“A STUDY TO ASSESS THE KNOWLEDGE ON INSTITU-

TIONAL DELIVERY AMONG PRIMI GRAVIDA MOTHERS AT

SELECTED HOSPITAL BANGALORE”

By
Mrs.SASIKALA.J

Dissertation submitted to Rajiv Gandhi University of Health sciences,

Karnataka, Bangalore.

In partial fulfillment of requirement for the degree of

Master of Science in Nursing

In

OBSTETRICS & GYNAECOLOGICAL NURSING

Under the guidance of

Asst. Prof. Mrs.Hemavathi.M.T. M.Sc. (N)

Department of Obstetrics and Gynecological Nursing

Shanthi Dhama College of Nursing

Bangalore – 91
2011-2012

I
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNA-

TAKA, BANGALORE.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “A STUDY TO ASSESS THE KNOW-
LEDGE ON INSTITUTIONAL DELIVERY AMONG PRIMI GRAVIDA MOTH-
ERS AT SELECTED HOSPITAL BANGALORE” is a bonafide and genuine research
work done by me under the guidance of Mrs.Hemavathi.M.T M.Sc., (N)
Asst.Professor Department Of Obstetrics & Gynaecological Nursing, Shanthi Dhama
College Of Nursing, Bangalore.

Date: SIGNATURE OF THE CANDIDATE

Place: Bangalore. (Mrs. SASIKALA J)

II
 CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A STUDY TO ASSESS THE

KNOWLEDGE ON INSTITUTIONAL DELIVERY AMONG PRIMI GRAVIDA
MOTHERS AT SELECTED HOSPITAL BANGALORE” is a bonafide and genuine re-
search work done by Mrs. Sasikala.J, M.Sc(N) II Year in partial fulfillment of the
requirement for the degree of Master of Science in Nursing (Obstetrics & Gynaeccologi-
cal Nursing).

Signature of Guide

Date: Mrs.Hemavathi M.T. MSc. (N)

Place: Bangalore Asst.Professor,

Department of Obstetrics

& Gynaeccological Nursing,

Shanthi Dhama College Of Nursing,

Bangalore.

III
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNA-
TAKA, BANGALORE.

ENDORSEMENT BY THE HEAD OF THE DEPARTMENT /

PRINCIPAL / HEAD OF THE INSTITITION

This is to certify that the dissertation entitled “A STUDY TO ASSESS THE KNOW-
LEDGE ON INSTITUTIONAL DELIVERY AMONG PRIMI GRAVIDA MOTH-
ERS AT SELECTED HOSPITAL BANGALORE” is a bonafide and genuine research
work done by Mrs. Sasikala J M.Sc(N) II year, under the guidance of Mrs. He-
mavathi.M.T,Asst.Professor Department Of Obstetrics & Gynaeccological Nursing.

Seal & Signature of the HOD Seal & Signature of the Principal

Mrs. Hemavathi.M.T M.Sc.(N) Mrs.Prof.Hamavathi M.Sc.,(N),

AssT.Professor.HOD, Principal,

Shanthi Dhama College Of Nursing, Shanthi Dhama College Of Nursing,

Bangalore. Bangalore.

Date: Date:

Place: Bangalore. Place: Bangalore.

IV
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNA-
TAKA, BANGALORE.

COPY RIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences, Bangalore, Karna-

taka, shall have the rights to preserve, use and disseminate this dissertation in print or

electronic format for academic / research purpose.

Date: SIGNATURE OF THE CANDIDATE

Place: Bangalore. (Mrs. Sasikala J)

V
 ACKNOWLEDGEMENT

“Ability is what you are capable of doing, Motivation determines

what you do, Attitude determines how well you do it”

-Lou Holtz.

Success of an individual is only possible when he or she is being supported by others. In

the course of research the investigator has been fortunate enough to receive immense

help from various sources. The investigator wishes to thank them all.

This piece of work will never be accomplished without our God Almighty for his bless-

ings, power and his abundant grace that enriched me throughout this study.

I express my gratitude to CHAIRMAN, MR. DHANANJAY SIR Shantidhama

Collge of Nursing for the support render throughout the course of the study period.

I express my sincere thanks to Prof. HEMAVATHI,M.SC (N) Shantidhama

College of Nursing for his valuable suggestions and motivation throughout my study pe-

riod.

It is my privilege to thank to my guide MRs. HEMAVATHI,M.SC Obstetrics and

Gynecological Nursing Department, Shantidhama College of Nursing, Bangalore, for

her good guidance, valuable suggestions motivation and constant support to complete my

VI
thesis successfully.

I am grateful to the MD and Administrator of Divakar BGS Hospital and

Sri Venkateshwara Hospital for permitting me to conduct the study and I am particu-

larly thankful to all the participants who voluntarily participated in the study without

whom the dissertation would have not been materialized.I extend my sincere thanks to The

Nursing superintendent and staffs of Divakar BGS Hospital and Sri Venka-

teshwara Hospital, for giving permission to conduct pilot study and main study and

extending full cooperation, help and support in carrying out the research project.

I sincerely thanks to Mr.Melbin M.Sc(N),Ms.Sowmiya M.Sc(N), Mr.lijo

M.Sc(N), Mr.Karthick Shivraj B.Sc(N), &Mrs.Uma M.Sc(N) Lecturers,Shanthi Dhama

College Of Nursing For Their Insightful Research Support, Timely advice and comments

which were helpful in making this study

I also wish to extend my sincere thanks to all the teaching faculties Master of

Nursing, and Bsc Nursing Staffs of Shantidhama College of nursing, Bangalore for

their valuable support and guidance.

I express my sincere thanks and gratitude to the Librarian for providing me books

and journals as needed

I express my sincere thanks to language expert Mrs.Sowmiya for translating the

tool in Kannada.

I convey my special thanks to My husband Mr.Sahaya Arokiya Doss, for their

constant help and encouragement throughout research work.

VII
 It is my proud privilege to express my sincere thanks to my beloved Mother

Mrs.Jayamary and my Father Mr.John Rockes and my relatives for their love, concern

and moral support throughout the course.

I also express heartfelt thanks to my Friends Mrs. Sabin jose and Mrs.Viji, for their

love, concern and moral support throughout the course.

I convey my special thanks to all participants for their cooperation and help during

the study period. My special thanks to Staff and Faculty members of Rajiv Gandhi Uni-

versity, Bengaluru.

An expression of deep warmth and thanks does not feel sufficient for my beloved

Parents, and all other family members, for their constant help, moral support, immense

patience and tolerance of my stress and strain due to pre-occupation with this research

work.

Once again, I express my heartfelt gratitude to each and everyone who was associ-

ated with this dissertation including those whom I may have inadvertently failed to men-

tion.

With a grateful heart …………

Date: Signature of the Candidate

Place: Bangalore. (Mrs. Sasikala J)

VIII
 LIST OF ABBREVIATIONS

1. WHO -World Health Organisation

2. IMR -Infant Mortality Rate

3. MMR -Meternal Mortality Rate

4. SD -Standard deviation

5. WHO -World Health Organization

6. CSSM -Child Survival and Safe Motherhood

7. RCH -Reproductive and Child Health

8. MHFW -Ministry of Health and Family Welfare

9. NRHM -National Rural Health Mission

10. MDG -Millennium development goals

11. UNICEF -United Nations (International) Children's Fund

12. UNFPA -United Nations Fund for Population Activities

13. NNT -Neonatal tetanus

14. NMCTH -Nepal Medical College Teaching Hospital

IX
15. MCH -Maternal and child health

16. FP -Family Planning

17. PPROM -Preterm Premature Rupture of the Membranes

18. HELLP -Hypertensive disease/hemolysis, elevated liver

Enzymes and low platelets

19. PTL -Preterm Threatened Labour

20. ICDS -Integrated Child Development Services

21. NON ICDS -Non Integrated Child Development Services

X
 ABSTRACT

BACKGROUND

The institutional delivery is being widely promoted because of its ability to promote child

survival and reduce risk of maternal mortality.A woman is likely to go through pregnancy

complications at the time of labour. Institutional delivery gives a safe environment for the

mother to avoid any risk of medical complications during labour.An institutional delivery

helps in the good care of the mother and the baby during and after delivery. Institutional

delivery takes the responsibility of offering childbirth and prenatal education classes to

help the parents of the newborn baby. India is a third-world country which has a high

growth rate, as it also has a high number of people living in BPL (below poverty line)

level. According to the Tenth Five-Year Plan (2002–2007), there were 3.26 lakhs BPL

families in rural areas and 1.25 lakhs in urban areas. Only three Indian states have

reported to have more than 75% of institutionalised birthing.

STATEMENT OF THE PROBLEM

“ Assess the knowledge on institutional delivery among primi gravida mothers at

selected hospital Bangalore.”

OBJECTIVES

1.To assess the knowledge on institutional delivery among primi gravide mothers...
2.To associate the findings with the demographic variables.

XI
METHODS

A descriptive survey design with Non probability Purposive sampling technique was used

to collect the data from 100 Primi gravida mothers in selected maternity hospitals, Ben-

galuru. Data was collected using a structured interview schedule. The results were de-

scribed by using descriptive and inferential statistics.

RESULTS:

Regarding demographic variables majority highest number of respondents were in

the age group of 24-29.Majority of the respondent (49%) had higher secondary educa-

tion.57% of them were house wives, 42% were belongs to 10,001-15,000 income

group,68% were in Hindu religion,68% were in nuclear family ,56% were residing in ur-

ban area 32% got information from magazines, news papers, journals or books and 76%

of them not experiance in institutional delivery before.

The mean knowledge score was 39.53% and 82% of the mothers had inadequate knowl-

edge regarding importance of institutional delivery. There was no association between

knowledge scores and selected demographic variables except educational status and place

of residence (P>0.05).

Conclusion

It was found that self instructional module was very effective in improving the

knowledge of mothers of adolescent girls on knowledge regarding institutional delivery.

Key words: Effectiveness; institutional Delivery; Knowledge, Mothers of primigravida; .

XII
 LIST OF CONTENTS

S.NO CONTENT PAGE NO

17-24
1. INTRODUCTION

25-30
2. OBJECTIVES

31-47
3 REVIEW OF LITERATURE

48-55
4 METHODOLOGY

56-79
5 RESULTS

80-84
6 DISCUSSION

85-89
7 CONCLUSION

90-92
8 SUMMARY

93-98
9 BIBILIOGRAPHY

10 ANNEXURES 99-120

XIII
 LIST OF TABLES

Sl.No List of tables Page

No
58
1 Distribution of respondents by age

60
2 Distribution of respondents by educational status

62
3 Distribution of respondents by occupation

64
4 Distribution of respondents by income

66
5 Distribution of respondents by religion

68
6 Distribution of respondents by type of family

70
7 Distribution of respondents by place of residence

72
8 Distribution of respondents by source of information

74
9 Distribution of respondents by previous knowledge on institutional

delivery

10 Assessment of knowledge regarding institutional delivery 76

11 78
Findings related to association between knowledge levels of primi

gravida mothers regarding institutional delivery and demographic

variable

XIV
 LIST OF FIGURES
S.no Page No

List of figures

1 Conceptual frame work 30

2 Schematic representation of research design 55

3 Distribution of respondents by age 57

4 Distribution of respondents by educational status 59

61
5 Distribution of respondents by occupation

63
6 Distribution of respondents by income

65
7 Distribution of respondents by religion

67
8 Distribution of respondents by type of family

69
9 Distribution of respondents by place of residence

71
10 Distribution of respondents by source of information

11 Distribution of respondents by previous knowledge on institutional 73

delivery

12 Aspect wise mean knowledge score related to institutional delivery 75

15
 LIST OF ANNEXURE

Sl. No. Annexure Page No.

Letter seeking permission for certificate of ethical clearance 99

A

Letter seeking permission for the conduct of pilot study 100

B,

Letters seeking permission for the conduct of research study 101

C,D

Letter seeking experts opinion for validation of the tool 102

E

Evaluation criteria checklist for validation of tool

F 103-104

List of experts consulted for validation of tool

G 106-107

Tool validity certificate

H 108

Content validity certificate

I 109

Structured knowledge questionnaire( English and kannada)

J 110-117

Key answer
K 118

Blue print for structured knowledge questionnaire

L 119

Letter to the subjects requesting to participate in the study and con-

M 120
sent form. ( English )

16
 1. INTRODUCTION

“Never knowing a gift so marvelous

Bringing into the world an wonderful arts

Is’nt the care of it much precious

Yes its accomplished through-Delivery care”

-BOB SMITH…

Health is the precious possession of all human beings as it is an asset for an individual

and community as well. Though health is related to individual and attained through individual

efforts to quite an extent but, it also depends upon the concerted and co-operative efforts of peo-

ple in the community to which the individuals belong. The health care providers including the

large number of doctors and nurses, who claim to be promoters of health concentrate on making

diagnosis and give therapeutic care to ill clients where as the emphasis has been on freedom from

disease and currently there is a shift in this trend i.e. increasing emphasis is on preventive and

promotive aspects of health.1

Evidence from across the world indicates that ill health disproportionately afflicts the

poor, since the poor have little or no insurance against risks of ill health. The probability of ill

health and its adverse effects is much more frequent and severe for those who are poor and this

subgroup is mostly ‘un reached’ by existing health care services. The poor have much higher le-

17
 vels of mortality, malnutrition and fertility than the rich. The poor –rich risk ratio is 2.5 for infant

mortality. 2.8 for under five mortality , 1.7 for childhood underweight and 2 for total fertility

rate. There is a glaring contrast in the health status of the rich and poor in India, as shown by the

differences in the various health indicators.2

In any community, mothers and children constitute a priority group. In sheer numbers,

they comprise approximately 70% of the population in the developing countries. Mothers and

children not only constitute a large group, but they are also a “vulnerable” or special-risk group

as the problems affecting the health of the mothers and child is multifactor. The risk is concerned

with child bearing and care of women and the infant during postpartum period. Despite current

efforts, the health of mothers and child will consider to be one of the most serious health prob-

lems affecting the community. Particularly in the developing countries as it is evidenced that

pregnancy complications are the major causes of death among women in their reproductive

ages.3

According to WHO about 495000 maternal deaths occurred globally during the year 200

of these deaths about 243000 occurred in African countries, 20000 in America, 65000 in Eastern

Mediterranean, 3000 in western pacific countries. The life time chances of maternal death in the

world as a whole is about 1 in 75 which varies from country to country. India is among those

countries which have a very high maternal mortality rate. As more than 100,000 women die each

year due to complications of pregnancy and child birth, most of them within 24hrs after child

birth. This indicates 20% of the global maternal deaths are from India. For every maternal death.

there are 10 newborn deaths are occurring.4

18
 As per sample registration system 2005, IMR in India was 58 and MMR was 301 whe-

reas in Karnataka IMR was 50 per 1000 live births and MMR was 228 per 100,000 live birth (SRS

2001-2003). The causes for such mortality rates are socio economic status of the family, long

distance to access health facility, illiteracy, home delivery, deliveries conducted by untrained dais,

early age of conception, lack of utilization of health services and other specific causes are anemia,

hemorrhage, puerperal sepsis and toxemia, multiparity, birth spacing, high fertility age of mother.5

The National health policy 2001 recognizes that ‘the morbidity and mortality levels in the

country are still unacceptably high’. These unsatisfactory health indices are in turn an indication

that the access to public health services is nominal and health standards are grossly inadequate

for the vulnerable sections of the society in the rural states.6

Most maternal and neonatal deaths take place at home, beyond the reach of health facili-

ties. Gultai et al, reported that 96% of deliveries were conducted at home in urban slums of Lu-

dina. Studies on few urban slums have indicated that despite availability of public hospitals up to

90% of deliveries in certain slums take place at home and antenatal care is minimal. But the stud-

ies conducted in India show that majority of births more particularly in the rural areas are still

delivered at home and India has a long way to achieve universalization delivery.7

The National health policy adopted by the Government of India in 2000 reiterates the

Government’s commitment to the safe motherhood programme within the wider context of re-

productive health. Among the national socio- demographic goals for 2010 specified by the pol-

icy. Several goals pertain to safe motherhood, namely that 80% of all deliveries should takes

19
place in institutions by 2010, 100% of home deliveries by trained personnal, to reduce MMR by

100 per 100,000 live births.8

Mother and family are among the key players in reduction of neonatal mortality and im-

provement in health status. The strength of any programme lies in community mobilization and

participation since the community participation is more of a challenge.9

It is well established that giving birth in a medical institution under the care and

supervision of trained health-care providers promotes child survival and reduces the risk of

maternal mortality. In India, both child mortality (especially neonatal mortality) and maternal

mortality are high. Seven out of every 100 children born in India die before reaching age one,

and approximately five out of every 1,000 mothers who become pregnant die of causes related to

pregnancy and childbirth. India accounts for more than one-fifth of all maternal deaths from

causes related to pregnancy and childbirth worldwide.10

Despite the many benefits associated with institutional delivery, India’s maternal and

child health programmes have not aggressively promoted institutional deliveries,except in high-

risk cases. The reason is that providing facilities for institutional delivery on a mass scale in rural

areas is viewed as a long-term goal requiring massive health infrastructure investments. In recent

years, however, there has been a shift in this policy with the establishment of the Child Survival

and Safe Motherhood (CSSM) and the Reproductive and Child Health (RCH) programmes. The

new programmes aim at expanding existing rural health services to include facilities for

institutional delivery. Existing maternal and child health services at primary health centres

PHCs) are being upgraded, and new first-referral units (FRUs) are being set up at the subdistrict

20
level to provide comprehensive emergency obstetric and new-born care (Ministry of Health and

Family Welfare, n.d.).9

NEED FOR THE STUDY

From time immemorial, the community through the organized efforts has been organiz-

ing certain activities which pertain to improvement of environmental aspects, promotion of

healthful living prevention of diseases, care of the sick at home. There has been an account of

organized Government efforts to provide such services to prevent and control diseases, to pro-

mote health and efficiency of people at large in a defined community and the goal was to attain

‘Health For All’. In our society, the pregnant women and her neonate from the vulnerable sector,

more importantly in rural areas and in the urban slums so, in the past few decades a greater em-

phasis has been laid in rural health as 80% of our population lived in villages.11

India accounts for over 20% of global maternal and child deaths, and also records 20%

of births world wide. Approximately 30 million women in India experience pregnancy annually

and 27 million have live births, among these 136,000 maternal deaths occur annually. Major

causes for such maternal deaths are excessive hemorrhage during child birth (generally among

deliveries at home), obstructed and prolonged labour, infection, unsafe abortions, disorders relat-

ing to high blood pressure and anemia. However most of the maternal deaths occur due to delays

in care seeking which is the ultimate result of low socio status of women, lack of awareness and

knowledge at the house hold, inadequate resources to seek care, and the poor access to quality

care (deliveries are oftenly conducted by untrained dais). Such maternal deaths can be brought

down considerably by promoting ‘safe motherhood’ through women’s programme, increasing

21
awareness of the community on safe motherhood through health care providers and engaging the

media in highlighting the issue.12

Although various safe motherhood initiatives have been taken, yet decline in maternal

ratio in India is far from the desired level of 100 by 2012 set b y the National Rural Health Mis-

sion (NRHM) and 109 by 2015 as per millennium development goals (MDG). Recent survey by

sample registration system has estimated the level of MMR in India to be about 300 in 2001-

2003. However, the level of MMR is about 400 in some of the states encompassing over 40% of

India’s population. Preconditions appear to have been early awareness of the magnitude of the

problem, recognition that most maternal deaths are avoidable, and mobilization of professionals

and the community. Still, there were considerable differences in the timing and speed of reduc-

tion of maternal mortality between countries, related to the way professionalization of delivery

care was determined.13

The report on maternal mortality rate compiled by WHO, UNICEF,UNFPA and the

world bank revealed that more women die in India during child birth than any where else in the

world. Among 5.36 lakh women who died during pregnancy or after child birth in 2005 globally,

India accounted for 1.17 lakh. The MMR in India is 450 per 100,000 while in Bangaladesh 570.

Pakistan 320. china 45, Nepal 83 and in Sri Lanka 58 per 100,000 live births. Home births are

still common in India accounting for almost for 60% of recent births. NFHS-III found that 37%

of deliveries where assisted by a traditional birth attendant, and 16% where delivered by a rela-

tive or other untrained person. Similarly in South India, Karnataka constantly holding the second

place from 1999 to 2003 having 49% of institutional deliveries to change this various major

22
program are to be adopted. States having higher institutional deliveries have low maternal mor-

tality rate and vice versa.14

23
 2. OBJECTIVES

This chapter deals with the statement of the problem, objectives of the study, operation

definitions and conceptual framework, which provide a frame of reference. The statement of the

problem selected for the study and its objectives are as follows:-

STATEMENT OF THE PROBLEM

”Assess the knowledge on institutional delivery among primi gravida mothers at

selected hospital Bangalore”.

OBJECTIVES OF THE PROBLEM

1. To assess the knowledge on institutional delivery among primi gravide mothers...

2. To associate the findings with the demographic variables.

3.To assess the knowledge regarding importants of institutional deliveries

ASSUMPTIONS

Primi gravida mothers may have some knowledge regarding

Institutional Delivery.

24
LIMITATIONS

1. Study is limited to primi mothers who are admitted in selected maternity hospital ,

Bengaluru.

2. Study is limited to primi mothers who can read and write English or Kannada.

3. Study is limited to primi mothers who are willing to participate in the study.

HYPOTHESIS

H1: There is a significant association between the knowledge score of primi mothers regarding

institutional delivery and selected demographic variables.

OPERATIONAL DEFINITIONS
Assess: It refers to the critical analysis, evaluation or judgment of knowledge of primi

mothers admitted in selected hospital regarding institutional delivery.

Knowledge: It refers to the level of understanding of primi mothers admitted in selected

hospitals regarding institutional delivery as per the structured questionnaire.

Institutional Delivery:

Institutional care, medical services are provided by Physicians, or other health

professionals who have professionally contact with a patient seeking medical treatment or

care

25
 Primi mother:

A woman pregnant for the first time; gravida I.

aternity hospitals:

It refers to hospitals, which provide care for women during pregnancy and childbirth and for new-

born.

CONCEPTUAL FRAMEWORK

Conceptualization is the battle plan of attack that is developed to research a topic that

demands an answer. Conceptual model is a set of highly abstract related constructs that broadly

explains phenomenon of interest, express assumptions and reflects a philosophical stance. The

study is aimed at determining the effect of institutional delivery among primi gravida mothers.15

The conceptual framework is a theoretical approach to the problems that is scien-

tifically based and emphasizes the selection, arrangement and classification of its concepts. It

provides clear description of variables suggesting methods to conduct the study and guiding the

interpretation, evaluation and integration of findings.16

The conceptual frame work chosen for this study is based on the Health Belief

Model. It is one of the most widely used models to explain why people do or do not take preven-

tive health actions. The model was first developed in early 1950’s by Godfrey Hochbaum, Irwin

Rosenstock, and Stephen Kegels and was later modified to include the influence of health moti-

vation.

26
The model comprised of three primary components, including

1. Individual perceptions

2. Modifying factors

3. Factors affecting the likelihood of initiating or engaging in action.

1. Individual Perceptions

• Perceived susceptibility: An individual’s estimated probability if encountering a specific

health problem. In the present study perceived susceptibility referred to the perceived risk

related to institutional delivery by the primi gravida mothers.

• Perceived seriousness: The degree of concern on experiences created by the thought of

problem or disease associated with a given health condition. In the present study per-

ceived susceptibility and perceived seriousness referred to the problem perceived by the

primi gravida mother related to knowledge towards institutional delivery.

• Perceived threat: The combined impact of perceived susceptibility and perceived seri-

ousness refers to the study subjects i.e.primi gravida mother. To identify the perceived

threat of primi gravida mother, to assess their knowledge through pre-tested instrument

developed for the study.

2. Modifying Factors

These include a variety of selected demographic, socio-psychological and structural fac-

tors that predispose the above factors of primi gravida mothers. Age, education status, occupa-

tion, income, religion, type of family, place of residence, source of information and previous

hospital experience are the modifying factors in this study.

3. The Likelihood of Action

27
 It is the positive difference between perceived benefits and perceived barriers. In this

study perceived benefits is belief about effectiveness of recommended action such as adequate

knowledge towards institutional delivery. Perceived barriers are hindrances to engaging in ac-

tions include poor knowledge regarding institutional delivery of primi gravida mother towards

institutional delivery.

Feed back: It refers to monitoring and evaluating health promotion activity. This is not in-

cluded in the study.

28
29
 3. REVIEW OF LITERATURE

According to Cooper (1988) a literature review uses as its database reports of primary

or original scholarship, and does not report new primary scholarship itself. The primary reports

used in the literature may be verbal, but in the vast majority of cases reports are written docu-

ments. The types of scholarship may be empirical, theoretical, critical/analytic, or methodologi-

cal in nature. Second a literature review seeks to describe, summarise, evaluate, clarify and/or

integrate the content of primary reports.17

According to Bruce (1994) who has published widely on the topic of the literature re-

view, has identified six elements of a literature review. These elements comprise a list; a search;

a survey; a vehicle for learning; a research facilitator; and a report.18

The related literatures are presented in the following subheadings:

1. Literature related to complications of home delivery

2. Literature related to factors affecting institutional delivery
3. Literature related to knowledge and utilization of institutional delivery
4. Literature related to importance institutional delivery

Literature related to complications of home delivery:

A study conducted on efficient and effective emergency obstetric care in a rural Indian
community where most deliveries are at home. The objective was to determine obstetric out-
comes, patterns and costs of obstetric care in a part of rural Maharashtra, India, 2905 pregnancies
were identified and eighty-five percent of 2861 deliveries after were at home. A total of 14.4% of
deliveries had identified complications. Of these complicated deliveries, 78.9% were in a hospi-
tal. Forty-eight percent of hospital deliveries were in a private hospital, 35% in our project hospi-
tal and 18% in a government hospital. Hospitalized patients with obstetric complications consti-

30
tuted 11.4% of all deliveries. The cesarean section rate for all deliveries was 2.0%. Overall case
fatality was 0.5%. The perinatal mortality rate was 36 per thousand live and still births. The
study recommended that both maternal deaths could have been prevented by early referral to
hospital.19

A study conducted to determine the epidemiological risk factor and its revealed causes
associated with maternal deaths in Delhi slums and found that most cases were illiterate, young
having high parity and no antenatal care taken during pregnancy as compared to controls: also
the major causes were found to be hemorrhage after delivery, retained placenta, and anemia. The
study findings revealed that women should be educated about the importance of antenatal regis-
tration and regular checkups as a preventive measure.20

A study conducted on home delivery and newborn care practices among urban women in
Nepal. Total of 240 mothers were interviewed. Planned home deliveries were 140 (58.3%) and
100 (41.7%) unplanned. Only 6.2% of deliveries had a skilled birth attendant percent and 38
(15.8%) mothers gave child birth alone. Only 46 (16.2%) women had used a clean home delivery
kit and only 92 (38.3%) birth attendants had washed their hands. Main reasons cited for deliver-
ing at home were ‘preference’ (25.7%) ‘case and convenience ’ (21.4%) for planned deliveries
while precipitate labour (51%), lack of transportation (18%) and lack of escort during labour
(11%) were cited for the unplanned ones and conducted that in –depth qualitative studies are
needed to explore the reasons for delivering at home. Community- based intervention are re-
quired to improve the number of families engaging a skilled attendant and hygiene during deliv-
ery.21

A study to assess the early postpartum maternal morbidity among rural women of Rajast-
han, India. Trained nurse-midwives used a structured checklist for detecting and managing ma-
ternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, represent-
ing 87.1% of all expected deliveries in a population of 58,000, were examined in their first post-
partum week during January 2007-December 2010. Haemoglobin was tested for 77.1% of
women in that 7.4% women have suffered from severe anaemia and 46% from moderate anae-
mia. Others were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-

31
threatening postpartum morbidities were detected in 7.6% of women--9.7% among those who
had deliveries at home and 6.6% among those who had institutional deliveries. Health pro-
grammes should invest to ensure that all women receive early postpartum visits after delivery at
home and after discharge from institution to detect and manage maternal morbidity. Further,
health programmes should also ensure that women are properly screened for complications be-
fore their discharge from hospitals after delivery.22

A study conducted on socio-demographic profile and obstetric experience of fistula pa-

tients managed at the Addis Ababa Fistula Hospital. The aim of the study is to identify the causes
of fistula obstetric. The study indicated in 639 fistula patients on 1999 to 2000. The 83.6% wom-
en had fistula through with delivery caused before the age of 20. In that 57% fistula was deliv-
ered at home. The outcome of the study was education about problems following teenage preg-
nancy, sign and symptoms of obstructed labor and the advantage of institutional delivery might
reduce the occurrence rate of obstetric fistula.23
A study conducted on comparison of domiciliary and institutional delivery-care practices in
rural Rajasthan, India. A retrospective cross-sectional survey was conducted to assess key prac-
tices and costs relating to home- and institutional delivery care in rural Rajasthan, India. In total,
1947 (96%) of 2031 listed women were successfully interviewed. While 34% of the women de-
livered in health facilities, modem care providers attended half of all the deliveries. It is con-
cluded that widespread irrational practices by a range of care providers in both homes and facili-
ties can adversely affect women and newborns while inadequate observance of beneficial prac-
tices and high costs are likely to reduce the benefits of institutional delivery, especially for the
poor. Study recommended the government health agencies need to strengthen regulation of de-
livery care and, especially, monitor perinatal outcomes. 24

A study to assess, ‘Neonatal tetanus: the Massey Street Children's Hospitalexperience’.The

aim of this study was to determine the current prevalence of the disease, describe the clinical
characteristics of NNT cases seen at the hospital and proffer solutions that would contribute to
the elimination of the disease.This was a retrospective study. The clinical record of 66 patients
with NNT admitted during a 2 year period (2006-2008) was reviewed.27%of the mothers had
ANC and delivered at the health clinics respectively.Only 2 (3%) of the mothers attended gov-

32
ernment hospitals.70% mothers had attened home delivery. The preference of mothers for health
clinics and government hospitals are the major concern which needs to be addressed.25

A study to assess ,’Ruptured uterus in rural Uganda: prevalence, predisposing factors and
outcomes’.A ruptured uterus is a life-threatening obstetric complication that remains a major
public health concern in low-income countries, particularly in Africa. It is a significant cause of
maternal and perinatal morbidity and mortality. In Uganda, the prevalence remains high largely
because most women do not deliver in health facilities. Further review of this problem may be
helpful in the development of appropriate preventive strategies.Uterine rupture is a disturbing
problem in Uganda. There is a need to put in place a functional referral system for pregnant
women that links the community and hospital, and a need to intensify information, education and
communication programmes to encourage women and their partners to use the reproductive
health services that are available to them. In addition, greater accessibility to equipped health fa-
cilities, the use of a partogram to monitor labour and timely interventions will go a long way to
reducing uterine rupture.26

A study to assess the Complications of home delivery: a retrospective analysis.This study

was conducted to analyze the cases who had attended Nepal Medical College Teaching Hospital
(NMCTH) after home delivery in order to broadly review the complications.This is a retrospec-
tive descriptive study. The number of total deliveries during the study period of two years (April,
2002- April, 2004) was 1619, among which 88 (5.4%) were cases who attended after home de-
livery. Majority of women (35.2%) were primi, 57.9% belonged to 20-25 year age group, 17%
were young primi, and 85.2% were full term deliveries whereas 9.1% were preterm. More than
half of them (57.9%) had regular antenatal check up. Most of them came from within 1-2 km
distance of NMCTH. 51.1% were brought only after 2 hrs of delivery. The most common reason
for attending hospital was retained placenta (84.1%-74 cases) among whom 51 (68.9%) needed
controlled cord traction, 8 cases (10.8%) needed manual removal, rest of the cases had placenta
lying in the vagina. Fifteen (17%) cases had post partum hemorrhage, 9 cases (10.2%) were
brought in a state of shock. 71.6% were anemic, 11 (12.5%) had Hb <7 gm%. Other complica-
tions included cervical, third degree perineal tear. Blood transfusion was needed in 19 (21.6%)
cases. All cases improved with proper resuscitation, use of antibiotics and definitive management

33
of complications. Most of them were discharged within 4 days of admission. Perinatal mortality
rate was 65.9/1000 births. This study showed that home deliveries were associated with in-
creased maternal morbidity especially the third stage complications. Studies done in developed
countries have shown that home birth is safe for normal, low risk women, with adequate infra-
structure and support i.e. given a well trained midwife and facilities to transfer to hospital if ne-
cessary.27

Astudy to assess ‘home birth: opinion of French women and perinatal risk. Results of the
French overseas departments 2000 survey.This study has two objectives: firstly, to find out what
are the women's views about home birth, and secondly to perform a review of the perinatal risk
associated with home birth.52% t of these women think that home delivery "should or could be
offered" (group I), 22% think that it "should never be offered" (group II); finally 26% "do not
know" whether it should or not be offered (group III). Even if it is not significant the number of
women belonging to group II increases with educational standards and maternal age. Most wom-
en believed that hospital delivery is safer, more restful, that pain relief is better, but also stated
that it is more impersonal than home delivery. The level of opposition to home delivery seems to
increase with the level of information about potential obstetrical complications. The analysis of
perinatal risks related to home delivery shows that two conditions should be fulfilled in order to
allow home delivery: a careful selection, with validated risk factor, to eliminate high risk preg-
nancies, and clear and complete information on the small but real risk of perinatal transfer.28

A study to assess Causes of stillbirths and neonatal deaths in Dhanusha district, Nepal: a
verbal autopsy study.The objective of this study was to classify and review the causes of still-
births and neonatal deaths.There were 25,982 deliveries in the 2 years from September 2006 to
August 2008. Verbal autopsies were available for 601/813 stillbirths and 671/954 neonatal
deaths. The perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate 38 per
1000 live births. 84% of stillbirths were fresh and obstetric complications were the leading cause
(67%). The three leading causes of neonatal death were birth asphyxia (37%), severe infection
(30%) and prematurity or low birth weight (15%). Most infants were delivered at home (65%),
28% by relatives. Half of women received an injection (presumably an oxytocic) during home
delivery to augment labour. Description of symptoms commensurate with birth asphyxia was

34
commoner in the group of infants who died (41%) than in the surviving group (14%).The current
high rates of stillbirth and neonatal death in Dhanusha suggest that the quality of care provided
during pregnancy.The need to reduce the uncontrolled use of oxytocic for augmentation of la-
bour.29

Astudy to assess The umbilical cord: care, anomalies, and diseases.The umbilical cord is
the lifeline of the fetus and of the neonate in the first few minutes after birth. Measures taken to
nsure sterility in cutting, tying, and painting the umbilical cord may prevent serious diseases such
as tetanus neonatorum. Care of the umbilical cord may be less than optimal in babies born at
home in unsupervised "home delivery." Minor congenital anomalies of the umbilical cord, such
as umbilical hernia, and major anomalies, such as gastroschisis and omphalocele, are reviewed in
this article. Survival in babies with major anomalies of the cord has been improving steadily be-
cause of early diagnosis (including prenatal diagnosis), better operative procedures, and better
understanding of the fluid and nutritional requirements of the neonate postoperatively. Diseases
of the cord include omphalitis and, rarely, tumors.30

Literature related to factors affecting institutional delivery

A study conducted on factors affecting the utilization of antenatal care in developing

countries. A range of electronic databases and searched for studies conducted in developing
countries and published between 1990 and 2006. Studies most commonly identified the follow-
ing factors affecting antenatal care uptake: maternal education, husband’s education, marital sta-
tus, availability cost, house hold income, women’s employment, media exposure, having a his-
tory of obstretric complications, cultural beliefs and ideas about pregnancy had an influence on
antenatal care use. The study suggested that more research is required to explore the effect of
women’s satisfaction, autonomy and gender role in the decision making process and adequate
utilization of antenatal care cannot be achieved merely by establishing health centers.31

A study conducted on obstretrics care practice in birbham district, West Bengal, India.
The present analysis includes 495 adult married women of both rural and urban areas. The study
revealed that 65% mothers go to Doctor’s for antenatal check-up during their pregnancy, but on-

35
ly 26 percent mothers get the help of professional health assistants during delivery. Educated
women have emphasized role in the practice of obstretric health care. Husbands education and
the antenatal check-up, place of delivery and assistance of health professional and concluded that
the status of literacy of mothers and standard of living of the family are of prime importance in
improving the obstretric health practices.32

A quantitative descriptive study conucted on factors contributing to low institutional deliv-

eries among women who attended ante-natal clinics in the Marondera District, Zimbabwe. The
purpose of the study was to enhance the number of institutional deliveries Gathering data by
conducting structured interviews with 80 women, All 80 women attended ante-natal clinics but
40 delivered at home and 40 delivered at an institution. The research results indicated that factors
that included traveling expenses, losing family support and the inability to meet cultural expecta-
tions; women's lack of knowledge about danger signs of pregnancy; and women's negative per-
ceptions of nurses working at the institution(s). The recommendations include reduced costs of
institutional deliveries; allowing family members (especially the mother-in-law) to be present
during institutional deliveries and to perform cultural rituals whenever possible.33

A study to assess changing trends on the place of delivery: why do Nepali women give
birth at home?. This study aimed to identify whether practice of delivery is changing over time
and to explore the factors contributing to women's decision for choice of place of delivery. A
community based cross sectional study was conducted among 732 married women of reproduc-
tive age in that there was almost 50% increased in institutional delivery over the past ten years.
The place of delivery varied according to residence. In urban area, 72.3% delivered in health in-
stitutions while only 35% women in rural and 17.5 % in remote parts delivered in health institu-
tions. The trend of delivery at health institution was remarkably increased but there were strong
differentials in urban--rural residency and low social status of women. Shyness, dominance of
mothers in law and fatalism was one of the main reasons contributing to home delivery.34

A study to assess Major barriers to effective delivery of health services in Nige-

ria.Associated with health service organizations, professionals, and care recipients in Nigeria are
reviewed. Discussed are: lack of health planning efforts by health agencies; problems of health

36
services accessibility; poor public health image; and inadequate health manpower and training
programs. Remedies suggested include comprehensive health planning and consumer involve-
ment in community health decision-making35

A study to assess , A review of barriers to utilization of the medicine hospice benefits in

urban populations and strategies for enhanced access.Disparities in access to health care extend
to end-of-life care. Lack of access to hospice mirrors lack of access to health maintenance and
primary care. Patients who are served by hospice nationally are disproportionately white and
likely to reside in economically stable communities. In many urban low-income communities,
less than 5% of decedents receive hospice care in the last 6 months of life. This review focuses
on barriers to palliative care and hospice in urban, predominantly low-income communities, in-
cluding cultural and reimbursement factors and the paucity of hospice providers, outreach pro-
jects, and in-patient hospice beds in urban communities. This review will also address some
strategies that are being implemented by hospices locally and nationally to overcome demo-
graphic barriers to hospice care.36

Literature related to knowledge and utilization of institutional delivery

A study conducted to assess the skilled attendants' delivery services among users of antena-
tal care in Kikoneni location, Kenya. The aim is to esimate the use of skilled antenatal care and
skilled attendant’s delivery services .The study was under taken among 994 women when the
period of march 2001 to march 2003 to find out 74(7.4%) presented for delivery services. The
coverage of deliveries assisted by skilled attendants was far below the national and international
goals. The use of institutional delivery services was very low even among antenatal care atten-
dees. Targeted programmatic efforts are necessary to increase skilled attendant-assisted births,
with the ultimate goal of reducing maternal mortality.37

A study conducted on complications during pregnancy, delivery and postnatal stages and
place of delivery in rural, Bangladesh, the study revealed that the utilization of safe motherhood

37
services including maternity care in Bangladesh is very poor. Only a small proportion during
pregnancy appears to have significant association with place of delivery in rural Bangladesh. The
utilization of a hospital/ clinic instead of birth at home is higher among women with secondary
or higher level of education. Delivery at a mother’s home appears to be positively associated
with higher economic status, desired pregnancy, gainful employment and visits for antenatal
care.38

A study conducted on role of traditional birth attendants in maternal care services a rural
study. This study was undertaken among 212 respondents to find out about the assistance 89%
of deliveries conducted by untrained dais, 5.2% by prenatal care assistances, 4.2% by Doctor and
1% by relatives. The utilization of existing prenatal care services was meager, as the majority of
pregnant women were illiterate and poor with this as many as 96.6% deliveries were done at
home which has significance in light of the fact that there is a wide gap between provision and
utilization of maternal care services and the people must be conducted to utilize the serevices of
trained personnal.39

A Study conducted on knowledge and utilisation pattern of MCH and family planning
services in Lucknow city. The aim of study is to find out the extent of knowledge and utilization
of MCH and FP service.Out of 100, 26% delivery in institution and 74% delivery in home. Over-
all performance is enhanced by a preference for institutional delivery and a low rate of FP post
acceptance because of lack of knowledge on recent methods and techniques. Targeted the institu-
tion should planned and organized the awareness about MCH care and family planning in institu-
tion.40

A study to assess 'Utilization of institutional delivery service in sekela district of Ethio-

pia.The study inducted in 100 participants in that 12.1% of the mothers delivered in health facili-
ties, 87.9% mothers delivered at home.Lack of knowledge on pregnancy and ANC.Strategies
with focus on increasing knowledge of the mothers and their partners would help to increase uti-
lization on service.41

38
 A study conducted on consumer satisfaction and dissatisfaction with maternal and child
health services Pakistan. The aim of the study was to assess the attitude of women towards preg-
nancy services and delivery care in Sindh province, Pakistan. Total 800 urban and 400 rural
women were surveyed. Most rural women delivered at home using the services of the traditional
midwife, the dai. Concern for costs and convenience was found to be coupled with a high degree
of trust in the services of the dai. In the urban setting preference for the dais' services was like-
wise expressed, but the hospital was considered the safest place for delivery by the majority of
respondents. The quality of the services rendered by all occupational groups was considered
highly, in particular those of the traditional dais. The absence of trained doctors in the rural areas
is noted and changes to increase their availability and services are proposed.42

A study to assess the effectiveness of emergency obstetric referral interventions in devel-

oping country settings. This study assesses the effects of referral interventions that enable preg-
nant women to reach health facilities during an emergency, after the decision to seek care is
made. Randomised controlled trials and quasi experimental study designs, studies of organiza-
tional interventions in communities that generated funds for transport reduced neonatal deaths,
with the largest effect had seen in India. Inform the implementation of effective referral interven-
tions; improved monitoring and evaluation practices are necessary, along with studies that de-
velop better understanding of how interventions work.43

A studyto assess the Institutional delivery service utilization in Munisa Woreda, South
East Ethiopia: a community based cross-sectional study. Reducing maternal morbidity and mor-
tality is a global priority which is particularly relevant to developing countries like Ethiopia. One
of the key strategies for reducing maternal morbidity and mortality is increasing institutional de-
livery service utilization of mothers under the care of skilled birth attendants. The aim of this
study was to determine the level of institutional delivery service utilization and associated fac-
tors. Out of all deliveries, only 12.3% took place at health facilities. Institutional delivery service
utilization was found to be low in the study area. Secondary and above level of mother`s and
husband`s education, urban residence and ANC visit were amongst the main factors that had an

39
influence on health institution delivery. Increasing the awareness of mothers and their partners
about the benefits of institutional delivery services are recommended.44

A study to assess the emergency air transport of obstetric patients.There were 121 maternal
air transfers, representing 1.3% of all deliveries at the Women's Hospital. The primary reasons
for transfer were threatened preterm labour (PTL) (41%); preterm premature rupture of the
membranes (PPROM) (21%); hypertensive disease/hemolysis, elevated liver enzymes, and low
platelets (HELLP) (16.5%); antepartum hemorrhage (13%); and others (8.5%). Of the women
transferred, 63% delivered at the Women's Hospital, and 37% returned for delivery to their home
hospital. Women transferred for threatened PTL were significantly less likely than those trans-
ferred for all other reasons to need delivery at the Women's Hospital (RR 0.44 [0.30-0.65], P <
0.0001).In almost two thirds of cases, the indications for emergency air transport of pregnant
women are threatened PTL or PPROM. The application of fetal fibronectin testing in cases of
suspected PTL has the potential to reduce the need for maternal air transfer.45

Literature related to importance institutional delivery

A study conducted in Uttar Pradesh, India the analysis of the revealed that the use of an-
tenatal care among low to middle income women in varanasi positively influences the likelihood
of using trained assistance at birth of a child. Women with relatively high level of care had esti-
mated odds of using trained assistance at delivery that was almost 4 times higher than women
with an low level of care.46

A study conducted on comparison of utilization of ICDS and NON-ICDS areas in urban

slums of Lucknow. A sample consisting of 400 house holds was covered and the study revealed
that a large proportion of the mothers had home deliveries in both areas that is 59% in ICDS and
73% in NON-ICDS areas but more deliveries took place in the institutions in the ICDS as com-
pared to the NON-ICDS area. Largely, non institutional deliveries were attended by the un-
trained personal including the traditional birth attendanats, family members or neighbors and
concluded that there is a need of antenatal and prenatal care in both the areas.47

40
 A study conducted on mother and child health care in Kabul, Afghanistan with focus on the
mother. The study examined the pattern of utilization of Maternal and Child Health (MCH)-
services of women with child-bearing experience. Semi-structured questionnaire had given to
100 women. Sixty one (61) women delivered at home exclusively, 35 having experienced both
home and institutional deliveries, 4 women had hospital childbirths only. Approximately half of
the women decided about utilizing the modern MCH services themselves. Promoting rooming-in
and early breast feeding in the maternity wards, ongoing education of the MCH-staff about
communication skills, ethics and teaching methods, dialogue with decision makers on all levels
in the society about MCH including family planning, ongoing training and support of community
midwives (dayas) in the community by local MCH-staff, adequate supplies, inexpensive ser-
vices, incentive money for the competent staff members are recommended.48

A study to determine two million intrapartum-related stillbirths and neonatal deaths. The
objectives are to clarify terminology for intrapartum-related outcomes; to describe the intrapar-
tum-related global burden; to present current coverage and trends for care at birth; and to outline
aims and methods for this comprehensive 7-paper supplement reviewing strategies to reduce in-
trapartum-related deaths. Birth is a critical time for the mother and fetus with an estimated 1.02
million intrapartum stillbirths, 904,000 intrapartum-related neonatal deaths, and around 42% of
the 535,900 maternal deaths each year. Most of the burden (99%) occurs in low- and middle-
income countries. Intrapartum-related neonatal mortality rates are 25-fold higher in the lowest
income countries and intrapartum stillbirth rates are up to 50-fold higher. The study recom-
mended that evidence-based strategies are urgently needed to reduce the burden of intrapartum-
related deaths particularly in low- and middle-income settings where 60 million women give
birth at home.49

A case study conducted on safe motherhood programme in Karnataka and the findings
revealed that non-institutional deliveries constituted almost 62 percent of all the deliveries. Insti-
tutional deliveries were more in the case of first order pregnancies and subsequently reduced
from the second order of pregnancy and also suggested that natal and postnatal services need to
be strengthened.50

41
 A study conducted to assess “ Is antenatal care effective in improving maternal health in
rural uttar Pradesh?”. Data from the district level household survey (2002) conducted by the
reproductive and child health project in India revealed that utilization of antenatal care services
may lead to the utilization of other maternal health related women in varanasi such as institu-
tional delivery, delivery assisted by trained professionals, seeking advice for pregnancy compli-
cations and seeking advice for post-delivery complications.51

A study to assess, ‘Emergencies in obstetrics.The survey on emergencies in Obstetrics is

addressed here to practitioners and advanced medical students. Acute abdominal pain in preg-
nancy challenges the diagnostic skills of the physician first contacted.Even seat-belts can cause
damages, if pelvic belts are used instead of shoulder belts.”HELLP"-syndrome [hemoly-
sis,elevated liver enzymes, low platelets]. This syndrome is a critical complication of preeclamp-
sia.One third of the cases occur after delivery. The mortality of mothers suffering from HELLP
remains to be high, the perinatal mortality is even higher. Post partum hemorrhage is due to the
lack of contractibility of the uterus after overdistension, protracted labour, malpositions, mere
inertia etc., from lacerations, or from placental retention. It is always an emergency with hemor-
rhagic shock impending. The risk situation around even normal birth is well known. Emergen-
cies will appear every time unannounced.52

42
 A study to assess, ‘Preventing the complications of preterm birth.Preterm birth is a major
cause of infant morbidity and mortality. Although studies have been complicated by problems of
definition and methodology, certain strategies have the potential to reduce both the incidence and
the impact of preterm birth. These strategies include accurate assessment of gestational age, edu-
cation about the signs and symptoms of early labor, recommendations for smoking cessation, and
screening for asymptomatic bacteriuria in all prenatal patients. In addition, specific interventions
such as cervical cerclage may be indicated in certain patients. The role of home uterine monitor-
ing is not yet established. If preterm labor does occur, tocolysis should be used to delay delivery,
and in appropriate cases the patient should be transferred to a medical center with a neonatal in-
tensive care unit. Antenatal administration of corticosteroids in preterm labor appears to signifi-
cantly reduce fetal morbidity.53

A study to assess failed homebirths: reasons for transfer to hospital and maternal/neonatal
outcome.A review of patients who had been transferred to the Royal Women's Hospital, Brisbane
after a failed homebirth was undertaken over a period of 5 1/2 years. There were 27 patients
identified. The most common reason for transfer was failed progress in labour, although 4 pa-
tients were transferred after delivery. Despite the resistance of these patients to medical interven-
tion, the study found that 63% of patients required assistance at delivery, by vacuum extraction,
forceps or Caesarean section. The morbidity suffered by the babies was significant (8 were ad-
mitted to special and intensive care nursery) but long-term sequelae cannot be determined be-
cause of early discharge against medical advice and refusal to be followed-up in some in-
stances.54

43
 4. METHODOLOGY

Research methodology organizes all the components of the study deals with the type of

research approach used, the setting of the study, the population, sampling technique, sample se-

lection, the inclusion and exclusion criteria, the development of the tool, collection of data, pilot

study, procedure of data collection and plan for data analysis.

Research Approach

The selection of research approach is the basic procedure for the conduction of research

enquiry. A research approach tells us, what data to collect and how to analyze it. It also suggests

possible conclusions to be drawn from the data. In view of the nature of the problem selected for

the study and the objectives to be accomplished, a descriptive research approach was used in the

study.

Research Design

The research design refers to the researcher’s overall plan for obtaining answers to the

research question and its spells out strategies that the researcher adopted to develop information

that is accurate, objective and interpretable.55

A descriptive research design is used in this study as there is a need to conduct general-

ized assessment of the knowledge of primi gravida mothers regarding institutional delivery

Research Setting

44
 Research Setting refers to the area where the study is conducted.57 It is the physical loca-

tion and depends on the condition in which data collection takes place in the study. The study

was conducted at Divakar BGS hospital,Bangalore and Sri Venkateshwara Hospital Bangalore.

Population

Population is the entire aggregation of the cases that meet a designed set of criteria.56 In

the present study, the populations were primi gravida mothers in selected hospitals, Bengaluru

Sample

Sample consists of the subject of the population selected to participate in a research

study.56 In the present study 100 primi gravida mothers in selected hospitals, Bengaluru are se-

lected as target population or samples of the study.

Sample Size

The total sample size of the study consists of 100 primi gravida mothers in selected hos-

pitals, Bengaluru

Sampling Technique

Sampling refers to the process of selecting the portion of population to represent the en-

tire population.56 In the present study non probability purposive sampling technique was adopted

for 100 primi gravida mothers from selected hospitals.

Sampling Criteria

45
 a) Inclusive Criteria

1. Primi gravida mother who are admitted in the selected hospitals, Bengaluru.

2. Primi gravida mother who are able to understand and read English or Kannada.

b) Exclusion criteria

Primi gravida mothers, who are not willing to participate in the study.

Data Collection Method

Method of data collection includes selection and development of tool, testing for validity and

reliability and administering on few samples for data collection procedure. 57

Selection of Tool

Tool is the instrument used by the researcher to collect the data. A structured knowledge

questionnaire and attitude scale based on the objective of the study as it was considered the best

instrument to elicit the responses from the participants.

Development of the Tool

Based on the objectives of the study, structured knowledge questionnaire was prepared in order

to assess the knowledge of primi gravida mothers.

The Sources of Tool Construction

• Review of literature from books, journals, news paper and on-line source reports and

other publications.

• Discussion with the experts, who included obstetrics and gynecology and refined the

investigator’s ideas about the tool preparation.

46
Description of the Tool

The tool consists of a structured knowledge questionnaire and 3 point attitude scale (likert’s

type). It is divided into 3 parts, they are as follows

Part I:

The investigator constructed the tool to collect the Socio - demographic data of the study sub-

jects. It consists of 10 demographic variables which includes age group, educational status, oc-

cupation, family income, religion, type of family ,place of residence, source of information and

previous institutional experience.

Part II:Knowledge scale for importance of institutional delivery

Investigator prepared structured knowledge questionnaire containing 30 knowledge questions

regarding importance institutionsl delivery which was further divided under 2 Sections.

Section A: concept of institutional delivery

Section B: importance of institutional delivry

Each correct response was given with score of ‘one’ and wrong answer was given a score

of ‘zero’. The maximum score was 30 and minimum score was 0. The respondents were

asked questions through structured knowledge questionnaire and had to put tick ( ) mark to the

appropriate answers. The resulting scores were ranged as follows:

• Adequate - more than 75%

• Moderate - 50% to 75%

• Inadequate - less than 50%

47
Testing of the Instrument

Content Validity

Content validity refers to the degree to which an instrument measures what it is intended

to measure.52

The prepared instrument along with the objectives, blue print and criteria check list was

submitted to 10 experts comprising of experts in the field of obstetrics and gynecology (7), Gy-

necologist (1), statistician (1) and language expert(1) for establishing the content validity. The

tool was modified as per suggestions of the experts and the final tool was constructed.

Reliability

Reliability of the research instrument was defined as the extent to which the instrument

yields the same results in repeated measures. It was then concerned with the consistency, accu-

racy, precision, stability, equivalence and homogeneity.57

The tool after validation was subjected to test for its reliability. The reliability of the tool was

tested by administering it to 10 Primi gravida mothers in Sri Venkateswara Hospital, Banga-

lore .

The reliability of the tool was computed by using split half Karl Pearson’s correlation

formula (raw score method).

The reliability co-efficient of both knowledge was found to be 0.89 and 0.85 revealing

the tool is feasible for administration for the main study.

48
Pilot study

“Pilot study is a small scale version, or trial run, done in preparation for a major Study”.58

After obtaining formal permission from authorities the pilot study was conducted from 08-

10-2011 to 17-10-2011 at Divakar BG Hospital,Bangalore. A sample of 10 primi gravida

mothers were selected by non probability purposive sampling technique. Informed consent

was taken from the primi gravida mothers who were willing to participate. Data was col-

lected by structured knowledge questionnaire and knowledge scale. An information booklet

was provided at the end of data collection.

Procedure for Data Collection

A formal written permission was obtained from Divakar BGS hospital,Bangalore and Sri

venkateshwara Hospital, Bangalore to conduct the study. The data was collected from 01-11-

2011 to 30-11-2011. The investigator explained the purpose of the study and selected the sam-

ples by non probability purposive sampling technique. Informed consent was taken from the

samples and the data was collected by self administered structured knowledge questionnaires and

knowledge scale. They were assured of anonymity and confidentiality. At the end of data collec-

tion an information booklet was given to the primi gravida mothers.

Plan for Data Analysis

The data obtained was analyzed in terms of objectives of the study using descriptive sta-

tistics.

• Organized data in master sheet.

• Frequencies and percentage for the analysis of demographic data.

• Mean and standard deviation of answered question.

49
• Chi-square test was used to determine the knowledge scores with selected demo-

graphic variables.

• The findings were presented in tables and graphs.

50
51
 5. RESULTS

This chapter deals with the analysis and interpretation of data collected to assess nowl-

edge of primi gravida mothers regarding institutional delivery. The purpose of this analysis is to

reduce the data to a manageable and interpretable form so that the research problems can be stud-

ied and tested.

The analysis and interpretation of data of this study are based on data collected through

structured questionnaire. The data collected from 100 primi gravida mothers and results were

computed by using descriptive and inferential statistics based on the objectives of the study.

Presentation of Data

To begin with, data was entered in a master sheet, for tabulation and statistical process-

ing. The findings were presented under the following headings.

Section I : Description according to demographic variables.

Section II : Assessment of knowledge regarding institutional delivery

Section III : Findings related to association between knowledge levels of

Primi gravida

52
 Section-I: Classification of Demographic Characteristics

Table 1

Distribution of Respondents by Age

N=100

Characteristics Category Respondents

Number Percent

Age Group (years) Below 15 15 15

18-23 74 74

24-29 08 08

30-35 03 03

Table 1 and figure 3 depict that among 100 respondents 15% of the respondents

were in the age group of 18-23 years, followed by 74%were in the age group of 24-29

years, 8% were in the age group of 30-35 years and remaining 3% found to be above

35years.

53
Figure 3: Distribution of Respondents by Age

54
 Table 2

Distribution of Respondents by Educational status

N=100

Characteristics Category Respondents

Number Percent

Educational status Primary 07 07

Secondary 29 29

Higher Secondary 49 49

Graduation & 15 15

above

Total 100 100

Table 2 and Fig. 4 give a description of classification of respondents by Educational sta-

tus.Out of 100 samples 7% of the respondents were identified as primary school category, 29%

of the respondents were in secondary school category, 49% of the respondents were noticed as

higher secondary category, 15% of the respondents were found to be Graduation & above cate-

gory.

55
Figure 4: Distribution of respondents by Educational status

56
 Table 3

Distribution of Respondents by Occupation

N=100

Characteristics Category Respondents

Number Percent

Occupation House wife 57 57

Private employ- 25 25

ees

Government em- 13 13

ployee

Business 05 05

Total 100 100

Table 3 and Fig. 5 give the description of classification of respondents by occupation.

The result indicates that 57% of the respondents were found to be house wives, 25% of

the respondents were private employees, 13% of the respondents were notice to be Govt. em-

ployees, followed by 5% of the respondents belong to business group.

57
Figure 5: Distribution of Respondents by occupation

58
 Table 4

Distribution of Respondents by income

N=100

Characteristics Category Respondents

Number Percent

Income Less than 5,000 11 11

5001-10,000 34 34

10,001-15,000 42 42

15,001 and 13 13

above

Total 100 100

Table 4 and Fig. 6 give a description of classification of respondents by income.

It shows 11% of the respondents have the income of less than Rs.5,000, 34% of the re-

spondents have the income from Rs.5,001 to10,000, 42% of the respondent’s income were from

Rs.10,001 to 15,000, 13% of the respondents have the income of above Rs.15,001 per month.

59
Figure 6: Distribution of Respondents by Income

60
 Table 5

Distribution of Respondents by Religion

N=100

Characteristics Category Respondents

Number Percent

Religion Hindu 68 68

Muslim 02 02

Christian 30 30

Others 00 00

Total no. of respondents 100 100

Table 5 and Fig.7 depicts the classification of respondents by religion

Religion –98.0% of the respondents belonged to Hindu religion,2% belonged to Muslim

religion and the remaining 30% were in Christian religion.

61
Figure 7: Distribution of Respondents by Religion

62
 Table 6

Distribution of Respondents by Type of family

N=100

Characteristics Category Respondents

Number Percent

Type of family Nuclear 68 68

Joint 32 32

Total no. of respondents 100 100

Table 6 and Fig. 8 depict the classification of respondents by type of family.

It shows that 68% of the respondents belonged to nuclear family followed by 32% in

joint family.

63
Figure 8: Distribution of Respondents by type of family

64
 Table 7

Distribution of Respondents by Place of residence

N=100

Characteristics Category Respondents

Number Percent

Place of residence Urban 56 56

Rural 44 44

Total no. of respondents 100 100

Table 7 and Fig. 9 depict the classification of respondents by place of residence. 56% of

the respondents belonged to urban area followed by 44% respondents in rural area.

65
Figure 9: Distribution of Respondents by Place of residence

66
 Table 8

Distribution of Respondents by source of information

N=100

Characteristics Category Respondents

Number Percent

Source of information Neighbors/family mem- 28 28

bers/friends

Magazines/news papers 32 32

/ journals and books

Radio/internet/ televi- 27 27

sion

Health professionals 13 13

Total no. of respon- 100 100

dents

Table 8 and Fig. 10 depict the classification of respondents by source of information

28 % of the respondents got the information on institutional delivery from Neighbors /Family

members / Friends, 32% from Magazines / News paper/ Journals books, 27% from Ra-

dio/internet/ television and 13% from the health personnel.

67
Figure 10: Distribution of Respondents by Source of information

68
 Table 9

Distribution of Respondents by previous knowledge in institutional delivery

N=100

Characteristics Category Respondents

Number Percent

Previous knowledge in Yes 24 24

institutional delivery
No 76 76

Total no. of respon- 100 100

dents

Table 9 and Fig. 11 depicts the classification of respondents by previous knowledge about

institutional delivery. Out of 100 postnatal primi mothers 24 % have knowledge on institutional

delivery and 76% have not knowledge on institutional delivery before.

69
Figure 11: Distribution of Respondents by previous knowledge on institutional delivery

70
 Section- II: Assessment of knowledge regarding institutional delivery

Table 10

Aspect wise Mean Knowledge Score related to institutional delivery

N=100

Knowledge Score
Knowledge No. of ques- Maximum
No Mean SD
Aspects tions score Mean
(%)

1 Concept of in- 23 23 8.56 37.22 2.56

stitutional de-
livery

2 Importance of 07 07 3.3 47.14 1.08

institutional
delivery

Combined 30 30 11.86 39.53 2.75

Table 10 reveals the mean knowledge score related to institutional delivery. The aspect

wise mean knowledge score range from 37.22% to 47.14%. Highest mean knowledge score is

found in the aspect of institutional delivery (47.14%) followed by concept of institutional deliv-

ery (37.22%).The combined mean knowledge score is 39.53% and SD is 2.75 %.( Fig 12.)

71
Figure 12: Aspect wise Mean Knowledge Score Related to institutional delivery

72
 Section-III Findings related to association between knowledge levels of Primi gravida

mothers regarding institutional delivery and demographic variable

Table – 14

Association between knowledge levels of primi gravida mothers regarding institutional de-

livery and demographic variable

N=100

2
Demographic Category Sample Respondents Knowledge χ d Table

Variables ≤ Median ≤ Median value f Value

N % N %

Age Group 18-23 years 15 11 73.33 04 26.67

24-29 years 74 40 54.05 34 45.95 2.7 3 7.82

30-35 years 08 04 50 04 50 NS

Above 35 years 03 01 33.33 02 66.67

Educational Primary 07 05 71.43 02 28.57

status Secondary 29 22 75.86 07 24.14 11.05 3 7.82

Higher secondary 49 24 48.98 25 51.02 *

Graduation and above 15 04 26.67 11 73.33

Occupation House wives 57 32 56.14 25 43.86

73
 Private employees 25 15 60 10 40 1.14 3 7.82

Government employ- 13 06 46.15 07 53.85 NS

ees

Business 05 02 40 03 60

Family in- < 5,000 11 07 63.64 04 36.36

come 5001-10,000 34 17 50 17 50 1.32 3 7.82

10,001-15,000 42 23 54.76 19 45.24 NS

>15,000 13 08 61.54 05 38.46

Religion Hindu 68 39 57.35 29 42.65

Muslim 02 01 50 01 50 0.48 3 7.82

Christian 30 15 50 15 50 NS

Others 0 0 0 0 0

Type of fam- Nuclear 68 35 51.47 33 48.53 1.07 1 3.84

ily Joint 32 20 62.5 12 37.5 NS

Place of resi- Urban 56 27 48.21 29 51.79 2.37 1 3.84

dence Rural 44 28 63.64 16 36.36 NS

Source of Neighbors/friends/ 28 18 64.29 10 35.71

information family members 2.55 3 7.82

Magazines/news pa- 32 18 56.25 14 43.75 NS

per/journals& book

Ra- 27 14 51.85 13 48.15

dio/television/internet

74
 Health personnel 13 05 38.46 08 61.54

Previous Yes 24 4 45.83 13 54.17

knowledge No 76 51 59.21 31 40.79 18.74 1 3.84

on institu-

tional deliv-

ery

Combined 100 56 56 44 44

* Significant at 5% Level, NS : Non-significant at 5% Level

The association between institutional delivery and demographic variables score of primi

gravida mothers and their personal profile such as age group, educational status, occupation,

family income, religion, type of family, place of residence, source of information and previous

knowledge on institutional delivery were analyzed in this section. Chi-square analysis was done

and result of the test is shown in table 14.

It is noted that the calculated value is greater than the table value for the demographic vari-

able of the educational status and previous knowledge on institutional delivery use hence the val-

ue was significant at 0.05% level. From the analysis it was concluded that there was a significant

association between the educational status and previous knowledge on institutional delivery of

the respondents . There was no significant association between age group, occupation, family

income, religion, type of family, place of residence and source of information.

75
 6.DISCUSSION

The aim of this study was to assess the knowledge regarding institutional delivery

among primi gravida mothers in selected maternity hospitals, Bengaluru. This chapter presents

the major findings of this study and discussion in relation to similar studies conducted by other

researchers. The study attempted to test the following objectives and hypothesis:

OBJECTIVES OF THE STUDY

To assess the knowledge regarding institutional delivery among primi gravida mothers

admitted in selected maternity hospitals, Bengaluru.

To determine the association between knowledge score with selected demographic vari-

ables.

HYPOTHESIS

H1: There is a significant association between the knowledge score of Primi gravida mothers re-

garding institutional delivery and selected demographic variables.

Major findings of the study and discussion

The findings of the study are discussed under the following headings:

• Section A: Demographic data.

• Section B: Objectives of the study

Section A: -Demographic characteristics of the sample

76
 Majority of the respondents, 74% belong to the age group of 24-29 years, 15% of the re-

spondents are in the age group of 18-23 years, 8% in the age group of 30-35 years and remaining

3% found to be above 35years old.

Considering the Educational status, 49% of the respondents are notice as higher secon-

dary category, 29% of the respondents belong to secondary school category,15% of the respon-

dents are found to be Graduation & above category ,7% of the respondents identified as primary

school category.

Considering the occupational status, 57% of the respondents are found to be house wives

, 25% of the respondents are private employees, 13% of the respondents noticed to be Govern-

ment employees, followed by 5% of the respondents belong to business group.

Regarding Family income per month, 42% of the respondents have the income from

Rs.10,001-15,000, 34% of the respondents have the income from Rs.5,001-10,000,13% of the

respondents have the income Rs.15,001 and above per month.11% of the respondents have the

income of less than Rs.5,000.

68% of the respondents belong to Hindu religion, 30% are Christian and 2% are in Mus-

lim category.

Regarding the type of family, 68% of the respondents belong to nuclear family followed

by 32% respondents belong to joint family.

Pertaining to the place of residence, 56% of the respondents belong to urban area fol-

lowed by 44% respondents in rural area.

32% of the respondents got information on importance of institutional delivery from

Magazines / News paper/ Journals books, 28% of the respondents got the information from

77
Neighbors /Family members / Friends, 27% from Radio/internet/ television and 13% from the

health personnel.

Majority of primi gravida mothers (76%) have not previous knowledge on institutional

delivery before.

A similar study was done on knowledge about institutional delivery among primi gravida mother

attending M.C.H Clinic at Damauli Hospital Tanahun .The findings of the study showed that

most of the respondents were literate 50(100%) and most of them were between age 15-21 years

30(60%). 15(30%) were Mongolian. Likewise the respondent's main religions were Hindu

37(74%). The study shows that the majority of respondents residence was city 28(56%) and was

of joint family and 23(46%). having more than seven family member. The majority of

respondents used to live on the distance of less than one hour 25(50%) from the hospital. The

majority of respondent's delivery practice was found 36(72%) to be hospital delivery.17

Section B: Objectives of the study

Objective 1: To assess the knowledge regarding institutional delivery among primi gravida

mothers admitted in selected maternity hospitals, Bengaluru.

In knowledge level of the primi gravida mothers, 82% of the respondents have inadequate

knowledge, followed by 18 of the respondents have moderate knowledge and none of the re-

spondents have adequate knowledge regarding institutional delivery. The findings reveal that the

mean knowledge score was 39.53% and SD was 2.75.

Similarly a descriptive study conducted on knowledge of primi gravida mother on institu-

tional delivery at Damauli Hospital Tanahun. The findings of the study showed that all 50

78
(100%) have heard about birth spacing. Highest number 24(48%) of respondents opinion was

institutional care very essential to primi mothers. The study shows that most of the respondents

have general knowledge about institutional delivery.59

Another study conducted on awareness, attitude and action about antenatal care in vil-

lages of Maharashtra. About 96% were aware that premacture births could be prevented, with

medical and surgical treatment. 86% of those aware that need of delivery care in health clinic

acceptable.59

Objective 2: To determine the association between knowledge score with selected demo-

graphic variables.

Significant association was found between knowledge score with the educational sta-

tus(χ2 8.13, P>0.05)and place of residence (χ2 6.66, P>0.05) .Hence for these findings H1 is ac-

cepted .

There was no significant association between knowledge with age group(χ 21.44, p >

0.05), occupation (χ 20.25, p > 0.05), family income(χ 20.89, p > 0.05), religion (χ 21.65, p >

0.05), type of family (χ 20.0019, p > 0.05), source of information(χ2..77, p >0.05) and previous

knowledge on institutional delivery (χ 201.32, p > 0.05).Hence for these findings H1 is rejected.

Similarly a cross-section observational descriptive study was conducted on factors influ-

encing institutional care acceptance or refusal in Mexico.Variables with statistical significance

related with institutional care acceptance or refusal were patient age (P < 0.05), marital status (P

79
< 0.001), pregnancies number (P < 0.001), parity (P < 0.01), cesarean section number (P < 0.001)

and previous knowledge on institutional delivery (P < 0.001).55

80
 7. CONCLUSION

Institutional delivery is to give the care to both mother and neonate.Institutional delivery

reduce risks for the mother and baby. The study focus was to assess the knowledge regarding

importance of institutional delivery among primi gravida mothers in selected maternity hospitals,

Bengaluru. The data was collected from 100 samples through non probability purposive sam-

pling technique. It was conducted during the period of 1-10-2011 to 31-10-2011. Analysis was

done and the following conclusions were drawn:

• Most of the subject had inadequate knowledge regarding institutional delivery.

• There was no association between knowledge scores and selected demographic

variables except educational status and place of residence.

The nursing implications

The findings of the study had shown that primi gravida mothers lack knowledge on

of institutional delivery .The implications of this study were discussed under the following

headings; nursing practice, nursing education, nursing administration, and nursing research.

Nursing practice

Health education is an important tool of healthcare agency. It is one of the most cost ef-

fective interventions. It is concerned with promoting health as well as reducing stress. The ex-

tended and expanded role of professional nurse is emphasis more about the preventive and pro-

motive aspects of the health.

81
 Primary prevention is one of the important components of obstetrical and gynecological

nursing. Nurses have a major role in preventive aspects than the curative aspect. One of the me-

thods of health promotion is by health education. A nurse can play an important role in improv-

ing the health of mother and child. She should create awareness among people that pregnancies

which are too early or too late in a woman's reproductive life or too closely institutional care or

unwanted carry higher health risks. The nurse has to motivate the people to adopt appropriate

institutional care to maintain optimal delivery care by informing them about the health maga-

zines, books, and health-related articles available. In the hospital and community the nurse will

have direct contact with people. This opportunity should be utilized by the nurse promptly by

giving prompt and adequate information to the public on institutional delivery by the use of elec-

tronic media, AV aids, and health education materials.

Nursing education

The present health care delivery system is emphasis more on preventive rather than the curative

aspect. The study also implies that health personnel have to be properly trained on how to teach

public regarding healthcare

The holistic health care approach should be emphasized during the training period of

nursing students. Nursing students should be made aware of the importance of educating the

public regarding various aspects of health. The nursing personnel should be given in-service

education to upgrade their knowledge. Student nurses can impart the knowledge to the public

regarding delivery by various methods of teaching like role play, puppet show, and street play to

create awareness.

82
Nursing administration

India is a developing country and over population is a major problem in our country .So

the administrative departments of nursing at the institutional, local, state and national levels

should focus their attention to educate the public regarding this commonly faced challenge.

The nurse administrator should plan and organize continuing education program for

ANM/JHA (F) to upgrade the knowledge and to motivate them in conducting teaching programs

on institutional delivery and method of ANC , PNC & Delivery care in community. She should

be able to plan and organize programs taking into consideration the cost effectiveness to carry

out successful educational programs.

In collaboration with education department, there should be necessary health education

materials and administrative support provided to conduct health programmers. Cost effective

production of health education should be provided to develop health teaching materials and make

them accessible to all staff in the hospital as well to as the community.

The nurse administrators should explore their potentials and encourage innovative ideas

in the preparation of appropriate teaching material. She should organize sufficient manpower;

money and material for disseminating health information.

Nursing research

The emphasis on research and clinical status is to improve the quality of nursing care.

Nurses needs to engage in multidisciplinary research so that it will help to improve the knowl-

edge and many health problems can be solved. They should take initiative to conduct research on

the institutional delivery and it’s importance

83
 Nurse researchers should be aware of the health care system and formulating new theo-

ries; researchers can improve the knowledge, skill and attitude of nurses and ultimately can im-

prove the status and standards of nursing profession too. The public and private agencies should

also encourage research in this field through materials and funds.

Limitations of the Study

1. Study is limited to Primi gravida mothers who are admitted in selected maternity hospi-

tal , Bangalore.

2.Study is limited to primi gravida mothers who can read and write English or Kannada.

Study is limited to primi gravida mothers who are willing to participate in the study

Recommendations

On the basis of the findings of the study following recommendations have been made:

• A similar study can be replicated on a large sample to generalize the findings.

• A quasi-experimental study can be undertaken with a control group for effective

comparison of the result.

• A study can be conducted by including additional demographic variables.

• A comparative study can be conducted between rural and urban settings.

• A study can be carried out to evaluate the efficiency of various teaching strategies

like SIM, pamphlets, leaflets and computer-assisted instruction on institutional

delivery.

84
 8. SUMMARY

Institutional delivery is an important aspect in reproductive health and family

planning .It helps to reduce the morbidity and mortality rate of mother and child.

Statement of the problem

A study to assess the knowledge regarding institutional delivery among primi gravida mothers

in selected hospitals, Bengaluru.

Objectives of the study

1.To assess the knowledge regarding institutional delivery among primi gravida mothers

admitted in selected hospitals, Bengaluru.

2.To determine the association between knowledge score with selected demographic va-

riables.

The study based on the assumption that:

Primi gravida mothers may have some knowledge regarding Institutional delivery.

The research hypothesis formulated were

1.H1: There is a significant association between the knowledge score of primi gravida

mothers regarding institutional delivery and selected demographic variables.

The review of literature included books , journals, pub-med search. In this study various

literature was reviewed which includes, literature related general information regarding institu-

85
tional delivery, knowledge regarding institutional delivery care, identify the barriers of institu-

tional delivery and importance of institutional delivery.

The conceptual framework used in the study was based on Health Belief Model by

Becker, Drachman RH and Kircht JP (1974).It is one of the most widely used models to explain

why people do or do not take preventive health actions.

The tool developed and used for the data collection. Pilot study was conducted from 08-

09-2011 to 17-09-2011 . The tool was found to be reliable and feasible. The reliability of the tool

was established by Spearman Brawn prophecy formula.

The study was a descriptive survey type. Study was conducted on 100 postnatal primi

mothers during the period of 1-10-2011 to 31-10-2011.The sample of this study comprised of

100 postnatal primi mothers in selected maternity hospital Bengaluru. Non probability purposive

sampling technique was used to draw the sample for the study.

After obtaining written permission from Arunodaya hospital, Bagalgunte and Sree Krish-

na Sevashrama Hospital Jayanagar Bengaluru .The data was collected by structured question-

naire.

The data gathered were analyzed and interpreted according to objectives. Descriptive sta-

tistics like mean, and standard deviation. And inferential statistics like χ2-test were included to

test the hypothesis at different levels of significance and the data obtained are presented in the

graphical form.

86
 The present study showed that highest number of respondents were in the age group of

24-29.Majority of the respondent (49%) had higher secondary education.57% of them were

house wives, 42% were belongs to 10,001-15,000 income group,68% were in Hindu relig-

ion,68% were in nuclear family ,56% were residing in urban area ,32% got information from

magazines, news papers, journals or books and 76% of them not used institution for delivery.

The mean knowledge score was 39.53% of the mothers had inadequate knowledge.

There was no association between knowledge scores and selected demographic variables except

educational status and place of residence (P>0.05). There was no association between attitude

level and selected demographic variables except educational status and previous institutonal de-

livery use (P>0.05).

87
 INDIVIDUAL MODIFYING FACTORS LIKELIHOOD ACTION
PERCEPTION

Demographic variables include

• Age Administered questionnaire
regarding institutional
• Educational status
delivery
Perceived Susceptibility • Occupation
Perceived Seriousness
• Monthly family income
Perceived Barriers
• Religion • Poor knowledge
• Type of family • Negative taught
regarding institutional
• Living area delivery
Knowledge on
primi mothers • Source of information
regarding
institutional • Previous knowledge- institutional delivery
Delivery. Recommendation for
Action
Development of an
Perceived Threat
information booklet in order
Affected financial status of life
to remove the barrier

Cues to Action Include

Source of information

Feed Back

Included in the study Figure 2.1: Health Belief Model by Godfrey Hochbaum, Irwin Rosenstock, and
Not included in the study Stephen RH
Kegels (1950).
THEORETICAL FKHEliveryALTH BELIEF MODEL BY BECKER, DRACHMAN, AND KIRCHT J.P. (1974)
30
LIST OF REFERENCES:

1. K. K. Community health nursing. 1st edition, Kumar publishing house, Jabalpur. 2005;

p.345-7.

2. Ingle. G.K, Nath.A. Reaching out to the unreached health care for the poor in Indian

Journal of community Medicine. 31;(2);2006.

3. Park. K. Preventive and social medicine.17 th edition, Banarsidas publishers, jabalpur,

2006.

4. John. D, Cathrine. T, Macarthur, population and reproductive health India delivers new

approaches to women’s health. Mac Arthur News letter: 2007.

5. RHS Bulletin Ministry of health and family welfare services, Govt. of India. 2006.

6. Indrani Gupta, Arindam Datta, Iequalities in health and health care I India can be the

poor hope for a respite.2003.

7. Anthony Costella, David Osrin, Dharma Manandhar, Reducing maternal and neonatal

mortality in the poorest communities. British medical journal; 329;(12);2004.

8. Armida Fernandez, Jeyashree Monkar ,Urban slum specific issues in neonatal survival,

Indian paediatrics;40;(23);2003.

9. Imitiaz Ahmed Bhat, Population research center, 2006.

10. Bhadra kamalasanan,Need to Promote Institutional Deliveries in India. Available from

http://mohfw.nic.in/NRHM/PRG-RA-Reports/Jammu,2012-05-29

11. Sudha Balakrishnan, Maternal audit project taken up in several districts one world net.

Available from : http//www.southasia.oneworld.net/article/view/146484/1/2269.

88
12. Vincent De Brouwere, Vincent rene Tonglet. Strategies for reducing maternal

mortality in developing countries. Journal of Tropical medicine and international

health, 3;(23);1998.

13. Times of India. A report on maternal mortality in India 2007; oct ;16;1;16.

14. Sample registration system, Maternal mortality in India 1997-2003 trends causes and

risk factors 1991-2003;24.

15. George J B. Nursing Theories. Connecticut: Hinge; 1995. p.37

16. Burns N, Grove KS. Understanding nursing research. 4th ed. Britain: WB Saunders;

2002. p. 128-40.

17. Cooper, Knowledge in society (Internet).1988 [cited on 2010 Nov 2] Available from :

http://www.deakin.edu.au

18. Halder K, Chachra KL, Sodhani P, Guptas. Early presumptive diagnosis in clinically

suspicious cervical cancer. Acta Cytologica. 2008 May-June; 52(3):286-96.

19. McCord C, Premkumar R, Arole S, Arole R. Efficient and effective emergency

obstetric care in a rural Indian community. Int J Gynaecol Obstet. 2001 Dec;75(3):297-

307;

20. Sarma. S, TRempel. H, Household decisions to utilize maternal health care in rural

and urban India, World health population. 9;(1);2004.

21. Sreeramareddy, CT, Joshi. HS, Sreekumaran, BV et al 2009.

22. TS Geoco jus, Early postpartum maternal morbidity among rural women of Rajasthan,

India.journal of urban health. Available from http://www.ncbi.nlm.gov/pubmed/

89
23. Socio-demographic profile and obstetric experience of fistula patients managed at the

Addis Ababa Fistula Hospital.journal of maternal health. Available from

http://www.ncbi.nlm.gov/pubmed/

24. Comparison of domiciliary and institutional delivery-care practices in rural Rajasthan,

India. Apr;27(2):303-12.

25. Adeniyi OF,Mabogunje CA,Okoromah CN,Renner JK. Neonatal tetanus the Massey

street children’s hospital experience. 2010 Oct-Dec;20(4):147-52.

26. Kadowa, Ruptured uterus in rural Uganda: prevalence, predisposing factors and

outcomes.2010 Jan;51(1):35-8.

27. Tuladhar H, Dali SM, Pradhanang. Complications of home delivery: a retrospective

analysis. Journal of the Nepal medical Association. 2005 Jul-Sep;44(159):87-91.

28. Dupuis O,de Tayrac R, Poilpot S, Minand S, Fernandez H,F rydman R, Levardon M,

Madelenat p,et al. Home birth: opinion of French women and perinatal risk. Results of

the French overseas departments 2000 survey. Article in French 2002 Sep;30(9):677-

83.

29. Manandhar SR, Ojha A, Manandhar DS, Shrestha B, Shrestha D, Saville N, et al

Causes of stillbirths and neonatal deaths in Dhanusha district, Nepal: a verbal autopsy

study. 2010 Jan-Mar;8(29):62-72.

30. Elhassani SB,The umbilical cord: care, anomalies, and diseases.1984 Jun;77(6):730-6.

31. Simkadha . B, Teijingen, E.N, Factors affecting the utilization of antenatal care in

developing countries, systemic review of literature, Journal of advance

nurses,61;(3);2010.

90
32. Susmita Bharadhi, Obstretric care practices in Birharm district, International journal

for quality in health care,14;2009.

33. Factors contributing to low institutional deliveries among women who attended ante-

natal clinics in the Marondera District, Zimbabwe. Available from

http://www.ncbi.nlm.gov/pubmed/

34. Changing trends on the place of delivery: why do Nepali women give birth at

home?Available from http://www.ncbi.nlm.gov/pubmed/

35. Williams PB, Omishakin MA. Major barriers to effective delivery of health services in

Nigeria. Journal of health,population,nutrition.1983 Jan 1;4(1):5-16.

36. O’Mahony S, McHenry J,Snow D,Cassin C,Schumacher D,Selwyn,et al. A review of

barriers to utilization of the medicare hospice benefits in urban populations and

strategies for enhanced access.J Urban Health. 2008 Mar;85(2):281-90.

37. Skilled attendants' delivery services among users of antenatal care in Kikoneni

location, Kenya. Available from http://www.ncbi.nlm.gov/pubmed

38. Islam, MA, Chowdry. R.I, Akhter NH, Complications during pregnancy, delivery

and postnatal stages and place of delivery in rural, Bangladesh, health care women

international,27;(9);2008.

39. Bharadwaj. N, Yunes. G, Role of traditional birth attendants in maternal care services,

Indian journal of maternal child health, 1;(29);2005.

40. Knowledge and utilisation pattern of MCH and family planning services in Lucknow

city. Available from http://www.ncbi.nlm.gov/pubmed

41. Parmar, Utilization of institutional delivery service in sekela district of Ethiopia

[Internet] Available from http://biomedcentral.com (8.2012 Jul 31;12:74.)

91
42. Consumer satisfaction and dissatisfaction with maternal and child health services

Pakistan. Available from http://www.ncbi.nlm.gov/pubmed/

43. Henry, Effectiveness of emergency obstetric referral interventions in developing

country settings online 2012 July 10.

44. Abdella Amano, Abebaw Gebeyehu, and Zelalem Birhanu. Institutional delivery

service utilization in Munisa Woreda South East Ethiopia a community based cross-

sectional study. online 2012 October 8

45. Uyirworth GP,Itsweng MD,Mpai S,Nchabeleng E and Nkoane H.Obstetrics service

utilisation by the community in Lebowa, northern Transvaal.2007 May;29(5):406-8.

46. Blooms. S, Lippedveld. T, Does antenatal care make a difference to safe delivery.

Health policy plan oxford journals,14;(1);2005.

47. Madhu Agarwal, Comparison of utilization of maternal services by mothers of ICDS

and NON-ICDS areas in urban slum of Lucknow, Indian journal of preventive and

social; medicine, 35;(3);2006.

48. Mother and child health care in Kabul, Afghanistan.Available from

http://www.ncbi.nlm.gov/pubmed/

49. Lawn JE,Lee AC,Kinney M,Sibley L,Carlo WA,Paul VK,Pattinson R, Darmstadt

GL,et.al. Two million intrapartum-related stillbirths and neonatal deaths.International

journal of gynaecoclogy and obstetrics.2009 Oct;107

50. Veeramatha. Cs, Safe motherhood programme in Karnataka, A study of population

research center, Ministry of health and family welfare, 2005.

51. Ram. F.Singh, Is antenatal care effective in improving maternal health in rural Uttar

92
 Pradesh? Evidence from a district level household survey,Journal of Boi social

sciences, 38;(4);2006.

52. Ludwig H, Emergencies in obstetrics.Article in German,1996 Jun;53(6):477-96.

53. Lefevre ML,Preventing the complications of preterm birth.1992 Aug;46(2):441-8.

54. Jony L,Baskett TF. Emergency air transport of obstetric patients.1996 Aug; 36(3):275-

8.

55. Burns N, Grove SK. Understanding nursing Research. 2nd ed. Philadelphia:

W.B.Saunders Company; 2002. p. 53-56.

56. Dr. Basavanthappa BT. Nursing Research.1st edition. New Delhi: Jaypee Brothers;

2001. p. 126-35

57. Treece EW, Treece TT. Elements of Research in nursing. 1st edition. St.Louis: Mosby

publication; 1986. p. 78-95.

58. Polit FD, Hungler PB. Nursing research principles and methods. 6th ed. Philadelphia:

Lippincot Company; 1999. p. 378.

59. Romero-Gutierrez G, Garcia Vazquez G M, Huerta Vargas L F, and Ponce de Leon A

L,Factors influencing contraceptive acceptance or refusal in puerperium. Ginecologiay

Obstetricia de Mexico. 2001; 69(4): 406–12.

93
 Schematic representation of research design

Target
Purpose Setting Population Sample Technique Tool Assessment

Assess the Selected Primi gravida 100 primi Non prob- *Structured Criterion

knowledge of hospitals, mothers in gravid ability questionery measure

primi Bengalore selected mothers purposive schedule on knowledge

gravida hospital, admitted in sampling knowledge with selected

mothers selected technique variable

Bangalore
regarding hospitals,

institutional
Bengalore
delivery

52
 INDIVIDUAL MODIFYING FACTORS LIKELIHOOD ACTION
PERCEPTION

Demographic variables include

• Age Administered questionnaire
regarding institutional
• Educational status
delivery
Perceived Susceptibility • Occupation
Perceived Seriousness
• Monthly family income
Perceived Barriers
• Religion • Poor knowledge
• Type of family • Negative taught
regarding institutional
• Living area delivery
Knowledge on
primi mothers • Source of information
regarding
institutional • Previous knowledge- institutional delivery
Delivery. Recommendation for
Action
Development of an
Perceived Threat
information booklet in order
Affected financial status of life
to remove the barrier

Cues to Action Include

Source of information

Feed Back

Included in the study Figure 2.1: Health Belief Model by Godfrey Hochbaum, Irwin Rosenstock, and
Not included in the study Stephen RH
Kegels (1950).
THEORETICAL FKHEliveryALTH BELIEF MODEL BY BECKER, DRACHMAN, AND KIRCHT J.P. (1974)
 ANNEXURE - A

CERTIFICATE OF ETHICAL CLEARANCE

This is to certify that Mrs.Sasikala.J,IInd Year M.Sc.,Nursing student in obstetric and

Gynecological Nursing.Thedessertation of the study as “A study to assess the knowledge

regarding institutional delivery amongprimigravida mothers in selected hospitals,

Bangalore”,has been subjected for ethical approval of the ethical commitee of ShanthiDhama

College of Nursing.I hereby certify that the study carries minimal risk and may be permitted to

carry out the study.

99
ANNEXURE - B

100
ANNEXURE - C

101
ANNEXURE - D

102
 ANNEXURE-E
Letter Seeking Expert’s Opinion for the Validity of the Tool

From,

Mrs .J.Sasikala

II year M.Sc. Nursing,

ShanthiDhamaCollege of Nursing,

sunkatkatte, Bengaluru

To,
_________________________________

_________________________________

_________________________________

_________________________________
Forwarded through:

The Principal,

ShanthiDhamaCollege of Nursing,

Sunkatkatte, Bengaluru

Respected Sir/Madam,
Sub: Requisition for expert opinion on content validity of the research tool.
I,Mrs .J.Sasikalastudent of II year M.Sc. Nursing in the above mentioned institution. As part of
partial fulfillment of M.Sc. Nursing programme (Obstetrics &Gynaecological Nursing specialty).
I have selected the below mentioned topic for the dissertation to be submitted to Rajiv Gandhi
University of Health Sciences, Bengaluru.

Topic: “A study to assess the knowledge regarding institutional delivery among

primigravida mothers in selected hospitals, Bengalure.”
103
 ANNEXURE-F

Evaluation Criteria Checklist for Validation of Tool

Instructions
1.A research tool is developed. I request you to give your expert comments and suggestions.

2.There are 3 columns given for responses place a tick (  ) mark in the appropriate column and
give your remarks in the columns.
Interpretation of columns:
 Column I completely meets the criteria.

 Column II partially meets the criteria.

 Column III does not meet the criteria.

 Remarks.

3.Your expert opinion and kind co-operation will be highly appreciated and gratefully
acknowledged.
Thanking you in anticipation.

104
 Sl i III
Evaluation Criteria III Remarks
No. I I

Part I: Demographic data.

The items on socio-demographic information
cover all aspects necessary for the study
Part II:
Divided into two sections.
 Section-A - Deals with the items on concept
of institutional delivery.
 Section-B - Deals with the items on
importance institutional delivery

Place:

Date: Signature of the Valuator

105
 ANNEXURE - G

LIST OF EXPERTS

Obstetrician and Gynecologist

1. Dr.D.MallinathaPrabhu.

Senior consultant of OBG

Goutam hospital,

Tumkur

2. Dr.Basavaraj,

Senior consultant of OBG

Charaka hospital,

Tumkur

3. Dr.siri

Senior consultant of OBG.

Vijaynagar global hospital. Bangalore

Obstetrician and Gynecological Nursing

4. Mrs. Riya Mathew, M.Sc.(N)

H.O.D of OBG nursing

Father Mathews College of Nursing,

Bangalore. 128

106
5. Mrs.Hemavathi. M.Sc.(N)

Co-guide of OBG nursing,

Shantidhamacollege of nursing,

Bangalore.

6. MRS.ManishaKadam, M.Sc.(N)

Asst. Professor, OBG Depart.

Sadhu Vaswani College of Nursing,

Pune .

7. Mr.chandrashekhar,

Department of statistics,

K.L.E college,

Bangalore.

107
 ANNEXURE-H

Tool Validity Certificate

This is to certify that the tool developed by, MrsJ.SasikalaII year M.Sc. Nursing student of

Shanthidhamacollege of Nursing, sunkatkatte, Bengalure (Affiliated Rajiv Gandhi University of

Health Sciences) is validated by the undersigned and can proceed to conduct the main study for

dissertation entitled “A study to assess the knowledge regarding institutional delivery

amongprimigravida mothers in selected hospitals, Bengalure”.

Place: (Signature of the Valuator)

Date: (Designation & Address)

108
 ANNEXURE-I
Content Validity Certificate

This is to certify that the tool, MrsJ.Sasikala II year M.Sc. Nursing student of ShanthiDhama

College of Nursing, sunkatkattee,Bengaluru (Affiliated Rajiv Gandhi University of Health

Sciences) is validated by the undersigned and can proceed to conduct the main study for

dissertation entitled “A study to assess the knowledge regarding institutional delivery among

Primigravida mothers at selected hospitals, Bengaluru”.

Place: (Signature of the Valuator)

Date: (Designation & Address)

109
 ANNEXURE -J

STRUCTURED KNOWLEDGE QUESTIONNAIRE

Questionnaires are divided into two parts which includes multiple choice questions.
Part-I
Consists of the nine items related to demographic variable of primigravida mothers from selected
hospitals in Bengaluru.
Part -II
Consists of thirty items on knowledge of primigravida mothers regarding institutional delivery
which is divided into two sections.

 Section-A - Deals with the items on items on concept institutional delivery.

 Section-B - Deals with the items on importance of institutional delivery
PART-I

Socio-Demographic Data

Dear participant,
This questionnaire is related to the demographic variables. I am here with requesting
you to answer all the questions by ticking the correct answer according to you from the answers
given below for the each question. This information will be treated as confidential

Sample Code Number: __________

1. Age in years
(a) 18-23 ( )
(b) 24-29 ( )
(c) 30-35 ( )
(d) Above 35 ( )

2. Educational status
(a) Primary ( )
(b) Secondary ( )
(c) Higher secondary ( )

110
 (d) Graduation & above ( )
3. Occupation
(a) House wife ( )
(b) Private employ ( )
(c) Govt employee ( )
(d) Business ( )
4. Monthly family income (in rupees)
(a) Less then 5,000 ( )
(b) 5,001 – 10,000 ( )
(c) 10,001 – 15,000 ( )
(d) 15,001 and above ( )
5. Religion
(a) Hindu ( )
(b) Muslim ( )
(c) Christian ( )
(d) Others ( )
6. Type of family
(a) Nuclear ( )
(b) Joint ( )
7. Living area

(a) Urban ( )
(b) Rural ( )
8. Source of information
(a) Magazines / News paper/ Journals and books ( )

(b) Radio /Television/internet ( )

(c) Health personnel ( )

(d) Family members / neighbors / Friends ( )

9. Have you ever knowledge about institutional delivery?

111
 a) Yes ( )
b) No ( )

PART II
SECTION – A
CONCEPT OF BIRTH SPACING:
1. What is the rank of India in population?
a) First ( )
b) Second ( )
c) Third ( )
d) Fifth ( )
2. What do you mean by delivery?
a) Expulsion of feotus from mothers birth canal ( )
b) Avoiding sex to prevent pregnancy ( )
c) Family with not more than 3 child ( )
d) Couples with no children ( )
3. What do you mean by institutional delivery?
a) Delivery is done under relatives ( )
b) Delivery is done under physicianin health institution ( )
c) Delivery conducted in home ( )
d) Delivery conducted by uneducated dai ( )
4. What is the reproductive age of women?
a) 15-45 years ( )
b) 13-30 years ( )
c) 18-50 years ( )
d) 12-60 years ( )
5. What do you mean by primigravida?
a) Age of the mother at which the first child born ( )
b) First pregnancy ( )
c) Interval between marriage and first child birt ( )
d) Interval between last child birth and sterilization ( )

112
6. What is the recommended time for normal delivery?
a) 30 weeks ( )
b) 11 months ( )
c) 36 weeks +7days ( )
d) 38 weeks ( )
7. What is the criteria for a mother to institutional care?
a) Caesarian Delivery ( )
b) The birth of dead baby ( )
c) For living child and mother ( )
d) All the above ( )
8. Which among the following is a health care institution?
a) PHC ( )
b) Health services ( )
c) Praivate health sector ( )
d) All the above ( )
9. Which among the following is not ainstitutional care?
a) Home delivery ( )
b) Delivery under trained midwife ( )
c) Delivery under trained dai ( )
d) Delivery under physician ( )

10. Which are barriersof institutional care?

a) High expense, travalling and lack of knowledge ( )
b) Good education about institution ( )
c) Structure of the hospital ( )
d) Medical and surgical care ( )
11. Which among the following is a healthy delivery?
a) Antenatal checkup ( )
b) Old women’s advice ( )
c) None of the above ( )
d) All the above ( )

113
12. What do you mean by caesarian?
a) One operation to save mother and child ( )
b) One operation to save mother ( )
c) Use of contraceptives during pregnancy period ( )
d) Avoiding sex during pregnancy ( )
13. What you mean by doplerscan ?
a) It shows growth of eyes ( )
b) It is a surgery to prevent pregnancy ( )
c) It shows babys heart beet ( )
And heart sound

d) It shows mother’s heart beat ( )

14. What is the effectiveness of periodical antenatal visitduring delivery?

a) Provide 2% protection for mother and child ( )
b) Provide 98% protection for mother and child ( )
c) Provide 50% protection for mother and child ( )
d) Provide 60% protection for mother and child ( )

15. At what time the mother give breast feedto her baby?
a) 1 hour ( )
b) 30 minits ( )
c) 3rd day ( )
d) 5th day ( )
16. When did you attend the first antenatal visit?
a) After 20 Weeks ( )
b) After 6 months ( )
c) Before 50 days ( )
d) After 12 weeks ( )
17. Short stature is highly risk for?
a) Fetal congenital abnormality ( )

114
 b) Increased perinatal morbidity ( )
c) Caesarean section ( )
d) All the above ( )
18. Immunization helps in preserving the health status of
a) Placenta and baby ( )
b) Mother and baby ( )
c) Mother and uterus ( )
d) Baby and umbilical cord ( )
19. What is the advantage of institutional care?
a) It provide critical care for mother and child ( )
b) Failure rate is increase than other methods ( )
c) increase chance for painful ( )
d) None of theabove ( )
20. Which are all the critical care deliveries?
a) Ventous delivery ( )
b) Vaccum delivery ( )
c) Caesarean ( )
d) All the above ( )
21. Which system is responsible for producing offspring?

a) Respiratory system ( )

b) Cardiovascular system ( )

c) Urinari system ( )

d) Reproductive system ( )

22. Which method is most suitable for those who have high set ?
a) Episiotomy ( )
b) Forceps delivery ( )
c) Natural method ( )
d) All the above ( )
23. Where do the facilities for family planning available?
a) Only in specialty hospital ( )

115
 b) Only in government hospital ( )
c) Only in PHC ( )
d) All the above ( )

SECTION B
IMPORTANCE OF INSTITUTIONAL DELIVERY

24. Who gets the health related benefits of institutional delivery?

a) Only mother ( )
b) Only child ( )
c) Only father ( )
d) Both mother and baby ( )
25. What is the relation between institutional delivery and death rate?
a) Reduces Neonatal death rate ( )
b) Reduces death rate of children below 1 year ( )
c) Reduces death rate of female due to complications of ( )
Pregnancy , Child birth or within 4 days of delivery

d) All the above ( )

26. Which is the effect of institutional delivery on subsequent pregnancy?
a) Reduce anemia ( )
b) Reduce third trimester bleeding ( )
c) Reduce premature delivery ( )
d) All the above ( )
27. What is the effect of decreased instutional care on birth weight of baby?
a) Increase birth weight ( )
b) Decrease birth weight ( )
c) Normal birth weight ( )
d) No effect on birth weight ( )
28. Institutional care will leads to
a) Infertility ( )

116
 b) Reduced unwanted pregnancies ( )
c) Abortion in subsequent pregnancies ( )
d) None of the above ( )
29. Why death occur among mothers with home delivery?
a) Uneducated dai not known about complication of delivery ( )
b) Mother’s body will get enough energy ( )
c) Mother’s body cannot use the stored iron ( )
d) Elimination of iron will be more ( )
30. What will happens if the mother exceeds exclusive breast feeding?
a) Baby will be healthy ( )
b) Second baby’s milk will be weak ( )
c) Mother will become fat ( )
d) Breast diseases will occur ( )

117
 ANNEXURE-K

KEY ANSWERS

Question No. Answer Question No. Answer

1 B 22 b

2 A 23 d

3 B 24 d

4 A 25 d

5 B 26 d

6 C 27 b

7 D 28 b

8 D 29 a

9 A 30 a

10 A
11 A
12 A
13 C
14 B
15 B
16 C
17 C
18 B
19 A
20 D
21 D

118
 ANNEXURE-L
Blue Print for Knowledge Questionnaire

Sl. Question Total Percentage

Items/Content
No Numbers Questions (%)

1 Concept of institutional 1-23 23 77%

delivery
Importance
2 institutional delivery 24-30 07 23%

Total 30 30 100%

119
 ANNEXURE- M

LETTER TO THE SUBJECTS REQUESTING TO PARTICIPATE IN THE STUDY AND

CONSENT FORM.

Dear Respondent,

The purpose of this study is to assess the knowledge regarding institutional delivery
amongprimigravida mothers in selected hospitals.
You are requested to participate in this study by responding appropriately to the simple
questionnaire, which will take about 50 - 60 minutes for you to complete. Your kind cooperation
is highly esteemed and your honest responses are valuable.
The information about your socio-demographic data and thelevels of knowledge among software
professionals will help me in the analysis process.
I assure you that the information given by you will be kept strictly confidential and used only for
the study purpose. If you are willing to participate in this study, please sign the consent form
given below.

Yours sincerely,
Place:
Date: (Ms. J.Sasikala)

CONSENT FORM
I have been informed of the purpose of the study and I voluntarily give my consent to participate
in this study.

Signature of the respondent

120