pregnancy and childbirth, a good postpartum care and well balanced diet during the puerperal
period is very important for her health. Several studies indicated that the incidences of postpartum health
problems are high and these problems maybe have relation to traditional and unscientific dietary and behavior
practices in the postpartum period ] 1 [
In Sudan, there is a change in eating habits during the puerperal period in women. Table 1 shows the
characteristics of the study sample and in the age group (25-30 years) 48.48% and a low level of education,
15.15%, highest 36.96% secondary education and higher education, 20.60% a large proportion of women
homemakers 61.81%, the highest percentage of family income less than 1,000 pounds per month 50, 30%, and
all these factors affect the pattern of food consumption during the postpartum period and social customs in
Sudanese solidarity and cooperation between families with food in the form of gifts for women over the period,
which To provide nutritional support for women in this critical period, the availability of food, especially high
energy foods lead to obesity and these results against the results [15] that social support can influence the
adoption of healthy behaviors during the puerperal period .
.
Table 2 shows the pattern of food consumption, so consumption of fruits and vegetables once a day
60.60% for women, 9.09 per cent, lack of consumption three times a day and 30.30% allocated in diet, eating
habits, and we believe they cause flatulence and full scan recurring dairy 72.84% three times a day and eating
meat and eggs three times a day, average 53.33% in daily food consumption 13.33 health risks, fish chicken
once at 73.93% eat soups eaten as food not shared in the post Birth and after birth like date porridge eaten once
33.93% twice-26.66% and 29.80% three times a day and consumes one ring on porridge 57.57%, 21.21% twice
and three times 7.27% and 10.9% in the daily diet. Squeeze fermented with sugar soup (traditional local food)
called starch consumed once every day 26.66% twice a day, 26.66% three times 40% 9.09% a special diet in this
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Dietary habits during the postpartum period among a sample of lactating women in Sudan
period. And consumption of rice with milk once% 32.72 today and twice 49.09 and 18.18 per cent non-private
daily diet due to high energy snacks, which enters into the composition of sugar, flour and milk, ghee and eaten
as a meal of additional weight gain during this period, and this behavior is unhealthy because excess weight and
obesity, which causes her future health risks in addition to this style of food helps lactating women to provide
nutrients such as carbohydrates, proteins, minerals, vitamins, which supports Breastfeeding the feeding practices
satisfactory during this critical period, and this is consistent with a study [14] As noted [19] to lactating women
in the Sudan promotes high-protein food consumption practices, particularly the origins of the ring ( nasha) .
Table 3 shows the foods to avoid during the postpartum period were onions and radishes 87.62%, 13.33% don't
avoid it. Avoid peppers and chili all responders avoid eating legumes 57.57 100%, do not avoid 42.42 percent.
Causes of Heroes: an undesirable effect on the fetus 35.75%, abdominal distension and intestinal 41.81%,
19.39% eating habits and 9.09% there are no reasons to avoid these foods during the post-natal period, and these
results demonstrate a lack of knowledge and reliance on legacy information in society, and these results are
consistent with a study [12, 18]
Table 4 shows foods consumed on the first day of birth and protein-rich foods 60.60% and energy rich
food for 27.27% there is no custom food day 12.12% and protein-rich foods are usually good for mothers and
children's health after birth while the energy rich food have addressed health hazards especially foods that enters
in the composition of animal fats, sugar, this result agrees with the study [16 [ There are some excellent food
and dangerous practices on the health of women following confinement in Saudi Arabia..
Table 5 shows the favorite foods during the postpartum period and hot drinks such as mutton soup
64.84% prefer to eat while prefer 35.15 percent prefer bird soup years% 27.27 72.84% favorite. Fenugreek tea
with milk in my favorite 90.90% and 15.9% no preference. Hot milk with butter animal 57.57%, 42.42 percent.
Milk 85.72% alhargl (herb), noted that the hot foods were more common in the food and favors prefer 6.06%.
Your favorite fruits and vegetables for 30.30% and 66.66% prefer women's favorite pastry 24.24% and% 75.75.
Reasons for preferring these foods available in: 24.24% and 57.3% help in weight gain, there are reasons for this
preference foods because these foods prefer 12.12% dietary habits in the community are considered overweight
manifestation of beauty.
V. Conclusion:
. The results indicate that food style for women in the postnatal period is characterized by excessive
intake of food energy and frequency in use today and can say that the transition from pregnancy to childbirth
may be linked to a negative impact on diet leading to obesity because of the habits, which can affect the health
of women in the future.
Recommendations:
Antenatal clinic should be carried out sensitization programmers on nutrition and health care for pregnant
women and their families. Some visits should include prenatal and postnatal visits to follow up and guide
women to contemporary practices, thereby enabling women to correct eating habits. Furthermore, as well as
future studies are necessary to explore the relationship between dietary practices and health outcomes for
women . The study also recommends a study include chemical analysis of traditional foods in the study area.
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Mustapha, R.A.Nutrients Composition of Some Traditional Soups Consumed ByPostpartum Mothers In Nigeria IOSR Journal of
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 07-11
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Assessment of Emotional Distress among Women Had Abortion
Saadya H. Humadee, PhD*
*Assistance Professor Department of nursing, Babel Technical Institute, Iraq.
Abstract: Objective: To assess the emotional distress following abortion.
Design: A descriptive analytic study.
Setting: Babel maternity- child hospital in Babylon governorate.
Population: A sample was fifty women who attended to maternity- child hospital during the period 15/5/201315/6/2013.
Methods: The mean with (SD) of age was 30.8 ± (7.4) years experiencing emotional distress symptoms. A
questionnaire format used for data collection was designed and constructed after reviewing related literatures
and previous studies and used the perceived emotional distress inventory scale to assess the emotional distress
for women and collected basic demographic data were also.
Main results: The study found that the highest percentage of age group was (32%) of study sample their age
group (23-27) years, the mean with SD. was 30.8 ± 7.4 years, (42%) of study sample was institutes and college
graduate and the highest percentage was (72%) of study sample at (1-2) having abortion and the study found
that the highest mean of score within item (2) was (2.24) refers to feel strained and the lowest mean of score
within item (3) was (1.6) refers to feel distant from friends. the mean of score for all items are (1.91) and found
that the statistical significant correlation between age, educational level and having abortions with the all items
of perceived emotional distress inventory scale.
Conclusion: There was emotional distress following abortion among women so they need help for coping with
their emotions by provide post-abortion counseling clinics and counseling services in community.
Key words: Assessment, the perceived emotional distress inventory scale, abortion.
I.
Introduction:
Abortion can occur spontaneously, it usually called a miscarriage, or it can be purposely induced [1].
The number of abortions worldwide has remained stable in recent years, with 41.6 million having been
performed in 2003 and 43.8 million having been performed in 2008. The abortion rate worldwide was 28 per
1000 women between 15 and 44 years of age, though it was 24 per 1000 women for developed countries and 29
per 1000 women for developing countries[2]. Abortion may have adverse effects on women's mental health.
Most women will find it difficult to make the decision to have an abortion and many find the experience
stressful, unpleasant and the most common emotional response after abortion is a profound of persistent feelings
of sadness and regret [3]. The decision-making process may be stressful, even if the outcome is ultimately
positive. Some women feel grief even though they know they made the right decision. this is a condition called
"Post-Abortion Stress Syndrome [4]. In the United States alone 1,300,000 abortions occur annually. Almost
everyone was directly or indirectly affected by abortions and even the second child did not alleviate the pain of
her earlier loss. Some women have trouble bonding with their other children because of fear and guilt [5]. Later
abortions harm women's mental health that make many women the abortion debate so heated [6]. One of the most
prevalent outcome of abortion was shame and guilt that the mother suffer sometimes for years. This is the most
common post abortion syndrome symptom. Because they believe they were doing something wrong, they had
difficulty talking about it. Many women hide this secret. This self-protective measure is self-defeating, many of
them are too ashamed to talk about it and lead that many women suffer from psychological disorders after
having an abortion, so women need support and help to heal from the devastating effects of an abortion.
Adolescents are more vulnerable to emotional and psychological issues after an abortion than older women .
Adolescents who aborted pregnancy presented significantly greater prevalence of depression and anxiety than
those who did not abort[7]. The current study assessed the emotional distress following abortion among women.
II.
Methodology:
A descriptive analytic study conducted a non-probability sample assessed 50 women who attended to
maternity- child hospital during the period 15/5/2013-15/6/2013. The mean with (SD) age of women were 30.8
± (7.4) years experiencing emotional distress symptoms. A questionnaire format used for data collection was
designed and constructed after reviewing related literatures and previous studies and use the perceived
emotional distress inventory scale for assess of emotional distress, the score: 0 for (not at all), 1for (sometimes),
2 for (often), 3for (very much so) and basic demographic data also collected.
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Assessment Of Emotional Distress Among Women Had Abortion
III.
Results:
The women who assessed had the highest percentage (32%) of study sample their age group (23-27)
years, the mean with SD. was 30.8 ± 7.4 years. (42%) of study sample were institutes and college graduate
while the lowest percentage (8%) of them was illiterate. The highest percentage was (72%) of study sample at
(1-2) abortion while the lowest percentage (10%) had (5-6) abortion as shown in table (1).
Table (1): Distribution of the Study Sample according to Demographic Characteristics.
(n=50)
Age group
(years)
frequency
%
Educational level
frequency
%
Number of
abortion
frequency
%
18-22
6
12
Illiterate
4
8
1-2
36
72
23-27
65
32
Read& write
6
12
3-4
9
18
28-32
33-37
38-42
6
12
5
12
28
10
Primary school
Secondary school
Institutes &college
6
13
21
12
26
42
5-6
Total
̅
5
50
10
100
43-47
2
4
Total
50
100
48-52
1
2
Total
̅
50
100
 Table (1) shows that the highest percentage of age group were (32%) of study
sample their age group (23-27) years, the mean with SD. was 30.8 ± 7.4 years.

Educational Level: (42%) of study sample were institutes and college graduate while the lowest
percentage (8%) of them was illiterate.
 Number of abortion: The highest percentage was (72%) of study sample had(1- 2) abortion while the
lowest percentage (10%) had (5-6) abortion.
Table(2):The emotional distress following abortion among study ample.(n=50)
Statements
Not at
all
%
Some
Times
%
Often
%
Very
Much so
(3)
%
̅
1- I get easily irritated
2- I feel strained
3- I feel distant from my friends
4- I am angrier than I am willing to admit
(0)
3
6
62
66
6
1
15
11
(1)
66
6
61
61
23
63
13
13
(2)
65
16
6
63
21
31
63
17
63
16
67
62
17
31
25
15
6871
1813
685
6847
5- I feel nervous
6- I feel confused and restless
7- I feel overwhelmed by “simple difficulties”
3
5
7
7
61
65
7
63
63
65
13
17
64
63
64
23
13
23
12
13
62
35
37
15
1863
1833
6855
8- I worry that my condition will get worse
6
63
5
61
64
23
11
33
1833
9- I am not enjoying the things I usually do for fun
7
65
63
17
64
23
62
15
6855
10- I am losing hope in the fight against my illness
61
25
7
65
66
11
68
27
6863
11- I “boil inside”, but I try not to show it
6
1
66
11
65
21
11
33
1867
12- I am losing faith in my medical treatment
8
67
7
65
66
23
65
21
687
13- I feel angry
14- I feel sad
15- I feel like a failure
Total
Mean
2
2
63
5
5
13
66
66
5
11
11
61
63
61
66
17
13
23
11
13
66
33
37
23
186
1863
6871
17854
6886
*Cut off point =1.5
Table(2) shows that the highest mean of score within item (2) was (2.24) refers to I feel strained and the lowest
mean of score within item (3) was (1.6) refers to I feel distant from my friends. The mean of score for all items
are (1.91).
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Assessment Of Emotional Distress Among Women Had Abortion
Table(3): Person correlation between age, educational level and number of abortion with the perceived
emotional distress inventory items.(n=50)
Statements
Age
Educational level
1- I get easily irritated
.036*
.109
Number of
abortions
.000**
2- I feel strained
.040*
.765
.032*
3- I feel distant from my friends
4- I am angrier than I am willing to admit
5- I feel nervous
.577
.010*
.011*
.122
.578
.763
.240
.005**
.011*
6- I feel confused and restless
.110
.532
.005**
7- I feel overwhelmed by “simple difficulties”
.025*
.352
.016*
8- I worry that my condition will get worse
.795
.870
.014*
9- I am not enjoying the things I usually do for fun
.154
.214
.009**
10- I am losing hope in the fight against my illness
.895
.517
.001**
11- I “boil inside”, but I try not to show it
.032*
.656
.001**
12- I am losing faith in my medical treatment
.070
.420
.000**
13- I feel angry
.253
.568
.055*
14- I feel sad
.959
.639
.037*
15- I feel like a failure
.889
.747
.006**
Sig.=significant
** Person's correlation is significant at the 0.01 level(2-tailed).
* Person's correlation is significant at the 0.05 level(2-tailed).
Table(3) shows that the statistical significant correlation between age, educational level and number of abortion
with the all items of perceived emotional distress inventory scale.
IV.
Discussion:
Main findings:
The study found that there was emotional distress following abortion among women and there was a
statistical significant correlation between age, educational level and number of abortion with the all items of
perceived emotional distress inventory scale. When assess the emotional distress following abortion among
women by using the perceived emotional distress inventory scale, revealed that the abort women suffered from
emotional distress, as shown in table (2).
The present study found that the women age with SD. was 30.8 ± 7.4 years. who had previous abortions suffering
from emotional distress. A previous study showed that almost every women directly or indirectly affected by
abortions[6].
Abortions percentage in 2008 were under age 15 (0.4%), ages 15-17 (6.2%), ages 18-19 (11%), ages 20-24
(33.4%), ages 25-29 (24.4%), that agreed with finding of this study. Ages 30-34 (13.5%), ages 35-39 (8.2%),
ages 40+ (2.9%), more than (57.8%) are performed on women between the ages of 20-29[7].
And stated that the education level of the woman having an abortion in 2008: Non-graduate of high school was
(12.3%), High school graduate was (28.3%), Some college was (39.5%), Post-college graduate degree was
(19.9%) [7,8]. The study found that there was significant correlation between age, educational level and number
of abortion with the perceived emotional distress inventory items, as shown in table (3).
Previous study stated that four factors are (age, level of education, socio-economic status and parity) were found
to be significantly correlated related Psychological disorders which the most prevalent outcomes of abortion was
shame and guilt that the mother suffer sometimes for years because they believe they are doing something
wrong, they have difficulty talking about it so many women hide this secret [9].
The task force studies indicate that some women experienced sadness, grief and feelings of loss
following an abortion and some may experience, clinically significant disorders including depression and
anxiety[10].
A study showed that 50–60% of women undergoing induced abortion experienced some measure of emotional
distress, classified as severe in 30% of cases [11]. Saddening experience because of male pressure on women to
have an induced abortion had a significant, negative influence on women's psychological responses in the 2
years following the event[12].
Robinson's criteria contrasting basic negative emotions related abortion were anger, rage, sorrow, grief
frustration and disappointment[13]. 40-45% of women experience significant levels of anxiety and around 30%
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Assessment Of Emotional Distress Among Women Had Abortion
experience significant levels of depressive symptoms and emotional problems following abortion after a month
[14]
. The pressure from partner was significantly associated with more negative emotional reactions following an
abortion[12].
A study reveals that the psychological trauma caused by a therapeutic abortion, the significant distress
of the mothers accentuated by guilt feelings, persistent symptoms of depression and anxiety. Different reactions
within the couple are perceived and can lead to marital conflict[15].
Habitual abortions and unexplained habitual abortion can lead to grief, anxiety, distress and depression [16]. The
highest quality studies found that women who had elective abortions experienced psychological distress and
negative mental health sequel of abortion[17].
The way of psychological responses to miscarriage and abortion differed during the five-year period after the
event. Women who had undergone an abortion exhibited higher scores during the follow-up period for some
outcomes [19,1]. This study agreed with these previous studies.
Strengths and limitations:
The strength of the study use of validated assessment tool and use of the perceived emotional distress inventory
scale[18]. I have limited the analysis to those who were have psychological and emotional problems due to other
causes and factors.
V.
Conclusion:
There was emotional distress following abortion among women so they need help for coping with
their emotions8
Disclosure of interests:
The authors report no conflict of interest.
Contribution to authorship:
No contribution to authorship.
Details of ethics approval:
No details of ethics approval.
Funding:
there was no fund.
Acknowledgement:
A grateful acknowledgement and appreciation to all women who made this study possible.
Recommendations:
1- Psychological therapy should be offered following abortion.
2- Mental health outcomes of abortion must be used as a rationale for policy-making following abortion.
References:
[1].
[2].
[3].
[4].
[5].
[6].
[7].
[8].
[9].
[10].
[11].
Anne N B.; Torbjørn M.; Anne S B. and Øivind E.: The course of mental health after miscarriage and induced abortion: a
longitudinal, five-year follow-up study Journal BMC Medicine ISSN: 17417015 Year: 2005 Volume: 3 Issue: 1 Pages: 18 Provider:
BioMed Central. DOAJ Publisher: BioMed Central. http://www.biomedcentral.com/1741-7015/3/18
Guttmacher Institute: Facts on Investing in Family Planning and Maternal and Newborn Health November 2010. Retrieved 24
October 2011.
Templeton A.; Grimes D A.: A Request for Abortion. New England Journal of Medicine .365 (23): 2198–2204. December 8,
2011. doi:10.1056/NEJMcp1103639.
National Abortion Federation: what should I expect after abortion: EMOTIONS 2010.
Steinberg J R.: Later Abortions and Mental Health: Psychological Experiences of Women Having Later Abortions—A Critical
Review of Research. May 2011. Women's Health Issues 21 (3): S44–S48.doi:10.1016/j.whi.2011.02.002. PMID 21530839.
Barnes S.: The Long Term Effects of Abortion on Women. February 10, 2009, Updated December 23, 2010.
Zulčić-Nakić V.; Pajević I.; Hasanović M.; Pavlović S. and Ljuca D.: Psychological problems sequalae in adolescents after artificial
abortion. 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. [PubMed - indexed
for MEDLINE] . J Pediatr Adolesc Gynecol. 2012 Aug;25(4):241-7. doi: 10.1016/j.jpag.2011.12.072. Study was last updated on
December 03, 2012.
Fleischmann R.: Sobering Statistics on Abortion. Clearly Caring Magazine-Home Edition, 1st Quarter 2011, Vol. 31, No.
1http://www.christianliferesources.com?9244
Fatoye FO.; Adeyemi AB. and Oladimeji BY.: Emotional distress and its correlates among Nigerian women in late pregnancy
Obstetrics, 2004, Vol. 24, No. 5 , Pages 504-509 (doi:10.1080/01443610410001722518)
Major B.; Appelbaum M.; Beckman L.; Dutton MA.; Russo NF. and Kim I: APA Task Force Finds Single Abortion Not a Threat to
Women's Mental Health. American Psychological Association. 12 August 2008. Retrieved 7 September 2011. (202) 336-6048
Wikipedia, the free encyclopedia: Emotional distress. This page was last modified on 11 November 2012 at 01:43. A Publication of
Rachel’s Vineyard Ministries.www.RachelsVineyard.org.
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10 | Page
Assessment Of Emotional Distress Among Women Had Abortion
[12].
[13].
[14].
[15].
[16].
[17].
[18].
[19].
Broen AN.; Moum T.; Bödtker AS. and Ekeberg O.: Reasons for induced abortion and their relation to women's emotional
distress: a prospective, two-year follow-up study. General Hospital Psychiatry, Volume 27, Issue 1 , Pages 36-43, January 2005.
Received 24 May 2004; accepted 21 September 2004.
Wikipedia, the free encyclopedia :Contrasting and categorization of emotions. This page was last modified on 17 May 2013 at
09:17.
Bradshaw Z.; Slade P. : Clinical Psychology Review [2003, 23(7):929-958] (PMID:14624822)DOI: 10.1016/j.cpr.2003.09.001
Gaudet C.; Sejourne N.; Allard MA. adn Chabrol H.: Women and the painful experience of therapeutic abortion. Gynécologie
Obstétrique & Fertilité, Volume 36, Issue 5, May 2008, Pages 536–542, 2008 Elsevier Publisher: Elsevier Masson SAS DOI:
10.1016/j.gyobfe.2008.02.021 http://dx.doi.org.tiger.sempertool.dk/10.1016/j.gyobfe.2008.02.021, How to Cite or Link Using DOI
Schulz-Du B C.: Psychological Factors in habitual abortions Der Gynäkologe. ISSN: 00175994 Year: 2009 Volume: 42 Issue: 1
Pages: 35-38 Provider: Springer Publisher: Springer DOI: 10.1007/s00129-008-2230-9 Not logged in Iraqi Virtual Science Library
(3000135768) 78.111.165.165
Charles VE.; Polis CB.; Sridhara SK. and Blum RW.: Abortion and long-term mental health outcomes: a systematic review of the
evidence :Journal Contraception ISSN: 00107824 Year: 2008 Volume: 78 Issue: 6 Pages: 436-450 Provider: Elsevier Publisher:
Elsevier DOI: 10.1016/j.contraception.2008.07.005 http://dx.doi.org.tiger.sempertool.dk/10.1016/j.contraception.2008.07.005, How
to Cite or Link Using DOI
Manolete SM: Perceived Emotional Distress Inventory, University of South Florida.
Broen AN, Moum T, Bodtker AS, Ekeberg O: Reasons for induced abortion and their relation to women's emotional distress: a
prospective, two-year follow-up study. Gen Hosp Psychiatry 2005, 27:36-43. This page was last modified on 13 September 2013, at
16:26.
www.iosrjournals.org
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 12-13
www.iosrjournals.org
Domains of Research Ethics
P.Subharani
Associate Professor, Saveetha College of Nursing, Saveetha University, India
I.
Introduction -Domains of Research Ethics
Ethics is rooted in the ancient Greek philosophical inquiry of moral life. It refers to a system of
principles which can critically change previous considerations about choices and actions.1It is said that ethics is
the branch of philosophy which deals with the dynamics of decision making concerning what is right and
wrong. Scientific research work, as all human activities, is governed by individual, community and social
values. Research ethics involve requirements on daily work, the protection of dignity of subjects and the
publication of the information in the research.
Key words –Ethics, Information, Intellectual Property
However, when nurses participate in research they have to cope with three value systems; society; nursing and
science. The societal values about human rights, the nursing culture based on the ethic of caring and the
researcher's values about scientific inquiry[1.]
Since 2001, the UK Government health departments have implemented the Research Governance Frame work
to strengthen public confidence in research and improve the management and monitoring of research. The
framework relates to set standards that outline the key principles of a quality research culture in five governance
domains.
Research adheres to its key principles. The research governance standards relate to five domains: Ethics;
Science;Information; Health, Safety And Employment; Finance And Intellectual Property.
The Ethic domain is concerned with ensuring the dignity, rights, safety and well-being of participants who are
the primary consideration in any research study. In addition, data protection, ethics committees, informed
consent and confidentiality are integral concerns to the research process.
The Science domain argues that unnecessary research duplication is unethical and that only original high quality
research should be generated. In practice, this means that existing sources of evidence should be used and all
research proposals should be subject to peer review.
Special guidance is given for research involving human embryos, animals, genetically modified organisms, and
medicines.
The Information domain highlights the need for information on research and subsequent findings should be
accessible to the public through publication.
The Health, Safety and Employment domain recommends that the safety of research participants and staff is
assured by adhering to health and safety regulations. New or existing medical devices need to be approved by
the medical devices agency to ensure safety for staff and patients.
Finally, the Finance and Intellectual property domain advocates compliance with the law and rules set for the
use of public funds. Compensation is recommended for anyone harmed as a result of studies.
Intellectual property (IP) is concerned with inventions, know-how (knowledge), copyrights and database rights,
designs, trademarks and materials..[2]
For example, it should be agreed who will be credited with funds and authorship at a study’s outset.
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Domains of Research Ethics
II.
Conclusion
Researchers should inculcate the basic qualities like facts finding, critical analysis, and scientific
enquiry for providing the quality studies.
Reference
[1]
[2]
Johnstone M. Bioethics. A Nursing Perspective, 5th edition Churchill Livingstone Elsevier, 2009. Georgia Fouka Marianna
Mantzorou RN, PhD.
Key information
Visit the Department of Health’s website:
www.dh.gov.uk.
For the UKCRC,
visitwww.ukcrc-rgadvice.org.
ROYAL COLLEGE OF NURSING
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13 | Page
IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 14-16
www.iosrjournals.org
Finger Print Analyze
(Health by Birth Knowing Through Finger Impressions)
Venkateswara Rao Madduru
Finger Print Expert, Inspector of Police, F P B. CID, District Police Office, Kurnool. Andhra Pradesh. India
Abstract: I am an expert in the arena of dermatoglyphics i.e. study of finger prints. On this discipline, I have an
experience of 28 years. Consequently I have done some research work in the formation of Patterns on the first
phalange of all the fingers and also on the skin of palms. By authenticating the finger impressions and its nature
of forming ridge characteristics, ridges as well as its patterns, I have understood that each finger impression is
working as an index of an organ which leads to the analysis of organ development and its condition. For
declaring this statement, I have verified thousands of finger impressions formed at first phalange of fingers.
Keywords: Health By Birth, Finger Impressions, Human Organs, Arches, Loops, Whorls.
I.
Evolution of Finger Prints
Finger Print patterns formed at first phalange of Fingers forming an evolution type i.e., Changes at
Womb simultaneously according to the Organs. So parallel changes of Organs as well as Finger Impressions.
On analyzing the finger impressions we can found the Organs development and its condition. Finger Print
Patterns are formed on the bulb of the first phalange of the fingers as just they are reference of the Organs.
Arch
to
Loop
to
Whorl
II.
Latest Information
Latest developments in the field of science have stated that each finger is associated with various
human organs. At the time of birth we can be aware of the human organ development and its issues by means of
finger print patterns formed in the first phalange of fingers. Through this linking, I have accomplished a number
of tasks in our place and given some suggestions for maintaining the organs.
III.
Organs and its Health Groups
Group -1:15 to 20 Percent of People have no resistance against virus.
(Having the patterns of Arches)
Group-2:65 to 70 Percent of People have some resistance against virus.
(Having the patterns of Loops)
Group-3:15 to 20 Percent of People have resistance against virus.
(Having the patterns of Whorls)
Group-4: between Group – 1 and Group-2
(Having the patterns of combined Arches and Loops)
Group-5: between Group-2 and Group-3
(Having the patterns of combined Loops and Whorls)
Group-6: People with under developed organs (Body Organs Construction)
(Having the patterns of Arches formed only straight flattered Lines)
Group-7: People with incorrect organ development (Reverse Organ Construction)
(Having the patterns of any pattern with converging ridges)
Now a day‟s people are not maintaining their organs properly. Therefore, it will be extremely useful to
the Public. If a person knows which group he belongs to then he/she will take care of their health. This is
achievable by verifying finger impressions.
IV.
Brain
Bladder /Sex
Kidneys
Pancreas
Incapable
No Strength
No Strength
No Strength
Capable
General
General
General
Organs
Extraordinary
More Strength
More Strength
More Strength
www.iosrjournals.org
No Problem
No Problem
No Problem
No Problem
Problem
Problem
Problem
Problem
14 | Page
Finger Print Analyze (Health By Birth Knowing Through Finger Impressions)
Heart
No Strength
General
More Strength
No Problem
Problem
Stomach
Liver
Spleen
Lung
No Strength
No Strength
No Strength
No Strength
General
General
General
General
More Strength
More Strength
More Strength
More Strength
No Problem
No Problem
No Problem
No Problem
Problem
Problem
Problem
Problem
We can analyze all the above through finger impressions of Ten from Right Thumb to Left Little.
V.
Finger Impressions Conversion System:
Identifying a person through finger impressions at present has a method of storing entire image and
then retrieving that for identifying a person an uniquely, which is complex. At Present the database required for
each person to maintain 10 fingers database in the same manner for all the population of India required memory
is 120, 00, 00,000 X 2500 KB. With this database the comparison of finger impressions take‟s maximum time.
Hence the conversion method helps us to maintain all the information about person in a single folder.
VI.
Single Finger Information:
Here single finger is sufficient to get unique identification number. String to String comparison is very
easy and fast even though the data is about 120 cores X 24 X 8 Bits. We are proposing a novel method which
stores the characteristics of termination & bifurcations of a finger impression and form unique identification
number code. This unique identification number code can be stored and retrieved for further processing.
VII.
Finger impression science:
The Pioneer‟s in Finger Print Science had given valuable and evergreen thesis to the World. Through
the Finger Prints Science and with the latest technology number of Software Program‟s are developed and
implemented for various requirements to full fill human essentials. One of such requirement is to identify a
person through finger impressions is easier and cheaper. This finger impression technology can be used in many
areas one such application is controlling of human transportation.
Finger impressions are formed in the first phalange of a finger from right thumb to right little and from
left thumb to left little 10 fingers having ridge characteristics (UNIQUE) with patterns. With these unique ridge
characteristics we can form unique Number. We need an easy method for identifying a person. The
identification is possible through forming unique identification number. So far developed software is used at
limited organizations for limited purpose. Why it is limited, because data of finger impressions takes high
storage space and everywhere required a Finger Print Expert to comparison and for results. Time Factor due to
this problem the software users are lower than the actual users. If the information retrieved at any place users
will be benefited.
VIII.
Advantages:
15 | Page
Finger Print Analyze (Health By Birth Knowing Through Finger Impressions)
Unique identification number can be obtaining for each person through finger impression. Search
Process is faster for identifying a person. With this string to string comparison the information about a person
will be retrieved within seconds from the database. With this unique identification number we can avoid
duplication. This UNIQUE identification number will never change even we scan the finger „N‟ Number of
times. The Police Department can use this Software for identifying a criminal. Prevention is possible through
this UNIQUE Identification Number. No two fingerprints are identical unless they are made by the same finger
of the same person. No two finger prints “UNIQUE Identification Number” are identical unless they are made
by the same finger of the same person.
With this concept developed a program In Visual Basic can be able to understand how the Finger
Impression converted to a Numerical Value and with that Numerical String how can we go for Tracing a Person
Information from Website. The Software was developed in VB.Net.
Present the Finger Impressions influencing in more activities and getting good result with our concept
we can increase the utility of Finger Impressions in Business and for Security. The comparison of finger
impressions is in a different way. So far it was not developed in the World. No doubt it is INVENTION. Every
Human being covered under this concept. Through Characteristics we can generate unique IDENTIFICATION
NUMBER. Through this number we can avoid duplication. And we can get whatever the information of a
person from website. And also we can use this UNIQUE ID number in all transactions either Government
issues or Private Maintenance.
8.1 Main Advantage: Identification of a person from anywhere to any person is possible through one finger
impression without delay from the website by using this software device. No need of Plastic Cards for Identity
Proof. No need of Finger Print Expert for Comparison and conclusion. In this report a method for unique
identification number was proposed unique identification number can be obtaining for each person through his
finger impression. Finger impression characteristics termination & bifurcations form UNIQUE number
identification code. This UNIQUE identification number code can be stored and retrieved for further processing.
The method was successfully discussed above and implemented in software in VB.Net.
The above method is used to identify a person. Search Process for identification is made easy and fast
using this string to string comparison the information about a person will be retrieved within seconds from the
database. With this proposed method we can allot unique identification number to each person. The advantage
of this method is to avoid duplicate records. Visit: www.healthbybirth.com
16 | Page
IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 17-21
www.iosrjournals.org
Effectiveness of a “Planned Teaching Programme”(PTP) on
Knowledge Related to Reproductive Tract Infections Among
Rural Women
Alka Chauhan, Divya Chawla, Garima Saini, Himani Rawat, Kuldeep Pundir*
Laxmi kumar** Piyalee Benjamin ***
*4th year B.Sc. Nursing Students, Himalayan College of Nursing, HIHT, Dehradun
**Lecturer, Obstetrics & Gynaecological Nursing, Himalayan College of Nursing, HIHT, Dehradun
***Nursing Tutor, Himalayan College of Nursing, HIHT, Dehradun.
Abstract :.The most important period in the life span of women is the reproductive period, which extends from
menarche to menopause. Reproductive tract infections are endemic in developing countries and entail a heavy
toll on women. If untreated reproductive tract infections can lead to adverse health outcomes such as infertility,
ectopic pregnancy and increased vulnerability to transmission of HIV. Quantitative evaluative approach was
used and research design was one group pre-test post-test design. Sample were women of reproductive age
group, sample size was 40 and sample technique was random sampling, setting for the study was Thano,
Dehradun, tool used were self prepared knowledge questionnaire related to reproductive tract infections.
Majority (80%) of the subjects were between 15 to 30 years. Majority (77.5%) of the subjects were married,
majority of (77.5%) subjects had educational status up to higher secondary and above, majority of (55%) of the
subjects have family monthly income above Rs 6,000, majority (65%) of the subjects were from nuclear family,
majority of (57.5%) of the subjects had moderate pre-test knowledge score regarding reproductive tract
infection. The mean of post-test knowledge score was higher than mean of pre-test knowledge score. Age,
educational status and marital status had significant association with pre test knowledge score. Study showed
that planned teaching programme regarding reproductive tract infections was effective in increasing women
knowledge level. There was a significant association of knowledge level with age, educational status and
marital status.
Keywords: Assess, Effectiveness, Knowledge, Planned teaching program, Reproductive tract infection.
I.
Introduction
Diseases are of many types such as communicable and non communicable, curable and incurable and
so on- W.H.O. (1948).Among them reproductive tract infections is one of the disease. Reproductive tract
infections are endemic in developing countries and entail a heavy toll on women. If untreated reproductive tract
infections can lead to .adverse health outcomes such as infertility, ectopic pregnancy and increased vulnerability
to transmission of HIV. It is also associated with adverse pregnancy outcomes.1
Reproductive tract infections are recognized as public health problem and rank second as the cause of
healthy life lost among women of reproductive age after maternal morbidity and mortality in developing
countries. In addition, the presence of reproductive tract infections is often associated with an increased risk for
acquiring and transmitting HIV in much different population.2
1.2 Need of Study:
Reproductive tract infections generally seen as a silent epidemic is one of the major public health
problems causing a significant proportion of gynecological morbidity and maternal mortality in developing
countries. Studies on women in developing countries have found reproductive tract infection prevalence rates
ranging from 52 to 92 percent. With an annual incident of 340 million STI cases globally and many more
endogenous and iatrogenic infections, reproductive tract infections are considered as global public health issue.
In resources poor countries, where 75 to 85 percent of these new cases occur, reproductive tract infections are
among the five most common health problems leading to contact with health system.3
The global burden of reproductive tract infection enormous and of a major public health concern,
particularly in developing countries where reproductive tract infections are endemic. Reproductive tract
infections, excluding HIV constitute the second major cause of disease burden in young adult women in
developing countries.4
Studies conducted in India indicate high prevalence of reproductive tract infections revealing a
prevalence varying from 19 to 71 percent. As per the survey conducted by the government of India during 1999,
involving 252 districts, the prevalence rate of reproductive tract infections in India was 28.8 percent.
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Effectiveness of a “Planned Teaching Programme”(PTP) on Knowledge Related to Reproductive
Reproductive tract infection is slightly more common among rural women (30 percent) compare to urban (26
percent) also the prevalence rate is lower for educated women 31 percent among illiterate compared to 22
percent among women who have completed 10th grade or high school level.5
In India the prevalence of reproductive tract infection is very high due to silent epidemic. The low status of
women in parts of India makes women suffer in silence or even feel too ashamed to seek treatment. Hence, there
is need to assess women’s level of knowledge regarding reproductive tract infection through study.6
1.3 Statement of Problem:
A study to assess the effectiveness of planned teaching programme on Reproductive Tract Infections
among women in selected rural community of Uttarakhand.
1.4 Objectives:
 To assess the existing level of knowledge of women regarding reproductive tract infections.
 To assess the effectiveness of planned teaching programme on reproductive tract infections by
comparing the pre-test and post-test knowledge score.
 To find out the association between pre-test knowledge score and selected demographic variables.
1.5 Hypothesis:
H1: There is a significance difference between pretest and post test level of knowledge.
H2: There is a significant association between the post test knowledge score and demographic variables at
the level of P<0.05
II.
METHODOLOGY
The research design used in this study was pre-experimental one group pretest post test design. The
study was conducted at community health center in Uttarakhand, INDIA. The sample of 40 women of
reproductive age group was selected by using convenient sampling technique. The tool used for the study was
the structured knowledge questionnaire consisting of section A (Socio- demographic variables such as age,
educational status, marital status, type of family and monthly family income Section B (consisting of 30 items
related to Knowledge regarding reproductive tract infections in five aspects i.e anatomy & physiology of
reproductive tract, syphilis, gonorrhea, vaginosis, candidiasis). The content validity of the tool was ensured by
giving the tool to experts in the field of Obstetrics and Gynecology, & Community health nursing of Himalayan
College of nursing.
III.
3.1
RESULTS AND FINDINGS
Related to Socio-Demographic Profile of women of reproductive age group:
Table No.1: Socio-Demographic Profile of the women
N=40
Sample character
frequency
Percentage
_______________________________________________________________________________
_________
AGE IN YEARS
15-30
32
80%
31-45
8
20%
MARITAL STATUS
Married
31
77.5%
Unmarried
9
22.5%
EDUCATIONAL STATUS
No formal education - primary education
9
22.5%
Secondary & above
31
77.5%
MONTHLY FAMILY INCOME
Up to Rs. 6,000
18
45%
Above Rs. 6,000
22
55%
TYPE OF FAMILY
Nuclear
14
35%
Joint
26
65%
___________________________________________________________________________________
Description of table no.1:- This table shows that majority 32(80%) of the samples were in the age group of 1530 years. One third 31(77.5%) of the samples were married. Majority 31(77.5%) of the samples have
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Effectiveness of a “Planned Teaching Programme”(PTP) on Knowledge Related to Reproductive
educational status secondary and above. Majority 22(55%) of the samples were having monthly family income
above Rs. 6,000. Majority 26(65%) of the samples were belonged to joint family.
3.2 Analysis of area wise knowledge score of women obtained in pretest and posttest
25
percentage
20
22.08
Pre test
Post test
16
15
10.83
10
8.83
9.91
10.83
9.5
7.41
5
2
3.33
0
Q 1 - 12
Q 13 - 17
Q 18 - 23
Q 24 - 26
Q 27 - 30
Knowledge Questionnaire related to reproductive
tract infections
Figure no.1 shows Knowledge Questionnaire related to reproductive tract infections
Data presented in figure no.1 that mean of pretest and posttest knowledge related to different areas
(Q1-12 Knowledge related to anatomy & physiology of reproductive tract, Q13-17 Knowledge related to
syphilis, Q18-23 Knowledge related to Gonorrhea, Q24-26 Knowledge related to vaginosis, Q27-30 Knowledge
related to Candidiasis). So it is interpreted that planned teaching programme was effective to increase
knowledge of women regarding reproductive tract infections.
Table No.2 Pretest and posttest knowledge of women related to reproductive tract infections.
N=40
Knowledge score
Mean + S.D
Mean difference
„t‟value
Pretest
13.25 + 3.71
3.67
6.23*
Posttest
16.93 + 3.70
__________________________________________________________________________________________
* significant at P<0.05 level
df(38)
Table no. 2 shows that the mean of post-test knowledge score (16.93) of the women was higher than
that of the mean of pre-test knowledge score (13.25 ).The scores predicted that the significant difference
between the mean of pre-test and post-test at p < 0.05 level. Hence, it is interpreted that planned teaching
programme regarding reproductive tract infections was effective in increasing the knowledge of women.
Table No.3 Association between pre- test knowledge score and selected demographic variables.
Demographic variables
Knowledge score
„t‟ value
________________________________________________________________________________
AGE IN YEARS
15-30
31-45
EDUCATION
Formal education- primary education
Secondary & above
MARITAL STATUS
Married
Unmarried
14.28
9.13
6.33
15.26
12.32
16.44
2.43*
8.71*
2.61*
________________________________________________________________________________
df= 38
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Effectiveness of a “Planned Teaching Programme”(PTP) on Knowledge Related to Reproductive
Independent ‘t’ test at significant at p<0.05 level
Table no.3 shows that mean pretest knowledge score for age group 15-30 is 14.28 which is higher than mean for
age group 31-45 years of age. Mean pretest knowledge score for secondary & above education is 15.26 is higher
than formal to primary education. Regarding marital status mean pretest knowledge score of unmarried is 16.44
which is higher than married. The calculated value is higher than table value. Hence, it is interpreted that there is
an association between demographic variables with pretest knowledge score.
IV. NURSING IMPLICATIONS
Nursing services:The study has revealed that maximum women have average knowledge regarding reproductive tract infection.
 Nurses can take active part in educating women regarding reproductive tract infection.
 Nursing personal can help the women by providing knowledge regarding reproductive tract infection,
so that women can be prevented from it.
 Nurses can educate the women through exhibition and role play.
Nursing Administration: - Nursing has become a complex and highly varied descriptive with the rapid
growing, well developed and well documented scientific and humanistic knowledge base.
 Nursing administration should provide necessary facilities to nursing staff and encourage use of cost
effective audio visual aids and material, models in client teaching.
 Continue nursing education can be organized by nursing personal to educate them regarding
reproductive tract infection so that nurses can educate women.
Nursing Education: Nursing student should be educated about the prevention of reproductive tract infection, so that they can educate
women regarding reproductive tract infection in community and clinical area.
Nursing Research: There is the need to conduct further research studies in the field related to knowledge, attitude and practice
regarding reproductive tract infections.
V.
CONCLUSION
Based on the findings of the study, it is concluded that most of the women had very good knowledge
regarding Reproductive tract infections after implementation of Planned Teaching Programme.
The following conclusions were drawn on the basis of the present study
1. The findings showed that out of 40 women 13 had good level of knowledge in the pre-test knowledge score
on the reproductive tract infections. The mean post-test percentage score and the gain scores in all areas
were found to be significantly high, the maximum gain being in the area of anatomy and physiology of
reproductive tract and lowest in the area of candidiasis.
2. From the findings of the study, it can be concluded that the administered a Planned teaching programme
was effective as a method to improve the knowledge of women regarding reproductive tract infections.
ACKNOWLEDGEMENT
Gratitude can never be expressed in words but this is only deep perception that makes the words to
flow from one’s inner heart.
A research project can never become successful without the coordinated efforts of members of the
team. I have been very fortunate indeed to have valuable guidance of our advisors and experts.
First and foremost, I would like to humbly thank almighty God for his divine interventions in my life without
which I would not have been able to make this study.
We give our sincere thanks to Mrs. Sanchita Pugazhendi (Principal and HOD, Community Department),
Himalayan College of Nursing for her guidance and supervision provided to us in conducting the present
research study. We give our heart full thanks to Mrs. Kamli Prakash (Vice Principal) for her constant support
and encouragement. We acknowledge our sincere thanks to Mrs. Laxmi Kumar & Mrs. Piyalee Benjamin who
has supported and helped us to sustain enthusiasm in completing this research study.
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2012Jan15];10[about 12 pages] available from: http://www.ncbi.nih.gov/pmc/articles/
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screens].available from: http://www.nbi.nlm.nih.gov /pmc/articles/PMC/2763657
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[10]. Kosambiya JK, Desai VK, Bhardwaj P,Chakraborty T.RTI/STI prevalence among urban and ural women of Surat:A community
based study.Indian Journal Of Sexually Transmitted Diseases anb AIDS[serial on the internet].2009[cited on
2012Jan17];30(2):[about 5 pages]available from:http://www.ijstd.org/text.asp?2009/30/2/89/62764
[11]. Li C,Han HR, Lee ZE, Lee Y, Kim MT.Knowledge,behavior and prevalence of reproductive tract infections:A descriptive study on
rural women in Hunchun, China. Asian Nursing Research[serial on the internet].2010Aug31[cited on2012Jan19];4(3):[about 7
screens].available from:http://www.kan.or.kr/new/kor/sub3/filedata-anr/2021003/122pdf.
[12]. Lan PT, Lundborg CS, Phuc HD,Sihavong A, Unemo M, Chuc NT, Morgen T et al.Reproductive tract infections including STI: A
population based study on women of reproductive age in a rural district of Vietnam.Sex Transm Infect. [serial on the
internet]2008April[cited on 2012Jan20]:84(2):[about 7 pages].available from:http://www.ncbi.nlm.nih.gov/pnc/articles/PMC2822203
[13]. GO FV, Quan MV, Celentano DD, Moulton LH, Jenilman JM.Prevalence and risk factor for reproductive tract infection among
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[14]. Aggarwal AK,kumar R,gupta V, Sharma M. Community based study of reproductive tract infections on ever married women of
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21 | Page
IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 22-31
www.iosrjournals.org
Perceived health status and adherence to haemodialysis by End
Stage Renal Disease patients: A case of a Central hospital in
Zimbabwe.
Geldine Chirondaᶦ, Ancia Manwere², Rudo. Nyamakura³, Tirivanhu Chipfuwa⁴,
Busisiwe Bhengu ⁵
ᶦ (School of Nursing and Public Health, University of Kwazulu Natal, South Africa), ²(Department of Health
sciences, Bindura University of Science Education, Zimbabwe), ³(Department of Nursing Science, University of
Zimbabwe, Zimbabwe), ⁴ (Department of Health sciences, Bindura University of Science Education,
Zimbabwe), ⁵(School of Nursing and Public Health, University of Kwazulu Natal, South Africa)
Abstract: Poor adherence to haemodialysis among End Stage Renal Disease (ESRD) patients has been a major
problem globally. Perceived physical health appears to be the major contributing factor to poor adherence to
haemodialysis. Improving the adherence to haemodialysis among ESRD patients improves their quality of life. A
descriptive correlational study was conducted to examine the relationship between perceived physical health
and level of adherence to haemodialysis among ESRD patients. The study was conducted at a central hospital in
Harare, Zimbabwe. A total of 85 ESRD patients who met the inclusion criteria were selected using simple
random sampling. Data was collected using an interview schedule with three sections namely: the demographic
data, adherence to haemodialysis and perceived physical health. Descriptive statistics, Pearson’s correlation
coefficient and linear regression were used to analyse the data. Eighty – three (97.6%) demonstrated low
adherence to haemodialysis. Eighty – two (96.5%) perceived their physical health to be average. The Pearson
correlation coefficient (r=-.44 p<.01) showed a weak negative significant relationship. Perceived physical
health had an impact of 19.7% on adherence to haemodialysis (R 2 0.197). The findings predict that as perceived
physical health increase, adherence to haemodialysis decrease among ESRD patients. Medical surgical nurses
should intensify individualized client programmes to correct ESRD clients’ perceptions and identify more
contributory factors to poor adherence to haemodialysis.
Keywords: adherence, end stage renal disease, haemodialysis, perceived physical health.
I.
Introduction
End stage renal disease (ESRD) is the complete or almost complete failure of the kidneys to function at
a level that is necessary for day to day life. In ESRD, renal failure has progressed to the point where kidney
function is less than ten percent of normal (Tolkoff-Rubin, 2008). Louis, Davies, & White (2001) defined ESRD
as a life threatening condition and survival is only with haemodialysis, a form of renal replacement therapy.
According to Tolkoff-Rubin (2008) without haemodialysis death will occur from the build up of fluids and
waste products in the body. End stage renal disease is increasing worldwide at an annual growth rate of 8% and
millions of people around the world suffer from this disease (Ayobiesu & Ayodele, 2005).
The prevalence of kidney disease ( ESRD) is estimated to be 8-16% worldwide and similar estimates of
the burden of Kidney disease has been reported around all continents (Vivekanand, etal, 2013). In Africa, there
is consistent increase in the Incidence of newly diagnosed individuals with ESRD and several studies report a
prevalence of ESRD of about 10% (Naicker, 2009, Singh et al, 2013 & Barsoum, 2013). Poor adherence with
heamodialysis is seen in almost half of the patients treated for ESRD yet heamodialysis is a life saving
procedure for these patients (Richard, 2006). Avu (2009) defined heamodialysis as a procedure that is perfomed
routinely on end stage renal disease patients and involves removing waste substances and fluid that are normally
eliminated by the kidneys from the blood. As with most chronic illnesses, poor adherence to prescribed
heamodialysis regimen is a pervasive problem in the ESRD population (Mitch, 2007). According to Ayobiesu
and Ayodele (2005), poor adherencce is seen in end stage renal disease patients’ undergoing haemodialysis yet
haemodialysis is a life saving procedure for these patients. Therefore, adherence to heamodialysis is most
important in ESRD patients undergoing heamodialysis.
1.2 Problem statement
In Zimbabwe, there appears to be reduced adherence to heamodialysis among ESRD patients. Statistics at
one local haemodialysis unit in Harare, Zimbabwe show that in 2007 and 2008, 55% of ESRD patients adhered
to heamodialysis during the initial month and the adherence levels deteriorated with time. About 20% adhered to
haemodialysis for 2 consecutive months, 8% for 3 consecutive months and none of the patients adhere to
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
heamodialysis for more than 12 consecutive months (Parirenyatwa Hospital Records, 2007-2008). At a second
haemodialysis centre in Harare, almost similar patterns of low adherence to haemodialysis by ESRD patients
were noted for the 2007 to 2008 period. Although 75% of ESRD patients adhered to heamodialysis for 3
consecutive months, 50% adhered for 3 to 6 months and only 37% adhered for more than 6 months (Harare
Haemodialysis Centre Records, 2007 – 2008 unpublished).
The deteriorating adherence rates to this important therapy which calls largely for patients’ motivation are a
cause for concern. Patient’s apparent willingness to follow medication regimens or to adhere to medical
treatment regimens reflects a significant barrier to the effective management of most chronic disorders (Mitch,
2007). However, there are no reliable statistics that describe adherence to dialysis of ESRD patients in all
African countries. However, given the poor socioeconomic status, reduced adherence to haemodialysis seems to
be higher in all African countries. In Nigeria, 70.8% of the patients are able to adhere to dialysis for one month,
12.7% between 3 and 6 months and 5.1% between 7 and 12 moths. Only 1.9% adheres to haemodialysis for
more than 12 months (Barsoum, 2003).
Reduced adherence to heamodialysis has been reported to be the most common cause of failure to respond
to medications and heamodialysis itself (Alebiosu & Ayodele, 2005). Tolkoff-Rubin (2008) further emphasized
that poor adherence to haemodialysis increases the risk of complications in ESRD patients. Complications
include chronic anaemia, brain dysfunction, congestive heart failure, decreased function of white blood cells,
excessive bleeding, infections, weakness of bones and pulmonary complications.Non adherence also leads to
additional and often unnecessary tests, dosage, adjustments, and changes in treatment plan, emergency
department visits and hospitalization which ultimately results in increased cost of medical care (Mitch, 2007).
Several studies have shown that poor adherence with heamodialysis treatment is associated with increased
mortality and morbidity. The mortality risk increases when the serum phosphorus level chronically exceeds
6.5mg/dl (Ayobiesu & Ayodele, 2005). Without adequate dialysis, death occurs from build up of fluids and
waste products in the body (Patel, 2008). According to the 2010 Global Burden of Disease Study, ESRD was
ranked 27th in the list of causes of total number of Global deaths in 1990 with age standardized annual death rate
of 15.7 per 100000, but rose to 18 th in 2010 with annual death rate of 16.3 per 100000 (Lozano, Naghavi &
Foreman, 2013).
In Zimbabwe, a mortality rate of 58% was recorded in the year 2007 to 2008 (Parirenyatwa Renal Unit records,
2008 unpublished). Therefore adherence to haemodialysis of end stage renal disease patients is an area of
concern locally, regionally and globally in medical surgical nursing. The most likely contributing factors to
reduced adherence to haemodialysis appear to be perceived physical health status. Informal observations
indicate that tendencies to omit haemodialysis sessions due to a feeling of well being among ESRD patients at a
central hospital in Zimbabwe appear to be on the increase. Physical health is the overall condition of a living
organism at a given time, the condition of optimal wellbeing and the ability of the body to carry out all the
activities of living (Kagaku, 20006).
It appears end stage renal disease patients have a false sense of well being and deliberately choose not to
report for the next dialysis session until symptoms worsen. The way end stage renal disease patients perceive
and react to their physical health appears to affect their adherence to heamodialysis. Elsevier (2009) stated that
patient’s beliefs about their physical health are important because they influence adherence and adjustment to
heamodialysis. Koudi (2004) expressed similar sentiments and stated that ESRD patients display physical health
disturbances as well as non adherence to heamodialysis treatment.
According to Louise, Davies, & White (2001), complications of end stage renal disease have been found to
have a significant impact on the physical health of these patients. It is well documented that the health status of
end stage renal disease patients is worse than that of the general population. For this reason, assessment of
physical wellbeing of end stage renal disease patients has received considerable attention. In this study, it has
been found important to recognize how well ESRD patients are able to function and how they feel about their
day to day life. Thus, understanding the impact of end stage renal disease and associated heamodialysis
treatment on functioning and wellbeing in physical dimensions of life is essential. Research and documented
evidence on perceived physical health in end stage renal disease patients is critical to medical surgical nurse
practitioners but is lacking in Zimbabwe. Therefore, the investigator sought to characterize perceived physical
health in ESRD population.
Previous studies have implicated perceived physical health as an important correlate of adherence
behaviour in other chronic illnesses groups but little research has examined this relationship in a heamodialysis
population with ESRD. Therefore, the investigator sought to fill this gap by examining the relationship between
perceived physical health and adherence to heamodialysis among end stage renal disease patients. Medical
surgical nurses would therefore disseminate appropriate and relevant information through focused health
education and individual client discussions to foster adherence to haemodialysis thus improving effective
management of the population.
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
1.3 Purpose of the study
The purpose of this study was to examine the relationship between level of adherence to heamodialysis
and perceived health status of ESRD patients at a central hospital in Harare. The study determined and
described the level of adherence to haemodialysis and perceived physical health of ESRD patients prior to
examining the relationship between the two variables.
1.4 Objectives
 To determine level of adherence to heamodialysis among ESRD patients at a haemodialysis centre in
Harare.
 To determine level of perceived physical health of ESRD patients on heamodialysis at a haemodialysis
centre in Harare.
 To examine the relationship between perceived physical health and adherence to heamodialysis among
ESRD patients at a haemodialysis centre in Harare.

1.5 Conceptual framework
The conceptual framework selected for this study was based on Roper, Logan and Tierney’s Activities
of Living Model.
II.
Materials And Methods
The research design used in this study was the descriptive correlational design. The study was
conducted at Parirenyatwa Haemodialysis Centre in Zimbabwe. The haemodialysis centre is situated in a tertiary
referral centre. It was also the only public haemodialysis centre functioning in the country at the time of the
study. Focusing at this haemodialysis centre hence posed a likelihood of capturing ESRD patients from all over
the country. A sample of 85 ESRD adult patients was selected using simple random sampling with replacement
on the basis of inclusion and exclusion criteria. The tool used for this study was the structured interview
schedule consisting of section 1 (Socio-demographic variables such as Age, Gender, Marital status, family
income, Duration of Renal failure illness), Section 11(consisting of 4 items related to adherence to
haemodialysis) and Section 111(consisting of 16 items related to Perceived Physical health). Face-to-face
interview was used to collect data. The content validity of the structured interview schedule was ensured by
submitting the tool to the experts in the field of renal failure and haemodialysis. A pilot study was conducted on
adult ESRD patients who met the inclusion criteria at a Private haemodialysis Centre (Harare Haemodialysis
Centre). Cronbach’s alpha was the psychometric test applied to measure the internal consistency of the
instrument. The reliability of the tool was calculated and it was 0.79.
III.
Results And Findings
A total of eighty-five (n=85) ESRD patients from Parirenyatwa Haemodialysis Centre participated in
the study.
3.1 Section 1: Demographic Characteristics
The age range for the 85 respondents was 19 to 60 years. The mean age was 43.67 years, median age
was 44 years and modal age was 40 years. The age categories are shown in Table 1. The majority of the
respondents 52(61.2%) were male. Thirty six (42.4%) of the respondents had secondary level education,
11(12.9%0 had advanced level education and 33(38.8%) had tertiary level education. The majority of the
respondents 50(58.8%) had no income. Most of the respondents 66(77.6%) had been on haemodialysis for more
than a year (Table 1).
Variable
Age categories (years)
19 -30
31-40
41-50
51-60
Level of Education
Primary
Secondary level
Advanced level
Tertiary level
Gender
Male
Table 1: Demographic Characteristics (n=85)
Frequency (n)
Percentage (%)
7
28
32
18
7.1
32.9
37.6
21.2
5
36
11
33
5.9
42.4
12.9
38.8
52
61.2
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
Female
Duration of haemodialysis
3 months to 1 year
1.5 to 2 years
2.5 to 3 years
3.5 t0 4 years
4.5 to 5 years
More than 5 years
33
38.8
19
19
18
1
10
18
22.4
22.4
21.2
1.2
11.8
21.2
Perceived Physical Health
Table 2 shows that 32(37.6%) of the respondents perceived their health status as poor, 41(48.2%)
perceived it as fair and 1(1.2%) perceived it as very good and excellent respectively. Furthermore, 40 (47.1%) of
the respondents perceived their physical health as worse, 34(40%) perceived it has not changed and 11(13%)
perceived it as better in the past 3 months.
Table 2: Perceived Physical Health (n=85)
Variable
Frequency (n)
Health Status
Poor
32
Fair
41
Good
10
Very good
1
Excellent
1
Physical health compared to 3 months ago
Worse
40
No change
34
Better
11
Percentage (%)
37.6
48.2
11.8
1.2
1.2
47.1
40.0
13.0
Perceived Physical Health (Activities of Daily Living)
Table 3 shows that most of the respondents 71(83.5%) perceived themselves as having problems with
elimination, mobilisation 51(60.0%), sleeping 51(60.0%), resting and working 51(60.0%) and eating and
drinking 51(60.0%).
Table 3: Perceived Physical Health (Activities of Daily Living) (n=85)
Variable
Frequency (n)
Percentage (%)
Problems with Elimination (urination)
Most of the time
71
Some of the time
9
A little of the time
1
I never do
4
Problems with Mobilization
Most of the time
51
Some of the time
18
A little of the time
8
I never do
8
Problems with Sleeping and Resting
Most of the time
51
Some of the time
21
A little of the time
7
I never do
6
Problems with Working
Most of the time
51
Some of the time
21
A little of the time
7
I never do
6
Problems with Cleansing Personal
and Dressing
Most of the time
26
Some of the time
38
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83.5
10.6
1.2
4.7
60.0
21.2
9.4
9.4
60.0
24.7
8.2
7.1
60.0
24.7
8.2
7.1
30.6
44.7
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
A little of the time
I never do
Problems with eating and drinking
Most of the time
Some of the time
A little of the time
I never do
8
13
9.4
15.3
59
16
3
7
69.4
18.8
3.5
8.2
Perceived physical health
Total perceived physical health scores ranged from 25 to 53 out of the possible score of 67. The
majority of the respondents 53 (62.4%) perceived their physical health as poor by scoring below the average
perceived physical health score of 33.5. Only 3(3.5%) perceived their physical health to be good (Table 4).
Score
25
26
27
28
29
30
31
32
33
34
35
36
38
39
41
42
44
45
46
48
49
53
Table 4: Total perceived physical health scores out of 67
Frequency (n)
5
5
5
6
5
7
3
6
11
6
5
3
3
3
2
4
1
1
1
1
1
1
Percentage (%)
5.9
5.9
5.9
7.1
5.9
8.2
3.5
7.1
12.9
7.1
5.9
3.5
3.5
3.5
2.4
4.7
1.2
1.2
1.2
1.2
1.2
1.2
Adherence to Haemodialysis
Table 5 shows that 6(7.1%) of the respondents attended haemodialysis sessions all the time and the
majority 52(38.9%) missed most of the haemodialysis sessions.
Table 5: Adherence to Haemodialysis (n=85)
Variable
Frequency (n)
Extent of attending Haemodialysis
Sessions in the past 3 months
All the time
6
Missed a few sessions
27
Missed most of the sessions
52
Rescheduled prescribed haemodialysis
Sessions in the past 3 months
None
1
Once
27
Twice
48
More than twice
9
Immediate arrangements for haemodialysis
Sessions after missing in the past 3 moths
Always
55
Sometimes
22
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Percentage (%)
7.1
31.8
61
1.2
31.8
56.5
10.6
64.7
25.9
26 | Page
Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
Never
8
9.4
Reasons for Non-adherence to Haemodialysis
Table 6 shows that the majority of the respondents 44(51.8%) agreed that they did not adhere to
haemodialysis because they were feeling physically fit and 30(35.3%) reported that it was not necessary to
follow haemodialysis schedules because of feeling generally well.
Table 6: Reasons for Non-adherence to Haemodialysis (n=85)
Reason
Frequency (n)
Percentage (%)
Missed haemodialysis session
Because of feeling physically fit
Not at all
13
15.3
Slightly agree
18
21.2
Agree
44
51.8
Strongly agree
10
11.8
Not necessary to follow haemodialysis
Schedule because of feeling generally well
Not at all
16
18.8
Slightly agree
23
27.1
Agree
30
35.3
Strongly agree
16
18.8
Total Adherence score
The highest total adherence score was 11 and the lowest score was 0. A score of 0 meant nonadherence at all and a score of 11 meant excellent adherence. Table 7 shows that the highest attained total
adherence score was 10 out of 11 and this was achieved by only 1(1.2%) of the respondents. Eighty-three
(97.6%) of the respondents had a score of 8 and below out of the possible 11 scores demonstrating low levels of
adherence to haemodialysis (Table 7).
Score
1
2
4
5
6
7
8
9
10
Table 7: Total Adherence score out of 11
Frequency (n)
1
1
7
25
28
11
10
1
1
Percentage (%)
1.2
1.2
8.2
29.4
32.9
12.9
11.8
1.2
1.2
Relationship between Perceived Physical Health and Adherence to Haemodialysis
The results shows a weak negative correlation (r= -0.44, p˂.01). Therefore, as people perceive their
physical health as getting better, adherence to haemodialysis slightly decreases. A linear regression result shows
that R2 is 0.197 which means that the effect of perceived health status accounts for 19.7% of the variance in
adherence to haemodialysis.
IV. Discussion
This study was to examine the relationship between perceived physical health status and adherence to
haemodialysis of ESRD patients. This will help nurses identify gaps in their health education on patients on
haemodialysis. The ultimate goal is to improve patients’ adherence to haemodialysis hence effective
management of ESRD population, consequently their quality of life.
4.1 Sample demographics
The sample demographics related to gender showed that more males 52(61.2%) presented with end
stage renal disease than females 33(38.8%). These findings are in contrast with Cucor, (2007), Cater, Coons,
Mapes, Kallich & Hays (2004), who noted that there are more females on heamodialysis with end stage renal
disease than males. According to Cucor (2007), women composed 53% of the sample while men composed 47%
of their sample.
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
The study showed that age ranged from nineteen years 19 to 60 years with the mean age of 43.67,
median age of 44 and modal age of 40. These results reinforce the study by Hanly (2006) which showed that the
mean age for end stage renal disease patients on heamodialysis was 44.1 and median age was 43 years. On the
contrary, Najma, Minhas, Aslam, Abbas and Asad (2005) had an average age for ESRD patients on
heamodialysis as 66 and the age ranged from 60 to 70 years. This difference could be a result of rising
prevalence of diseases causing ESRD such as hypertension and diabetes among the younger generation in the
developing countries.
Results of this study also showed that 5(5.9%) had attained the primary seven years of education and
below, 80(94%) had attained at least two years in high school. This showed higher prevalence of ESRD among
the educated patients. These results are similar to those of Nizam (2005) which showed that 53.3% had
education above matriculation whereas 46.7% were below matriculation. However, higher level of education
enables an individual to be literate, understand health education and health instructions. According to Golper
(2002), low education level may lead to decreased adherence to heamodialysis and poor correlation with
knowledge of disease
On income, 50(58.8%) did not have any income. In most of developing countries, the patient provides
bulk of the funds for heamodialysis therapy whereas in developed countries, the costs of heamodialysis are
borne by the government (Alebiosu & Ayodele, 2005).The current situation in Zimbabwe is such that ESRD
patients are paying for heamodialysis. This situation makes heamodialysis treatment unavailable to all patients
thus reducing heamodialysis adherence and adequacy to end stage renal disease patients.
Concerning duration of illness on heamodialysis, the results showed that m;mmk 19(22.4%) had end
stage renal disease for 3 months to 1 year, 19(22.4%) had end stage renal disease for 1 to 2 years, 18(21.2%) had
end stage renal disease for 2 to 3 years, 1(1.2%) had end stage renal disease for 3 to 4 years, 10(11.8%) had end
stage renal disease for 4 to 5 years and 18(21.2%) had end stage renal disease for more than 5 years. Duration of
disease or treatment is a determinant of adherence to heamodialysis in end stage renal disease patients. Cramer
(1991) did a study and found out that adherence wanes with longer treatment. Treatment of end stage renal
disease by heamodialysis is a lifelong saving procedure and adherence to heamodialysis might be affected by
duration of end stage renal disease.
4.2 Perceived Health Status
The results of the perceived physical health questionnaire were attempting to establish perception of
physical health among end stage renal disease patients attending heamodialysis at Parirenyatwa hospital a
Central Hospital in Zimbabwe. Thirty-two respondents (37.6%) perceive their health as poor and 41(48, 2%)
pereceived their health as fair. Only 12 (14%) of the respondents perceived their physical health status as at least
good. Only 11 (13%) of the respondents perceived their health as improved in the past 3 months while the rest
perceived their health as having remained static or had worsened. A total score of 67 points was the highest
possible score expected in this study. According to the perceived physical health questionnaire, the mean score
was 33.11.The results show that, the majority 53(62%) of respondents had total perceived physical health scores
below the mean and 32(38%) had total perceived physical health scores above the mean. According to the scale
developed by the investigator, 82(96, 5%) of respondents perceived their physical health as average. The
perceived physical health scores were assessed according to categories of general perception of physical health,
how perceived physical health affect activities done on a typical day, how physical health affect activities of
daily living and to what extent had perceived physical health affected adherence to heamodialysis.
From the above results it is clear that ESRD patients had a fair perception of their physical health
status. Activities of living are known to be greatly deranged and the patient is far from being independent in the
performance of activities of living. These results support the findings by Kouidi (2004), who found out that
ESRD patients have low functional capacity and physical limitations. According to Davies (2001), it is well
documented that the physical health status of end stage renal disease is worse than that of the general healthy
population. Noam et al (2005) also reinforced that patients with end stage renal disease perceive themselves as
being unwell, physical health impaired due to heamodialysis and having reduced quality of life.
Sanjeek, Mittal & Lori (2009), did a cohort study on self assessed physical function of heamodialysis
patients. The study sought to evaluate the physical function in heamodialysis population as compared to the
general population and other chronic illnesses. The results of the study showed that physical function in end
stage renal disease patients is lower than in most other chronic illnesses. These findings also supported the study
results.
In relation to how perceived physical health affect activities done on a typical day, the results showed
that, 83(97.6%) are limited a lot by their physical health in performing vigorous activities such as lifting heavy
objects and participating in strenuous sports. Morais (2004), suggested that because of signs and symptoms of
end stage renal disease and heamodialysis, we need to understand that end stage renal disease patients suffer
several physical limitations including limitations in performing vigorous activities, moderate activities, walking
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
more than a kilometer and lifting of heavy objects and groceries. Therefore, the present study findings concur
with the results from Morais (2004). Kouide (2004) concurs as his findings confirmed that ESRD patients have
low functional capacity and physical limitations in their daily activities.
Kirsten (2001) conducted a study to estimate physical activity and functioning in ESRD patients.
Results showed that ESRD patients on heamodialysis are less physically healthy than persons with normal
kidney function. On personal cleansing and dressing, 26(30.6%) reported having problems most of the time.
The results showed that some end stage renal disease patients generally have problems in personal cleansing and
dressing. Bezerra, Piantino & Morais (2005) also found out that end stage renal disease patients usually presents
with deficits in personal cleansing and dressing due to altered physical health. According to Mitch (2007),
symptoms in end stage renal disease that affects personal cleansing and dressing includes, drowsiness, fatigue,
general ill feeling, and muscle cramps. ESRD patients are therefore physically ill and they usually don’t have
the energies to bath and dress themselves, therefore need to be assisted.
Eating and drinking also posed challenges to most study participants in the present study. Fifty – nine
(69.4%) reported having difficulties most the time. According to Mitch, 2007, eating and drinking in end stage
renal disease patients is affected by changes in dietary plans, restrictions in some type of food intake and
restrictions in fluid intakes. Symptoms of ESRD that affects eating and drinking includes poor appetite, nausea,
vomiting and bad breadth. On elimination, 71(83.5%) reported having problems with associated with urination
most of the times. Due to the pathologic process of ESRD patients continue to suffer elimination problems
(Mitch, 2007). Elimination plays a major role in the everyday life. That is why ESRD patients have to be
adherent to haemodialysis for the rest of their life to get rid of toxic substances in the body.
Concerning mobilization, 51(60%) reported having problems most of the time, 18(21.2%) reported
having problems some of the time, 8(9.4%) reported having problems a little of the time and 8(9.4%) reported
never having problems with this activity. According to the study results, 92% of end stage renal disease patients
exhibit signs of altered mobility in carrying out their daily chores. Tedsco (2006) stated that most end stage
renal disease patients are usually limited in body movements such as walking, jogging, exercising and carrying
of groceries. This study reinforced these previous findings. According to Mitch (2007) symptoms of ESRD that
affect mobility include weakening of the bones, joint disorders, and poor muscle tone and tissue swellings.
Fifty – one (60%) reported having sleep problems most of the time. The prevalence of sleep disorders
is high and this may contribute to an impaired quality of physical health (Mucen, Boisteau, Wirth & Covic,
2007). It is also evident that sleep disorders are more frequent in heamodialysis populations than the general
population (Sakkas, 2008). These two studies support the study findings which are showing high rate of sleep
problems. Sleep disturbances are a possible consequence of the long process of ESRD and the exposure to the
uremia milieu.
The high percentage of respondents with problems associated with working, 64(75.3%) support earlier
findings by Mitch (2007). According to Mitch (2007), ESRD patients exhibit symptoms that affect patients’
ability to work and these include, muscle cramps, fatigue, pain, headaches, general body weakness and poor
appetite among other things.
4.3 Adherence to Haemodialysis
Seventy-nine (93%) respondents had missed at least one session with 52 respondents (61%) missing
most of the scheduled sessions and only 6 (7%) attending all the haemodialysis sessions as scheduled. Fiftyseven (67%) had rescheduled the prescribed haemodialysis sessions more than once. This confirms the findings
by Tolkoff-Rubin (2008) that patient’s non adherence to prescribed heamodialysis regimen is a pervasive
problem in the end stage renal disease population.
Patient’s apparent unwillingness to follow medication regimens or to adhere to medical treatment
regimens more generally reflects a significant barrier to the effective management of most chronic disorders. As
a result, prevalence of non adherence is estimated to be 50% or higher among patients following chronic
medical regimens (Mitch, 2007). This has been shown in this study were more than 50% of patients were not
adherent to scheduled heamodialysis plan. Zimbabwe is a developing country and epidemiologic studies showed
that adherence to heamodialysis is generally lower in developing countries than in the industrialized world
(Remmuzi, 2000). The results confirmed lower adherence to heamodialysis in Zimbabwe. On the contrary,
Bleyer, Hylander & Sudo (1999) reported that missed dialysis treatments were virtually nonexistent in Japan,
Sweden and only 2.3% of dialysis treatments were missed by patients in the United States of America. Although
many factors may contribute to these differences, emphasis on patient independence in the USA might be a
positive factor.
Adherence to heamodialysis remains a major problem in Zimbabwe and this also affects families and
medical surgical nursing. Consequences of inadequate adherence pose more problems to the end stage renal
disease patient, medical surgical nurses, families and society as a whole.
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
4.4 Perceived Physical Health and Adherence to Haemodialysis Among ESRD Patients
Fifty-three (63%) agreed to missed haemodialysis sessions because of feeling physically fit and 46
(54%) agreed that it was not necessary to follow prescribed haemodialysis schedule. The results showed a weak
significant weak negative correlation (r=-.44 p<.01) between perceived physical health and adherence to
heamodialysis among end stage renal disease patients. As perceived physical health increases in the end stage
renal disease patients, adherence to heamodialysis decreases.
Regression analysis showed R2 of .197 which shows the impact or effect of the independent variable
(perceived physical health) on the dependent variable (adherence to haemodialysis). The effect of the
independent variable accounts for 19.7% of the variance in adherence to haemodialysis. Therefore, 19.7% of the
changes in adherence to haemodialysis are due to perceived physical health. The significant negative effect (b= .104, p<.01) represents a change in adherence for every unit change in perceived physical health. The significant
standardized coefficient b (-.44 p <.01) indicates the relevant importance of perceived physical health as an
independent variable. The bigger the value, the more important the independent variable is in terms of its
contribution towards the dependent variable. Perceived physical health is therefore less important in terms of its
contribution towards adherence to haemodialysis in this study sample.
The findings of this study are reinforced by Mapes, Gresham & Bommer (2004). These
investigators showed that perceived physical wellbeing of end stage renal disease patients have been seen to
affect their adherence to heamodialysis. Elsevier (2009) concurred and further stated that patient’s beliefs about
their physical health are important because they influence adherence and adjustment to heamodialysis. A study
by Obialo, Hunt, Bashir and Zanger (2012)which revealed that non-adherence was more prevalent in younger
patients who may feel they are physically healthier than the older patients thus can get away with missed
haemodialysis sessions, also supporst results of this study. However, the present study results contrast with
those by Koudi (2004) who found out that ESRD patients display physical health disturbances as well as non
adherence to heamodialysis treatment.
V. Nursing Implications
5.1 Nursing Practice
It appeared that lower adherence to heamodialysis was partially due to false sense of good physical
health among end stage renal disease patients. If this situation is not addressed the positive effects of
haemodialysis will not be realized. More and more patients will continue to deteriorate and even require more
aggressive therapies. The more aggressive therapies may entail more dialysis hours per week or use of stronger
dialysate solutions. Both these strategies call for more resources as well as increasing workload on the nurses.
5.2 Nursing Education
The study equips practising nurses with adequate knowledge on subtle areas pertaining to ESRD
patients’ perceptions and behaviours. Medical surgical nurses need to be given adequate evidence based
knowledge to enable them to appropriately address ESRD patients’ issues.
5.3 Nursing Research
A significant but weak negative correlation was found between perceived physical health and
adherence to heamodialysis. Perceived physical health only explained 19.7% of the variance in adherence to
haemodialysis. There should be more contributory factors leading to varying adherence levels among ESRD
patients. Important implications to nursing research are inevitable as nursing research is called for to set up more
inquiry into the major contributory factors to dialysis adherence problems among ESRD patients.
5.4 Nursing Administration
Nurse Administrators are the backbone for providing facilities to improve knowledge on the
importance of adhering to the prescribed haemodialysis. Administrative policies should be formulated at the
large scale to address issues that affect adherence to haemodialysis.
VI.
Conclusion
The level of adherence to heamodialysis was low for 83 (97.6%) of participants. In addition, 82
(96.5%) of participants perceived their physical health to be average. Pearson correlation analysis showed a
weak negative correlation (r = .44, p<.01) of perceived physical health and adherence to heamodialysis among
ESRD patients. The results imply that to a small extent, as the level of perceived physical health increases,
adherence to heamodialysis decreases. The weak relationship between the study variables was further supported
by a linear regression analysis which showed perceived physical health can only explain 19.7% of the variance
on adherence to haemodialysis.
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Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 32-40
www.iosrjournals.org
Mother’s Education and her Knowledge about Home Accident
Prevention among Preschool Children in Rural Area in Sharkia
Governorate
Amirat Ali El-Sabely1, Abd El-Aziz Ismail Yassin2 , and Salwa Ahmed Zaher 3
1
Department of Pediatric health Nursing, Faculty of Nursing, Zagazig University, Egypt
2
Department of Community Medicine, Faculty of Medicine, Tanta University, Egypt
3
Department of Nursing, College of Applied Medical Science, Salman Bin Abd El-Aziz University, Saudi
Abstract: Unintentional injury remains the leading cause of morbidity and mortality among children worldwide.
The aim of this study was to describe the mother’s education and her knowledge in relation to home accidents
prevention in rural area in Sharkia Governorate. Study design, a cross-sectional descriptive study design was
adopted in this study. The sample size was 150 mothers from Kafr Mohsen village, this number was drawn by a
systematic random by visiting every 5 house in the village, those mother’s were inter-viewed in their homes
through home visits. Structured interview sheet was developed based on relevant literature ,it contained the
following data: A) The first part included socio-demographic characteristics of the families as mother's age,
educational level, occupation, family size and number of children .B) The second part included mother
knowledge towards home accidents among children and its occurrence, types and mother’s knowledge regarding
causes of home accidents. C) The third part included mother’s practice or first aid measures she followed
towards her child in case of exposure to any type of home accidents. The study result indicated that, the mean
age of the mothers was (34.1±9.6) years. Regarding educational level, 33.3% had completed university
education, while 25.3% of them were illiterate. Occupational status showed that more than one half of the
studied mothers (58%) didn’t work, while 14% worked as health care personnel. 61.3% were of middle socio
economic status. More than half of the injured children (59.3%) were aged 3years or less, over half of them
(58.7%) were males. The majority of the mothers (84.7%) reported that the child had suffered an injury at home.
Cut/wound represented the highest percentage of home injury (37.3%) followed by fall (29.3%), burn (12%),
animal bite (3.3%) then poisoning (1.3%). The study revealed that the majority of mothers (80%) heard of the
term of first aid and the main source of their knowledge was from "radio and television" (24%) then "doctors
and nurses" (15.3%) , "part of curriculum" nearly(14%) and the lowest source was from "books" (6.7%). More
than half of the studied mothers (55.3%) did not have any knowledge about the causes of home accidents. the
relation between mother's age and her knowledge regarding causes of home accidents was proved to be
statistically non significant (p>0.05). mother's knowledge regarding causes of home accidents increased with
increasing educational level. The relation was proved to be statistically significant (p<0.001).The conclusion of
this study revealed that, well educated mothers will use the proper first aid. So there is need for parent’s
educational programs especially mothers with preschool children about home accidents and how to manage.
Key words: Mother’s Education, Home Accident Prevention , Preschool Children
I.
Introduction
Injuries and accidents are the leading causes of death in children worldwide (Krug et., al 2000).
Children are prone to unintentional injuries and are at a higher risk of experiencing injuries, because their bodies
are developing and they have not yet learned to be aware both of themselves and various environmental dangers
(Bruce and McGrath, 2005). In Egypt too it has become a concern. For example, in 1998 the overall rate of
injuries in the indoor home environment was 72.5% among children below age 5 years (Amin et., al, 1998). The
incidence of home accidents among children under 6 years in Assuit governorate in the year 2003 as perceived
by their mothers was 50.3% (Abd El-Aty et al, 2005). According to the National Safe Kids Campaign in the
United States, 40% of deaths and 50% of non-fatal unintentional injuries occur in and around the home (National
Safe Kids Campaign, 2012). A child's environment plays a critical role, both in the occurrence and the severity of
an injury. Most injuries take place in or near a child's home (WHO Issue Brief Series, 2013). The most Common
injuries include: drowning, falls, fires or burns, poisoning, suffocation, and transportation-related injuries (
Home Accident Presentation Strategy & Action Plan 2004 – 2009). Prevention and control of home accidents
among children has been recently a target and very important area for health promotion(Abd El Wahed, et al.,
2000) . First aid is the provision of initial care for an illness or injury, usually by a non-expert but trained person,
until medical treatment can be accessed. Provision of immediate first aid to patients who require emergency care
can make a big difference to the outcome [Tomruk et al, 2007], as the first action taken for management of
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
injuries and common illness decides the future course of disease and complication rates [Hecht , 2012]. Parents’
knowledge and practice about first aid is especially important in injury care for children, as many adverse
consequences of injuries can be averted if parents know what actions to take, (Ibrahim , 1991). It is a true saying
that education improves people’s ways of life and gives way for enlightenments, (National safe kids
campaign,(2000). Ignorance and negligence of the mother are the fundamental causes of accidents. So it is
important to improve the mother knowledge, attitude and practice to prevent accidents at home. Education is an
important nursing role and was the primary intervention strategy chosen to address and prevent childhood home
injuries. The nurse will try to ensure that people know how to prevent accidents and injuries in their
communities, at homes, schools and work places.
Aim of the study:
This study aimed to describe the effect of mother’s education and her knowledge about home accidents
prevention among preschool children in rural area in Sharkia Governorate.
Research question:
What is the relation between mother’s education and her knowledge about home accidents prevention?
II.
Subject And Methods:
Design:
A cross-sectional descriptive study was adopted in this study to describe the effect of mother’s
education and age in relation to home accident prevention among preschool children in rural area in Sharkia
Governorate.
Setting:
The study was conducted at Kafr Mohsen village in Sharkia Governorate
Subjects:
The sample size was 150 mothers from Kafr Mohsen village, this number was drawn by a systematic random
by visiting every 5 house in the village, those mother’s were inter-viewed in their homes through home visits.
Tools:
Structured interview sheets was developed based on relevant literature to describe the effect of mother’s
education and age in relation to home accidents prevention, it contained the following data:
A) The first part:
It included socio-demographic characteristics of the families as mother's age, educational level,
occupation, and family size.
B) The second part:
It included mother’s knowledge towards home accidents among children and its occurrence, types and
mother’s knowledge regarding causes of home accidents.
C) The third part:
It included mother’s practice or first aid measures she followed towards her child in case of exposure to any type
of home accidents.
Pilot Study:
A pilot study was carried out before performing the actual study on ten mothers in order to test the validity and
clarity of the tools items as well as to estimate the time needed for data collection, the necessary modifications
were done, and those participants were excluded from the sample.
Methods:
1- Ethical approval:
A written informed consent (in Arabic language) was obtained from mothers before participation.
2- Data collection technique:
Data collected through home visits by interviewing every mother individually at her home to identify her
knowledge and practice towards home accidents prevention. The average number interviewed was 3-5 cases per
day and average time taken for completing each sheet was around 20- 30 minutes, this was depending on the
response of the mothers
III.
Study period:
Data was collected over a period of two months (July & August 2013).
1.1.
Statistical methods
The collected data were tabulated and analyzed using SPSS statistical package version 20. Qualitative variables
were presented as frequencies and percentages. Chi-square test was used to test significance. Significance level
used was 0.05.
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
IV.
Results
TABLE-1
Distribution of the mothers by selected socio demographic characteristics
characteristics
Mother’s age:
< 25 years
25 - < 35
35 - < 45
≥ 45
No= 150
Percent
29
53
46
22
19.3
35.3
30.7
14.7
34.1± 9.6
Mean±SD
Mother’s education:
University education
Secondary education
Preparatory education
Read & write
Illiterate
Mother’s occupation:
Working at health sector
Other jobs
Not working
Family size
Three members
Four members
Five members
Six members
Seven or more members
Socioeconomic status
High
Middle
Low
50
41
11
10
38
33.3
27.3
7.3
6.7
25.3
21
42
87
14.0
28.0
58.0
57
35
28
17
13
38.0
23.3
18.7
11.3
8.7
19
92
39
12.7
61.3
26.0
Table 1 show that the mean age of the mothers was (34.1±9.6) years. Regarding educational level, 33.3% had
completed university education, while 25.3% of them were illiterate. Occupational status showed that more than
one half of the studied mothers (58%) didn’t work, while 14% worked as health care personnel. According to
family size, the present study showed that 38% of families had three members and 61.3% were of middle socio
economic status.
TABLE-2
Distribution of the studied sample of mothers and their children suffering injury by their age,
sex, and type of injury
Variable
Child’s age (years)
≤ 3 years
3 ≤ 6 years
Child’s sex
Male
Female
Occurrence of home accidents:
Occurred
Not Occurred
Types of home accidents:
Cut / Wound
Fall / Fracture
Burn
Poisoning
Choking
Animal bite
Not occurred
Heard about first aids
Yes
No
Source of knowledge
From books
Part of curriculum
Friends and relatives
Doctors and nurses
Radio and television
Attend training periods
Not hearing
No= 150
Percent
89
61
59.3
40.6
88
62
58.7
41.3
127
23
84.7
15.3
56
44
18
2
2
5
23
37.3
29.3
12.0
1.3
1.3
3.3
15.3
120
30
80
20
10
21
17
23
36
13
30
6.7
14.0
11.3
15.3
24.0
8.7
20.0
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
Table 2. reveals that more than half of the injured children (59.3%) were aged 3years or less, over half of them
(58.7%) were males. The majority of the mothers (84.7%) reported that the child had suffered an injury at home.
Cut/wound represented the highest percentage of home injury (37.3%) followed by fall (29.3%), burn (12%),
animal bite (3.3%) then poisoning (1.3%). The study revealed that the majority of mothers (80%) heard of the
term of first aid and the main source of their knowledge was from "radio and television" (24%) then "doctors
and nurses" (15.3%) , "part of curriculum" nearly(14%) and the lowest source was from "books" (6.7%).
TABLE-3
Distribution of the mother's knowledge regarding to cause of home accidents in studied sample
Table 3 illustrates that more than half of the studied mothers (55.3%) did not have any knowledge about the
causes of home accidents.
Mother’s knowledge regarding causes
of home accident
Know
Do not know
No= 150
Percent
67
83
44.7
55.3
TABLE-4
Distribution of mother's knowledge regarding their practices toward different types of home accidents
Mother's practice
Fracture:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one approach
5- Don’t know
Wound:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one approach
5- Don’t know
Bleeding:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one approach
5- Don’t know
Choking:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one approach
5- Don’t know
Poisoning:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one approach
5- Don’t know
Animal bites:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one approach
5- Don’t know
Burn:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one approach
5- Don’t know
No.= 150
Percent
47
0
1
60
42
31.3
0.0
0.7
40.0
28.0
6
0
4
100
40
4.0
0.0
2.7
66.6
26.7
0
0
0
78
72
0.0
0.0
0.0
52
48
30
2
18
24
76
20.0
1.3
12.0
16.0
50.7
31
0
25
38
56
20.7
0.0
16.7
25.3
37.3
19
0
8
45
78
12.7
0.0
5.3
30
52.0
22
0
11
76
41
14.7
0.0
7.3
50.7
27.3
Table 4 Shows that in case of fracture, about one third of mothers (31.3%) went to hospital& two fifth of them
(40%) practiced more than one approach. Regarding mothers practice in case of wound slightly more than two
thirds of mothers (66.6%) used more than one method. According to mother’s practice in case of bleeding, it was
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
clear that slightly more than half of mothers (52%) used more than one method while 48% of them didn’t know
what to do in case of bleeding. As regards mother’s practice in case of choking it was clear that nearly half of
mothers (50.7%) didn’t know what to do and 20% of them went to hospital. Concerning mother’s practice in case
of poisoning and animal bite, it was found that the highest percentage of mothers didn’t know what to do (37.3%
and 52%) respectively. As regards mother’s practice in case of burn, 50.7% of them used more than one method.
TABLE-5
Relation between mother’s education and her practice in case of poisoning and choking in studied sample
Mother's practice
Poisoning:
1- Go to hospital
2- Counsel relatives
3-Traditional method
4- More than one method
5- Don’t know
6- total
P-value
Choking:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one method
5- Don’t know
6- Total
Mother's education
Preparatory
Secondary
No.
%
No.
%
Illiterate
No.
%
Read&write
No.
%
4
0
3
1
30
38
10.5
0.0
7.9
2.6
78.9
100
4
0
2
1
3
10
40
0.0
20
10
30
100
4
0
4
1
2
11
36.4
11
0.0
0
36.4
8
9.1
9
18.2
13
100
41
0.001
26.8
0.0
19.5
22
31.7
100
8
0
8
26
8
50
16
0.0
16
52
16
100
31
0
25
38
56
150
5
1
2
1
29
38
13.2
2.6
5.3
2.6
76.3
100
3
0
1
0
6
10
30
0
10
0
60
100
3
0
0
2
6
11
27.3
0
0
18.2
54.5
100
26.8
0
14.6
7.3
51.2
100
8
1
9
18
14
50
16
2
18
36
28
100
30
2
18
24
76
150
11
0
6
3
21
41
University
No.
%
Total
0.001
P-value
Table 5 clears that more than three quarters of illiterate mothers (78.9%) did nothing regarding poisoning while
more than half of highly educated mothers (52%) practiced more than one method. The difference between
mothers education and practice regarding poisoning was proved to be statistically significant (p value >0.001).In
case of choking more than three quarters (76.3%)of illiterate mothers did nothing, while more than one third of
highly educated mothers(36%) did more than one method. The difference was statistically significant (p value
>0.001).
TABLE-6
Relation between mother’s education and her practice in case of burn and fracture in studied
sample
Mother's practice
Burn:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one method
5- Don’t know
6- Total
P-value
Fracture :
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one method
5- Don’t know
6- Total
Mother's education
Preparatory
No.
%
Illiterate
No.
%
Read & write
No.
%
1
0
2
6
29
38
2.6
0.0
5.3
15.78
76.3
100
2
0
2
4
2
10
20
0.0
20
40
20
100
3
0
2
5
1
11
13.2
0
0
7.9
78.9
100
5
0
0
2
3
10
50
0
0
20
30
100
6
0
0
2
3
11
5
0
0
3
30
38
Secondary
No.
%
University
No.
%
Total
27.3
0.0
18.2
45.5
9.1
100
0.001
11
0
2
21
7
41
26.8
0.0
4.9
51.2
17.1
100
5
0
3
40
2
50
10
0.0
6
80
4
100
22
0
11
76
41
150
54.5
0
0
18.2
27.3
100
18
0
1
16
6
41
43.9
0
2.4
39
14.6
100
13
0
0
37
0
50
26
0
0
74
0
100
47
0
1
60
42
150
P-value
0.001
Table (6) shows that about three quarters of illiterate mothers (76.3%) did nothing regarding care of burn, while
(80%) of highly educated mothers practiced more than one method. The relation between mothers education and
practice regarding burn was proved to be statistically significant (p value >0.001). In case of fracture, more than
three quarters (78.9%) of illiterate mothers did nothing, while about three quarters of highly educated mothers
(74%) did more than one method and the relation between mothers education and practice regarding fracture
was proved to be statistically significant (p value >0.001).
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
TABLE-7
Relation between mother's education and her practice in case of wound and bleeding in studied sample
Mother's practice
wound:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one method
5- Don’t know
6- Total
P-value
Bleeding:
1- Go to hospital
2- Counsel relatives
3- Traditional method
4- More than one method
5- Don’t know
6- Total
P-value
Mother's education
Preparatory
No.
%
Illiterate
No.
%
Read write
No.
%
0
0
0
9
29
38
0
0.0
0
23.7
76.3
100
0
0
0
8
2
10
0
0.0
0
80
20
100
0
0
0
9
2
11
0
0
0
6
32
38
0.0
0.0
0.0
15.8
84.2
100
0
0
0
3
7
10
0.0
00.
0.0
30
70
100
0.001
0
0
0
8
3
11
Secondary
No.
%
University
No.
%
Total
0
0.0
0
81.8
18.2
100
0.001
5
0
3
28
5
41
12.2
0.0
7.3
68.3
12.2
100
1
0
1
46
2
50
2
0.0
2
92
4
100
6
0
4
100
40
150
0.0
0.0
0.0
72.7
27.3
100
0
0
0
23
18
41
0.0
0.0
0.0
56.1
43.9
100
0
0
0
38
12
50
0.0
0.0
0.0
76
24
100
0
0
0
78
72
150
Table (7) shows that more than three quarters of illiterate mothers (76.3%) did nothing regarding care of wound,
while the majority (92%) of highly educated mothers practiced more than one method. The relation between
mothers education and practice regarding wound care was proved to be statistically significant (p value >0.001).
Regarding care of bleeding (84.2%) & (70%) of illiterate and "read and write" mothers did nothing, while more
than three quarters of highly educated mothers (76%) did more than one method. The relation between mothers
education and practice regarding bleeding was proved to be statistically significant (p value >0.001).
TABLE-8
Table (8): Relation between mother's education and her practice in case of animal bites in studied
sample
Mother's practice
Animal bite :
1- Go to hospital
2- Counsel relatives
3-Traditional method
4- More than one method
5- Don’t know
6- Total
P-value
Illiterate
No.
%
7
0
0
1
30
38
18.4
0.0
0.0
2.6
78.9
100
Read & write
No.
%
3
0
1
2
4
10
30
0.0
10
20
40
100
Preparatory
No.
%
2
0
0
2
7
11
18.2
0.0
0.0
18.2
63.6
100
0.001
Secondary
No.
%
4
0
2
13
22
41
9.8
0.0
4.9
31.7
53.7
100
University
No.
%
3
0
5
27
15
50
Total
6
0.0
10
54
30
100
19
0
8
45
78
150
Table (8) clears that (78.9%) & (63.6%) respectively of illiterate and preparatory mothers did nothing regarding
animal bite, while more than half (54%) of highly educated mothers practiced more than one method. The
relation between mothers education and practice regarding animal bite was proved to be statistically significant
(p value >0.001).
Figure - 2
Relation between mother’s education and her knowledge regarding causes of home accidents
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
Figure 2. Shows that mother's knowledge regarding causes of home accidents increased with increasing
educational level. The relation was proved to be statistically significant (p<0.001).
Figure 3
Relation between mother’s education and her hearing about first aids
Figure3. The proportion of mothers hearing about first aid increased with increasing educational level. The
relation was proved to be statistically significant (p<0.001)
V.
Discussion
The first five years are considered as a critical period of life where the child learns to investigate and
react with his surrounding and they have curious move too much (Wong et al., 1999). Preschool children
accidents are an important cause of injuries and deaths so that accidents among children under the age of five
years are important problems that need active reduction intervention. So the aim of the present study was to
describe the effect of mother’s education in relation to home accidents prevention in rural area in Sharkia
Governorate.
The present study revealed that more than half of mothers (58%) were not working. This finding agrees
with (Hussein, 2009), (Abd El-Aty., et al, 2005) and (Ibrahim, 2004) who mentioned that the majority of mothers
were housewives and the home accidents rate was high among their children
Regarding the mother’s age, it was found that the highest percentage of mothers (35.3%) were in age group of 25
- < 35 years. This finding contradicted with (Hussein, 2009) who found that less than half mothers (45.3%)
were in age group of 25 – 29 years. The present study revealed that nearly one quarter (25.3%) of mothers were
illiterate and this finding contradicted with (Hussein, 2009) who found in his study more than half of mothers
(52.6%) were illiterate . This difference may be related to the systematic random selection of the sample.
The results showed that the incidence of home accidents among children in a rural area in Egypt was 84.7%. This
result nearly agrees with study done in a rural community in Qalubeya Governorate revealed that the over all
prevalence of injuries indoor environment were (72.6%) among children below five years (Amin, et al., 1998)
and contradicted with (Eldosoky , 2011) who found that the incidence of home related injuries among children
was 38.3%. This difference may be due to the difference in the age of the studied children, different
methodology, study area and habits of rural area.
The current study revealed that more than half of injured children (59.3%) were aged ≤ 3 years, this may be due
to the younger the child , the higher the frequency of household injuries. This finding contradicted with(Eldosoky
, 2011) who revealed that more than half of injured children (50.6%) were aged 9 – 12 years. Regarding sex
differences it was found that more than half of the injured children were boys (58.7%) than girls (41.3%) this
result agrees with (Eldosoky , 2011) who found that the incidence rate of home accidents constituted (57.5%)
for boys and (42.5%) for girls and also similar to study in Turkey (53.4% for boys and 46.6% for girls) and (
ztürk C et al, 2010 )who and also agreed with (Mahalakshmy et,al , 2011 ) who found that prevalence of injury
was high among male children. Differences in regional and sample characteristics may affect the statistical
significance of the impact of gender in injuries (Polat S et al, 2005)
As regards types of home accidents the present study indicates that Cut/wound represented the highest
percentage of home injury (37.3%) and this agrees with ( Abd El-Aty., et al, 2005) who indicated that wounds
were the most common accidents among studied children was (37.4%). Many studies had been conducted in
Assiut Governorate by Ibrahim, (2004), and Helmy, (2002) revealed that wounds represented (66.2%, and 43.4%
respectively) among studied children. These findings were higher than the present study because of different
methodology and different age structure. Other studies conducted by Hamza (2000), El-sabakhy, et al., (1981),
Sadek and Ahmed (1989) and Nosseir, et al., (1990)who reported that wounds accounted for (26.3%, 15.7%,
14.0% and 14.9% respectively) these findings were lower than the present study .
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
According to burns the present study recorded that burns represented (12%) of the total child injuries
and this agrees with Ibrahim, (2004), Hamza (2000) Amin, et al., (1998) and Laffoy (1997) who reported that
burns represented (8.2%, 15.4%, 10.5% and 13.0% respectively) of all injuries. As well as with WHO news
bulletin ,the global childhood unintentional injury conducted a pilot study in 2007 as reported that burns
(13%) of childhood unintentional injury. And the present study disagrees with Helmy, et al., (2002), Nossier et
al., (1990) and El-Gendawy, (1978) who mentioned that burns represented (20.2, 22.6%and 20.4%
respectively)of injuries among preschool children. These findings were lower than the present study.
According to poisoning the present study recorded that poisoning represented (1.3%) of the total injuries among
studied children. This disagrees with another studies conducted by, Ibrahim (2004), Helmy et al., (2002), Sadek
and Ahmed (1986),( Abd El-Aty., et al, 2005) who reported that poisoning cases represented (10.9%, 9.6% and
7.9%, (7.6%) respectively) of total injuries among children.
Regarding fractures the present study recorded that fractures represented ( 29.3%) this agrees with Hassan and
El-Sheikh (1996) and Ibrahim, (1991) who reported that fractures accounted for (29.0% and 30.0%
respectively).and this disagreed with (Abd El-Aty., et al, 2005) who reported that fracture accounted (15.8%)
These findings were lower than the present study.
In spite the importance of a topic like first aid, 20% of the mothers had not hear the term, and those who were
familiar with it, 24% reported that T.V and radio were the sources of their knowledge and this contradicted with
(Sonavane &, Kasthuri , 2008) who reported higher proportion rate of the studied women had not heard about
first aid (65.7%) and agreed with (Eldosoky , 2011) who showed similar results regarding the source of
knowledge in which T.V and radio accounted for about 45.8% .
Concerning to mothers knowledge regarding causes of home accidents the current study revealed that more
than half (55.3%) of mothers didn’t know causes of home accidents. This finding agreed with( Ibrahim, 1991)
who revealed that more than half of the mothers (56,0%) in the accidents group did not know anything about
home accidents to which their children might be exposed and contradicted with (Abd El-Aty., et al, 2005) who
found that about three quarters (74.5%) of mothers did not know the causes of home accident and. This can
attributed to the difference in the educational level of the studied samples.
Mothers' practice in different types of home accidents:
In case of fracture, wound, bleeding , the highest percentage of mothers used more than on approach in
(40%, 66,6%, and 52% respectively) . This finding contradicted with (Hossein, 2009), who revealed that the
percentage of mothers practiced more than one method constituted (11.3%, 4% and 10.8% respectively) and
(Abd El-Aty., et al, 2005) who revealed that the percentage of mothers practiced more than one method
constituted (11.7%, 4.5%, and 10.5%) respectively . This difference may be related to the difference of
educational level of the studied sample.
Regarding mothers' practice in case of choking, poisoning, animal bite, and burn, results of the current
study showed that going to hospital constituted 20%, 20.7%, 12.7% and 14.7% respectively of mothers answers
and this contradicted with( Hossein, 2009), (Abd El-Aty., et al, 2005) and (Ibrahim, 2004). Who reported that the
highest percentage of mothers going to hospital in case of choking, poisoning, animal bite, and burn.
As regarding to relation between mother’s education and their practices regarding care of poisoning, choking,
burn, fracture, wound, bleeding and animal bite there was statistically significant difference where with higher
educational level there were good practices
Regarding to relation between mother’s education and their knowledge regarding causes of home accidents
among children, the present study revealed that illiterate mothers did not have knowledge about causes of home
accidents (37.3%) compared to (52.2%) of university educated mothers who had knowledge regarding causes of
home accidents and this agreed with (Hossein, 2009), (Abd El-Aty., et al, 2005) and (Helmy, 2002). Who
reported that illiterate mother’s failed to obtain knowledge regarding home accidents.
VI.
Conclusion
Although home accidents are a common problem among preschool children, mothers’ knowledge
regarding home accidents were deficient and the mothers’ education was variable significantly in relation with
mothers’ knowledge regarding home accidents. As well as the relation between mother’s education and their
practices in first aid was statistically significant with higher educational level.
.
VII.
Recommendations
1- Increase public awareness regarding home accidents through mass media.
2- Health education program for mothers about safe housing condition should be held in MCHC
3- Health education program about causes of home accidents, first aid management and method of prevention
into the curriculum at different levels.
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Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children
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El-Sebakh H, Fahmi S I, Tantawy A S, & Moustafa K, (1981): "Reported accidents of university students in Alexandria University
health services". Bulletin of High Institute of Public Health in Alexandria, 9: 353-366.
Nossier S, Sherif A A, Mortuda M M, Dobbous N I, & El-Shan F F, (1990): "A study of accidents among preschool children
attending MCH centers in Alexandria". Alexandria J. of Pediatrics, (4): 45-48.
Laffoy M, (1997): "Childhood accidents at home". Ir. Med. J. 1997. Jan. Feb, 90 (1): 26-27.
El-Gendawy H A S, (1978): "Exploration of the predominant external causes of burns attended to the major medical centers in
Assiut". Thesis for M P H, Assiut University
Ahmed H, (1989): "Study to assess safety measures adopted at home to prevent poisoning among children under five years of age".
Master thesis Public Health Nursing. Higher Institute of Nursing, University of Alexandria.
Ibrahim A, (1991): "Assessment of knowledge, attitude and practice of mothers attending Cairo University Hospital toward home
accidents among preschool children. Master Thesis in Nursing", Higher Institute of Nursing, Cairo University.
Hassan F & El–Sheikh E, (1996): "Surveillance of trauma in Port- Said", Egypt. Comm- Med–Dept. Faculty of Medicine Suez
Canal University, Ismailia, Egypt.
Sonavane R, Kasthuri A. Knowledge, attitude and practice of first aid among women in a rural area [MD thesis]. Bangalore, India,
Department of Community Health, Bangalore University, 2008.
Helmy F E, Labeeb S A, & Shafie I F, (2002): "Assessment of home environmental risk factors regarding accidents among
preschool children. Assiut University", Bulletin for environmental researchers: 5 (1), pp. 21-29.
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 41-44
www.iosrjournals.org
Effect of Longstanding Diabetes Mellitus Type II on Hand
Grip Strength and Pinch Power of Females in the City of
Hail-KSA
Mohamed E. Khallaf Ph D PT*, Eman E. Fayed MSc PT **,
Manal I. Al-rashidi BSc PT **
* Department of Physical Therapy for Neuromuscular Disturbances and its Surgery, College of Physical
Therapy, Cairo University, Egypt.
**
Department of Physical Therapy, College of Applied medical sciences, University of Hail -KSA.
Abstract: Background: Diabetes mellitus type II is the most common endocrine disorder all over the world,
which is characterized by metabolic abnormal conditions and many long term illness. These complications can
lead to social threatening problems due to loss of jobs. Objectives: This study aimed at measuring the effects of
Type II diabetes mellitus on hand grip and Pinch power of adult females in the city of Hail-KSA Methods: A
cross-sectional study was carried out in the outpatient clinics of the King Khalid Hospital. Forty Female
patient represented the sample of the study. A JAMAR dynamometer and a pinch gauge were used to measure
the participants’ hand holding action and Pinch power. Results: Statistical analysis showed a significant
decrease (P≤ 0,05) of the hand grip and pinch power strength among patient with long standing diabetes as
compared to healthy matched group. Conclusion :The results of the current study concluded that the hand
muscles strength represented in grip and pinch power which are important parameters of hand function is
significantly affected by long standing type 2 diabetes mellitus.
Key Words: Diabetes - Diabetic neuropathy - hand grip strength –pinch power
I.
Introduction.
Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycaemia, with
resultant morbidity and mortality. Type 2 diabetes mellitus (DMII) accounts for about 95% of diagnosed
diabetes in adults.1
It is considered as is one of the most common risk factor for functional disability specially after a long
duration of illness in older people. It may be associated with peripheral neuropathy, coronary, cerebral or
tangential vascular disease, retinopathy, nephropathy, diabetic foot syndrome and depression which are
demonstrated to be the predictor of disability related to activities of daily living. 2,3
The clinical importance of DMII have been increased due to a dramatical increase of its incidence
together with high life expectancy. In Saudi Arabia, the life expectancy has been increased in 2011 to be 76
years (males: 74, females 80 years) as compared to 73.13 years in 2005 (males: 72.24, females 74.41 years). 4
Additionally the diabetes prevalence is showed to be 30% of Saudi population (34.1% in males and 27.6% in
females).5
Patients with DMII have reported to be more disabled in self-care tasks and other daily living activities
than non-diabetic subjects because of many hand complications. However, there is a limited number of
researches related to such problems.5
The longer the duration of illness the greater will be the reduction of hand grip strength, agility, and
disabilities.2,6,7
Muscle weakness has been associated with DMII can be attributed to increased insulin tissue resistance
and hyperglycaemia, which cause a reduction in the number of mitochondria in the muscle cells, a decrease in
glycogen synthesis and an increase in the amount of circulating systemic inflammatory cytokines, all of which
have a detrimental effect on the skeletal muscles.8
Additionally, the physiological cross section of the muscles is significantly lower in individuals with
diabetes, with being worse with longer duration of illness and poorer control.9Diabetic stiff hand syndrome or
limited joint mobility syndrome, is found in 8-50% of all patients with type 1 diabetes and is also seen in type 2
diabetic patients. The prevalence increases with duration of diabetes. This condition is associated with and
predictive of other diabetic complications.9
The metabolic disturbances associated with DMII also cause damage to the connective tissues of the
hand leading to limitation in joint range of motion, Dupuytren’s contracture, and flexor tenosynovitis in
approximately 50% of individuals with DMII. 2, 7,9
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Effect of diabetes on Grip strength and Pinch power for females in the city of Hail-KSA
Carpel tunnel syndrome has been reported to be the most common pathology with an incidence of
45%. Its specific relationship to diabetes is thought to be median nerve entrapment caused by the diabetesinduced connective tissue changes. 7
Identification of such changes can be a warning signs for more diabetic complications. To our best
knowledge, there are no studies in this theme in Saudi Arabia. Therefore, we tested hypothesis that hand grip
and pinch strength are lowered in patients with DMII and the effect of that on the functional abilities of the
hand.
II.
Methods:
This cross-sectional study was carried out in the outpatient clinics of the King Khalid Hospital. The target
population of this study consisted of diabetic forty subjects (mean age: 51 ±5.58 years) and Forty matched
healthy volunteers (mean age: 49.05±6.73 years). The mean duration of illness of the patients in the diabetic
group was (7.8±1.46). The right hand was the dominant in more than 90% of participants. The patients were
recruited from diabetes’s clinic in the king Khalid hospitals, Hail, KSA. Participant with history of cervical
spondylosis, cervical pott's disease, primary and metastatic tumours of the cervical vertebrae , fracture and
dislocation of the cervical vertebrae , cervical neurofibromatosis ,dejerine-klumpke's paralysis secondary to
birth injury , thoracic outlet syndrome and carpal tunnel syndrome, peripheral nerve injury, Amyotrophic lateral
sclerosis , and cervical radiculopathy during the previous 6 months were excluded from the study.
Identifying the participants age at time of diagnosis was used to calculate the duration of illness. The
healthy Participants had no glucose intolerance, no history of pain and musculoskeletal problems in the
shoulder, arm or hand, no documented history of trauma or brachial plexus injury, peripheral nerve injury,
Amyotrophic lateral sclerosis ,cervical radiculopathy in the previous 6 months.
Anthropometric variables included body weight, duration of illness, occupation were taken. Body weight
was measured using a calibrated scale (GIMA Pegaso Electronic Body Scale-Italy). Duration of illness,
occupation were taken through assessment charts. JAMAR Hydraulic hand dynamometer and a pinch gauge
(5030J1 ,CANADA) were used to measure the hand muscle strength and the key pinch respectively. Both the
dynamometer and pinch gauge were reset to the starting point (zero) before each reading as the red peak-hold
needle was rotated counter-clockwise to zero. Subjects seated comfortably on a chair with armrests. The
shoulder was adducted and rotated neutrally, with 90 degrees elbow flexion, and the forearm and wrist in a
neutral position. Measurements were started with the dominant hand. A proper verbal support (‘‘press the
handle/button as could as possible’’) was used during the measurements the peak-hold needle then automatically
recorded the maximum force was exerted. The Reading is then recorded.
Statistical analysis:
The Social Package for Social Sciences (SPSS) version 16.0 (SPSS Inc, Chicago, IL, USA) was used to
analyze the data. Descriptive statistics such as means, standard deviations were used to describe the participants’
demographic data. Statistical measures of the mean scores and standard deviation were calculated for the
baseline measurement for each participant. Paired t test was used for comparing clinical patient’s data it was
also used for within group comparison of the hand grip and key pinch.
III.
Results
The anthropometric characteristics and of the subjects were given in Tables 1. There were no
significant difference between the groups with respect to age, body weight ( p > 0.05). the mean age of the
patients represented in G1 is 51±5.59 and 49.84±4.82 in G2 . The mean body weight in G1 is 82.62±11.14 and
48.32±12.01. Patients with hypertension represented 66.21% and 52.57% in the diabetic group the mean
duration of illness in the diabetic group is 7.41±3.76 years.
Table 1: The anthropometric and clinical characteristics patients and of the healthy subjects
Group 1
Age (years)
Body weight (Kg)
Hypertension
Duration of illness
51±5.59
Group 2
P value
48.05±6.73
0.42
48.32±12.01
82.62±11.14
0.14
66.21%
52.57%
0.43
7.41±3.76
----
----
Handgrip strength was measured with an isometric hand dynamometer and comparisons were made
between diabetic and non-diabetic females. The t-test were used to analyze the significance difference in hand
grip and pinch power strength between the diabetic and the non- diabetic subjects (p≤0.05). Hand grip strength
was significantly lower in the diabetic group as clearly shown in figure 1.
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Effect of diabetes on Grip strength and Pinch power for females in the city of Hail-KSA
The mean value of the right hand of the diabetic patient group was 24.9±5.63 Ib and 42.75 Ib in the
healthy subject. The mean value of left hand of the diabetic patients was 19.07±4.64 while it is 37.87± 4.65 Ib
in the non diabetic subjects.
Pinch power strength was significantly lower in the diabetic group, the mean value of the right hand of
the diabetic patient group was 5.75±1.75 Ib and 11.3±2.11 Ib in the healthy subject. The mean value of left
hand of the diabetic patients was 5.52. ±2.07while it is 10.72± 1.15 Ib in the nondiabetic subjects.
Group 1
Group 2
50
40
30
20
10
0
Hand grip
Key Pinch
Right hand
Hand grip
Key Pinch
Left hand
Figure 1. The results of the hand grip strength test (Ib)with the Jamar dynamometer were significantly
lower in the diabetic group compared with the control group ( p < 0.05). The key pinch strength value for
the right hand (Ib) was significantly lower in the diabetic group than the control subject.
IV.
Discussion
Diabetes mellitus is usually associated with mild hand muscle weakness associated with peripheral
sensory neuropathy in DM patients.10 To the best of our knowledge, this is the first study in Saudi Arabia that
measure the influence of diabetes on grip strength and pinch power and emphasize the importance of
measuring hand functions as a measure for prevention and treatment of hand complications caused by DM.
The results of the current study revealed that there is a significant decrease of the hand grip strength using the
Jamar dynamometer in the diabetic patient compared with healthy matched subjects . Again, the key pinch
power value for the right and left hand was markedly decreased in the DM group.
The grip strength test was commonly done to evaluate the performances of hand muscles by measuring
the maximal grip force that could be executed in one muscular contraction.10,11 the results of this study is not
consistent with other researches that find that there was a significant reduction in the muscle strength of the
ankle dorsal and plantar flexors using isokinetic dynamometer, but there was insignificant reduction in muscle
strength of the wrist flexors and extensors. 11
Our study presented slight difference between the dominant and nondominant hand and this not go with
some researcher reported that there were no marked differences in grip strength between the dominant and
nondominant hand28 but go with others who found only a slight, non-significant difference in hand strength
between the dominant and non-dominant hand .12
On the other hand, the results of this study is in close agreement with Ezema and colleagues who
stated that DMII seems to result in a decrease in handgrip strength in both male and female adults. This physical
limitation may contribute to low productivity in people with DMII. 13
Our results also is consistent with other studies that reported that DMII is associated with poorer upper
limb muscle strength and quality. 14,15 These features may contribute to upper limb functional limitation and
physical disability in individuals with long-standing type 2 diabetes.16,17
An important limitation of this study is the small sample size. Nevertheless, we were able to show that
there is a significant decrease of the hand grip strength and pinch power in the diabetic patients compared with
the normal subjects. Further detailed studies are needed to explain the relationship between neuropathy and hand
grip strength and pinch power.
V.
Conclusion
The results of the current study concluded that the hand muscles strength represented in grip and pinch
power which are important parameters of hand function is significantly affected by long standing type 2 diabetes
mellitus Individuals with long-standing type 2 diabetes mellitus have been found to have an increased risk of
developing functional disabilities due to hand muscle weakness.
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Effect of diabetes on Grip strength and Pinch power for females in the city of Hail-KSA
References:
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Prevention, US Department of Health and Human Services; 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011. pdf. Accessed
April 16, 2012
Savaş S, Köroğlu BK, Koyuncuoğlu HR, Uzar E, Celik H, Tamer NM. The effects of the diabetes related soft tissue hand lesions
and the reduced hand strength on functional disability of hand in type 2 diabetic patients. Diabetes Res Clin Pract. 2007 Jul;77(1):7783.
Bruce DG., Davis WA. Davis T.M. Longitudinal predictors of reduced mobility and physical disability in patients with type 2
diabetes: the Fremantle Diabetes Study, Diab. Care 28 (10) (2005) 2441–2447.
WHOdatabas2013 http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013.
Badran M and Laher I. Type II Diabetes Mellitus in Arabic-Speaking Countries. Int J Endocrinol. 2012;2012:902873.
Mathy SC, Freid LP, Volpato S, Williamson J, Brancati FL, Blaum CS. Patterns of disability related to diabetes mellitus in older
women, J. Geontol. A: Biol. Sci. Med. Sci. 2004; 59 (2):148–153.
Gamstedt A, Holm-Glad J, Ohlson CG, Sundstrom M. Hand abnormalities are strongly associated with the duration of diabetes
mellitus. J Intern Med. 1993;234:189-193.
Helmersson, JB. Larsson VA. Basu S. Association of type 2 diabetes with cyclooxygenase-mediated inflammation and oxidative
stress in an elderly population. Circulation 2004, 109: 1729 –1734.
Kim RP, Edelman SV, Kim DD. Musculoskeletal Complications of Diabetes Mellitus. CLINICAL DIABETES 2001, 19(3): 132135.
Redmond CL, Bain GI, Laslett LL, McNeil JD. Hand syndromes associated with diabetes: impairments and obesity predict
disability. J Rheumatol. 2009;36:2766-2771.
Infante JR, Rosenbloom AL, Silverstein JH, Garzarella L, Pollock BH. Changes in frequency and severity of limited joint
mobility in children with type 1 diabetes mellitus between 1976–78 and 1998. J Pediatr 2001;138:33–7.
Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N,Harris TB, Schwartz AV, et al. Decreased muscle strength and
quality in older adults with type 2 diabetes: the health,aging, and body composition study. Diabetes 2006;55:1813-8
Ezema CI, Iwelu EV, Abaraogu UO, Olawale OA. Handgrip Strength in Individuals with Long-Standing Type 2 Diabetes
Mellitus: A preliminary report. AJPARS 2012, 4( 1): 67 – 71.
Bus SA, Yang QX., Wang JH, Smith MB, Wunderlich, Cavanagh PR., Intrinsic muscle atrophy and toe deformity in the
diabetic neuropathic foot: a magnetic resonance imaging study, Diabetes Care 2002, 25: 1444–1450.
Andersen H, Poulsen PL, Mogensen CE, Jakobsen J. Isokinetic muscle strength in long-term IDDM patients in relation to diabetic
complications, Diabetes 1996, 45: 440–445.
Zdirenc MO, Biberog˘LU, zcan AS. Evaluation of physical fitness in patients with type 2 diabetes mellitus, Diabetes Res. Clin.
Pract. 2003, 60: 171–176.
Clerke A, J. Clerke. A literature review of the effects of handedness on isometric grip difference of the left and right hands.
American Journal of Occupational Therapy 2001, 55(2): 206-11.
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 45-48
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A Research Critique on the Lived-In Experience of Adolescents at
Selected Orphanages in Thiruvallur District
Mrs. S. Tamil Selvi, Community Health Nursing, Dept.,
M.Sc (N), (Ph.d) Lecturer, Saveetha College of Nursing, Saveetha University, Thandalam.
Abstract: Parents are the primary care givers of the children. Once a child loses a parent or both the parents,
such children may be adopted by relatives from either of the parents’ families. In most cases adopting parents
live in a different environment to which a adolescent may not be familiar. These child when grows into
adolescent associated with many physical and psychological problems. The present study was undertaken to
critique the lived in experience of Orphan adolescents are vulnerable for a number of reasons. The study
reveals that the efforts to improve their conditions in orphanages are important, the greater effort has moved to
find stable homes for adolescent in such situations, where they may have the chance to experience the love of
family despite their tragic past.
Key words;lived in experience,adolescents, orphanages.
Objectives
1. Elicit the lived-in experiences of adolescent in selected orphanages.
2. Explore the problem revealed by the adolescents.
I. Introduction.
World Orphanage Statistics, (2007) states that in Asia out of 993 million children 65 million children
are orphans, 34 million are orphans in Sub-Saharan Africa out of 288 million children and out of 162 million
adolescent, 8 million adolescent are orphan in Latin America and the Caribbean Children on the Brink, (2002 )
AIDS caused orphans will rise to nearly 50% by 2010 when it is
stigmated that the total number of orphans in the region will be 42 million. In Ukraine and Russia 10%
-15% of the adolescent who age out of an orphanage commit suicide before age of 18. 60% of the girls are lured
into prostitution. 70% of the boys become hardened criminals and many of these adolescent accept job offers
that ultimately result in their being sold as slaves. Millions of girls are sex slaves today, simply because they
were unfortunate enough to grow up as orphans. Reliable statistics are difficult to find, even the sources often
lists only the estimates, and the street adolescent are rarely included. But even if these figures are exaggerated
by double, it is still an unacceptable tragedy that over a million adolescent would still become orphans every
year, and every year 7 million adolescent would still grow to adulthood as orphans with no one to care for and
no place to live in. They are totally vulnerable and easily fall as a prey to the predators and the slave
recruitersThe Government of India, (2000) stated that adolescent who are living in Orphanages in North West,
Delhi, tends to be in inadequate facilities and unhygienic environment. The boys were malnourished and the
promotion activities are needed to improve the health status of this population.
AMES. T, (2000) examined the behavioral problems of institutionalized adolescent. The majority of
orphanage adolescent (84%) displayed stereotyped behavior, mostly in the form of rocking. These studies have
found that orphanage adolescent display rather unique behavioral problems when compared with the home
reared adolescent of the country.
II. Review of Literature
Furhmann. G, (1999) stated that the orphanages need immediate attention, improvement in the
educational quality, living standards, facilitating training of care givers, staff working in orphanage and
providing mental health services into the institution, are needed.
Munchel. J, (2000) analyzed the problems related to the staffing in the institutional settings of limited
training, and lack of appropriate supervision for the care givers in orphanage.
Margoob. P, (2006) conducted a study on the adolescent living in orphanages in Kashmir. The result
showed that the most common problem faced by the orphans were loss of home, poor recreational facilities,
overcrowding, high dropout rate, lack of health care and problems with immunization, child labour and drug
abuse among adolescents.
Statement of The Problem
A research critique on the lived-in experiences of adolescent at selected orphanages in Thiruvallur
district.
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A Research Critique On The Liven-In Experience Of Adolescents At Selected Orphanages In
Objectives
1. Elicit the lived-in experiences of adolescent in selected orphanages.
2. Explore the problem revealed by the adolescents.
III. Methodology
RESEARCH DESIGN
Qualitative research design and phenomenological approach was selected for the study.
SETTING OF THE STUDY
A study was conducted in Maranatha Ophanage situated at Srinivasapuram in Ayyapanthangal and
Baraniputhur, Chennai.
SAMPLING TECHNIQUE
The convenient sampling technique was used.
SAMPLE AND SAMPLE SIZE
The study sample comprised of adolescent who were residing at Maranatha Orphanages in Ayyapanthangal and
Baraniputhur. The size of the sample was 15 adolescents. .
POPULATION
The study population includes male and female adolescent who were staying in the selected orphanages at
Thiruvallur district
DATA COLLECTION
Informed consent was obtained to audio tape interview. Each adolescent was questioned by the investigator an
in depth, the interview as conducted on one – to – one basis.
DATA ANALYSIS
The collected date was analyzed using Colaizzis 7 step methodological interpretation approach.
DESCRIPTION OF THE TOOL
The tool consists of
Section – A : Socio – Demographic data of the adolescent
Section – B : Interview with open – ended question
IV. Results & Findings
The distribution of demographic variables of the adolescents such as age, sex, education and number of
living parents. The data indicated that three (20%) were between the age group of 12 - 13 years, and in the age
group of 15 – 16 years whereas two (13%) were between the age group of 16 - 17 years and seven (47%)
belonged to the age group of 18 – 19 years.
Fig:1. Percentage distribution of age of the adolescent in Orphanage homes
12-13
Years
20%
20%
47%
13%
Fig:2. Percentage distribution of living parents of the adolescent in Orphanage homes
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A Research Critique On The Liven-In Experience Of Adolescents At Selected Orphanages In
Single Parent
Both Parent
Living parents of
adolescents
80
70
60
50
40
30
20
10
0
67
20
13
Single Parent
Both Parent
Parentless
In this study most of the most of the adolescents ten (67%) had no parent and three (20%) had
single parent two (13%) had both parents.
adolescents ten (67%) were male and five (33%) were female. With regard to
educational status 33% of the adolescents had education upto the secondary level and ten (67%) had high school
education.
under the following dimension:
1.Physical dimension, 2.Psychological dimension, 3. Emotional dimension, 4.Social dimension, 5.Educational
dimension, 6.Spiritual dimension, 7.Vocational dimension.
With regard to food six (40%) have received adequate food, four (27%) adolescents expressed the
inadequacy of food and five (33%) adolescents expressed that the food was tasty. With regard to the
environment two (13%) adolescents expressed that the food was safe to eat and five (33%) reported cleanliness
and eight (53%) of them expressed the poor maintenance of the surrounding.
With regard to the medical help 10(67%) adolescents reported that they received adequate medical help
and five (33%) adolescents reported inadequate medical help and 10 (67%) reported that they occasionally fell
sick, and five (33%) would get frequent sickness. With regard to personal hygiene majority 11(73%) of the
adolescents were reported that latrine facility is very poor and four (27%) were good.
Regarding other discomfort which was experienced by the adolescents were inadequate ventilation, and
inadequate latrine facilities and seven (47%) expressed inadequately of ventilation, and eight (53%) had the
complaints of inadequate latrine facility.
The findings have highlighted adolescents’s feelings, food habits, environmental problem, medical
help, sickness, personal hygiene, other discomforts like inadequate latrine facilities, inadequate support from the
family and society, emotional reactions like depression, extra-curricular activities, and spiritual aspect like belief
in God.
The study showed that most of the adolescents were felt inadequate facilities. The consumption of food
is also not adequate for their growth and development. The orphanages should provide adequate attention to
each individual in order to have good health.
Recommendations for Future Study
1.
2.
3.
4.
A detailed study can be done for a longer period
A descriptive study can be done to assess the needs of orphanage homes.
A comparative study can be conducted between orphanage adolescents and other adolescents.
A study can be conducted to explore the experience among working members in orphanage home.
References
[1].
[2].
[3].
[4].
[5].
[6].
[7].
[8].
Anes. T (2000). Consequences of an institutionalized adolescents :Indian journal of public health 40 (4) 126-129.
Assumeberi T.M (2009). Nursing care of children (2nded.) Philadelphia:W.B Sounders company 221-225.
Batchelor, (2000). Adaption to childhood parental loss.
Journal of Neuro sciences, 53(4) 141-146.
Cohen N.J (2008) Prospective study of their growth and development.
Journal of child psychiatry 49 (4) 458-468.
Cauduce (2006) Growing responsibilities in the absence of adequate support in orphanages. American journal public health 96 (8)
1429-1435.
Damribgsach.M (1987) Sulphur for scabies outbuall in orphanages.”
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A Research Critique On The Liven-In Experience Of Adolescents At Selected Orphanages In
[9]. Indian journal of paediatrics 19 (5) 448-453.
[10]. Erol. T (2007) Predicts of disruptive behaviour, development delays among institutionalized adolescents, journal of adolescent
psychiartry 43 (10) 123-126.
[11]. Eisenberg “Experiences of young adolescents. American journal of medical association 13 (10) 234-236.
[12]. Furhmann.G (1999) “Quality of life in orphanages.” Journal of adolescent health 17 (4) 51-54.
[13]. Heji.Z (2007) “Quality of life is Orphan.” Journal of adolescent health 42 (4) 410-417.
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 49-56
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Breastfeeding knowledge, attitude and practice among mothers in
Hail district, northwestern Saudi Arabia
Sohair AM Shommo1and Hessa AS Al-Shubrumi2
1,2
(Department of House Economics,(Food and Nutrition), Faculty of Education, Hail University, Hail,
Kingdom of Saudi Arabia)
Abstract: Limited knowledge, or improper practice, of breastfeeding may lead to undesirable consequences.
The aim of this study was to assess breastfeeding knowledge, attitude and practice (KAP) among mothers in
Hail District and identify factors that may affect breastfeeding practice in the study population.
Methods: A cross-sectional study using a questionnaire was conducted among mothers in Hail district.
Breastfeeding KAP of participants who had at least one child aged five years or younger at the time of the study
were assessed using a questionnaire, with emphasis on their experience with the last child.
Results: A total of 60 women whose education was mainly university (39.7% ) and secondary (24.1 %) were
included in the study. Most of them were from middle economic status. Most of the mothers 31.7 % (n= 19)
mentioned only two benefits. Seventy percent (70 %) of the mothers initiated breastfeeding while 30 % did not,
mean duration was 9.3 ± 8.97 month. The major reason for ceasing breastfeeding before two years was mothers
work 38.6 % followed by disease(15.8 %).
Conclusions: This study showed that adverse work and maternal health related issues were the main reasons
for a low rate of breastfeeding among women in Hail district-Saudi Arabia. Limited knowledge addressing the
breastfeeding issues during pregnancy. Such findings should be useful to health professionals and officials when
attempting to overcome breastfeeding barriers and to devise targeted breastfeeding interventions.
Keywords: Breastfeeding; Knowledge, Practice, Attitude, Hail, Saudi Arabia.
I.
Introduction:
Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy
growth and development. It is an important public health strategy for improving infant and child morbidity and
mortality, improving maternal morbidity, and helping to control health care costs. Virtually all mothers can
breastfeed, provided they have accurate information, and the support of their family, the health care system and
society at large [1].
Breastfeeding is an important public health strategy for improving infant and child morbidity and
mortality, improving maternal morbidity, and helping to control health care costs. Breastfeeding offers many
benefits to nutrients to help infants to grow into strong and healthy toddlers. Some of the nutrients in breast milk
also help protect infants against some common childhood illnesses and infections. It may also help maternal
health. Certain types of cancer may occur less often in mothers who have breastfed their babies[2].
Women who don't have health problems should try to give their babies breast milk for at least the first six
months of life. There are some cases when it's better not to breastfeed. If you have HIV or active tuberculosis,
you should not breastfeed because you could give the infection to your baby. Certain medicines, illegal drugs,
and alcohol can also pass through the breast milk and cause harm to your baby [2].
There is a growing concern recently about the changing patterns of breastfeeding, especially in societies in rapid
transition, such as Saudi Arabia. Breastfeeding is the normal way of providing young infants with the nutrients
they need for healthy growth and development [3].
In an estimated 35% of all deaths of children under five years of age, under-nutrition is the underlying
cause of death. Including underweight, suboptimal breastfeeding, and vitamin and mineral deficiencies. The
proportion of underweight children in developing countries declined from 28% to 17% between 1990 and 2011.
Although this rate of progress is close to the rate required to meet the relevant target, significant variations
persist between and within regions[4].
Malnutrition stands behind 35 % of disease burden on children under the age of five. It is worth
mentioning that the feeding of infants and young children of the key areas to improve child survival and
promote the growth and development of children healthily. The first two years of a child 's life is particularly
important, where he managed the ideal nutrition during this period of reduced morbidity and mortality , and
reduce the risk of chronic diseases, and improve the overall development of the child . In fact, the best practices
in the areas of breastfeeding and complementary feeding are important degree awarded by the ability to save the
lives of 1.5 million children under the age of five every year [5].
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Breastfeeding knowledge, attitude and practice among mothers in Hail district, northwestern
Breastfeeding is associated with a reduced risk of infections otitis media, gastroenteritis, respiratory
illness, sudden infant death syndrome, necrotizing enterocolitis, obesity, and hypertension [6] as well as it
protects mothers from breast cancer[7]. Breastfeeding provides unsurpassed natural nutrition to the newborn and
infant. Human breast milk also contains numerous protective factors against infectious disease and may
influence immune system development, as noted in previous studies of infant response to vaccination and
thymus gland development[8].
The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) recommend
that every infant should be exclusively breastfed for the first six months of life, with breastfeeding continuing
for up to two years of age or longer [8-10]. Exclusive breastfeeding is defined as feeding the infant only breast
milk, with no supplemental liquids or solids except for liquid medicine and vitamin/mineral supplements [11].
Factors that might influence breastfeeding include race, maternal age, maternal employment, level of education
of parents, socio-economic status, insufficient milk supply, infant health problems, maternal obesity, smoking,
parity, method of delivery, maternal interest and other related factors [12].
Numerous barriers to breastfeeding are lack of knowledge, social norms, poor family and social
support, embarrassment, lactation problems, employment and child care and barriers related to health services
[13].Exclusive breastfeeding has many benefits for the baby and mother. Most important of which is the
protection from gastric and intestinal contagious infections that cannot be noticed not only in developing
countries but also in industrialized countries as well [5].
The mother 's milk is also one of the important sources of energy and nutrients for children aged
between 6 months and 23 months. It can provide half of the energy needs or more than that for children aged 612 months, and one-third of the energy needs of children aged 12-24 months. The mother 's milk as well as an
important source of energy and nutrients during infection, as it limits the death rates of children suffering from
malnutrition [5,13].
A number of studies addressed breastfeeding in Saudi but still there is insufficient data available on
breastfeeding in Saudi Arabia to monitor progress and develop promotion programs. The World Health
Organization does not report any breastfeeding data in the country profile because there are no national data on
breastfeeding [14,15].
A very recent review study by Juaid et al 2014 documented that there is a need for cohort studies to
more accurately measure breastfeeding and risk factors. It also found out that the duration of any breastfeeding
had shown a decline over time, within the limitations of the samples used. This study recommended that cohort
studies are needed to inform the breastfeeding promotion programs in this country in KSA [16].
II.
Methods
2.1. Study setting and population:
This was a pilot cross-sectional conducted among Hail District, northwestern Saudi Arabia during the
months of January to February 2012. The target group of the study was mothers at the city of Hail, who had at
least one child aged five years or younger at the time of the study with emphasis on their experience with the
last
child.
The sample size of the study was 60 mothers within the period of fertility.
2.2. Study instrument
Questionnaire was used as screening tool used in the present study was prepared. Besides personal and
socioeconomic data, the resulting self- administered questionnaire included questions addressing knowledge
(importance of breast milk and its constituents, preference of breast milk over
artificial milk, general knowledge of breastfeeding benefits),questions addressing attitude (general attitude
towards adoption of breast feeding, reasons for adopting breastfeeding, reasons for stopping breastfeeding,
questions addressing practice (time of commencement of breastfeeding after delivery, duration of breastfeeding,
difficulties in initiating breastfeeding, age at which breastfeeding was stopped and attending classes related to
breastfeeding during pregnancy).
2.3. Ethical Approval:
The study received the approval of the Research Committee of Faculty of Education - Hail University for
the Third Scientific Conference for Hail University Students.
2.4. Data collection
By the end of the study period sixty questionnaires were completed from mothers. Mother’s
knowledge, attitude and practice of breastfeeding were assessed from their responses.
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Breastfeeding knowledge, attitude and practice among mothers in Hail district, northwestern
Subjects included in the study must have given birth to at least one child in the five years prior to commence of
the study. Responses of the participants to the questionnaire emphasized on their experience with their last
child.
2.5. Analysis
Data were coded, validated and analyzed using SPSS PC + software package version 16. Descriptive
statistical analyses were performed. Student t-test and analysis of variance was used as test of significance at
95% confidence interval.
III. Results
A total of 60 questionnaires were distributed but responses varied between different questions .The
mean age of the participants was 32.27 ± 5.42 years and their age ranged from 21 to 46 years.
3.1. Description of the participants
The mean and standard deviation (SD) of the number of persons per household were 5.94 ± 3.5 persons,
family members ranged from 2- 23 members per household. Mean age of mothers who gave birth to the first
baby was 23.21 ± 4.27, it ranges between 14 – 31 years (Table 1).
Other selected characteristics of the participants are shown in Table 1.
3.2. Knowledge
Table 2 reveals breastfeeding knowledge by Hail women.
Fifteen (31.2 %) of the participants reported that breast milk constituents is good for immunity protection
against diseases, thirteen (27.1 %) reported its being sufficient in nutrients, whereas 8(16.7 % ) did not know
any advantage.
Subjects who mentioned two and one benefits of breast feeding were 19(31.7 %) and 18(30 %), respectively.
Eight (13.3%) did not mention any benefit, whereas no one mentioned more than four benefits (Table 2).
Importance of breast milk explained by medicals or paramedcials for participants in this study was 60%(n= 36),
40% (n=24) did not get any source of education about encouraging breast feeding.
3.3. Attitude
Attitude of participants towards breastfeeding is shown in Table 3.
General attitude towards adoption of breast feeding over bottle feeding was found positive within 53
mothers(88.3 %) while not always better among 7 mothers(11.7 %).
Reasons given by mothers for adoption of breast feeding vs. bottle feeding was 46.7 % because it is more
healthy (n =14), 40.0 % because it strengthens child’s immunity (n= 12), and 10.0 % (n= 3) for both reasons.
Only one mother (3.3%) had adopted bottle feeding because there is not enough breast milk.
3.4. Practices
Table 4 shows breastfeeding practice by mothers in Hail district. Seventy percent of the mothers (n =42),
had initiated breast feeding after birth while 30 % (n=18) did not. Reasons for stopping breast feeding
mentioned by mothers were mainly mother’s work22 (38.6 %), mother’s disease 9 (15.8 %), whereas only 2 (3.5
%) because of child refusal.
Mean duration of breast feeding practice in months ranged between 0-24. Mean duration ±SD (range) was:
for the currently breastfed baby 9.3 ±8.97 months; 8.84 ±8.49 (0.23 – 24) for the first baby,7.87 ± 8.08(0 – 24)
for the second, 11.23 ± 8.87 (0.67 – 24) for the third, and 10.14 ± 9.26 (1 – 24) for the fourth baby.
3.5. Statistical analysis
Duration of breast feeding was significantly different for all babies than standard recommended. Mean
duration of breast feeding was less in the first and second baby than for the third and fourth. The duration of
breastfeeding was not significantly different between women who breastfed their first and fourth baby.
IV.
Discussion
Mothers knowledge was assessed by information given by mothers about breast milk constituents.
The most important reason given by the participants for initiating breastfeeding was mentioned its being for
immunity (31.2 %), followed by their knowledge about its being a sufficient in nutrients within27.1 %, whereas
8(16.7 % ) have not reported any knowledge about breast milk did not know any advantage. This finding is
similar to the health care workers’ study where the main reason was the child health (43.7%), followed by
religious background (17.2%). Our result is different from other studies by Al-Binalia(2012) and Alwww.iosrjournals.org
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Breastfeeding knowledge, attitude and practice among mothers in Hail district, northwestern
Binalib(2012) where the most important reason given was their Islamic religious background 58.6 % and 56.6
%, respectively [17,18].
Although breastfeeding have several well known benefits [19], participants’ general knowledge was
limited since the majority mentioned only one benefit and no one mentioned more than four benefits of breast
feeding. This might be attributed to limited sources of education received by participants.
The majority of Most of the mothers had positive attitude towards adoption of breast feeding (n= 53, 88.3 %),
breastfeeding, most of mothers 96.7 % mentioned child’s health related reasons for adoption of breast feeding
vs. bottle feeding, whereas only 3.3 % preferred bottle feeding due to milk insufficiency. Despite this positive
attitude towards breastfeeding, but gaps in knowledge and practices were noted. Our results are similar to other
studies [20].
The breastfeeding initiation rate, defined as the proportion of infants who received any breastfeeding
whatsoever within the first 48 hours, was found to be 70%, which is similar to the Eastern Mediterranean
Regional Office of WHO (EMRO) which has reported high rates (>60%) of early breastfeeding initiation [21].
Our result is lower than Other Saudi Arabian studies have reported breastfeeding initiation rates ranging
between 92 and 100% [17,18,22,23,24].
Table 1 Selected characteristics of the participants
Variable
Number
Age range of participants
Mean age of participants
Ages of mothers when gave
birth to babies
First baby
Second baby
Third baby
Fourth baby
Education Background
Illiterate
Primary
Intermediate
Secondary
University
Postgraduate
Husband Education
Background
Illiterate
Primary
Intermediate
Secondary
University
Postgraduate
Mother’s occupation
Government
Employee
Private Sector
Others
Husband’s occupation
Government
Employee
Private Sector
Others
Economical Status
Low
Medium
High
Importance of breast milk
explained by medicals or
paramedcials
Yes
No
Percent
(%)
21 to 46
32.27 ± 5.42
23.21 ± 4.27
25.59 ± 4.88
27.44 ± 5.13
29.05 ± 5.56
Age
range(years
)
14 - 31
16 - 36
18 - 38
20 - 40
5
10
4
14
23
2
8.6
17.2
6.9
24.1
39.7
3.4
3
8
7
15
24
2
5.1
13.6
11.9
25.4
40.7
3.4
Mean
age(years)
33
2
23
38
56.9
3.4
39.7
66.7
11
8
19.3
14
4
27
18
8.2
55.1
36.7
36
24
66
06
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Breastfeeding knowledge, attitude and practice among mothers in Hail district, northwestern
Table 2 Breastfeeding knowledge by mothers in Hail district
Variable
Knowing the advantages of
breast milk constitution
Do not know
-
Immunity protection
Sufficient Nutrients
Others
-
Immunity protection+
Sufficient Nutrients
Healthy and protects
immunity
Sufficient and protects
immunity
Knowing the benefits of breast
feeding
Do not know
One benefit
-
Two benefits
Three benefits
Four benefits
-
> four benefits
Number
Percent (%)
8
15
16.7
31.2
13
3
27.1
6.2
6
12.5
2
4.2
1
2.1
8
18
19
13.3
30
31.7
10
5
16.7
8.3
0
0
The breastfeeding was stopped at a mean age of 9.3 ±8.8 months. This is lower than figure reported by AlBinalia (2012) [17], where breastfeeding was stopped at a mean age of 8.7 ± 7.8 months. Breastfeeding practice
duration was longer in the third and fourth baby (11.23 ± 8.87 and 10.14 ± 9.26) compared to first and second
baby (8.84 ±8.49 and 7.87 ± 8.08), respectively. This might be attributed to the 60% of the mothers being
advised by health workers.
Continued professional support may be necessary to address these challenges and help mothers meet their
desired breastfeeding duration.
The most common reason given for stopping breastfeeding practice was mother’s work 22 (38.6 % of the
participants),which is similar to a study which reported work-related problems within (38.5%). Our result is
somewhat less than what was reported by the health care workers (45.7%) [25]. In fact 60.3 % of the subjects
in this study were engaged in work.
The next most important factor for early cessation of breastfeeding was mother’s disease 9 (15.8 %). Our
finding agrees with a study by Odom et al. in 2012, their findings indicated that the major reasons why mothers
stop breastfeeding before they desire included concerns about maternal or child health (infant nutrition, maternal
illness or the need for medicine, and infant illness) and processes associated with breastfeeding (lactation and
milk-pumping problems[26].
The effect of these two factors is most likely to be the reason that most of the participants shifted to formula
feeding. This practice might be attributed to the willingness of the mother to adapt her baby to use formula
from a young age due to her engagement in work where there is unsuitable environments for breastfeeding.
Mothers who stopped breastfeeding because of milk insufficiency were only 8.8 % which is different from a
number of studies [17,22,27], where it was the main reason. Our finding was lower than other studies where up
to (50%) or more reported that they perceived insufficient milk for their babies [28,29].
Whereas only 2 (3.5 %) because of child refusal. This result is lower than another study by Li et al. 2008 [30].
Only a small number of participants (16.7 %) ignored benefits of breast milk constituents. Lower figure than
our study was reported by others studies in the country Al-Binalia (2012) and Al-Jassir et al. 2006 [17,31]. In
contrary to our finding was higher figures reported by others studies [32-34].
Low rates of knowledge regarding the appropriate duration of breastfeeding are important factors in limiting
breastfeeding prevalence. It also indicates the crucial role of health care providers and peer support to pregnant
women and breastfeeding mothers. Such support, as well as face-to-face and pre- and postnatal classes, has been
proven to be effective in reducing early cessation of breastfeeding and was a very effective way to promote
breastfeeding prevalence [35,36].
In order to help mothers meet personal goals and expert recommendations for breastfeeding, pediatricians
should educate themselves regarding predictors of and barriers to successful breastfeeding. Once these
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Breastfeeding knowledge, attitude and practice among mothers in Hail district, northwestern
Table 3 Breastfeeding attitude by mothers in Hail district
Variable
General attitude towards
adoption of breast feeding over
bottle feeding
Better
Not always better
Reasons for adoption of breast
feeding vs bottle feeding
More Healthy
Strengthens child’s
immunity
Health and Strengthens
immunity
Reasons for adoption of bottle
feeding vs breast feeding
Not enough breast milk
Number
Percent (%)
53
7
88.3
11.7
14
46.7
12
40.0
3
10.0
1
3.3
Table 4 Breastfeeding practice by mothers in Hail district
Variable
Number
Percent (%)
Initiation of breast feeding
-
Yes
42
70
-
No
18
30
Reasons for stopping breast
feeding
Mother’s work
22
38.6
-
Mother’s disease
9
15.8
-
Child’s disease
7
12.3
-
Insufficient milk
5
8.8
-
2
3.5
-
Use of
contraceptive pills
New pregnancy
-
Child refusal
Mother’s work and
disease
Breast feeding practice
duration of different babies
Last baby
-
4
7
2
3.5
6
10.5
Mean
duration(days)
9.3± 8.97
Duration
range
1-24
8.84 ±8.49
0.23 - 24
-
First baby
-
Second baby
7.87 ± 8.08
0 - 24
-
Third baby
11.23 ± 8.87
0.67 - 24
-
Fourth baby
10.14 ± 9.26
1 - 24
predictors and barriers have been identified, targeted anticipatory guidance can be provided to help mothers
achieve breastfeeding success [37].
When working mothers possess certain personal characteristics and develop a strategic plan, breastfeeding is
promoted. When social support is available and when support groups are utilized, lactation is also facilitated.
Part-time work, lack of long mother-infant separations, supportive work environments and facilities, and child
care options facilitate breastfeeding [38].
Health care providers can use the findings of this review to promote breastfeeding among working women by
using tactics geared toward the mother, her social network, and the entire community. Adequate support for
mothers requires greater attention to prevention and resolution of these very common problems. Physicians and
their staff must be competent to do so. Primary care interventions can improve breastfeeding durations, but
lactation problems must be routinely addressed at early hospital follow-up visits.
V. Conclusion
This study revealed that adverse work related issues and maternal health were the main reasons for the
very low rate of breastfeeding among women in Hail district, Saudi Arabia. Limited knowledge about
breastfeeding and breast milk and unfavorable breastfeeding practices. Such findings should be useful to health
professionals when attempting to help mothers overcome breastfeeding barriers and to health officials
attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age.
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Breastfeeding knowledge, attitude and practice among mothers in Hail district, northwestern
Intervention programs can be effective in promoting support for breastfeeding among health workers. Similar
interventions may contribute to the overall effectiveness of breastfeeding promotion programs. Continued
professional support may be necessary to address these challenges and help mothers meet their desired
breastfeeding duration. Such findings, if addressed comprehensively by health care providers and decisionmakers, will lead to improvement of child health in the study community.
This study can be a pilot study in the Hail district and should be a more comprehensive study should be done in
the district. Breastfeeding should be re-assessed at a national level using a more appropriate research design
like cohort studies which can analyze follow up data and present more accurate and valid results. This is
necessary to inform the breastfeeding promotion programs in this country. It is hoped that this review will serve
as baseline information for any upcoming longitudinal studies on breastfeeding in Saudi Arabia.
Competing interests:
The author declares that he has no competing interests.
Acknowledgments:
I would to express my thanks and appreciation to Student Affairs Deanship University ofHail
for supporting this work.
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 57-62
www.iosrjournals.org
Factors Influencing Clients’ Compliance with Therapy of
Tuberculosis in Ibadan, Nigeria
Oladeji Oloyede Michael Rn, *Tijani Wakili Adelani Rn, Bello Yisau Aderemi
Rn, Hamid Oluyedun, B.Pharm, Prefa Victor Rn,
MSc FWACN Lecturer Department of Nursing Ladoke Akintola University of Technology, Ogbomoso NIGERIA
PhD, FWACN Senior Lecturer Department of Nursing Ladoke Akintola University of Technology, Ogbomoso
Nigeria
BSc, MPP, MSN Clinical Instructor VA Medical Centre, Morcon College, USA
MSc, FWACP Deputy Director of Pharmaceutical Services Mininstry of Health, Oyo State
MBBS, Bls. Senior Medical Officer Niger Delta University Teaching Hospital Okolobiri Yenagoa Bayelsa State,
Nigeria.
Abstract: The study was carried out to investigate factors influencing clients’ compliance with treatment of
tuberculosis in Ibadan. The study was descriptive with a sample size of 212 randomly selected from three health
centres. Sample selection were as follows: 50 respondents at the Catholic Hospital, Oluyoro; 67 at the Primary
Health Care, Oniyanrin and 90 at the Chest Hospital, Jericho. The mean age of the respondents was 32 
11.67. Males were 69.8% and female 30.2% with majority being Yorubas (59.9%) and Christians (76.9%) while
as much as 61.3% were married. Educational status of the respondents showed only 19.8% possess bachelor
degree, the rest others were school certificates (34.4%) and national diploma (15.6%) holders. As much as
33.5% of the respondents were unemployed, 24.5% Civil Servants and only 1.9% were self employed. On the
respondents’ knowledge of tuberculosis, majority (83.5%) of them knew tuberculosis as an infection of
respiratory system, 85.9% knew it is caused by germ and 94.8% of them were aware it could be spread to other
people through living in overcrowded places. All the respondents (100%) experienced coughing that lasted
over four weeks before reporting in the hospital where tuberculosis was diagnosed. On the expected duration of
cure of tuberculosis, majority (82%) of the respondents were aware that their ailment could take up to two years
before they could get cured. They were however encouraged to comply with the treatment as 92.5% of them
acknowledge the government largess in providing free treatment. The friendly attitude of the health personnel
(without discrimination based on their health status) - 90.1%, and coupled with failure of traditional treatment
earlier sought before reporting in the orthodox hospital (76%), further encouraged the respondents to comply
with treatment. Two hypotheses were tested. The results of the first hypothesis showed that there was a
significant association between the respondents’ knowledge and their compliance with tuberculosis treatment
regimen. The result of the second hypothesis revealed that there was no significant association between the
respondents’ social stigma and their compliance with tuberculosis treatment regimen. It was therefore
recommended that the Damien’s Foundation, with collaboration of the Federal Government, should continue to
provide free treatment of tuberculosis until the disease ceased to be public health problem in Nigeria.
Key concept: Clients, Compliance, Therapy, Tuberculosis, Stigmatization
I.
Introduction
Tuberculosis is one of the leading infectious diseases responsible for high rate of death globally.
Tuberculosis kills someone approximately every 20 seconds and nearly 4,700 people every day. According to
the latest estimates from the World Health Organization Global TB Control report (2010), in 2009 alone
1.7million people died of tuberculosis.
The report rated tuberculosis as second only to human
immunodeficiency virus as the leading infectious killer of adults worldwide. It is among the three greatest
causes of death of women aged 15 – 44. WHO (2005) discovered that tuberculosis kills 5000 people daily
across the globe with 98% of death occurring in developing world and this affected mostly young adult in their
most productive years. Nigeria ranked fourth among 22 burden countries for tuberculosis in the world. WHO
(2006) reported that a total of 450,000 new cases occur yearly. In Nigeria, the National Tuberculosis and
Leprosy Control Programme - NTLCP (2002) stated that a total of 86,241 of all forms of tuberculosis were
notified from 36 states in 2007. NTLCP (2002) observed that tuberculosis has been steadily increasing over the
years. The annual risk of infection is between 1-2%. It is estimated that about 200,000 of tuberculosis cases
occur annually in Nigeria, of which 50% are smear-positive. The national programme detected and treated
26,641 cases while 17% of tuberculosis cases were also patients that are HIV positive. Johansson et al (1999)
also observed that, tuberculosis, after many years of decline in incidence, has once again started to increase
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Factors Influencing Clients’ Compliance with Therapy of Tuberculosis in Ibadan, Nigeria
worldwide. The reported male to female ration based on passive case finding is 2:1 and suggests differences in
health services accessibility. Poor compliance with tuberculosis treatment has repeatedly been cited as one of
the major obstacles in tuberculosis control.
There are ample evidences to support that non compliance of patients to treatment is the major problem
in tuberculosis control. World Health Organization had devised different methods to promote compliance to
treatment of tuberculosis and this include in-built monitoring system, pill counts, combination of tablets, blister
packs, urine tests, hospitalization and supervised therapy. Furthermore, directly observed therapy was
introduced to a number of chest clinics to promote compliance. This method entails nurses delivering anti
tuberculosis drugs to the patient and observing the patient ingesting the drug. Erhabor et al. (2000) stated that
the category of treatment did not significantly influence the rate of compliance of the patient despite the
availability of anti tuberculosis drugs. Tuberculosis treatment programmes in most developing countries have
not succeeded because of poor patient compliance with therapy, emergence of drug – resistant organisms and
failure to carefully control drug supplies and therapy. Presently the cure rates in developing countries are
frequently less than 50%; however, cure rates of greater than 90% can be achieved when short course
chemotherapy regimens are given under supervision. Sabate (2003) was of the view that tuberculosis is the most
common infectious disease that represents a major public health threat to global population. The report
observed that up to 8million new cases and 2.3 million deaths are attributed to tuberculosis infection annually
due to multi drug resistance and non compliance to treatment.
Silvio (2005) believed that control of tuberculosis could be planned and implemented at primary,
secondary and tertiary level of prevention. Primary prevention includes basic health promotion to limit
susceptibility to disease. There should be good nutrition and effort to relieve conditions of poverty and improved
living conditions. It also includes measures to improve ventilation and ultraviolet light in areas in which aerosol
sputum specimens are collected; also in area where immunization and Chemoprophylaxis are administered.
Secondary Prevention includes screening, diagnosis and treatment of existing disease. Tertiary prevention
efforts are focused on three areas which includes preventing recurrence of the disease in the individual;
notifying the appropriate health centre; and treating contact of cases of tuberculosis and isolation of infected
person as needed.
Tuberculosis coalition for technical assistance, as observed by Stanhope and Lancaster (2000) viewed
relapse as a state in which a patient first improves while on treatment but becomes ill again after stopping
treatment. The study then view relapse of tuberculosis among adults worldwide as the leading cause of death
from single infectious agent. It was observed that the incidence of tuberculosis in the United States showed a
steady decline during the 1970s and early 1980s but began to increase again in 1989. The increase is believed to
have been due to the growing incidence of tuberculosis in the following group of people; people living with
HIV-AIDS, homeless, substance abusers, the elderly, immigrants, people in nursing homes and correctional
facilities. In the study it was further discovered that in the development of multi drug resistance cases, the
clients exhibited mortality rates of 43% to 89%. The peak of relapse was in 1992 and this was observed among
the foreign born persons. Tuberculosis continues to cause a large burden of disease in the world. To control the
further spread of tuberculosis, the World Health Organization has put in place many strategies in order to
achieve 85% of treatment success. It was observed that the challenges been faced by WHO strategies are
behavioural in nature. The clients’ behaviour in terms of self administration of drugs, treatment adherence and
completion of treatment needs modification. Also knowledge and delayed diagnosis of tuberculosis. These
challenges were observed to be prevalent in the three selected health care facilities. There has been increase in
relapse case of patients based on hospital records; client commencing treatment and failed to complete treatment
and reporting back to the hospital. Therefore, this study tends to investigate factors influencing client’s
compliance with treatment of tuberculosis in selected health centres in Ibadan.
Health Belief Model
Health belief model assumes that the beliefs and attitudes of people are critical determinants of their
health related behaviour. The health belief model was first developed in the 1950s by Social psychologists,
Hochbaum, Rosenstock and Kegels (Becker, 1985). Dracup and Meleis (1982) address the relationship between
a person’s beliefs and behaviours. It provides a way of understanding and predicting how clients will behave in
relation to their health and how they will comply with health care therapies. The health belief model is a model
based on the perceptions of the individual in any given health situation. The model states that an individual will
take action to avoid health problem if he feels threatened. Threat is composed of three components; first, the
person must perceive he is susceptible that is he believes that he personally has a reasonable chance of acquiring
the health problem. Secondly, the individual perceives the severity of health problem, that is, in event of the
problem occurring it would have a moderate or severe impact on his life. The third component is that the
likelihood that a person will take preventive action result from the person’s perception of the benefits and
barriers to taking action. The preventive action may include life style changes, increased adherence to medical
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Factors Influencing Clients’ Compliance with Therapy of Tuberculosis in Ibadan, Nigeria
therapies, or a search for medical advice or treatment. A client’s perception of susceptibility to disease will help
to determine the likelihood that the client will or will not partake in healthy behaviours.
Hypotheses
1
There is no significant association between clients’ knowledge and compliance to tuberculosis
treatment
2
There is no significant association between clients’ stigmatization and compliance of tuberculosis
treatment.
II.
Materials and Methods
The study is descriptive, and was carried out in the government Chest hospital Jericho, Primary health
care, Oniyanrin and Catholic hospital all within Ibadan city. These centres are known for treatment of
tuberculosis in Ibadan. The target population consists of diagnosed clients with tuberculosis who reported at the
clinics. The record of admitted cases of tuberculosis from year 2000 to 2010 showed that the year 2008
recorded the highest number of diagnosed clients with tuberculosis in each of the centre. In 2008, Oluyoro
Catholic hospital had 31, Primary health care, Oniyanrin recorded 384 cases while the Jericho Chest hospital
had 517, making a total of 1213. Out of this figure, 212 that gave their informed consent were chosen as sample
size, with an average of 67 cases per centre. A self developed instrument was used and this includes self report
and structured questionnaire that assessed the socio-demographic characteristics of the subjects. The
questionnaire contained 29 items and it consisted of three sections namely: Section A (respondents’
characteristics), section B (respondents’ knowledge on tuberculosis) and Section C (factors influencing
respondents’ compliance with treatment). The last section is D (level of compliance with treatment). With the
Cronchbach’s alpha estimate of 0.74, the reliability of the instrument was determined. The data obtained was
analyzed using the Statistical Package for Social Sciences (SPSS) version 11 and Ms-Excel.
III.
Results
A sample of 212 tuberculosis patients was used and all were administered questionnaire with a 100%
response rate. Figure 1 shows the selection ratio among the three study centre.
No of Respondent
Distribution of Respondents among selected Centres
100
90
80
70
60
50
40
30
20
10
0
Catholic Hospital,
Oluyoro
1
Primary Health
2
Centre
Chest Hospital
3
Jericho
Centres
Demographic variables showed that the respondents’ age ranges from 15-64 with a mean 32  11.67. Females
were 69.8% and male 30.2% with majority being Yorubas (59.9%) and Christians (76.9%) while as much as
61.3% were married. Educational status of the respondents showed only 19.8% possess school certificate, 34.4%
were primary school leaving certificate holders while the rest 45.8% had no formal education. As much as
33.5% of the respondents were unemployed, 24.5% junior civil servants and only 1.9% were self employed.
On the respondents’ knowledge of tuberculosis, majority (83.5%) of them knew tuberculosis as an infection of
respiratory system, 85.9% knew it is caused by germ and 94.8% of them were aware it could spread to among
people through living in overcrowded places. All the respondents (100%) experienced coughing that lasted over
four weeks before reporting in the hospital where tuberculosis was diagnosed.
On the expected duration of cure of tuberculosis, majority (82%) of the respondents were aware that
their ailment could take up to two year before they could get cured and they were ready to endure till they get
cured. They were however encouraged to comply with the treatment as 92.5% of them acknowledge the
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Factors Influencing Clients’ Compliance with Therapy of Tuberculosis in Ibadan, Nigeria
government largess in providing free treatment. The friendly attitude of the health personnel (without
discrimination based on their health status) - 90.1% and coupled with failure of traditional treatment earlier
sought before reporting in the orthodox hospital (76%), further encouraged the respondents to comply with
treatment.
Table 1 shows respondents’ level of compliance with treatment regimen.
Table 1: Compliance with Treatment (N=212)
QUESTION
Always
F(%)
Sometimes
F(%)
Rarely
F(%)
Never
F(%)
-
-
42(19.8%)
170(80.2%)
Do you consider that medical advice is an
important aspect of your treatment?
187(88.2%)
25(11.8%)
-
-
Have you ever been diagnosed and never return
for treatment?
18(8.5%)
42(19.8%)
19(9.0%)
133(62.7%)
Have you ever started treatment before and did
not continue with the treatment?
-
-
-
212(100.0%)
Have you ever been transferred from your
previous place of treatment to another place
and you failed to continue treatment due to
your work schedule?
-
-
-
212(100.0%)
20(9.4%)
171(80.7%)
-
21(9.9%)
-
85(40.1%)
21(9.9%)
106(50.0%)
Do you miss your appointment with the
doctor?
Do you find taking your drug palatable?
Do you experience drug reactions that
discourage you from continuing with
treatment?
Hypothesis testing
Table 2 shows hypothesis I.
Table 2: Chi-square table for testing association between clients’ knowledge and compliance to
tuberculosis treatment
Compliance
Non compliance
Total
Adequate
124
3
127
2
 cal
 18.54
Knowledge
Inadequate
68
17
85
d.f.  2,
2
 tab
 3.84
Total
d.f
Chi-square
Sig.
192
20
212
1
18.54
<.05
P  0.05
From the table, chi-square calculated is greater than chi-square tabulated with the degree of freedom 1. The null
hypothesis was therefore rejected. This indicates that there was a significant association between the
respondents’ knowledge and their compliance with tuberculosis treatment.
Hypothesis II: There is no significant association between clients’ stigmatization and compliance of
tuberculosis treatment.
Table 3: Chi-square table for testing association between clients’ social stigmatization and compliance
Compliance
Non compliance
Total
Positive
153
16
169
2
 cal
 0.001
Social stigmatization
Negative
39
4
43
d.f.  1,
2
 tab
 3.84
Total
d.f
Chi-square
Sig.
192
20
212
1
0.001
>.05
P  0.05
Table 3 shows chi-square calculated is less than chi-square tabulated with the degree of freedom 1. The null
hypothesis is therefore rejected. This indicates that there was no significant association between the
respondents’ social stigma and their compliance with tuberculosis treatment.
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Factors Influencing Clients’ Compliance with Therapy of Tuberculosis in Ibadan, Nigeria
IV.
Discussion
According to the WHO (2010), 1.7 million people died of tuberculosis globally in 2009. It also
observed that tuberculosis kills at least a person every 20seconds and 4700 people every day through its
spreading among people of poor socio-economic status in the world. However, Akinkugbe and Falase (2004)
observed that tuberculosis patient under treatment constitutes no more danger to the society. The results of the
present study corroborate this observation as the disease was not found to spread among the relatives and coinhabitants of the respondents. 98.9% of the respondents said the disease was limited to them since the time
they have been receiving treatment in the hospital.
It was discovered that 69.8% of the study sample were female compared to 30.2% male. Male to
female ratio is >1:2. The increase in female proportion might be due to higher cultural responsibility the society
placed on female than their male counterpart. Johansson et al. (1999) and Holmes et al.(1998) observed some
factors contributing to gender inequality in tuberculosis infection and these include higher gender role for
female; low prioritization of women’s health; poverty which affects female more in patriarchal society; poor
health service provision for women. In developing countries like Nigeria, most of these factors may propel the
female gender to have higher percentage in the spread of tuberculosis. Similar findings were observed in the
work of Vorokhobkin (2005). Female were found to be infected with tuberculosis at a rate thrice that of male.
Tuberculosis has been found to spread more in overcrowded places such as living rooms, markets, schools and
poorly ventilated places. According to Suzanne et al. (2007) and Park, (2009) tuberculosis has been found to
spread mostly among people of poor socio-economic status. The results of the present study are in line with this
discovery as married respondents (61.3%) were more than singles (29.7%). Also, percentage of respondents
with poor educational status (47.6) was found to be higher than respondents with up to and above school
certificate level (12.7%). Likewise, unemployed respondents in the study were 87.1%. It is clear that the
respondents were affected by the disease since they could not afford good diet that could have improved their
resistance to diseases. Also from the study, it was discovered that 92.5% of the respondents complied with
treatment regimen because the treatment of tuberculosis is free. If the subjects were to pay just like in other
ailments, the level of compliance might not be up to the recorded level. This is in consonance with the findings
in Buchanam (1997) where it was discovered that provision of various forms of incentives encouraged larger
number of tuberculosis patients to comply with treatment regimen. The free treatment is a form of incentives for
the subjects. Most of the subjects would not have turn up for treatment and would have constituted great danger
to the society if the National Tuberculosis and Leprosy Control Programme (NTLCP) as well as the Damien’s
Foundation have not worked together to reduce tuberculosis burden on the nation. Damien’s Foundation
provides free treatment while the NTLCP increases people’s awareness on cardinal signs of tuberculosis.
Unemployed individual could not afford to pay for treatment and would have continued to spread the disease
among the populace before they either die or recover from the disease. This therefore indicates that the
prevalence of tuberculosis in most developing countries is due to poverty.
The study also assessed the respondents’ compliance with treatment regimen. 80.2% of the respondents
said they never missed keeping appointment with doctor while 88.2% of them used to comply with medical
advice and they (81.2%) used to put into practice always the knowledge gained in health education to improve
their health status. On the attitude and dexterity of health personnel, 90.1% of the respondents indicated that the
medical personnel, showed concern for them and great dexterity in their job. Also, 63% respondents were
particularly grateful to the nurses that used to encourage them to take their daily drugs in their (the nurse)
presence. Without the nurse encouragement on daily intake of the anti-tuberculosis drugs, 45% respondents said
they could not have taken the drug regularly on their own accord. This, 44% of them observed, would have
delayed the improvement in their health status. On the drug adverse reactions, 40.1% said they had not
experience any serious adverse reaction and the little problem they had at initial stage of their drug intake were
ameliorated by the health personnel. The empathy and the dexterity of the health personnel, observed by 87.4%
of respondents, contributed immensely to their improvement. The concern and passion for welfare of clients as
well as maintenance of professional ethics of health personnel do contribute immensely to aid clients’
compliance with treatment and recovery (Norma, 1978).
From the study, 79.7% of the respondents did not want people to know that they were tuberculosis
patients for fear of stigmatization. Majority of respondents (67%) said they did not encourage their neighbour to
come to the hospital to ‘greet’ them because they did not disclose their ailment to people outside their family
members. Stigmatization is a major cause of spread of tuberculosis in most communities because most clients
do not want to report in hospital for fear of the stigmatization among the relatives. Johansson et al. (1999) were
of the view that stigmatization deters people from seeking care and diagnosis. They further reiterated that
stigmatization is perpetrated by family members and sometimes reinforced by health personnel.
The chi-square test for the first hypothesis indicated that there was a significant association between the
respondents’ knowledge and their compliance with tuberculosis treatment. Park (2009) identified knowledge as
an important factor that helps the host of tuberculosis to control the spread of the disease. It was further stated
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Factors Influencing Clients’ Compliance with Therapy of Tuberculosis in Ibadan, Nigeria
that the propensity to seek care depends on knowledge and perceived risk of tuberculosis within the reference
groups and communities at large and this has assisted in compliance with treatment.
The second hypothesis tested significant association between stigmatization and compliance to treatment. The
results of the chi-square test showed that there was no association between stigmatization and compliance with
treatment regimen. The respondents though fear stigmatization, did not give room for people to stigmatize them
as they limited the knowledge of their ailment (tuberculosis) to only their immediate family. Therefore, there
was no stigmatization that could affect their compliance to treatment regimen.
V.
Conclusion and Recommendation
It was discovered that the subjects’ compliance to treatment was based on the largess of the Damien’s
Foundation and the Nigeria government in providing free treatment. The friendly attitude of the health
personnel was also acknowledged as the contributory factor to their compliance. The subjects praise the nondiscriminatory efforts of the health personnel in their recovery. They were encouraged to complete their
treatment as no one stigmatized them among other patients within the hospital.
It is therefore recommended that the free treatment and the acknowledged professionalism of the health
personnel should continue till tuberculosis disease is eradicated or at least is drastically reduced.
Acknowledgement
The research team appreciates the cooperation of the subjects and the permission granted for carrying
out the study by the authorities of the health facilities used.
References
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Sabate, E. (2003): Adherence to Long Term Therapies: Evidence for Action. World Health Organization. Geneva. 212
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Falase, A.O. and Akinkugbe (1999): A Compendium of Clinical Medicine Spectrum Publishers, Ibadan page 152 - 157
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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 1 Ver. V (Feb. 2014), PP 63-65
www.iosrjournals.org
Knowledge and attitude of adults on kidney donation in selected
village of Udupi district, Karnataka.
Mrs. Leena Sequira1, Dr. Mamatha S Pai2
1
(Medical Surgical Nursing, Manipal College of Nursing / Manipal University , India)
2
(Child Health Nursing, Manipal College of Nursing / Manipal University , India)
Abstract : To assess the knowledge and attitude of adults on kidney donation, a descriptive survey was carried
out in one of the villages of Udupi District. Objectives of the study were to assess the knowledge and attitude of
adults on kidney donation, to find the correlation between knowledge and attitude and to find the association
between knowledge and gender, marital status and education.
A survey approach was used for the study. Hundred adults aged 19 years and above were included in the study.
Tools used for data collection were demographic proforma, knowledge and attitude questionnaire on kidney
donation. Convenience sampling method was used for selecting the sample.
Among 100 participants recruited for the study, 64% were between the age group of 19-40 years, 60%of them
were females. Most of the adults were graduates (52%) and majority (89%) of them were Christians. . With
regard to the knowledge on kidney donation, it was observed that 76 % had good knowledge and 88% of adults
had unfavourable attitude towards kidney donation. A significant association was found between the knowledge
and gender, education and religion.(p value=0.009,0.001 and 0.003 respectively). There was a weak correlation
between the knowledge and attitude of adults on kidney donation (r=0.20 p = 0.041).
Keywords: adults, attitude, Kidney donation, knowledge.
I.
INTRODUCTION
The need of kidney transplant is increasing year by year. According to the Indian transplant Registry,
number of kidney transplant in 2000 was 1137 which increased to 1214 in 2004. [1]. Kidney transplants in India
first started in 1970s and since that time, India has been a leading country in this field on the Asian subcontinent. In India, despite the Transplant of Human Organs Act (THO), neither has the commerce stopped nor
have the number of deceased donors increased to take care of organ shortage [2]. The studies carried out in India
stresses the importance of increased public awareness on the need for deceased donor organs [3, 4,5 ]. Problems
and mortality among people with kidney disease are increasing that necessitates the importance of finding the
knowledge and attitude of adults about kidney donation.
This study was carried out to get an understanding of the knowledge and attitude of adults towards organ
donation and to find the factors associated with the same among the adults living in selected villages in Udupi
Distrcit, India.
II.
METHODOLOGY
The study used survey approach with descriptive survey design. The population for the study was
adults aged between 19-60 years residing in one of the villages covered under Udupi District of South
Karnataka, India. Adults aged between 19-60 years and holding membership in any one of the social
organization such as Jaycees, Lions or Rotary club was the inclusion criteria to select the sample for the study.
This study consisted of 100 adults chosen using convenient sampling method.
2.1. Data collection instruments
The instruments used for data collection were:
Demographic proforma
To understand the characteristics of the participants, the items included in the Demographic proforma
were age, gender, marital status, education, occupation and religion.
Knowledge questionnaire
Knowledge questionnaire consisted of 24 items related to various aspects of kidney donation.
Maximum possible score was 24. Score between18 to 24 is considered as good knowledge and score below 18 is
considered as poor knowledge.
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Knowledge and attitude of adults on kidney donation in selected village of Udupi district, Karnataka.
Attitude questionnaire
Attitude scale was a five point likert type scale consisted of 12 items (05 as strongly agree and 01 as
strongly disagree). Maximum possible score was 60. Score above 40 is considered as favorable attitude and
score below 40 were considered as unfavorable attitude.
Content validity of the instruments were established by taking the suggestions from the experts from
nephrology and nursing. The tools were modified based on the suggestions given by the experts.
The reliability of the knowledge questionnaire was established by using spilt half technique and Spearman
Brown prophecy formula (r=0.78), attitude questionnaire was done using Crohnbach’s Alfa (r=0.8).
2.2. Data collection procedure
Data were collected in one of the villages in Udupi District by meeting the adults from January 2013 to
November 2013. Adults were explained about the study and informed written consent was obtained. Participants
of the study were instructed to read and fill the questionnaire on knowledge and attitude.
2.3. Ethical considerations
The study was approved by Institutional Review Committee (IRC) and Institutional Ethics Committee
of Kasturba Hospital, Manipal. (IEC 544/2012). Written informed consent was taken from the participants and
they were assured of confidentiality.
III.
RESULTS
3.1. Sample characteristics
Out of 100 participants, 54% of the sample was between the age group of 19-40 years, 60%of them were
females. Most of the adults were graduates (52%) and majority (89%) of them were Christians. (Table 1)
Table 1: Sample Characteristics
n=100
Variables
Age in years
Marital status
Gender
Education
Occupation
Religion
Frequency(f) & %
19-40
64
41-60
Unmarried
36
47
Married
53
Female
Male
60
40
Graduation and above
Below graduation
Skilled
52
48
28
Unskilled
11
Other
61
Christian
89
Hindu
Muslim
09
01
3.2. Knowledge and attitude of adults on Kidney donation:
With regard to the knowledge on kidney donation, it was observed that 76 % had good knowledge and 88% of
adults had unfavorable attitude towards kidney donation. Mean knowledge score was 14.9 and the attitude was
31.92. (Table 2)
Table 2. Distribution of sample based on knowledge andattitude score
Variables
Knowledge on kidney donation
Attitude regarding kidney donation
Knowledge
Good
Poor
Favorable
Unfavorable
Frequency & %
74
26
12
88
n=100
Mean and SD
14.9+ 3.90
31.92 + 6.99
Attitude of adults in selected items:
The item wise frequency on attitude showed that only 35% of adults like to donate kidney but 45 % of adults
said that they would recommend a relative to donate kidney. 55% of the adults said that “it is good thing to
donate kidney but not me.”
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Knowledge and attitude of adults on kidney donation in selected village of Udupi district, Karnataka.
3.3 Correlation between knowledge and attitude:
To find the relationship between knowledge and attitude, correlation was computed and the Correlation
coefficient obtained was r= 0.205 (p= 0.041). The result showed a weak correlation between knowledge and
attitude scores of adults on kidney donation.
3.4. Association between Knowledge and selected variable:
To find the association between the knowledge and selected variables chi square was computed (Table
3). Statistically significant association was present between knowledge level of the adults and gender, education
and religion. However, there was no significant association between knowledge and marital status and age of the
adults. Younger the age knowledge was better and females had higher knowledge score than males.
Table 3: Chi-Square values computed between the knowledge scores and selected variables n = 100
Variable
Age
19-40
41-60
Category
Good
47
27
Poor
17
09
Chi-Square
0.029
P value
0.864
Gender
Male
Female
24
50
16
10
6.791
0.009
Education
Graduation and above
Below graduation
21
05
31
43
11.651
0.001
Marital
status
Married
Unmarried
16
10
37
37
1.028
0.311
Religion
Christians
Hindu &Muslim
19
07
70
04
9.099
0.003
IV.
DISCUSSION
The aim of this study was to find the knowledge and attitude of adults regarding kidney donation. It
was found that majority of the adults had good knowledge regarding kidney donation. Findings of this study are
comparable with the studies carried out by Khan N et.al. which reported statistical significance between
knowledge and gender.. This study also reported that knowledge and age were not significantly associated (5).
The study carried out by Mithra P et.al showed that 59.6% of the participants expressed willingness to donate
organs (4).
Generally the attitude of the adults regarding kidney donation was not favourable. The number
participants who would recommend relatives to donate kidney were more than those who expressed to donate
kidney themselves.
V.
CONCLUSION
This study was able to give an idea about the knowledge and attitude regarding kidney donation in
adult population. Findings of this study suggest the need for an awareness program for adults regarding kidney
donation to discuss various areas of kidney donation. Sample size of this study was only 100 and conveniently
selected. Lack of participants from all religion poses limitations for the generalizability of the study results.
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