A PRE-EXPERIMENTAL STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING
ANTENATAL CARE AMONG PRIMIGRAVIDA
MOTHERS ATTENDING ANTENATAL
OPD IN A SELECTED HOSPITAL
OF MOHALI, PUNJAB.

A THESIS SUBMITTED TO

BABA FARID UNIVERSITY OF HEALTH SCIENCES FARIDDKOT

IN THE PARTIAL FULFILMENT

FOR THE AWARD OF DEGREE OF

MASTER OF SCIENCE IN NURSING

2023
SUBMITTED BY
NEHA KUMARI

(OBSTETRICS AND GYNAECOLOGICAL

NURSING) RATTAN PROFESSIONAL EDUCATION
COLLEGE, SECTOR- 78 SOHANA, MOHALI,
PUNJAB
 ACKNOWLEDGEMENT

“All dreams can come true if we have the courage to pursue them.”

-Walt Disney

This study is the end product of immense hard work and sincere efforts of those who have
extended their help and guidance to give concrete shape to my plans and make them
conspicuous in the dissertation. It is practically impossible to mention all by name, but some
of those I would like to thank particularly.

This work would not have the spirit it has been without the invaluable academic, educational,
psychological and human support and belief in me as a writer and researcher, provided by the
following scholars.

First and foremost I thank to god almighty for being with me all the time and hearing my
prayers during the ups and downs of my life.

I sincere word of gratitude to Ms. Kamlesh Rani, Principal of Rattan Professional

Education College, Mohali, Punjab for exhibiting such cooperation that helped me to
undertake this study and also for her guidance and suggestions for providing study material,
facilities, support and guidance without which my research would only have remained a
dream.

It is my proud privilege to express my deepest regards and my heartfelt gratitude to the guide
of my research project Ms. Khushdeep Kaur, Assistant Professor of Obstetrics and
Gynaecological Nursing, Rattan Professional Education College Mohali, Punjab under
whose meticulous guidance , invaluable suggestions and constant motivation, this endeavor
could become possible.

I wish to express my heartfelt regards to the co-guide of my research project Mrs. Rajinder
Kaur, Associate Professor of Community Health Nursing for her guidance, easy
approachability and understanding and above all, for her constant encouragement which
helped me to conduct the study.

I am extremely grateful to the library staff of my college for granting the permission to utilize
the library facilities.

This page of acknowledgement would remain incomplete and out of term if I do not express
 TABLE OF CONTENTS

SR. NO. CHAPTER PAGE NO.

I BACKGROUND OF STUDY 1-12
 Introduction
 Need of the study
 Research Problem
 Aim of the study
 Objectives
 Operational definitions
 Hypothesis
 Limitations
 Research Variables
 Delimitations
 Conceptual Framework
II REVIEW OF LITERATURE 13-18
III RESEARCH METHODOLOGY 19-27
 Research Approach
 Research Design
 Research Variables
 Research settings
 Target population
 Sample and sampling technique
 Inclusion and Exclusion Criteria
 Selection and development of tool
 Validity of tool
 Reliability of tool
 Pilot study
 Ethical consideration
 Plan of data analysis
IV ANALYSIS AND INTERPRETATION OF DATA 28-37
V DISCUSSION 38-39
VI SUMMARY, CONCLUSION, IMPLICATIONS AND 40-42
RECOMMENDATIONS
VII REFERENCES 43-46
VIII ANNEXURES 47-97
 LIST OF TABLES

S.NO. TITLE PAGE NO.

1.(a,b) Frequency and percentage distribution of subjects as per their socio- 29-30
demographic variables
2. Frequency & Percentage distribution of subjects as per pre-test 33
knowledge score regarding antenatal care.
3. Descriptive statistics of pre-test level of knowledge 34
4. Frequency & Percentage distribution of post-test level of knowledge 34
5. Comparison of frequency & percentage distribution of pre-test and post- 35
test level of knowledge
6. Comparison of descriptive statistics of pre-test and post-test Scores of 36
knowledge
7. Table Showing Association of Scores and Demographic Variables. 37
 LIST OF FIGURES

SR. NO. TITLE PAGE NO.

1. Conceptual framework based on Ludwig Von Bertalanffy 11
2. Flow Chart Depicting Research Methodology 20
3. Schematic representation of Data collection 26
4. Frequency and percentage distribution of subjects according to the 31
Age
5. Frequency and percentage distribution of subjects according to the 32
Diet
6. Bar Diagram showing the percentage distribution of pre-test 33
knowledge
7. Diagram representing comparison of percentage distribution of pre- 35
test and post-test level of knowledge
 LIST OF ANNEXURE

SR. NO. ANNEXURE Annexure No.

1. Letter Seeking Permission From Principal of Rattan ANNEXURE I
Professional Educational College of Nursing, Sohana,
Sector 78 Mohali, Punjab to Conduct Research Study
2. Letter Seeking Permission From Civil Surgeon of Civil ANNEXURE II
Hospital Phase 6, Mohali, Punjab to Conduct research
study
3. Letter Seeking Opinions and Suggestions From Expert to ANNEXURE III
Establish Content Validity for Research Tool
4. Acceptance form for Validation of Tool ANNEXURE IV
5. Certificate of content validity from Experts ANNEXURE V
6. List of experts ANNEXURE VI
7. Certificate of English language Editorial (English) ANNEXURE VII
8. Certificate of Hindi language Editorial (Hindi) ANNEXURE VIII
9. Certificate of Punjabi language Editorial (Punjabi) ANNEXURE IX
10. List of Experts ANNEXURE X
11. List of Guide and co-guide ANNEXURE XI
12. Permission Letter to Conduct Pilot Study ANNEXURE XII
13. Permission Letter to Conduct Main Study ANNEXURE XIII
14. Approval Letter from University of Plan of Thesis ANNEXURE IX
15. Permission for Ethical Committee ANNEXURE X
16. Plagiarism report ANNEXURE XI
17. Master data sheet ANNEXURE XII
 LIST OF ABBREVIATIONS

Abbreviations Full form

et.al And all other

N Number

% Percentage

F Frequency

Fig. Figure

SD Standard deviation

P value Probability value

NS Not significant

N Total no. of samples

< Less than

> More than

SR.NO. Serial number

ANC Antenatal care

M Mean
 ABSTRACT

Antenatal care (ANC) is an opportunity to promote a positive pregnancy experience and

improved maternal and child survival. The study's goal was to see how well a structured
teaching programme affected the primigravida mother‟s understanding of antenatal care.
Methodology: A quantitative approach was used to conduct the study. A one group pre-test,
post-test research design was adopted for the study. This study was conducted in antenatal
OPD at Dr. B. R. Ambedkar State Institute of Medical Science, phase 6, Mohali, Punjab. The
sample consisted of 60 primi-gravida mothers. The investigator adopts convenient sampling
technique to collect the data from the primi-gravida mothers in the month of March 2023.
The collected data was analysed by using descriptive and inferential statistics methods. Tool
was developed by investigator to collect the data from subjects. Ethical permission was taken
from concerned authorities prior to the study and informed consent was taken from subjects
prior to the data collection for maintained confidentiality. The reliability of tool was checked
and tool was found reliable. Result: The finding of the pre-test knowledge scores that out of
60 subjects 17(28.3%) had poor knowledge, 43(71.7%) had average knowledge. The finding
of the post-test knowledge scores that out of 60 subjects 21(35%) had average knowledge and
39(65%) subjects had good knowledge. The mean +SD of pre-test score of knowledge is
12.42 +2.959 and the mean +SD of post-test score of knowledge is 21.32+1.9. Result of
association indicates there is no significance were found in pre-test knowledge score and
selected socio- demographic variables.

Conclusion: Teaching programme is a useful strategy to improve the knowledge of antenatal

care during pregnancy.

Keywords: Antenatal Care, Structured Teaching Programme, Primigravida mothers.

 CHAPTER - I
BACKGROUND OF STUDY
 CHAPTER-I
INTRODUCTION

BACKGROUND OF THE STUDY

Antenatal care (ANC) is an opportunity to promote a positive pregnancy experience and
improved maternal and child survival. Care in the antenatal period is also important for
supporting the long-term growth and development of the child. It serves as a facilitating
platform linking the woman and her family to the healthcare system and possibly promotes
higher utilisation of essential services like breastfeeding and nutritional counselling, post-
partum family planning and childhood vaccination.1

The World Health Organization (WHO) envisions a world where every pregnant woman and
newborn receives quality care throughout the pregnancy, childbirth and the postnatal period.
Within the continuum of reproductive health care, antenatal care (ANC) provides a platform
for important health-care functions, including health promotion, screening and diagnosis, and
disease prevention. It has been established that by implementing timely and appropriate
evidence-based practices, ANC can save lives.2

COVID-19 pandemic has posed unprecedented challenges to public health, food systems and
economic structure of the world leading to dramatic loss of human life and income. The
obstacles were not only in treating patients infected by the virus but also for seeking medical
care for other non-COVID pathological and physiological health conditions. Antenatal care is
one such non-emergency yet essential health service which got overlooked and hence was
compromised. In the current pandemic situation such frequent visits to hospital for seeking
care; will expose the expectant mothers and their fetuses to COVID-19 infection. Due to
physiological alterations in immune and cardio-respiratory systems, the pregnant women fall
under vulnerable group to develop complications due to virus even though are not at an
increased risk of getting infected as compared to the general population.3

In India, Reproductive and Child Health (RCH) Programme under the Ministry of Health and
Family Welfare advises to receive at least three ANC checkups, iron and folic acid (IFA)
tablets, calcium tablets, tetanus toxoid (TT) injections, weight monitoring, blood pressure
check, abdominal examination, and counselling by a frontline health worker. It is likely to
happen that not all pregnant women who receive ANC services may utilize the entire package

1
of services (full ANC). Some might register but never utilize, whereas some might utilize
only part of the services, and others may not meet the minimum number of contacts
required.4

It is estimated that improved (Quality of Care) can annually save about 1,325,000 neonatal
deaths, 531,000 stillbirths and 113,000 maternal deaths globally. The QoC includes the
provision of effective, efficient, safe care that is accessible, acceptable, patient-centered and
equitable with patient satisfaction. Quality improvement (QI) strategies attempt to close the
know-do gap using scientific thinking and simultaneous health systems strengthening. The QI
interventions have used combinations of the six dimensions of the health system: service
delivery, health workforce, information, medical products/vaccines/technologies, financing
and leadership and governance.5

Maternal malnutrition is an important public health concern both globally and in India.
Consequences associated with maternal under nutrition include the mortality and morbidity
burden for mothers and their children, specifically, fetal growth restriction, stunting, wasting,
nutrient deficiencies, and neonatal deaths. About 3.1 million global child deaths and 68%In
India, about 1/3rd women of reproductive age group are undernourished and more than 60%
are anemic. Maternal health status during pregnancy and nutrition is a strong determinant of
health and survival of foetus in utero & the child post-birth. Maternal nutrition is influenced
by many biological as well as socio-cultural factors inherent in local community that affect
women‟s dietary habit and pattern.6

Pregnancy should be seen as an opportunity to embrace exercise routines and women should
be encouraged to maintain those habits. Antenatal exercises are tailored to promote health
benefits to both pregnant women and fetuses. According to the National Institute for Health
and Care Excellence guidelines (NICE) and the American Congress of Obstetricians and
Gynecologists (ACOG), antenatal exercise (ANEx) has minimal risks and paramount
benefits, although some modification is needed as per maternal and fetal requirements.
ACOG recommended that low-impact or moderate exercise for 30 minutes on most days of
the week, helps with weight management, reduced risk of gestational diabetes mellitus
(GDM), and improved psychological well-being.7

Urinary tract infections (UTI) are frequent during pregnancy. UTIs occur when there is a shift
in the normal flora dominated by lactobacilli to coliform uropathogens. UTIs can result to

2
disabilities and serious health problems for the mother and the new-born, such as
pyelonephritis, low birth weight, premature labor, preterm birth, hypertension, preeclampsia,
and increased incidence of perinatal death. Several studies have reported physiological
changes that occur during pregnancy as factors decreasing the ability of the lower urinary
tract to resist invading bacteria. These factors, including anatomical factors, altered vaginal
biota, genetic factors and diabetes, dysfunctional voiding, coupled to poor vaginal hygiene
and not wearing proper underclothes contribute to the development of urinary tract infections
(UTI) in women.8

Iron deficiency during pregnancy is acknowledged as a serious public health problem around
the globe. In low and middle-income countries, like India, pregnant women are most
vulnerable part of society suffering from nutritional deficiencies to a significant degree due to
long lasting gender inequality. The WHO estimates that 58% of the women in developing
countries are anemic and in India status of women health is tragic and about 87% pregnant
women are suffering from anemia regardless of their age and parity. Folate and iron
deficiency during pregnancy are risk factors for anemia, leads to preterm delivery, low birth
weight and poor neonatal health. To combat this threat, the composition of Iron along with
Folic acid in the form of tablets is prescribed to pregnant women that are helpful in increasing
the hemoglobin concentration so that the level of anemia at term could be reduced. The
provision of consumption of 100 iron and folic acid (IFA) tablets during pregnancy forms an
essential component of the safe motherhood services offered as part of the Reproductive and
Child Health Programme in India. In 2005-06 it was reported that only 23% women
consumed iron tablets for at least 90 days during pregnancy. Lack of iron consumption during
pregnancy leads to exhaustion, improper work performance and diminution of the immune
system as well as may affect newborn health. Many studies related to iron supplementation in
pregnancy have shown improved iron stores in the supplemented women compared with non-
supplemented women. Thus, appropriate iron supplementation is essential for maternal and
newborn health.9

NEED OF STUDY
Safe Motherhood Initiatives, a worldwide effort was launched by the World Health
Organization in 1987 which aimed to reduce the number of deaths associated with pregnancy
and childbirth. Appropriate antenatal care (ANC) is one of the pillars of this initiative. It
highlights the care of antenatal mothers as an important element in maternal healthcare as

3
appropriate care will lead to successful pregnancy outcome and healthy babies.
Improving maternal health is one of the eight-millennium development goals (MDGs). Under
MDG5, countries committed to reducing maternal mortality by three-quarters between 1990
and 2015.10

Worldwide, approximately 830 women died every single day due to complications during
pregnancy or childbirth in 2015. Reducing the global maternal mortality ratio (MMR) from
216 per 100 000 live births in 2015 to less than 70 per 100 000 live births by 2030 will
require a global annual rate of reduction of at least 7.5% – which is more than triple the
annual rate of reduction that was achieved between 1990 and 2015. Most maternal deaths are
preventable as the necessary medical interventions are well known. It is therefore crucially
important to increase women‟s access to quality care before, during and after childbirth. In
2016, millions of births globally were not assisted by a trained midwife, doctor or nurse, with
only 78% of births were in the presence of a skilled birth attendant.2

Globally, 62% of pregnant women received the WHO recommended minimum 4 antenatal
visits during 2010–2016. Latest research has shown a lower still birth rate, among women
with a minimum of 8 antenatal visits, based on which the minimum recommended number of
antenatal contacts has now been increased from 4 to 8.1

In India data from the most recent National Family Health Survey-3 suggest that the maternal
mortality ratio has fallen from approximately 400 deaths per 100,000 live births in 1997 to
301 deaths per 100,000 live births in 2006. The maternal mortality ratio (MMR) in India has
been maintained at a higher level since long. It was reported that the MMR among Indian
women national average of MMR is 212 per 100,000 live births (SRS - 2007-2009) which in
itself is very high compared to the international scenario like Sweden (5), USA (24), and
Brazil (58) and even in neighbouring countries such as Sri Lanka (39) and Thailand (48).
Although the health status of women has improved over the years due to concentrated efforts
of Government of India, it is still not at par with the international benchmark and is
unacceptably high. Health outcome goals established in the 12th 5-year plan are to reduce
infant mortality rate to 25 per 1000 live births, to reduce maternal mortality ratio to 100 per
100,000 live births by 2017.10

In India, the proportion of pregnant women receiving the minimum 4 antenatal visits has
increased from 37.0 to 51.2% during 2006–2016. This is relatively modest when compared to

4
increase in the rate of institutional delivery which has doubled from 38.7 to 79% during the
same time period, largely driven by the conditional cash transfer schemes of the government.
This differential coverage reflects a missed opportunity, as about one fourth of the maternal
deaths are attributable to pre-eclampsia, eclampsia and antepartum haemorrhage, which could
be identified and managed during the antenatal contacts.1

Several research studies have focused on women of all reproductive age groups, with
inadequate attention given to understanding factors associated with ANC utilization among
adolescent pregnant women. According to the NFHS-4 survey, the proportion of ANC
coverage among women aged 15–49 years has increased by 7% during 2005–2006 to 2015–
2016. Around 59% of women of reproductive age received first ANC check-up during the
first trimester of pregnancy, and 51% had more than three ANC visits, which is comparable
to the global coverage of 58.6% and slightly higher than ANC coverage for South Asia
(50.0%). There are notable variations in the exploitation of ANC services by younger
(adolescents) and older (adult) pregnant women. Adult pregnant women are more likely to
utilize ANC as compared to adolescent pregnant women, and a number of socioeconomic and
demographic factors like education, employment, income, place of residence, geographical
variations, birth order, and parity explain the differences in utilization of ANC services
among adolescent and adult pregnant women. However, there is insufficient evidence
available exclusively on the use of ANC services by adolescent pregnant women, and their
specific vulnerabilities. Exploring the ANC utilization among adolescent pregnant women
and adult pregnant women may be useful to spot disparities, distinguish barriers, and suggest
appropriate measures to enhance the uptake of ANC services.4

A comprehensive understanding of determinants of antenatal care utilisation in India is

lacking. In context of the recent focus of the Indian government on antenatal services,
through Pradhan Mantri Matru Vandana Yojana (PMMVY), a conditional cash transfer
scheme, understanding the factors driving the utilisation is crucial to aid the development of
an informed policy. In this scheme the pregnant woman is eligible if she registers her
pregnancy at the Anganwadi centre (AWC) within four months of conception, attends at least
one prenatal care session and is taking Iron-folic acid tablets and TT (tetanus toxoid)
injection.1

According to the data released by UNICEF, India is projected to record the highest number of
births since Covid-19 was declared a pandemic in March 2020, with 20.1 million babies

5
expected to be born between March and December. This gave a rough estimate that a large
number of women were deprived of appropriate prenatal care during their pregnancy. The
factors affecting these services were present on both supply and demand sides. As majority of
health care delivery facilities are dedicated to COVID-19 care, staff getting engaged in
emergency COVID-19 duties, several staff becoming positive and mandatory quarantines of
staff have restricted delivery of ante-natal care. On the demand side, lack of information
about availability of services, increased fears and concerns of being exposed, movement
restrictions, loss of income, and social factors caused hindrance in seeking continuous
antenatal care. There has been a sharp rise in obstetric abuse and violence at institutions and
home hampering the maternal mental health. Social ignorance, lack of family support and
increased household workload has increased mental pressure and has disturbed lifestyle.
There has also been difficulty in availing obstetric services during labour. Most of the
ambulance services are diverted for COVID-19 related activities and with suspension of
transportation facilities, women in labour fond it difficult to reach a healthcare facility. There
have been reported cases of women giving birth in ambulances because of delay in transport.
Even if they reach a facility on time, they have to get COVID-19 testing done and in case
they report positive, they are referred to a COVID-19 designated facility for delivery which
led to further delay.3

Between 2000 and 2017, neonatal mortality rate (NMR) by 47%, infant mortality rate (IMR)
declined by 51%, and maternal mortality rate (MMR) by 59% in India, which were slower
than expected. The Sustainable Development Goals have set ambitious health-related targets
for mothers, newborns, and children under the umbrella of Universal Health Coverage (UHC)
by 2030. The World Health Organisation (WHO) envisages that „every pregnant woman and
newborn will receive quality care throughout pregnancy, childbirth and the postnatal period‟
under the umbrella of UHC, which is aligned with „Ending Preventable Maternal Mortality‟
and the „Every Newborn Action Plan‟. Good quality of care (QoC) is a key to achieve these
goals. Estimates project that improved QoC can annually save about 1,325,000 neonatal
deaths, 531,000 stillbirths and 113,000 maternal deaths globally.5

The investigator during the work experience in the hospital observed that the primigravida
mothers had inadequate knowledge about antenatal care. Lack of knowledge, awareness and
attitude makes incorrect perception of health practice which deals with the individual to move
towards the unsafe motherhood. These can be prevented if the mother had a teaching on

6
antenatal care during her pregnancy. By considering the above factors, the investigator
developed a genuine interest and felt a need of conducting a study to test that the
effectiveness of structured teaching programme on knowledge antenatal among primigravida
mothers.

PROBLEM STATEMENT
A pre-experimental study to assess the effectiveness of structured teaching programme on
knowledge regarding antenatal care among primigravida mothers attending antenatal OPD in
a selected hospital of Mohali, Punjab.

AIM OF THE STUDY

The aim of the study is to assess the effectiveness of structured teaching programme on
knowledge regarding antenatal care among primigravida mothers.

OBJECTIVES
1. To assess the pre-test level of knowledge regarding antenatal care among primigravida
mothers.
2. To develop and administer structured teaching programme on knowledge regarding
antenatal care among primigravida mothers.
3. To assess the post-test level of knowledge regarding antenatal care among
primigravida mothers.
4. To evaluate the effectiveness of structured teaching programme on antenatal care
among primigravida mothers.
5. To associate the pre-test level of knowledge on antenatal care among primigravida
mothers with selected socio-demographic variables.

OPERATIONAL DEFINITION
 Effectiveness: - Statistical Measurement of difference between pre and post-test
knowledge scores on antenatal care among primigravida mothers after administering
structured teaching programme.
 Structured teaching programme: - It refers to the systematically structured group
instructions designed for primigravida mothers to gain knowledge on antenatal care. It
includes definition, importance of antenatal care, antenatal visit, antenatal diet,
antenatal exercises, antenatal medication and supplementation, personal hygiene, rest
and sleep, antenatal immunization, warning signs, labor preparation, regular antenatal
check-ups and minor disorders during pregnancy and its management.
7
  Knowledge: - It refers to the ability of the primigravida mothers to give response to
the item in the structured teaching programme questionnaire regarding antenatal care.
Each correct response score one (1) mark and wrong response scores zero (0) mark.
 Antenatal Care:- It refers to the knowledge and ability of the pregnant mother to care
for themselves regarding antenatal visit, antenatal diet, antenatal exercises, personal
hygiene, rest and sleep, antenatal immunization, warning signs and labor preparation.
 Primigravida Mothers: -It refers to the pregnant women attending the antenatal
OPD of Selected hospital of Mohali, Punjab.

HYPOTHESIS
 H1: There is a difference in the score of pre-test and post-test level of knowledge
regarding antenatal care among primigravida mothers at 0.05 level of significance.

VARIABLES
 Dependent variable:
It refers to the knowledge of the primigravida mothers regarding antenatal care.
 Independent variable:
It refers to the structured teaching programme regarding antenatal care among the
primigravida mothers.

DELIMITATIONS
The study was delimited to:
 does not have labor pain
 are all able to read and write Hindi/Punjabi
 are all available during data collection period

8
 CONCEPTUAL FRAMEWORK
A conceptual framework is an approach to study the problems that are scientific based
emphasizes the selection, arrangement and classification of its concepts.

 The researcher created a conceptual framework for the study based on LUDWIG VON
BERTALANFFY model, which was first introduced in 1970s “Nurse‟s knowledge on
Nursing theory”, is a prescriptive conceptual framework. Theory can be thought of as a
conceptualization framework, which is made up of 5 factors/ concepts:
1. Realities
2. Input
3. Throughput
4. Output
5. Feedback

REALITIES
It involves all the factors such as physical, psychological, emotional, spiritual, and
physiological in which the Nurses action occur at any given moment. In this study Realities is
socio demographic variables including age, occupation, education, monthly income of family,
religion, type of family residence and dietary habits.

INPUT
System balance is maintained by self-regulation of the input. Some inputs may be utilized
instantly, while other needs further information from the enviourment. Primigravida mothers
comprehension of an ability to consume antenatal care will be primary focus on this inquiry.

THROUGHPUT
Process that takes place between the point of input and output. When input is converted into
output in this manner, the system can more easily make use of it. There are many ways in
which raw materials or energy from the environment may be transformed into useful products
by a system, and this is one of them. This study defines throughput as "the need felt by the
investigator" based on pre-test levels of knowledge. The investigator will give a thorough
education programme to primigravida mothers in order to assess their knowledge of antenatal
care.

9
OUTPUT
When a system's technological, social, financial, and human inputs have been processed, the
outcome is called the "output." The energy, information, or materials that are released into the
environment are referred to as output. In order to survive, a system must attain and maintain
equilibrium between its internal and external environments, which it does via a variety of
adaptations. Primigravida mother's awareness of antenatal care and how to avoid it is the
focus of this investigation.

FEEDBACK
Data or energy processing information that may be utilized to analyze and monitor the system
and to steer it for better performance. A appraisal of knowledge and re-implementation of a
structured education programme for primigravida mothers who did not alter their level of
knowledge are examples of feedback in this research. However, it is omitted from this
investigation

10
 INPUT THROUGHPUT OUTPUT

DEMOGRAP Teaching given by

HIC lecture method
VARIABLES with AVaids chart,
. ACghearts pamphlets
.Educational
status
.Religion Pre Post POSITIVE
.Type of interventional Interventional OUTCOME
family knowledge Knowledge INCREASES THE
.Occupation Assessment Assessment KNOWLEDGE
.Residence
.Income of
family
.Number of
family
members
.Type of
gravida
.Dietary
habits

FIGURE 1: CONCEPTUAL FRAMWORK BASED ON MODIFIED LUDWIG

VON BERTALANFFY-GENERAL SYSTEM MODEL

11
SUMMARY
Chapter deals with Introduction, Background of the study, Research problem statement, Aim,
Objectives, Hypothesis, Delimitations, Operational definitions and conceptual framework
based on Ludwig Von Bertalanffy model. In next chapter Review of literature will be done.

12
 CHAPTER - II
REVIEW OF LITERATURE
 CHAPTER-II
REVIEW OF LITERATURE

A valuable component of research is the review of literature. It is the particular phenomenon

to know what is already done. Relevant literature is being studied and reviewed for purpose
of gaining in depth knowledge on the topic under study by the investigator. The studies
reviewed have been written below:

Janakiraman B, Gebreyesus T, Yihunie M et.al (2021) A cross-sectional study was

conducted on knowledge, attitude, and practice of antenatal exercises among pregnant
women in Ethiopia. The objective of this study was to evaluate the knowledge, attitude, and
practice of antenatal exercises among Ethiopian women during pregnancy, and also to
examine the barriers to prenatal physical activity. The sample consisted of 349 pregnant
women receiving prenatal care at the ante-natal care clinic, University of Gondar
comprehensive specialized hospital were recruited. Data were obtained on maternal
characteristics, knowledge, attitude, practice, and barriers towards antenatal exercise (ANE)
by interview method. The results showed that among 349 pregnant women, 138 (39.5%) and
193 (55.3%) had adequate knowledge, a positive attitude, and good practice respectively.

Fulpagare PH, Saraswat A, Dinachandra K et.al (2021) A study was conducted on

antenatal care service utilization among adolescent pregnant women–evidence from
Swabhiman Programme in India. The present study aims to test the hypothesis and assess
determinants of ANC service utilization among currently adolescent pregnant women. Out of
a total 2,573 pregnant women (15–49 years) included in the sample, about 10% (N = 278)
were adolescent girls (15–19 years) at the time of the survey, and the rest were adults. Sample
was selected from the population using simple random sampling, and information was
collected using pretested questionnaires. The results showed that for all indicators of ANC
service utilization, performance of adolescent pregnant women was better than adult pregnant
women. However, Public Distribution System and Integrated Child Development Services
entitlements, and knowledge of family planning methods had a significant effect on the ANC
service utilization. Hence, it was concluded that adolescent pregnant women have shown
better utilization of selected indicators than their adult counterparts. Utilization of full ANC
services starting from first trimester itself for adolescent pregnant women is an urgent need in
present context. Intervention program must pay attention to such adolescent married girls
who are entering into the motherhood phase of their lives.4

Das MK, Arora NK, Dalpath SK et.al (2021) A quasi-experimental study was conducted
on improving quality of care for pregnancy, perinatal and newborn care at district and sub-
district public health facilities in three districts of Haryana, India. The aim of the study was to
improve the Quality of Care (QOC) for maternal and newborn care in the hospitals The
study was conducted at nine district and sub-district referral hospitals in three districts
(Faridabad, Rewari and Jhajjar) Antenatal identification of high-risk pregnancies increased
from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7%
(p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent
in antenatal clinics declined by 19–42 minutes (p<0.01). Hence, it was concluded that
multipronged quality improvement strategy improved the maternal and newborn services,
case documentation and patient satisfaction at district and sub-district hospitals. The
processes and lessons learned shall be useful for replicating and scaling up.5

Kanimozhi T. k. (2021) A study was conducted to assess the effectiveness of structured

teaching programme on knowledge on antenatal care among primigravida mothers at selected
PHC, at Coimbatore. Research approach quantitative research approach was used for the
present study. The finding implies that the educational intervention has significant effect in
the improvement of practice regarding antenatal care among primi gravida mothers. The
study concluded that antenatal effects the global health of individual. Antenatal care its self-
care activity and more important carefully we can do it.

Biradar S, Patil A (2020) A study was conducted to assess the effectiveness of planned
health teaching on knowledge regarding antenatal care among primi gravida mothers. The
study aimed to assess the knowledge of primi mothers on antenatal care and to evaluate the
effectiveness of planned health teaching on knowledge regarding antenatal care among primi
mothers. A sample of 60 primi mothers who met the inclusion criteria was selected. The
study findings imply that there is a need for educational programme to create awareness
among the primi mothers regarding antenatal diet.

Upadhyay C, Nayak B (2020) A cross-sectional study was conducted on knowledge and

practices of antenatal care among pregnant women attending antenatal clinic at a Tertiary
Care Hospital of Pune, Maharashtra. The main objective of the study was to determine the
level of knowledge, attitude, and practice on ANC among pregnant women attending the
antenatal clinic at a Tertiary Care Hospital in Pune and their association with various socio-
demographic factors. A cross-sectional study was carried out among 384 pregnant women in
their 3rd trimester attending the antenatal clinic in a Tertiary Care Hospital. Pretested
questionnaire was used for collecting data by interview after obtaining informed consent. The
results of the study revealed that about 58% women had adequate knowledge regarding
Antenatal care. It was found that almost all the variables such as age, education, occupation,
parity, type of family, and socioeconomic status (SES) had a significant association with
awareness about antenatal care. Hence, it was concluded that these findings can be used to
plan a Health Intervention Program aiming to improve the maternal health practices and
eventually improve the health status of the women. 10

Jain R, Taksande V (2020) A study was conducted on knowledge and practices of antenatal
care among pregnant women attending antenatal clinic at a tertiary care hospital, Gujrat,
India. The study aimed to determine the level of knowledge, attitude and practice ion ANC
among pregnant women attending the antenatal clinic at a tertiary care hospital. It was carried
out among 384 pregnant women in their 3rd trimester attending the antenatal clinic at a
tertiary care hospital. It was concluded that the findings can be used to plan a health
intervention programe aiming to improve the health practices and eventually improve the
health status of the women.

Abirami M, Biradar S (2020)A study was conducted to assess the effectiveness of planned
Health teaching on knowledge regarding antenatal care among primigravida mothers. The
aim of this study to assess knowledge of primi mothers on antenatal care and to evaluate the
effectiveness of planned health teaching on knowledge regarding antenatal care among primi
mothers.

Jessie A, Dayna A(2020) A study was conducted to evaluate the effectiveness of structured
teaching programme on knowledge regarding antenatal care among primigravida mothers in a
selected village of Mehsana District. A Quantitative approach using pre experimental one
group pre-test post-test design. A total of 60 primigravida mothers were selected by using
convenient sampling technique. Self-structured questionnaire was used to assess the level of
knowledge regarding antenatal care among primi mothers. The findings of the study indicated
the structured teaching programme is effective in research knowledge regarding antenatal
care among primigravida mothers.
Kumar S, Khanna A, (2019) A study was conducted on utilization, equity and determinants
of antenatal care in India. The major objective of the study was to examine the utilization, equity
and determinants of antenatal care (ANC), defined as 4 or more antenatal visits, at least one
tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100
days, in India. A sample of 190,898 women from India‟s National Family Health Survey 4
was analyzed. Concentration curves and concentration index were used to assess equity in
full Antenatal care utilization. It was used to examine the factors associated with full ANC
utilization. The results revealed that in India, 21% of pregnant women utilized ANC. Overall,
51.6% had 4 or more ANC visits, 30.8% consumed IFA for at least 100 days, and 91.1% had
one or more doses of tetanus toxoid. Hence, it was concluded that full ANC utilization in India
was inadequate and inequitable. Strategies to address the socio-demographic factors associated
with low and inequitable utilization of full ANC are imperative for strengthening India‟s maternal
health program.1

Pete PMN, Biguioh RM, Izacar AGB et.al (2019) A cross-sectional descriptive study was
conducted on genital hygiene behaviour and practices among antenatal care . The aim of this
study was to assess pregnant women behaviour and practices regarding genital hygiene.
Overall, 80 pregnant women were enrolled. Data were collected using a paper based standardized
questionnaire directly self-administered after obtain a free consent. The majority of them had
attended at least primary education (97.5%; n=78/80) and many were lived in couple (81.25%;
n=65/80). Almost one on three participants identified antenatal consultation as a key element to
be taken into account by pregnant women. 70.1% (n=56/80) of women declared wearing
undergarments in cotton and use antiseptic solutions for genital cleaning. It was concluded that
knowledge and genital hygiene cleaning practices are acceptable among our study population.
Skills of health care providers on good hygiene practices for pregnant should be improved
and community-based communication strategies need to be implemented to reach all women
of child bearing age.8

Kaur A, Singh J, Kaur H et.al (2018) A study was conducted on knowledge and practices
regarding antenatal care among mothers of infants in an urban area of Amritsar, Punjab. The aim of
the present study was to find the knowledge and practices regarding antenatal care among the
mothers of infants. The mothers having less than one year child according to the annual report
of year 2017 were included in the study. A pre-designed questionnaire, which was pre tested was
used to collect the information. Out of 332 mothers 327 were willing to participate in the study.
House to house survey was done to collect the information. Statistical analysis was done by using
SPSS 20.0. The results revealed that the knowledge about the antenatal care 22% mothers had
poor knowledge while 45.6% and 32.4% had average and good knowledge respectively. Age and
education status of
the mother had significant relation with the knowledge regarding ANC (p=0.00). 96% of
mothers started ANC in first trimester. 79.5% of mothers had regular ANC visits during
pregnancy. Regarding post natal visits 86.5% of the mothers visited for the same. Hence, it was
concluded that considerable gaps were found in the knowledge and practices regarding ANC.
The health workers should be trained adequately about the available ANC services. Community
IEC activities should be increased to create awareness about the ANC services which are
available free of cost in our country.

Ahirwar N (2018) conducted a descriptive case control study to assess the knowledge of
antenatal care among antenatal women attending outpatient clinic. Study group included all
unbooked antenatal women and control group consisted of booked antenatal women. Data
collection was done by using predesigned, pretested, structured questionnaire. The study findings
concluded that knowledge attitude and practices of antenatal care is good in the subjects who
were booked in the ANC.

Mohamed A H G (2018) conducted a descriptive study to assess the self-care performed by

pregnant women.60 women were selected for the study. Structured interview questionnaire
was used in the study. The study findings concluded that the majority of the studied women
had deficient self-Care practices in second and third trimester.

Chourasia A, Pandey M (2017)A study was conducted on factors influencing the consumption
of iron-folic acid supplementations in high focus states of India. The purpose of this study to
assess the factors influencing the consumptions of iron folic acid (IFA) supplementation in high
focus state of India. Total 11085 recently delivered women from high focus states were
included in the study. Women who received at least 90 IFA tablets were considered as
outcome variable. The results revealed that well educated women are four times more likely to
adhere recommended dose of iron supplements. It was concluded that higher education and
lower birth order infer to more consumption among pregnant women.

Sijo Koshy, Pinal Bhabhor (2016 ) A study conducted to determine the effectiveness of structured
teaching programme on knowledge regarding antenatal care among pregnant women in
selected rural area of Vadodra, Gujrat. The aim of the study was to assess the level of
knowledge on antenatal care among pregnant women. Pre-experimental one group test- post-test
research design, and non-probability convenience sampling technique was adopted to achieve
the goal of the study.

Patel BB, Gurmeet P, Sinalkar DR,et.al (2016) A cross-sectional study was conducted on
knowledge and practices of antenatal care among pregnant women attending antenatal clinic at
a
tertiary care hospital, Gujarat, India. This study aim to determine the level of knowledge,
attitude, and practice on ANC among pregnant women attending the antenatal clinic at a
tertiary care hospital and their association with various socio-demographic factors. It was carried
out among 384 pregnant women in their 3rd trimester attending the antenatal clinic in a tertiary
care hospital of Gujarat during April 2018 to September 2018.. It was found that almost all
the variables such as age, education, occupation, parity, type of family, and socioeconomic status
(SES) had a significant association with awareness about ANC. 100% women were having a
positive attitude toward Antenatal care. It was concluded that the findings can be used to plan a
health intervention program aiming to improve the maternal health practices and eventually
improve the health status of the women.12

Kadham M N, Jihad S K et.al (2015) conducted a descriptive analytical design study for the
assessment of antenatal care practices during prenatal period among mothers. Non-
convenient sampling technique was used to collect the data. The study concluded that antenatal
care practices among primigravida mothers during pregnancy (Nutritional status, Physical
activities, personal hygiene, rest and sleep) it was a good level of assessment.

Mangal A, Shah H(2015) A study was conducted on dietary assessment and factors affecting
it among pregnant women attending antenatal clinic in a tertiary care centre in Jamnagar, Gujarat.
The study was conducted in Guru Gobind Singh Hospital of Jamnagar district in western part of
Gujarat state during July to September 2011. A pretested semi structured questionnaire was
used to interview women.. The results revealed that the majority of women were from urban
slum area attending the clinic. Majority of women were Hindu and about 3/4th of women from
joint family and about 9 out of 10 females were from lower social class. 29% women were
taking adequate calorie intake and only 19.3% women were taking adequate protein intake in
their daily diet. Hence, it was concluded that many areas still in health programme related with
the women and children require sincere concern from all the stakeholders are needed to be
explored to get better outcome.

Panmei J, Mukhia S (2015) conducted a cross sectional study on knowledge and practice of
antenatal care. The findings revealed that the majority of the respondents were in the age group
of 20-29 years. The study concluded that there is need of enhancing awareness about the
importance of antenatal care and for motivating women to utilize maternal care services.

SUMMARY: The literature review, above describes regarding various researches conducted
on antenatal care among primigravida mothers.
 CHAPTER – III
RESEARCH METHODOLOGY
 CHAPTER III
METHODOLOGY

Research methodology involves the systematic proceedings by which the researcher starts
from the initial identification of the problem to its final conclusions. 11

Research methodology is a systematic approach to solving a research problem. It is science

that deals with different steps which are commonly used by the researchers to study
researcher‟s problems and the logic behind it. This organizes all of the studies components in
a way that is most likely to lead to valid answers to the problems which have been posed.
The methodology chapter provides a brief overview of the many steps perform to carry out
the current investigation. A schematic representation of the methodological steps undertaken
for the present study are depicted in figure2.
 METHODOLOGY

RESEARCH APPROACH
Quantitative approach

RESEARCH DESIGN
Pre-Experimental Research Design

RESEARCH SETTING
Antenatal OPD in a selected hospital of Mohali, Punjab

TARGET POPULATION
Primigravida mothers attending Antenatal OPD

ACCESSIBLE POPULATION
Primigravida mothers who are attending antenatal OPD in selected hospital
Mohali, Punjab

SAMPLE SIZE
60 Primigravida mothers

SAMPLING TECHNIQUE
Convenient sampling technique

DATA COLLECTION TOOLS

Section A: Socio-demographic Variables
Section B: Structured Knowledge Questionnaire

ANALYSIS AND INTERPRETATION OF DATA

Descriptive statastics (Percentage, Mean, SD)
Inferential statistics (Chi square test)

FLOW CHART DEPICTING RESEARCH METHODOLOGY

 MATERIAL AND METHODS

RESEARCH APPROACH:

A quantitative approach was adopted for the study to assess the effectiveness of structured
teaching programme on knowledge regarding antenatal care among primigravida mothers
attending antenatal OPD in a selected hospital of Mohali, Punjab.

RESEARCH DESIGN:

Pre-experimental research design will be used in this study.

E O1 X O2
Keys:

E: Experimental
O1: Pre Test
X: Teaching
O2: Post Test

RESEARCH VARIABLES:

Independent variables: An independent variable is the variable that is believed to cause or

influence the dependent variables. Pregnant women act as an independent variable in the
present study.

Dependent variables: The variable that is hypothesized to depend on or be caused by the

independent variable. It is an outcome variable. In the current study, the dependent variable
was the effectiveness of structured teaching programme or knowledge regarding antenatal
care among primigravida mothers.

RESEARCH SETTINGS

The location in which data collection is conducted in the study is refers to as the setting. The
current study was conducted in the Antenatal Outpatient Department (OPD) of 6 phase a
Mohali, Punjab. This hospital was selected by the investigator because antenatal OPD in the
hospital were functioning and the authorities gave the permission.
POPULATION
The population includes all the entities that fulfill certain eligibility criteria to get included in
an investigation. In the current investigation, the population consists of all the primigravida
mothers receiving antenatal care in the hospital.

TARGET POPULATION
The target population of the study was comprised of all primigravida mothers attending the
Antenatal Outpatient Department (OPD) of selected hospital Mohali, Punjab.

ACCESSIBLE POPULATION
Primi gravida mothers who are attending Antenatal OPD in selected hospital Mohali, Punjab.

SAMPLE AND SAMPLING TECHNIQUE:

A sample is a subset of the population chosen to take part in a research study. A sample is a
small subset of people chosen for observation and analysis. Sampling is the process of
selecting a subset of a population to represent the entire population.
In the current study subjects were selected by convenient sampling technique.

Sample Size
The sample size of 60 primigravida mothers were selected as sample under study.

CRITERIA FOR SAMPLE SELECTION

Inclusion criteria: Pregnant women who were: -
 Receiving the antenatal care at selected hospitals of Punjab.
 Who were first time pregnent.
Exclusive criteria: Pregnant women who were: -
 Not willing to participate in this study.
 Not able to respond.

TOOLS & TECHNIQUES

Development of the Tool:
The tool is the instrument used by the researcher to collect the data. The tool was prepared
based on the study‟s objectives.
Tool description:
1. Socio- Demographic Data.
2. Structured Knowledge Questionnaire to assess the knowledge regarding antenatal
care.
The above mentioned tool was prepared by the researchers after an extensive review of
literature, books, journals, online resources and other publications.
Description of study tool

Tool 1: Socio demographic Data

Socio demographic data was developed for the present study to collect subject‟s personal
characteristics, which consist of 9 items which include age, education status, Occupation,
family monthly income, religion, type of family, residence and dietary habitat.

Tool 2: Structured Knowledge Questionnaire to assess the knowledge regarding

Antenatal care
This section consists of 30 items to assess the knowledge of primi gravida mothers regarding
antenatal care.

CRITERION MEASURES:
Structured knowledge questionnaire consists of 30 items. Each correct item was given „1‟
score and each wrong item was given „0‟score.
Maximum score = 30
Minimum score = 0

Knowledge of subject was graded as given below:

SCORING KNOWLEDGE SCORE
1. Poor 0-10
2. Average 11-20
3. Good 21-30

STRUCTURED TEACHING PROGRAMME

Structured teaching programme was titled as “Knowledge of antenatal care.” It includes
following aspect of antenatal care.
 Definition of antenatal care - Antenatal care coverage is an indicator of access and use
of health care during pregnancy
CONTENT VALIDITY
Content validity of the demographic tool and interventional procedures was verified by
consultation with guide and co- guide regarding the content and language of the tool. The tool
was given to a total 8 experts to check on the relevance of items. These experts were from the
various specialities of obstetrical and gynaecological nursing and education based on their
suggestions, opinions, modifications and rearrangements were accepted and incorporated and
the modifications was done.

RELIABILITY OF TOOLS
Internal consistency of the questionnaire was assessed by split half method and was
calculated by Karl Pearson correlation coefficient (r) formula.
The reliability of the structured questionnaire was found to be r=0.80 which is highly
significant.

PILOT STUDY
The pilot study was conducted at the Radiance Hospital in Landran from the 3rd-11th of March
2023 to determine the tools reliability and the feasibility of the study. The pilot study
included 60 pregnant mothers of the total number of subjects. Informed consent was taken
from the subjects. The average time taken by each respondent for the interview was 15 to 20
minutes.
After data collection, data was analyzed using descriptive and inferential statistics. The
findings demonstrated the viability of using the same research instruments employed in the
pilot project for the larger investigation. Minor changes were incorporated into the tool after
consultation with guide and co-guide.

DATA COLLECTION PROCEDURE

The investigator obtained permission from Rattan College of Nursing to conduct the final
study in the selected hospitals and data was collected from 19 th March to 19th June. The main
study was conducted in civil Hospital Phase 6 Mohali, Punjab. The data was collected from
60 subjects receiving the antenatal care from hospitals. Prior to the study, to get full
corporation and researcher.
Introduce herself to the subjects, explained the purpose of the study to them, and assure them
about confidentiality of the data.
A self- structured interview was conducted to collect the data from subjects. The interview
was conducted by verbal inquiry, the questions were asked from the respondent by the
researcher and their responses were also written by the researcher.
 DATA COLLECTION SCHEME

The researcher collects the data from Civil Hospital phase 6 Mohali, Punjab

The researcher visited the hospital in the morning time (9:00am -2:00pm)

Study subjects were selected by convenient sampling technique

Data collected by using structured questionnaire and record method(socio demographic

variables, to assess the knowledge regarding Antenatal care

Time taken to complete one sample is 15-20 minutes

FIGURE 3: SCHEMATIC REPRESENTATION OF DATA COLLECTION

ETHICAL CONSIDERATION
1. Ethical approval for this study was obtained from ethical committee of Rattan College
of Nursing.
2. Written permission for final data collection was obtained from the principal, Rattan
College of Nursing (Mohali, Punjab)
3. Informed consent for data collection was attained from the Senior Medical Officer,
Civil Hospital Phase 6 Mohali, Punjab.
4. Informed consent was received from every study subject after completing explanation
of this study.
5. All study subjects were informed about participation in the research, the objectives of
the study, and duration of their involvement.

PLAN FOR DATA ANALYSIS

 Coding sheet will be prepared for data analysis.
 Data will be analyzed by using descriptive and inferential statistics.

SUMMARY

This chapter discusses research methodological assurance for the current studies. This
includes the research approaches design, setting, samples and sampling technique inclusion
and exclusion criteria, tool selection and development, pilot study, tool description, data
gathering method, and data analysis plan. The interpretation and analysis will be completed
in the following chapter.
 CHAPTER – IV
ANALYSIS AND
INTERPRETATION OF DATA
 CHAPTER IV
DATA ANALYSIS AND INTERPRETATION

This chapter discuss interpretation and analysis of data collection from primigravida mothers
in order to access the knowledge regarding Antenatal care.

Analysis of data involves the translations of informational collected during research project
into interpretable, descriptive and inferential statistics based on the objectives of the study.

“A pre-experimental study to assess the effectiveness of structured teaching program on

knowledge regarding antenatal care among prim gravida mothers attending antenatal OPD in
a selected hospital of Mohali, Punjab”

Objectives

1. To assess the pre-test level of knowledge regarding antenatal care among

primigravida mothers.
2. To develop and administer structured teaching program on knowledge regarding
antenatal care among primigravida mothers.
3. To assess the post-test level of knowledge regarding antenatal care among
primigravida mothers.
4. To evaluate the effectiveness of structured teaching programme on antenatal care
among primigravida mothers.
5. To associate the pre-test level of knowledge on antenatal care among primigravida
mothers with selected socio demographic variables.
 SECTION-A
DISCRIPTION OF SOCIO- DEMOGRAPHIC DATA

TABLE: 1(a) Frequency and percentage distribution of subjects as per their Socio –
demographic variables
N=60
S. No Socio Demographic Variables Frequency(f) Percentage (%)
1 Age (in years)
20-25 years 17 28.3%
26-30 years 30 50.0%
31-35 years 13 21.7%
2 Educational Status
No formal education 19 31.7%
Primary 18 30.0%
Secondary 20 33.3%
Graduate or above 3 5.0%
3. Occupation
House wife 24 40.0%
Private job 4 6.7%
Government job 32 53.3%
4. Type of family
Nuclear 35 58.3%
Joint 22 36.7%
Extended 3 5.0%

Table 1(a) depicts that half of the subjects 30 (50.0%) were in the age group of 26-30 years.
17(28.3%) subjects were in the age group of 20-25years. 13(21.7%) subjects were above in
the age group of 31-35 years.

According to the Education status of women 20(33.3%) subjects studied up to secondary

education. 18(30.0%) subjects has completed primary school. Whereas 3(5.0%) subjects
studied up to graduation or above.

According to the type of family more than half 35(58.3%) subjects were from Nuclear family
whereas 22(36.7%) subjects from the joint family and 3(5.0%) subjects from the Extended
family.
Table: 1(b) Frequency and percentage distribution of subjects as per their Socio –
demographic variables
N=60

S. No. Socio Demographic Variables Frequency(f) Percentage (%)

5. Religion
Hindu 26 43.3%
Muslim 18 30.0%
Sikh 11 18.3%
Christian 5 8.3%
Others 0 0.0%
6. Residential Area
Rural 23 38.3%
Urban 37 61.7%
7. Family Monthly Income
<5,000/- 7 11.7%
5,000- 10,000/- 28 46.7%
11000 – 15000/- 19 31.7%
15000- 20000/- 6 10.0%
8. Dietary habits
Vegetarian 33 55.0%
Non- Vegetarian 27 45.0%

Above table depicts regarding family income in which half of the subjects 28(46.7%) subjects
had income Rs. 5,000-10,000, 19(31.7%) subjects had income Rs. 11,000-15,000.

As per religion majority of subjects 26(43.3%) were Hindu, 18(30.0%) were Muslim,
11(18.3%) were Sikh and 5(8.3%) were Christian.

As per Residential area most of the subjects 37(61.7%) were residing in urban area,
23(38.3%) subjects were residing in rural area.
Fig 2: Frequency and percentage distribution of subjects according to the Age

AGE

50.0%

50.00%

45.00%

40.00%

35.00%
28.3%
Percentage%

30.00%

25.00% 21.7%

20.00%

15.00%

10.00%

5.00%

0.00%
20-25 years 26-30 years 31-35 years
Age

The bar diagram shows the percentage distribution of subjects according to the age. Half of
the subjects 30(50.0) were in the age group of 26-30 years. 17(28.3%) subjects were in the
age group of 20-25 years.13 (21.7%) subjects were in the age group of 31-35 years.
Fig 3: Frequency and percentage distribution of subjects according to the Diet

Dietary Habits

45%

55%

Vegetarian Non-vegetarian

The pie chart shows the percentage distribution of subjects according to the diet. 33(55.0%)
subjects were vegetarian. And 27(45.0%) subjects were non-vegetarian.
 SECTION – B

PRE-TEST KNOWLEDGE SCORE

Table –2: Frequency & Percentage distribution of subjects as per pre-test knowledge
score regarding antenatal care.

N=60
Knowledge Frequency(f) Percentage (%)
Poor 17 28.3%
Average 43 71.7%
Good 0 0%

80
71.7

70

60

50

40

28.3
30

20

10
0

0
POOR KNOWLEDGE.(0-10) AVERAGE KNOWLEDGE.(11-20) GOOD KNOWLEDGE.(21-30)

Fig 5: Bar Diagram showing the percentage distribution of pre-test knowledge

Above table shows frequency and percentage distribution of subjects as per Pre-test
Knowledge score regarding antenatal care. Majority of subjects 43(71.7%) had average
knowledge, 17(28.3%) subjects had poor knowledge related to antenatal care.
Table – 3: Descriptive statistics of pre-test level of knowledge
DESCRIPTIVE STATISTICS MEAN S.D. MAXIMUM MINIMUM
PRE-TEST KNOWLEDGE 12.42 2.959 18 5

Table 3 Represents the descriptive statistics of pretest level of knowledge. It was found that
the mean value was 12.42, maximum score was 18, minimum score was 5, range of score was
13.

Table – 4: Frequency & Percentage distribution of post-test level of knowledge

Knowledge Frequency (f) Percentage (%)
Poor 0 0%
Average 21 35%
Good 39 65%

Above table and figures shows frequency and distribution of post-test level of knowledge
regarding antenatal care. Majority of subjects 39(65%) had good knowledge, 21(35%)
subjects had average knowledge.
 SECTION – C

Table – 5: Comparison of frequency & percentage distribution of pre-test and post-test

level of knowledge
Knowledge Pre- test Frequency (%) Post –test Frequency (%)
Poor 17(28.3%) 0(0%)
Average 43(71.7%) 21(35%)
Good 0(0%) 39(65%)

80.0
71.7

70.0 65.0

60.0
Percentage%

50.0

40.0 35.0

28.3
30.0

20.0

10.0
0.0 0.0
0.0
POOR KNOWLEDGE.(0-10) AVERAGE KNOWLEDGE.(11-20) GOOD KNOWLEDGE.(21-30)

Fig 6: Diagram representing comparison of percentage distribution of pre-test and post-

test level of knowledge

Above table an figure shows frequency and percentage distribution of subjects as per Pre-test
Knowledge score regarding antenatal care. Majority of subjects 43(71.7%) had average
knowledge, 17(28.3%) subjects had poor knowledge related to antenatal care.
Table – 6: Comparison of descriptive statistics of pre-test and post-test Scores of
knowledge
N=60
PAIRED T-TEST MEAN+SD MEAN % PAIRED T-TESTWITH T VALUE
P VALUE At 0.05
PRE-TEST 12.42+2.959 41.40 26.563(<0.001) 2.00
KNOWLEDGE
POST-TEST 21.32+1.9 71.10
KNOWLEDGE
 ASSOCIATION OF PRE-TEST KNOWLEDGE SCORES

Table No 7: Table Showing Association of Scores and Demographic Variables.

Variables Good Knowledge Average Knowledge Poor Knowledge Chi Test P Value df Result
20-25 years 0 9 8
Age 26-30 years 0 23 7 4.378 0.112 2 Non- Significant
31-35 years 0 11 2
Hindu 0 18 8
Muslim 0 16 2
Religion Sikh 0 5 6 6.598 0.086 3 Non-Significant
Christian 0 4 1
Others 0 0 0
Nuclear 0 27 8
Type of family Joint 0 13 9 3.416 0.181 2 Non-Significant
Extended 0 3 0
No formal education 0 11 8
Primary 0 12 6
Educational Status Secondary 0 17 3 4.933 0.177 3 Non-Significant
Graduate or above 0 3 0
<5,000/- 0 4 3
5,000- 10,000/- 0 21 7
Monthly income of family 11000 – 15000/- 0 14 5 0.992 0.803 3 Non-Significant
15000- 20000/- 0 4 2
House wife 0 16 8
Occupation Private job 0 4 0 1.878 0.391 2 Non-Significant
Government job 0 23 9
Rural 0 17 6
Residential area Urban 0 26 11 0.093 0.761 1 Non-Significant
Vegetarian 0 27 6
Dietary habits Non- Vegetarian 0 16 11 3.722 0.054 1 Significant

Above table depicts that association of pre-test knowledge score level and demographic variables. The calculated chi-square values were more
than the table value at the 0.05 level of significance.
There is no significance association between the level of scores and other demographic variables (Age, Religion, Type of family, Educational
Status, Monthly income of family, Occupation, residential area, Dietary habits) The calculated chi-square values were less than the table value at
the 0.05 level.

37
CHAPTER – V
DISCUSSION
 CHAPTER - V
DISCUSSION

This chapter deals with the findings of the present study. Entitled “A pre experimental study
to assess the effectiveness of structured teaching programme on knowledge regarding
antenatal care among primi-gravida mothers attending antenatal OPD in a selected hospital of
Mohali, Punjab”.

In this chapter, an attempt has been made to discuss the findings of the present in the
accordance with the previously conducted research studies available in the literature. An
attempt has been made by the investigator to put the findings in the perspective by comparing
the results of methodology of the present study and previous research, which might lent
support or contradict of this study.

Present study findings revealed that 85% subjects had average knowledge, 7.5% subjects had
good and poor knowledge respectively regarding self care among antenatal women. A similar
study conducted by Patel B et.al (2016) on knowledge and practices on antenatal care
among pregnant women. Result reported that (58%) woman had adequate knowledge
regarding antenatal care.

A study conducted by Saraswat A et.al (2021) to assess the antenatal care services utilization
among adolescent pregnant women. The present study aims to test the hypothesis and assess
determinants of ANC service utilization among currently adolescent pregnant women.

A study conducted by Kaur H et.al (2018) A study was conducted on knowledge and
practices regarding antenatal care among mothers of infants The aim of the present study was
to find the knowledge and practices regarding antenatal care among the mothers of infants.

A supported study conducted by Izacar AGB et.al (2019) A cross-sectional descriptive study
was conducted on genital hygiene behaviour and practices among antenatal care . The aim of
this study was to assess pregnant women behaviour and practices regarding genital hygiene.
Overall, 80 pregnant women were enrolled. Data were collected using a paper based
standardized questionnaire directly self-administered after obtain a free consent. The majority
of them had attended at least primary education (97.5%; n=78/80) and many were lived in
couple (81.25%; n=65/80). Almost one on three participants identified antenatal consultation

38
as a key element to be taken into account by pregnant women. 70.1% (n=56/80) of women
declared wearing undergarments in cotton and use antiseptic solutions for genital cleaning.

Another study conducted by Dalpath SK et.al (2021) A quasi-experimental study was

conducted on improving quality of care for pregnancy, perinatal and newborn care at district
and sub-district public health facilities in three districts of Haryana, India. The aim of the
study was to improve the Quality of Care (QOC) for maternal and newborn care in the
hospitals The study was conducted at nine district and sub-district referral hospitals in three
districts (Faridabad, Rewari and Jhajjar) Antenatal identification of high-risk pregnancies
increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to
58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The
time spent in antenatal clinics declined by 19–42 minutes (p<0.01). Hence, it was concluded
that multipronged quality improvement strategy improved the maternal and newborn
services, case documentation and patient satisfaction at district and sub-district hospitals.

Kumar S, Khanna A, (2019) A study was conducted on utilisation, equity and determinants
of antenatal care in India. The major objective of the study was to examine the utilisation,
equity and determinants of antenatal care (ANC), defined as 4 or more antenatal visits, at
least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a
minimum of 100 days, in India. A sample of 190,898 women from India‟s National Family
Health Survey 4 was analysed. Concentration curves and concentration index were used to
assess equity in full Antenatal care utilisation. It was used to examine the factors associated
with full ANC utilisation. The results revealed that in India, 21% of pregnant women utilised
ANC.

39
 CHAPTER - VI
SUMMARY, CONCLUSION,
IMPLICATIONS AND
RECOMMENDATIONS
 SUMMARY, CONCLUSIONS, IMPLICATIONS AND
RECOMMENDATIONS

This chapter deals with brief account of study undertaken including the conclusion
drawn from findings, implications of the study and recommendations for further
research. The study was undertaken to assess the knowledge regarding Antenatal care
among primigravida mothers in a selected hospital of Mohali, Punjab.

SUMMARY
The investigator used descriptive approach to study the self-care strategies among
antenatal women. After the review of literature and discussion with experts the
investigator had developed 2 tools i.e. Socio demographic data sheet and knowledge
questionnaire. The sampling technique was used to select 60 primi-gravida mothers
visiting the OPD. Analysis and interpretation of data was done according to the
objectives of the study. Descriptive statistics was done to analyses the data.

Content validity of the study tool was determined. Reliability of the tool was checked
by split half method and tool was found reliable. Pilot study was conducted and
feasibility of the study was determined where the study found to be feasible. Written
consent was obtained from the study participant was assured for all the information
provided.

CONCLUSION
Present study revealed that 85% subjects had average knowledge on antenatal care
during pre-test. There was significant improvement in the level of knowledge of
primigravida mothers after administration of structured teaching programme.
 There was no negative impact of structured teaching programme was seen on
primigravida mothers.

 The socio-demographic variables such as age, religion, type of family,

education, income of family per month, occupation, residential area, type of
gravida, total no. of family members and dietary habits had no influence on the
knowledge of primigravida mothers on antenatal care before intervention.
LIMITATION
1. The study was limited to OPD patients, Punjab.
2. The study was limited to selected hospital of Punjab.
3. The study was limited to 60 samples only.

IMPLICATIONS
The findings of the study were implicated in different areas such as nursing practice, nursing
administration and nursing research. The findings of the study have several implications
which were discussed in the following areas:

NURSING EDUCATION
 The nurse educator can provide education to the patients regarding self-care during
pregnancy.
 The nurse educator can provide Knowledge and organize the awareness program
among public regarding antenatal care.
 The nurse educator should improve the knowledge of nursing students regarding
antenatal care during pregnancy.
 The study can be helpful in nursing curriculum to provide opportunity for students to
gain knowledge regarding antenatal care.
 The study has an implication on nursing education will regard to preparing nursing
students competency in giving nursing education to clients about their health.

NURSING PRACTICE
 As the study revealed the majority of the primigravida mothers had adequate level of
knowledge regarding antenatal care.
 It has the implication for enhancement of good knowledge to primigravida mothers
regarding antenatal care.
 Structured teaching programme on antenatal care is a practical strategy to make the
primigravida mothers aware of the antenatal care.
 The nurse has to play a major role in health promotion. Patient education is a process
of assisting people to learn and incorporate health related behavior into everyday life.

NURSING ADMINISTRATION
 Nurse administrators may take initiative to develop self- instructional module for
nurses, ASHA workers, midwives, etc. regarding structured teaching programme.
 Regular formal teaching programs should be organized to enhance the knowledge of
staff keep them updated regarding antenatal care.
 Administrator should periodically evaluate the developed teaching programs.
NURSING RESEARCH
 Nursing research should be conducted to explore antenatal care among primi-gravida
mothers.
 It proves that the study participant may have independent learning and improve the
self-efficacy.
 As nursing profession becomes more grounded in research, the study is valuable
reference material for future research. It can help them in conducting research on
large sample size in any other different culture and ethinic group.

RECOMMENDATIONS
Based on the results of study following recommendations are made:
1. A pre-experimental study can be conducted to assess the effectiveness of structured
teaching programme on knowledge regarding antenatal care among primigravida
mothers in community.
2. The study can be replicated on large sample to validate and generalize its findings.
3. Similar studies can be conducted in different settings like community.
4. A quasi-experimental study can be conducted to assess the effectiveness of structured
teaching programme on knowledge regarding antenatal care among primigravida
mothers in community or hospital.
5. Similar study can be done by using randomization principle
CHAPTER - VII
REFERENCES
1. Kumar et al. BMC Pregnancy and Childbirth Utilisation, equity and determinants of
full antenatal care in India: analysis from the National Family Health Survey 4. (2019)
19:327, https://doi.org/10.1186/s12884-019-2473-6.

2. Kaur A, Singh J, Kaur H, Kaur H, Devgun P, Gupta VK. Knowledge and practices
regarding antenatal care among mothers of infants in an urban area of Amritsar,
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http://dx.doi.org/10.18203/2394-6040.ijcmph20183868

3. Aggarwal R, Sharma AK, Guleria K. Antenatal care during the pandemic in India: the
problem and the solutions. Int J Pregn & Chi Birth. 2021;7(1):15‒17. DOI:
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4. Fulpagare PH, Saraswat A, Dinachandra K, Surani N, Parhi RN, Bhattacharjee S, S S,

Purty A, Mohapatra B, Kejrewal N, Agrawal N, Bhatia V, Ruikar M, Gope RK,
Murira Z, De Wagt A and Sethi V (2019) Antenatal Care Service Utilization Among
Adolescent Pregnant Women–Evidence From Swabhimaan Programme in India.
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5. Das MK, Arora NK, Dalpath SK, Kumar S, Kumar AP, Khanna A, et al. (2021)
Improving quality of care for pregnancy, perinatal and newborn care at district and
sub-district public health facilities in three districts of Haryana, India: An
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10.1371/journal.pone.0254781.

6. Nimavat K, Mangal A, Shah H, Parmar D.V, Yadav S. study of dietary assessment

and factors affecting it among pregnant women attending antenatal clinic in a tertiary
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: 10 | Oct 2013 • ISSN No 2277 – 8160.

7. Janakiraman B, Gebreyesus T, Yihunie M, Genet MG (2021) Knowledge, attitude,

and practice of antenatal exercises among pregnant women in Ethiopia: A cross-
sectional study. PLoS ONE 16(2): e0247533. https://doi.org/10.1371/
journal.pone.0247533.

8. Pete PMN, Biguioh RM, Izacar AGB, Adogaye SBB, Nguemo C. Genital hygiene
behaviors and practices: A cross-sectional descriptive study among antenatal care
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PMID: 31214303; PMCID: PMC6548999.

9. Chourasia A, Pandey M. Awasthi A. Factors influencing the consumption of iron and

folic acid supplementations in high focus states of India Published: May 06, 2017.
DOI:https://doi.org/10.1016/j.cegh.2017.04.004.

10. Patel BB, Gurmeet P, Sinalkar DR, Pandya KH, Mahen A, Singh N. A study on
knowledge and practices of antenatal care among pregnant women attending antenatal
clinic at a Tertiary Care Hospital of Pune, Maharashtra. Med J DY Patil Univ
2016;9:354-62.

11. Sharma SK. Nursing Research and Statistics. 3rd ed. Elsevier. 2019.

12. Jain R, Upadhyay C, Nayak B. A study on knowledge and practices of antenatal care
among pregnant women attending antenatal clinic at a tertiary care hospital, Gujarat,
India. Int J Reprod Contracept Obstet Gynecol 2020;9:60-4.

13. Singh P, Yadav RJ. Antenatal Care of Pregnant Women in India. Indian J Community
Med. 2000 Jul 1;25 (3);112.

14. Ahirwar N. A study to assess knowledge and practices of antenatal care among
antenatal women attending outdoor clinic in tertiary care Hospital International
journal of Reproduction. Contraception, Obstetrics and Gynaecology Ahirwar N. Int J
Reprod Contracept .2018 May ; 7 (5) : 1754-1759 www.ijrcog. Org.

15. Chourasia A, Pandey M. Awasthi A. Factors influencing the consumption of iron and
folic acid supplementations in high focus states of India Published: May 06, 2017.
DOI:https://doi.org/10.1016/j.cegh.2017.04.004.

16. Shah H, Parmar D.V, Yadav S. study of dietary assessment and factors affecting it
among pregnant women attending antenatal clinic in a tertiary care centre in
Jamnagar, Gujarat. GRA - Global Research Analysis. Volume : 2 | Issue : 10 | Oct
2013 • ISSN No 2277 – 8160

17. Devgun P, Gupta VK. Knowledge and practices regarding antenatal care among
mothers of infants in an urban area of Amritsar, Punjab. Int J Community Med Public
Health 2018; 5:xxx-xx. DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20183868
18. Mahen A, Singh N. A study on knowledge and practices of antenatal care among
pregnant women attending antenatal clinic at a Tertiary Care Hospital of Pune,
Maharashtra. Med J DY Patil Univ 2016;9:354-62.

19. Adogaye SBB, Nguemo C. Genital hygiene behaviors and practices: A cross-sectional
descriptive study among antenatal care attendees. J Public Health Afr. 2019 May
3;10(1):746. doi: 10.4081/jphia.2019.746. PMID: 31214303; PMCID: PMC6548999.

20. Gadiya P. Effectiveness of an information booklet on knowledge regarding antenatal

care among primigravida mothers at selected villages of Waghodia Taluka; 3.

21. Bhende B. Taksande V. Assess the knowledge of self-care strategies on antenatal

mothers attending OPD in selected hospital of Wardha.International Journal of
Nursing Education and research.2018 March 31;6 (1) : 39-40.

22. Alam A.Y, Indian Journal of Community Medicine [Internet] [Cited 2018 Oct 30]
Available from : http: // Medind .nic.

23. Priyadharshini. M. P.Mangala Gowri . Assess the knowledge on antenatal care among
antenatal care giver. 2014;3(10):2.

24. Yihunie M, Genet MG (2021) Knowledge, attitude, and practice of antenatal exercises
among pregnant women in Ethiopia: A cross-sectional study. PLoS ONE 16(2):
e0247533.

25. Sasi S, Vaz SM ,A study to assess and compare the knowledge and attitude regarding
antenatal care among pregnant women Consulting in selected urban and rural
Hospitals of Uttar Kannada, District Karnatka. 2017;(11):5.

26. David, Rodreck; Evans, Ruth; Fraser, Hamish SF (2021-01-01). "Modelling Prenatal
Care Pathways at a Central Hospital in Zimbabwe". Health Services Insights. 14:
11786329211062742. doi:10.1177/11786329211062742. ISSN 1178-6329. PMC
8647229. PMID 34880627.

27. Dowswell, T; Carroli, G; Duley, L; Gates, S; Gülmezoglu, AM; Khan-Neelofur,

D; Piaggio, G (16 July 2015). "Alternative versus standard packages of antenatal
care for low-risk pregnancy". The Cochrane Database of Systematic Reviews. 2015
(7): CD000934. doi:10.1002/14651858.CD000934.pub3. PMC 7061257. PMID
26184394.
28. "Health IT Startup: Doxy.me - Electronic Health Reporter". Electronic
healthreporter.com. Retrieved 2016-05-11.

29. Mbuagbaw, L; Medley, N; Darzi, AJ; Richardson, M; Habiba Garga, K; Ongolo-

Zogo, P (1 December 2015). "Health system and community level interventions for
improving antenatal care coverage and health outcomes". The Cochrane Database of
Systematic Reviews. 12 (12): CD010994. doi:10.1002/14651858.CD010994.pub2.
PMC 4676908. PMID 26621223.

30. Andrea D Shields, MD, FACOG; Chief Editor: Nicole W Karjane, MD. Pregnancy
Diagnosis. Medscape. 26 May 2023. Available from: https://emedicine.medscape.
com/article/262591-overview.

31. National Health Service Trust (NHS). Doing a pregnancy test. 9 February
2022.Available from: https://www.nhs.uk/pregnancy/trying-for-a-baby/doing-a-
pregnancy-test/#:~:text=You%20can%20carry%20out%20most,before% 20you
%20miss%20a%20period.

32. WHO recommendation on antenatal care contact schedules". WHO. World Health
Organisation. Retrieved July 30, 2020.[dead link]

33. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
(Antenatal care during pregnancy), The Royal Women's Hospital, Victoria (Your first
pregnancy checkup), Raising Children Network (Appointments during pregnancy),
Women's and Children's Health Network (Pregnancy: Antenatal visits - check-ups
during your pregnancy). May 2020. Available from: https://www.pregnancy
birthbaby.org.au/antenatal-care-during-your-pregnancy.

34. Symon A, Pringle J, Downe S, et al; Antenatal care trial interventions: a systematic
scoping review and taxonomy development of care models. BMC Pregnancy
Childbirth. 2017 Jan 617(1):8. doi: 10.1186/s12884-016-1186-3.

35. Bhaskar Nima. Midwifery & Obstetrical Nursing: Administration of Midwife

and Obstetrical Nursing. 2nd ed. Bangalore: EMMESS Medical Publishers,
2015.P- 130 – 40.
ANNEXURES
 ANNEXURE - I
LETTER SEEKING THE OPINIONS AND SUGGESTIONS FROMEXPERTS TO
ESTABLISH CONTENT VALIDITY FOR RESEARCH TOOL
From
NehaKumari
M.Sc. Nursing 2nd year,
Rattan Professional Educational College of Nursing,
Mohali, Punjab.
To
………………………..
Forwarded Through
Dr. Rajinder Kaur

The Principal
Rattan Professional Educational college of Nursing,
Mohali, Punjab

Subject: A letter to request for expert opinion and suggestion and for establishing content
validity of research tool.
Respected Madam/Sir,
I, Neha Kumari, student of M.Sc. Nursing 2 nd year of Rattan Professional Educational college
of Nursing, Mohali, Punjab have selected the following topic for research project as a partial
fulfillment to be submitted to Baba Farid University of Health Sciences, Faridkot, as a
requirement for the award of M.Sc. Nursing degree.

“A Pre- Experimental study to assess the effectiveness ofstructured teaching programme on

knowledge regarding Antenatal care among primigravida mothers attending Antenatal OPD
in a selected hospital of Mohali, Punjab” I am enclosing the below mentioned documents for
your kind suggestions.
Enclosure:
A. Socio – demographic data.
B. Structured knowledge questionnaire an antenatal care among primigravida mothers.
With regard to this, I kindly request you to go through the content of the tool and provide me
your valuable suggestions regarding accuracy, appropriateness and relevancy of the items
included.
Hope for your kind
cooperationYours sincerely
Neha Kumari
M.Sc. Nursing 2nd
year, Obstetrics and
Gynaecological
Nursing

Signature of Guide Signature of Principal

ANNEXURE - II
 ANNEXURE - III

ACCEPTANCE FORM FOR VALIDATION OF TOOL

I would / would not agree upon to validate the research tool entitled. “A Pre- Experimental study to
assess the effectiveness of structured teaching programme on knowledge regarding Antenatal
care among primigravida mothers attending Antenatal OPD in a selected hospital of Mohali,
Punjab”

I have gone through the tool and suggested the necessary suggestions.

Name of the Expert:

Designation of Expert:

Name of the Institution

Date: Signature of the expert:

 ANNEXURE - IV

CONTANT VALIDITY CERTIFICATE FROM EXPERTS

I .................................................................hereby certify that I have validated the research tool

of Neha Kumari who is understanding a research project entitled,

“A Pre- Experimental study to assess the effectiveness of structured teaching programme

on knowledge regarding Antenatal care among primigravida mothers attending Antenatal
OPD in a selected hospital of Mohali, Punjab”

I have gone through the tool and suggested the necessary suggestions.

Name of the Expert:

Designation of Expert:

Name of the Institution

Date: Signature of the expert:

Place:
 ANNEXURE - VI

LIST OF

EXPERTS

1. Ms. Khushdeep Kaur

Assistant Professor
RPEC of Nursing,
Mohali
2. Mrs. Baljeet Kaur
Assistant
Professor
Guru Hari Krishan College of Nursing, Mohali
3. Mrs. Veer Devinder
Kaur Assistant Professor
Guru Hari Krishan College of Nursing, Mohali
4. Miss Poonam
Assistant
Professor
RPEC of Nursing, Mohali
5. Miss Harpreet
Kaur Assistant
Professor
Rayat Bahara College of Nursing, Chandigarh
6. Miss Anupama
Assistant
Professor
RPEC of Nursing, Mohali
7. Mrs. Kanchan Thakur
Assistant Professor
Ambika College of Nursing, Mohali

54
8. Miss Karman
Assistant
Professor
Sarswati College of Nursing, Punjab

55
ANNEXURE - VII

56
 ANNEXURE - VIII

PERMISSION LETTER TO CONDUCT PILOT STUDY

To
The Human Resource Management Radiance Hospital Mohali, Punjab

Subject: Request for permission to conduct the pilot study

Respected Sir/Madam,
This is to bring your kind notice that I am a student of M.Sc. Nursing (Medical Surgical
Nursing) 2nd year of Rattan Professional Educational College of Nursing Sector 78, Sohana
Mohali, Punjab. I have selected below mention topic for research project to be submitted to
Baba Farid University of Health Science to partial fulfillment of M.Sc. Nursing Programme.

Title:“A Pre- Experimental study to assess the effectiveness of structured teaching

programme on knowledge regarding Antenatal care among primigravida mothers
attending Antenatal OPD in a selected hospital of Mohali, Punjab”

So kindly its humble request to permit me to conduct pilot study above mentioned .The
findings of the study will be confidential and will only be used for the research purpose.

Thanking you

Yours faithfully
Neha Kumari
M.Sc. Nursing 2nd year
Obstetrics and Gynaecological Nursing

To
Medical
Superitendent
Civil Hospital

57
 ANNEXURE - IX

PERMISSION LETTER TO CONDUCT MAIN STUDY

Phase 6 Mohali, Punjab

Subject: Request for permission to conduct the study

Respected Sir/Madam,
This is to bring your kind notice that I am student of M.Sc. Nursing (Medical Surgical
Nursing) 2nd year of Rattan Professional Educational College of Nursing Sector 78, Sohana
Mohali, Punjab. I have selected below mention topic for research project to be submitted to
Baba Farid University of Health Science to partial fulfillment of M.Sc. Nursing Programme.

Title: - “A Pre- Experimental study to assess the effectiveness of structured teaching

programme on knowledge regarding Antenatal care among primigravida mothers
attending Antenatal OPD in a selected hospital of Mohali, Punjab.

So kindly its humble request to permit me to conduct research study above mentioned

The findings of the study will be confidential and will only be used for the research purpose.

Thanking you
Yours faithfully
Neha kumari
M.Sc. Nursing 2nd year

Obstetrics and
Gynaecological
Nursing

58
ANNEXURE - X

59
ANNEXURE - XI

60
61
 STRUCTURED TEACHING PROGRAMME ON ANTENATAL CARE
Topic : Antenatal Care

Group : Primi gravida Mother

Place: Antenatal OPD in a selected hospital Method of teaching: Lecturer cum discussion
Medium of instruction:

Teaching aids: Over head projector, Leaflets, Pamphlets, Flash cards and chart
Time: 45 minutes.

General objectives:
At the end of the teaching programme Primi gravida mothers acquire knowledge and apply
this knowledge in their practice.

Specific objectives at the end of structured teaching programme: The Primi gravida
mothers will be able to: define antenatal care enlist aims and objectives of antenatal care
discuss diagnosis of pregnancy list down the frequency of antenatal visitsdiscuss the antenatal
services describe the antenatal examination explain the antenatal advice demonstrate the
antenatal exercises

62
Time Specific Content Teaching A.V. Evaluation
Objective LearningActivities Aids
5 At the end of INTRODUCTION DISCUSSES Chart What do you mean by
mt this programme antenatalcare?
the primigravida Preventive healthcare includes prenatal care, sometimes referred to as antenatal
mothers will be care. It is given in the form of medical checkups, which include advice on leading a
ableto: healthy lifestyle and the distribution of medical information about prenatal nutrition,
including prenatal vitamins, and maternal physiological changes in pregnancy. This
prevents potential health issues throughout the course of the pregnancy and promotes
the health of both the mother and the unborn child.1

MEANING-
Systematic supervision (examination & advice) of a woman during pregnancy is QUESTIONING FLA SH
called antenatal (Prenatal) care. The supervision should be regular and periodic in CA RD
nature according to the need of the individual.2

Antenatal care comprises of:

 Careful history takingand
examination (general and
obstetrical)
 monthly visits during the first
two trimesters (from the 1st week
to the 28th week)
 fortnightly visits from the 28th
week to the 36th week of
pregnancy
 weekly visits after 36th week to
the delivery,from the 38th week to
the 42nd week
The advice is given to the pregnant
woman.3

63
2 define antenatal DEFINITION- D ESCRI BES OHP What are the aims and
mt care objectives of antenatal
Antenatal care refers to the care that is given to an expected mother from timeof care?
conception is confirmed until the beginning of labor.

Planned examination and observation for the woman from conception until the
beginning of labor.4

AIMS AND OBJECTIVE –

enlist aims The aims are-

and objectives of
 To screen the „high risk‟ cases.
antenatalcare
 To prevent or to detect and treat at the earliest any complications.
 To ensure continued risk assessment and to provide ongoing primary preventive
health care.
 To educate the mother about the physiology of pregnancy and labor by
demonstration, charts, and diagrams, so the fear is removed, and psychology is
improved.
 To discuss with the couple about the place, time and mode of delivery,
provisionally and care of the newborn5

The objectives are-

 To ensure a normal pregnancy with delivery of a healthy baby from a healthy

mother.
 Prevention, early detection, and treatment of pregnancy-related

64
3 discuss diagnosis complications as Pre-eclampsia, eclampsia, and hemorrhage. EX PLA I N S CH A RT How to diagnose
mt. ofpregnancy  Prevention, early detection and treatment of medical disorders as anemia and pregnancy?
antenatal care.
 Detection of early malpresentation, malposition‟s, and disproportion that may
influence the decision of labor.
 Instruct the pregnant woman about hygiene, diet andwarning symptoms.
 Laboratory studies of parameters may affect the fetus as blood group, Rhtyping,
toxoplasmosis, and syphilis5

DIAGNOSIS OF PREGNANCY:
Most pregnancy tests are usable starting on the first day after a missing period. The
test should be performed at least 21 days after the last unprotected sex if the woman
isunsure of when the next period will arrive.6

Methods of confirming the pregnancy:

There are two ways to diagnose early pregnancy
1. Missed Menstrual Period: Check for Motivational Signs
 L.M.P
 nausea and vomiting
 mild fatigue
 Breast changes: breast enlargement and tingling sensation

2. Pregnancy Testing- Through the use of Home Pregnancy Test Kit

 A positive test means the woman is pregnant.
 A negative test means the woman is not pregnant7

65
 3 List down the FREQUENCY OF ANTENATAL VISIT S – D ESCRI BES PAMP L What areantenatal
mt. frequency of ET services?
antenatalvisits  Generally, a check-up is done at an interval of 4 weeks up-to 28 weeks, at an
interval of 2 weeks up-to 36 weeks and thereafter till delivery.
 WHO recommends the visit may be curtailed to at least 4 visits,
 1st visit – around 16 weeks
 2nd visit – Between 24 -28 weeks 3rd visit – around 32 weeks
 4th visit – around 36 weeks.8

5 Discuss the ANTENATAL SERVICES:

mt. antenatal services
The antenatal care throughout the pregnancy depends on:

 health and any risks to the mother and baby

 stage of pregnancy
 any problems the mother may be experiencing
There are a number of checks, scans, tests and discussions, such as: D I SCU SS CH A RT

 when the baby is due, what trimester the mother is in and what this means for
mother and baby
 finding out about medical history, general health and how any previous
pregnancies were
 discussing any medication the mother is taking
 ensuring the mother is up to date with cervical screening
 making sure her mental health is good
 checking blood pressure and weight and testing the urine
 organising blood tests and screening
 providing advice on healthy eating and lifestyle changes
 feeling and measuring your tummy, and listening to the baby's heartbeat
 asking about home environment, work and the available support. If the motheris

66
 experiencing family violence.
 checking about any physical symptoms that may be bothering the mother and
baby
 running through the birth plan with pregnant woman
 advice about taking your baby home, feeding them and other care.9
DESCRIB PAMPH
2mt Describe the ANTENATAL EXAMINATION:
LETS
antenatal Examination routinely done at the first appointment includes:
examination Measurement of weight and height in order to determine body mass index(BMI).
Measurement of baseline blood pressure (BP).
10 explain the Testing of urine for glycosuria/proteinuria. ES What are the main
mt antenatal advice Antenatal advices given
to themother?

67
ANTENATAL ADVICE:

Principles:

1) To counsel the women about the importance of regular check-up.

2) To maintain or improve, the health status of the woman to the
optimum till delivery by judicious advice regarding diet, drugs and
hygiene.
3) To improve the psychology and to remove the fear of the unknown
by counselling the women.11 DISCUSSES
A. Diet:
The diet during pregnancy should be adequate to provide-
a) Good maternal health
b) Optimum fetal growth
c) The strength and vitality required during labor and
d) Successful lactation. During pregnancy, there is increased calorie requirement due
to increased growth of the maternal tissues, fetus, placenta and increased basal
metabolic rate.

The increased calorie requirement is to the extent of 300 over the non- pregnancy state
during second half of pregnancy. Generally the diet in pregnancy should be with
woman‟s choice as regard the quantity and the type. Woman with normal BMI should
eat adequately so as to gain the optimum weight (11 kg). Overweight women with
BMI between (26 - 29) should limit weight gain to 7 kg and obese women (BMI>29)
should gain less weight. Excessive weight gain increases antepartum and intrapartum
complications including fetal macrosomia.12

68
B. Antenatal Hygiene:
In otherwise uncomplicated cases, the following advises are to be given:-
Rest and Sleep:The patient may continue her usual activities throughout
pregnancy. However, excessive and strenous work should
be avoidedspecially in the first trimester and the last 4 weeks. Recreational
exercises arepermitted as long as she feels comfortable.

Bowel: Constipation is common. It may cause backache and

abdominal discomfort. Regular bowel movement may be facilitated by
regulation of diet taking plenty of fluids, vegetables and milk or prescribing
stool softners at bed time. There may be rectal bleeding, painful fissures or EXPLAINS LEA FLE
haemorrhoids due to hard stool. TS
Bathing: The patient should take daily bath but be careful against
slipping in the bathroom due to imbalance.

Clothing, shoes and belt: The patient should wear loose but comfortable
garments. High heel shoes should better be avoided in advanced pregnancy
when the centre of balance alters. Constrictingbelt should be avoided.

Dental care: Good dental and oral hygiene should be maintained. The
dentist should be consulted, if necessary. This will facilitate extraction or
filling of the caries tooth, if required, comfortably in the 2 nd trimester.

Care of the breasts: Breast engorgement may cause discomfort

during late pregnancy. A well fitting brassiere can give relief.

Coitus: Generally coitus is not restricted during pregnancy. Release of

prostaglandins and oxytocin with coitus may cause uterine contractions. Women
with increased risk of miscarriage or preterm labor should avoid coitus if they feel
such increased uterine activity.

Travel: Travel by vehicles having jerks are better to be avoided specially in

first trimester and the last 6 weeks. The long journey is preferably be limited to the
second trimester. Rail route is preferable to bus route. Travel in pressurized aircraft is
safe upto 36 weeks. Air travel is contraindicated in case with placenta praevia, pre-
eclampsia, severe anaemia and sickle cell disease. Prolonged sitting in a car or
aeroplane should be avoided due to the risk of venous stasis and thromboembolism.
Seat belt should be under the abdomen.

69
15 Demonstrate the Smoking and alcohol: In view of the fact that smoking is injurious to health, it is DISCUS CHART
mt antenatal exercise better to stop smoking not only during pregnancy but even thereafter. Heavy smokers
have smaller babies and there is also more chance of abortion. Similarly alcohol
consumption is to be drastically curtailed or avoided, so as to prevent fetal
maldevelopment or growth restriction.

C. Immunisation:
Fortunately most of the life threatening epidemics are rare. In the developing
countries immunization in pregnancy is a routine for tetanus; others are given when
epidemic occurs or travelling to an endemic zone or for travelling overseas.
 Live virus vaccines (rubella, measles, mumps, yellow fever) are contraindicated.
Rabies, Hepatitis A and B vaccines, toxoids can be given asin nonpregnant state.
 Tetanus: Immunization against tetanus not only protects the mother but also the
neonates.
 Drugs: Almost all the drugs given to mother will cross the placenta to reach the
fetus. Possibility of pregnancy should be kept in mind while prescribing drugs to
any woman of reproductive age.13

ANTENATAL EXERCISE:

Antenatal exercises are intended to enhance the physical and mental health of the
expectant woman in preparation for labour and to prevent pregnancy-related diseases
through a variety of physical measures. It often consists of stretching and low-impact
aerobic exercises.
Pregnancy causes some physical changes during the first trimester, such as morning DE MONS T RAT
sickness, exhaustion or poor energy, nausea, and increased relaxin hormone release. ES
Exercise helps the mother get over these changes and lifts her spirits and energy levels.
Healthy pregnant women should engage in moderate to strenuous aerobic activity for
20 to 30 minutes each day, or at least 150 minutes each week.14

Guide lines for exercises during pregnancy

 Maintain adequate fluid intake.
 Warm up slowly, use stretching exercises but avoid over stretching to prevent
injury to ligaments.
 Avoid jerking or bouncing exercises.
 Be careful of loose throw rugs that could slip& cause injury.
 Exercises on regular basis (three times per week).

70
 After first trimester, avoid exercises that require supine position.15
 Kegels month
exercise  Labor education
 Antenatal
education

CARDIOVASCULAR EXERCISE:
 The intensity of the workout will be decided by an assessment on pre-pregnancy
fitness level.
 It is important to choose any aerobic activity based on one's interests, such as
walking, swimming, hiking etc.
 So if walking is the only cardio workout done by an individual, it can be practiced
20-30 minutes 3-4 times a week safely16

STRETCHING EXERCISE

Pectoral Stretch:
 This exercise helps in the opening of the chest and prevents the development of
round shoulders.
 Nudge the ball in the corner or near the wall.
 Sit in a comfortable position keeping theback on the ball.
 Keep your hands by the side or clasp thembehind your head.
 Rest the head on ball and let the elbowsexpand and open your chest.
 Repeat 3 to 5 times.17

71
Piriformis Stretch:

Piriformis muscle plays an important rolein pelvic stabilization and

ADL's.
Sit on the chair with neutral pelvis.
Now keep your foot over the opposite knee and bend forward from the
hips keeping your pelvis neutral until you feelthe stretch.
Hold it for 20-30 seconds.
Repeat for the other side as well.
Do 3 to 5 sets.18

72
Hamstring Stretch:
Shortening of hamstring can cause back pain and pelvic misalignment.
This stretch can be performed in various positions and bilaterally or unilaterally.
Sit in long sitting position, bend one knee and try to reach your extended leg
as muchas you can.
Hold it for 20-30 seconds and repeat it for 3- 5 times on each side.
During first trimester, supine lying hamstringstretch can also be done.19

Calf Stretch:
 The more the available length of Tendo achilies, the more force production
duringpush off phase of walking and greaterstability.
 Place rolled towel, mat or foam roller on the floor.
 Place ball of the foot on the towel, mat or roller and heel on the floor. keep the
legstraight. hold this position for 20-30 seconds.
 Repeat on the other side and perform 3-5 setson each side.20

73
HIP OPENING STRETCHES TO DO DURING PREGNANCY

Butterfly /Tailor Pose:

 sitting on the ground, bring the soles of shoestogether, allowing knees to point out
to each side.
 Grasping feet or ankles, draw both heels in asclose to body as is comfortable.
 Lean forward slightly and hold that position. Focus on taking big deep belly
breaths.
For
 an even deeper stretch, press your thighs down with your hands or elbows to
bring your knees closer to the ground. Hold that pose and focus on the stretch
and your breath.21

74
Squats/ Garland Pose:
 Stand with feet facing forward or slightlyoutward, shoulder-width or slightly wider
than hip-distance, apart.
 Slowly and fluidly bend your knees and lower your body, extending the arms out
in front for balance if helpful.
 Balance your weight on the balls of yourheels and pause.
 Breathe and slowly rise back up and then repeat the action.

Hip Flexor Stretch:

 Kneel on your right knee and put your left foot in front of you, so your leg forms a
rightangle.
 Put your left hand on your left thigh for balance and put your right hand on your
righthip or also on your left thigh.
 Keeping your back straight, lean forward, and shift your body weight to the
forward leg. You will feel the stretch in the rightthigh.
 Hold for 30 seconds, then switch legs and repeat.22

75
Seated straddle:
 Extend both legs out wide with your feetflexed.
 Press your pelvis and hamstrings into the floor to help straighten your spine.
 Stay in this position if this is enough of a stretch for the backs of your legs
or walk your hands out in front of you.23

STRENGTHENING EXERCISES

Bridging:
 This exercise put more emphasis on the gluteus maximus and other larger
posturalmuscles.
 Lie on your back, hands by your side, knee hip-width apart and heel under
the knee.
 Keep your pelvis neutral, now squeeze your buttocks and lift the pelvis up.
 Hold it for 10-20 seconds, breath regularly.
 Come back to the starting position slowly.

76
Squats:
 Great exercise for all the lower extremitiesmuscle majorly focuses on gluteus
maximus.
 Stand feet slightly more than hip width apart.
 Clasp the hands and bring them forward.
 Squat while exhaling and make sure kneeswon't go beyond the great toes.
 Press down and straighten the legs whilegoing up.
 Ensure the stability.

The Kegal :
 A Kegel exercise is like pretending you have to urinate and then holding it.
 You relax and tighten the muscles that control urine flow.
 It is important to find the right muscles to tighten. Next time you have to urinate,
startto go and then stop.

Third Trimester Specific Exercise:

 To begin with the duck walk, one should first stand with feet placed wide apart
and both arms at sides. While performing the exercise it is important that the
abdominal muscles should be in tighten position so that the back and abdominal
muscles are not accidentally injured.

77
 Thereafter one should required to lower body from the hips as if individual were
about to sit on a chair, ensuring that the heels should be bearing the weight
 This way there will be no damage done to the knees. Clasping hands together in
front of chest is helps to maintain balance during the duck walk.
 Once in the required position, progress walk forward a few steps at a time
without changing squat position, then turn around and walk back to the place
from where started and slowly stand up. It is advisable that while performing the duck
walk exercise, individual should lean forward to retain balance ensuring that the
weight remains on the heels
 A modification to the duck walk exercise to increase the difficult level
involves placing a resistance band around the ankles right from the start of the
exercise. Of late there is a new form of exercise also referred to as the duck walk
exercise which requires the individual to squat further down till they are almost seated
on their heels.24

Women can also practice the duck walk exercise during pregnancy specifically
towards the last few months of the pregnancy. it will help to strengthen their thighs and
will allow the baby‟s head to move lower easily .Duck Walk is highly effective in
facilitating easy & normal labor/delivery.25

Advantages:
 Reduces morning sickness.
 Reduces insomnia, anxiety and stress.
 Reduces other pregnancy-related complaints, eg: fatigue, leg cramps, oedemaof
extremities, etc.
 Prevents excessive weight gain during pregnancy.
 Improves muscle strength.
 Improves core stability.
 Maintains muscle length and flexibility.
 Improves glycemic control.
 Improves posture.
 Enhances relaxation.
 Prepares for physical demands of labour.26

78
 PART – A Code……….
SOCIO – DEMOGRAPHIC VARIABLES

INSTRUCTIONS: -
All information gathered will be kept confidential only conclusion drawn will be used for
research purpose without naming individuals. Kindly answer all the questions accurately and
carefully as it applies to you.

Demographic Variables :-
1. Age in years
a) 20-25
b) 26-30
c) 31-35
2. Type of gravidas
a) Primigravida
b) multigravida
c) Nulligravida
3. Educational status
a) No formal education
b) Primary
c) Secondary
d) Graduateor above

4. Religion
a) Hindu
b) Muslim
c) Sikh
d) Christian
e) others
5. Type of family
a) Nuclear
b) Joint
c) Extended
6. Occupational status

79
 a) House wife
b) Private job
c) Government job
7. Residential Area
a) Rural
b) Urban
8. Total family income per month in rupees
a) <5,000/-
b) 5,000- 10,000/-
c) 10001 – 15000/-
d) 15000/- or above
9. Total no. of family members
a) 2
b) 3
c) more then 3
10. Type of pregnancy
a) Single
b) Twins
c) Triplets
11. .Dietary habits
a) Vegetarian
b) Non- vegetarian
12. Source of information
a) Family
b) Friends and relatives
c) Neighbors

80
 PART-B
SEMI-STRUCTURED QUESTIONNARIE REGARDING SELECTED ASPECTS OF
ANTENATAL CARE AMONG PRIMIGRAVIDA MOTHERS
Q.1 Which test is more preferred to confirm the pregnancy
a) Urine pregnancy test
b) Beta HCG test
c) Ultrasound
d) Urine examination
Q.2 Where you have register your pregnancy
a) Anganwadi
b) PHC
c) CHC
d) Private Hospital
Q.3 Which month you have registered your pregnancy
a) First month of pregnancy
b) Second month of pregnancy
c) Third month of pregnancy
Fourth month of pregnancy
Q.4 What is the first symptom of pregnancy
A) Amenorrhea
b) Fatigue
c) Headache
d) Morning Sickness
Q. 5 What are the benefits for antenatal visit
a) To Promote health during pregnancy
b) To increase the knowledge
c) To reduce the abortion chances
d) All of above
Q.6 How much total weight gain during pregnancy
a) 3-5 kg.
b) 5-8 kg.
c) 8-10kg.
d) 10-12kg.

81
Q.7 When will you start taking Folic acid tablets during pregnancy
a) Before pregnancy
b) 1 Month after pregnancy
c) 2 Month of pregnancy
d) 3 Month of pregnancy
Q.8 What are the calcium rich sources in pregnancy
a) Shells
b) Milk
c) Beetroot
d) Junk foods
Q.9 Which fruit we have to avoided during pregnancy
a) Citrus fruits
b) Papaya
c) Juicy fruits
d) Apple
Q.10 What are the sources of protein rich diet during pregnancy
a) fish
b) meat
c) Egg
d) Sunlight
Q.11 What are the main sources of iron rich diet in pregnancy
a) Dates
b) Drumstick leafs
c) Milk
d) Apple
Q.12 How many Calories should be taken during pregnancy
a) 700 Kcal
b) 300 Kcal
c) 800 Kcal
d) 900 Kcal
Q.13 What is the purpose of checking blood pressure during pregnancy
a) To prevent hypertension
b) To maintain blood glucose level
c) To maintain the Respiratory rate
d) To maintain normal bowel pattern

82
Q.14 What is the purpose of checking fetal heart rate
a) To find out live the baby
b) To find out the movement of the baby
c) To find out the age of fetus
d) To find out blood volume of the baby
Q.15 First fetal movement felt by mother is
a) Quickening
b) increased respiratory rate sound
c) Excessive bowel sound
d) none of the above
Q.16 What is purpose of checking Blood Glucose level
a) To find out live the baby
b) To find out the movement of the baby
c) To find out the age of fetus
d) To find out blood volume of the baby
Q.17 Glucose Tolerence Test (GTT) is performed in which trimesterof pregnancy
a) Ist trimester
b) IInd trimester
c) IIIrd trimesters
d) Never
Q.18 What are the purpose of maintaining personal Hygiene during pregnancy
a) To avoid infection
b) To maintain Good health
c) To improve the baby Growth
d) To gain weight of the baby
Q.19 Why breast care is important during pregnancy
a) To check breast discharge
b) To find out abnormalities
c) To maintain health of woman
d) None of the above
Q.20 Why we avoided wearing tight dresses during pregnancy
a) To releived suffocation
b) To support the uterus
c) To promote fetal growth
d) To reduce chances of infection

83
Q.21 Which month you take first dose of Teatnus
a) First month
b) Second month
c) Third month
d) Fourth month
Q.22 How many doses of Injection Tetanus Toxoid is advised to doctor during pregnancy
a) 1 Time
b) 2 Time
c) 3 Time
d) 4 Time
Q.23 What is the purposes of taking vaccines during pregnancy
a) To maximum growth of baby
b) To prevent cross infection to the baby
c) To weight-gain of the baby
d) To gain weight
Q.24 When will you start breast feeding after delivery
a) Within half one hour
b) Within 2 hours
c) Within 1 day
d) Within 4 days
Q.25 What are the benefits of exclusive breast feeding?
a) To increased baby weight
b) To promote good health for baby
c) To promote mother life
d) To provide immunity to the baby
Q.26 When will you put the BCG Vaccine to the newborn baby
a) at birth
b) 1 weeks
c) 1 months
d) 3 Days
Q.27 What is the advantages for exercise during preganancy
a) increase the blood circulation for mother & fetus
b) increase appetite
c) lose weight of the mother
d) Gain the weight of the mother

84
Q.28 Which type of exercise is advised to maintain good abdominal tone
a) Breathing exercise
b) Stomach strengthening exercise
c) Weight lifting exercise
d) Racing
Q.29 How will be counted the Expected date of delivery in pregnancy
a.) 9 Months +7 days
b.) 10 Month of Pregnancy
c.) last date of menstruation+9 months+7 days
D.) 10 Months +7 days
Q.30 Veneral Disease research laboratory (VDRL) is used for the screening of
a.) Anemia
b) HIV
c.) Diabetes Mellitus
D.) Syphilis

85
भाग – एक कोड……….
सामाजजक-जनसाांख्यिकीय
चर
जनदेश: -
एकत्र की गई सभी जानकारी गोपनीय रखी जाएगी, के वल जनकाले गए जनष्कर्ष का उपयोग जकसी व्यख्यि का
नाम जलए जबना अनुसांधान उद्देश्य के जलए जकया जाएगा। कृ पया सभी प्रश्ोां का सटीक और सावधानीपूवषक
उत्तर दें क्ोांजक यह आप पर लागू होता है।

जनसाांख्यिकीय चर: -

1. आयु वर्ों में

ए) 20-25
बी) 26-30
ग) 31-35

2. ग्रेजवडा का प्रकार
ए) प्राइजमग्रेजवडा
बी) मल्टीग्रेजवडा
ग) न्यूजलग्रेजवडा

3. शैजिक ख्यथथजत
क) कोई औपचाररक जशिा नही
ां बी) प्राथजमक
ग) माध्यजमक
घ) स्नातक से ऊपर

4. धम
ष क)
जहांदू
बी)
मुख्यिम ग)
जसख घ)
ईसाई ई)
अन्य

5. पररवार का
प्रकार ए) परमाणु
बी) सांयुि
ग) जवस्ताररत

6. व्यावसाजयक ख्यथथजत
एक गृजहणी
बी) प्राइवेट
नौकरी ग) सरकारी
नौकरी

7. आवासीय
िेत्र क)
ग्रामीण
86
बी) शहरी

87
8. प्रजत माह कु ल पाररवाररक आय रुपये
में ए) <5,000/-
ख) 5,000- 10,000/-
ग) 10001 – 15000/-
घ) 15000/- या अजधक

9. कु ल सांिा पररवार के
सदस्ोां का ए) 2
ख) 3
ग) 3 से अजधक

9. गभाषवथथा का प्रकार
एक भी
बी)जुड़
वााँ ग)
जत्रगुण

10.आहार सांबांधी आदतें

शाकाहारी
ख) माांसाहारी

10. सूचना का स्रोत

एक पररवार
बी) दोस्त और ररश्तेदार
ग) पड़ोसी

88
भाग-बी
प्राइजमग्रेजवडा माताओां के बीच प्रसवपूवष देखभाल के चयजनत पहलुओां के सांबांध में अधष-सांरजचत प्रश्ावली

Q.1 गभाषवथथा की पुजि के जलए कौन सा परीिण अजधक पसांद जकया

जाता है क) मूत्र गभाषवथथा परीिण
बी) बीटा एचसीजी परीिण
ग) अल्टर ासाउांड
घ) मूत्र परीिण

Q.2 जहाां आपने अपनी गभाषवथथा का पांजीकरण कराया

है ए) आांगनवाड़ी
बी) पीएचसी
ग) सी.एच.सी
घ) जनजी अस्पताल

Q.3 आपने अपनी गभाषवथथा जकस महीने में पांजीकृ त कराई

है क) गभाषवथथा का पहला महीना
बी) गभाषवथथा का दू सरा
महीना ग) गभाषवथथा का
तीसरा महीना गभाषवथथा का
चौथा महीना

Q.4 गभाषवथथा का पहला लिण क्ा

है? ए) एमेनोररया
बी) थकान
ग)
जसरददष
घ) सुबह की बीमारी

प्र. 5 प्रसव पूवष जाांच के क्ा लाभ हैं?

क) गभाषवथथा के दौरान स्वास्थ्य को बढावा देने के
जलए ख) ज्ञान बढाने के जलए
ग) गभषपात की सांभावना को कम करने के
जलए घ) उपरोि सभी

Q.6 गभाषवथथा के दौरान कु ल जकतना वजन बढता

है ए) 3-5 जकग्रा.
बी) 5-8 जकग्रा.
ग) 8-10 जकग्रा.
घ) 10-12 जकग्रा.

Q.7 गभाषवथथा के दौरान आप फोजलक एजसड की गोजलयाां कब लेना शुरू करें

गी? क) गभाषवथथा से पहले
बी) गभाषवथथा के 1 महीने
बाद ग) गभाषवथथा का दू सरा
महीना घ) गभाषवथथा का
तीसरा महीना

Q.8 गभाषवथथा में कै ख्यशशयम से भरपूर स्रोत क्ा

हैं? ए) गोले
ख) दू ध
ग) चुकां
89
दर
घ) जांक फू ड

90
Q.9 गभाषवथथा के दौरान हमें जकस फल से परहेज करना
चाजहए? क) खट्टे फल
ख) पपीता
ग) रसदार फल
घ) सेब

Q.10 गभाषवथथा के दौरान प्रोटीन युि आहार के स्रोत

क्ा हैं? एक मछली
बी)
माांस ग)
अांडा
घ) सूरज की रोशनी

Q.11 गभाषवथथा में आयरन युि आहार के मुि स्रोत

क्ा हैं? ए) जतजथयााँ
ख) सहजन की
पजत्तयााँ ग) दू ध
घ) सेब

Q.12 गभाषवथथा के दौरान जकतनी कै लोरी लेनी

चाजहए ए) 700 जकलो कै लोरी
बी) 300 जकलो कै
लोरी ग) 800 जकलो
कै लोरी घ) 900
जकलो कै लोरी

Q.13 गभाषवथथा के दौरान रिचाप की जााँच करने का क्ा उद्दे

श्य है? ए) उच्च रिचाप को रोकने के जलए
बी) रि शकष रा के स्तर को बनाए रखने के
जलए ग) श्वसन दर को बनाए रखने के जलए
घ) सामान्य आांत्र पैटनष को बनाए रखने के जलए

Q.14 भ्रूण की हृदय गजत की जााँच करने का उद्दे श्य

क्ा है क) यह पता लगाने के जलए जक बच्चा जीजवत है
ख) जशशु की गजतजवजध का पता लगाना
ग) भ्रूण की उम्र जानने के जलए
घ) जशशु के रि की मात्रा का पता लगाना

Q.15 मााँ द्वारा महसूस की गई पहली भ्रूण हलचल

है ए) तेज़ करना
बी) ध्वजन की श्वसन दर में वृख्यि
ग) अत्यजधक आांत्र ध्वजन
घ) उपरोि में से कोई नही ां

Q.16 रि ग्लूकोज स्तर की जााँच करने का उद्दे श्य

क्ा है? क) यह पता लगाने के जलए जक बच्चा जीजवत है
ख) जशशु की गजतजवजध का पता लगाना
ग) भ्रूण की उम्र जानने के जलए
घ) जशशु के रि की मात्रा का पता लगाना

91
Q.17 ग्लूकोज टॉलरें स टेस्ट (जीटीटी) गभाषवथथा की जकस जतमाही में जकया
जाता है ए) पहली जतमाही
बी)दू सरी
जतमाही ग)
तीसरी जतमाही
घ) कभी नही ां

Q.18 गभाषवथथा के दौरान व्यख्यिगत स्वच्छता बनाए रखने का क्ा उद्दे

श्य है? क) सांक्रमण से बचने के जलए
ख) अच्छे स्वास्थ्य को बनाए रखने के
जलए ग) जशशु के जवकास में सुधार के
जलए
घ) बच्चे का वजन बढाने के जलए

Q.19 गभाषवथथा के दौरान स्तन की देखभाल क्ोां महत्वपूणष है?

a) स्तन स्राव की जाांच करने के
जलए ख) असामान्यताओां का पता
लगाना
ग) मजहला के स्वास्थ्य को बनाए रखने के
जलए घ) उपरोि में से कोई नही ां

Q.20 हम गभाषवथथा के दौरान टाइट कपड़े पहनने से क्ोां बचते

हैं? क) घुटन से राहत पाने के जलए
ख) गभाषशय को सहारा देने के जलए
ग) भ्रूण के जवकास को बढावा देना
घ) सांक्रमण की सांभावना को कम करने के जलए

Q.21 आप टीटनस की पहली खुराक जकस महीने लेते हैं

ए) पहला महीना
ख) दू सरा
महीना ग)
तीसरा महीना
घ) चौथा महीना

Q.22 गभाषवथथा के दौरान डॉक्टर को टेटनस टॉक्सॉइड इांजेक्शन की जकतनी खुराक लेने की सलाह दी
जाती है क) 1 बार
बी) 2 समय
ग) 3 बार
घ) 4 समय

Q.23 गभाषवथथा के दौरान टीके लेने का क्ा उद्दे

श्य है? क) अजधकतम वृख्यि के जलए ओ
ख) शििु को संक्रमण से बचाने के शिए
ग) बच्चे का वजन बढाने के शिए
घ) वजन बढाने के शिए

Q.24 आप प्रसव के बाद स्तनपान कब िुरू

करेंगी? क) आधे एक घंटे के भीतर
बी) 2 घंटे के भीतर
ग) 1 ददन के भीतर
घ) 4 ददनों के

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भीतर

93
Q.25 के वि स्तनपान के क्या िाभ हैं?
a) बच्चे का वजन बढाने के शिए
ख) शििु के अच्छे स्वास््य को बढावा
देना ग) मातृ जीवन को बढावा देना
घ) शििु को प्रशतरक्षा प्रदान करना

Q.26 आप नवजात शििु को बीसीजी वैक्सीन कब

िगाएंगे क) जन्म के समय
बी) 1 सप्ताह
ग) 1 महीने
घ) 3 ददन

Q.27 गभाावस्था के दौरान व्यायाम के क्या फायदे

हैं? ए) मााँ और भ्रूण के शिए रक्त पररसंचरण में
वृशि
बी) भूख बढाएाँ
ग) मााँ का वजन कम करना
घ) मााँ का वजन बढना

Q.28 पेट की टोन को अच्छा बनाए रखने के शिए दकस प्रकार के व्यायाम की सिाह दी
जाती है क) सााँस िेने का व्यायाम
ख) पेट को मजबूत बनाने वािा व्यायाम
ग) वजन उठाने का व्यायाम
घ) रेससग

Q.29 गभाावस्था में प्रसव की अपेशक्षत शतशथ की गणना कै से की जाएगी

ए.) 9 महीने +7 ददन
बी.) गभाावस्था का 10वां महीना
सी.) माशसक धमा की अंशतम शतशथ+9 महीने+7 ददन
डी.) 10 महीने +7 ददन

Q.30 यौन रोग अनुसंधान प्रयोगिािा (वीडीआरएि) का उपयोग दकसकी जांच के शिए दकया जाता
है ए.) एनीशमया
बी) एचआईवी
सी.) मधुमेह मेशिटस
डी.) शसफशिस

94
ਬਾਕ – ਇੱ ਓ ਓ੅ਡ……….
ਸਭਾਜ - ਜਨਸੰ ਖਔਆ ਵ੃ਯੀਏਫਰ
ਹਦਾਇਤਾਂ:-
ਇਓੱ ਠੀ ਓੀਤੀ ਕਈ ਸਾਯੀ ਜਾਣਓਾਯੀ ਨੰ ੂ ਕੁ਩ਤ ਯੱ ਖਔਆ ਜਾਵ੃ਕਾ ਖਸਯਪ ਓੱ ਢ੃ ਕਏ ਖਸੱ ਟ੃ ਨੰ ੂ ਖਵਅਓਤੀਆਂ ਦਾ ਨਾਭ
ਰਏ ਖਫਨਾਂ ਔ੅ਜ ਦ੃ ਉਦ੃ਸ਼ ਰਈ ਵਯਖਤਆ ਜਾਵ੃ਕਾ। ਖਓਯਾ ਓਯਓ੃ ਸਾਯ੃ ਸਵਾਰਾਂ ਦ੃ ਸਹੀ ਅਤ੃ ਖਧਆਨ ਨਾਰ ਜਵਾਫ ਖਦ਑
ਖਓਉਂਖਓ ਇਹ ਤੁਹਾਡ੃ 'ਤ੃ ਰਾਕੂ ਹੰ ੁਦਾ ਹ੄।

ਜਨਸੰ ਖਔਆ ਵ੃ਯੀਏਫਰ: -

1. ਸਾਰਾਂ ਖਵੱ ਚ ਉਭਯ
a) 20-25
b) 26-30
c) 31-35

2. ਕਯ੃ਖਵਡਸ ਦੀ ਖਓਸਭ
a) ਖਿਖਭਕਿਾਖਵਦਾ
b) ਭਰਟੀਕਿ੃ਖਵਡਾ
c) ਨਰੀਕਿਾਖਵਡਾ

3. ਖਵਖਦਅਓ ਸਖਥਤੀ
a) ਓ੅ਈ ਯਸਭੀ ਖਸੱ ਖਔਆ ਨਹੀਂ
b) ਿਾਇਭਯੀ
c) ਸ੄ਓੰ ਡਯੀ
d) ਉ਩ਯ੅ਓਤ ਕਿ੄ਜੂਏਟ

4. ਧਯਭ
a) ਖਹੰ ਦੂ
b) ਭੁਸਰਭਾਨ
c) ਖਸੱ ਔ
d) ਈਸਾਈ
e) ਹ੅ਯ

5. ਩ਖਯਵਾਯ ਦੀ ਖਓਸਭ
a) ਿਭਾਣੂ
b) ਸੰ ਮੁਓਤ
c) ਖਵਸਖਤਿਤ

6. ਖਓੱ ਤਾਭੁਔੀ ਸਖਥਤੀ

a) ਖਯ੃ਰੂ ਩ਤਨੀ
b) ਖਨਜੀ ਨ੆ ਓਯੀ
c) ਸਯਓਾਯੀ ਨ੆ ਓਯੀ

95
7. ਖਯਹਾਇਸ਼ੀ ਔ੃ਤਯ
a) ਡੂ
61
b) ਸ਼ਖਹਯੀ

8. ਯੁ਩ਏ ਖਵੱ ਚ ਿਤੀ ਭਹੀਨਾ ਓੁਰ ਩ਖਯਵਾਯਓ ਆਭਦਨ

a) <5,000/-
b) 5,000- 10,000/-
c) 10001 - 15000/-
d) 15000/- ਜਾਂ ਵੱ ਧ

9. ਓੁਰ ਨੰ . ਩ਖਯਵਾਯ ਦ੃ ਭੈਂਫਯਾਂ ਦ੃

a) 2
b) 3
c) 3 ਤੋਂ ਵੱ ਧ

9. ਕਯਬ ਅਵਸਥਾ ਦੀ ਖਓਸਭ

a) ਖਸੰ ਕਰ
b) ਜੁੜਵਾਂ
c) ਤੀਹਯ੃

10. ਔੁਯਾਓ ਦੀਆਂ ਆਦਤਾਂ

a) ਸ਼ਾਓਾਹਾਯੀ
b) ਭਾਸਾਹਾਯੀ

10. ਜਾਣਓਾਯੀ ਦਾ ਸਯ੅ਤ

a) ਩ਖਯਵਾਯ
b) ਦ੅ਸਤ ਅਤ੃ ਖਯਸ਼ਤ੃ਦਾਯ
c) ਕੁਆਂਢੀ

96
ਬਾਕ-ਫੀ

ਖਿਖਭਕਿਾਖਵਡਾ ਭਾਵਾਂ ਖਵੱ ਚ ਜਨਭ ਤੋਂ ਩ਖਹਰਾਂ ਦੀ ਦ੃ਔਬਾਰ ਦ੃ ਚੁਣ੃ ਕਏ ਩ਖਹਰੂਆਂ ਦ੃ ਸਫੰ ਧ ਖਵੱ ਚ ਅਯਧ-ਸੰ ਯਚਨਾ ਵਾਰੀ
ਿਸ਼ਨਾਵਰੀ
Q.1 ਕਯਬ ਅਵਸਥਾ ਦੀ ਸ਼ਟੀ
' ਓਯਨ ਰਈ ਖਓਹੜਾ ਟ੄ਸਟ ਵਧ੃ਯ੃ ਤਯਜੀਹੀ ਹ੄
a) ਖ਩ਸ਼ਾਫ ਕਯਬ ਅਵਸਥਾ
b) ਫੀਟਾ ਐਚਸੀਜੀ ਟ੄ਸਟ
c) ਅਰਟਯਾਸਾਊਂਡ
d) ਖ਩ਸ਼ਾਫ ਦੀ ਜਾਂਚ

Q.2 ਤੁਸੀਂ ਆ਩ਣੀ ਕਯਬ ਅਵਸਥਾ ਖਓੱ ਥ੃ ਯਖਜਸਟਯ ਓਯਵਾਈ ਹ੄

a) ਆਂਕਣਵਾੜੀ
b) PHC
c) ਸੀ.ਐਚ.ਸੀ
d) ਿਾਈਵ੃ਟ ਹਸ਩ਤਾਰ

Q.3 ਤੁਸੀਂ ਆ਩ਣੀ ਕਯਬ ਅਵਸਥਾ ਖਓਸ ਭਹੀਨੇ ਦਯਜ ਓਯਵਾਈ ਹ੄

a) ਕਯਬ ਅਵਸਥਾ ਦਾ ਩ਖਹਰਾ ਭਹੀਨਾ
b) ਕਯਬ ਅਵਸਥਾ ਦਾ ਦੂਜਾ ਭਹੀਨਾ
c) ਕਯਬ ਅਵਸਥਾ ਦਾ ਤੀਜਾ ਭਹੀਨਾ
d) ਕਯਬ ਅਵਸਥਾ ਦਾ ਚ੆ਥਾ ਭਹੀਨਾ

Q.4 ਕਯਬ ਅਵਸਥਾ ਦਾ ਩ਖਹਰਾ ਰੱ ਛਣ ਓੀ ਹ੄?

a) ਅਭ੃ਨੋ ਯੀਆ
b) ਥਓਾਵਟ
c) ਖਸਯ ਦਯਦ
d) ਸਵ੃ਯ ਦੀ ਖਫਭਾਯੀ

ਿ. 5 ਜਨਭ ਤੋਂ ਩ਖਹਰਾਂ ਦ੃ ਦ੆ਯ੃ ਦ੃ ਓੀ ਪਾਇਦ੃ ਹਨ

a) ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਖਸਹਤ ਨੰ ੂ ਉਤਸ਼ਾਖਹਤ ਓਯਨਾ
b) ਖਕਆਨ ਨੰ ੂ ਵਧਾਉਣ ਰਈ
c) ਕਯਬਾਤ ਦੀਆਂ ਸੰ ਬਾਵਨਾਵਾਂ ਨੰ ੂ ਖਟਾਉਣ ਰਈ
d) ਉ਩ਯ੅ਓਤ ਸਾਯ੃

Q.6 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਓੁਰ ਖਓੰ ਨਾ ਬਾਯ ਵਧਦਾ ਹ੄

a) 3-5 ਖਓਰ੅ਕਿਾਭ।
b) 5-8 ਖਓਰ੅ਕਿਾਭ।
c) 8-10 ਖਓਰ੅ਕਿਾਭ।
d) 10-12 ਖਓਰ੅ਕਿਾਭ।

97
Q.7 ਤੁਸੀਂ ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਪ੅ਖਰਓ ਐਖਸਡ ਦੀਆਂ ਕ੅ਰੀਆਂ ਓਦੋਂ ਰ੄ਣਾ ਸ਼ੁਯੂ ਓਯ੅ਕ੃?
a) ਕਯਬ ਅਵਸਥਾ ਤੋਂ ਩ਖਹਰਾਂ
b) ਕਯਬ ਅਵਸਥਾ ਦ੃ 1 ਭਹੀਨੇ ਫਾਅਦ
c) ਕਯਬ ਅਵਸਥਾ ਦ੃ 2 ਭਹੀਨੇ
d) ਕਯਬ ਅਵਸਥਾ ਦ੃ 3 ਭਹੀਨੇ

Q.8 ਕਯਬ ਅਵਸਥਾ ਖਵੱ ਚ ਓ੄ਰਸ਼ੀਅਭ ਬਯਯ

& ਸਯ੅ਤ ਓੀ ਹਨ?
a) ਸ਼ਰ=7
b) ਦੁਧ
c) ਚਓੰ ਦਯ
d) ਜੰ ਓ ਪੂਡ

Q.9 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਸਾਨੰ ੂ ਖਓਹੜ੃ ਪਰਾਂ ਤੋਂ ਩ਯਹ੃ਜ਼ ਓਯਨਾ ਚਾਹੀਦਾ ਹ੄?
a) ਖਨੰ ਫੂ ਜਾਤੀ ਦ੃ ਪਰ
b) ੀਤਾ
c) ਯਸਦਾਯ ਪਰ
d) ਸ੃ਫ

Q.10 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਿਟੀਨ ਬਯਯ

& ਔੁਯਾਓ ਦ੃ ਸਯ੅ਤ ਓੀ ਹਨ?
a) ਭੱ ਛੀ
b) ਭੀਟ
c) ਅੰ ਡ੃
d) ਸੂਯਜ ਦੀ ਯ੆ਸ਼ਨੀ

Q.11 ਕਯਬ ਅਵਸਥਾ ਖਵੱ ਚ ਆਇਯਨ ਬਯਯ

& ਔੁਯਾਓ ਦਾ ਭੁਔ ਸਯ੅ਤ ਓੀ ਹਨ?
a) ਤਾਯੀਔਾਂ
b) ਡਯੱ ਭਸਖਟਓ ਤ੃
c) ਦੁਧ
d) ਸ੃ਫ

Q.12 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਖਓੰ ਨੀ ਓ੄ਰ੅ਯੀ ਰ੄ਣੀ ਚਾਹੀਦੀ ਹ੄

a) 700 ਓ੄ਰਸੀ
b) 300 ਓ੄ਰਸੀ
c) 800 ਓ੄ਰਸੀ
d) 900 ਓ੄ਰਸੀ

98
Q.13 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਫਰੱ ਡ ਿਸ਼ਯ ਦੀ ਜਾਂਚ ਓਯਨ ਦਾ ਓੀ ਭਓਸਦ ਹ੄?
a) ਹਾਈ਩ਯਟ੄ਨਸ਼ਨ ਨੰ ੂ ਯ੅ਓਣ ਰਈ
b) ਔੂਨ ਖਵੱ ਚ ਕਰੂਓ੅ਜ਼ ਦ੃ ਧਯ ਨੰ ੂ ਫਣਾਈ ਯੱ ਔਣ ਰਈ
c) ਸਾਹ ਦੀ ਦਯ ਨੰ ੂ ਓਾਇਭ ਯੱ ਔਣ ਰਈ
d) ਆਭ ਅੰ ਤੜੀ ਩੄ਟਯਨ ਨੰ ੂ ਫਣਾਈ ਯੱ ਔਣ ਰਈ

Q.14 ਕਯੱ ਬਸਥ ਸ਼ੀਸ਼ੂ ਦ੃ ਖਦਰ ਦੀ ਕਤੀ ਦੀ ਜਾਂਚ ਓਯਨ ਦਾ ਉਦ੃ਸ਼ ਓੀ ਹ੄?
a) ਫੱ ਚ੃ ਦ੃ ਰਾਈਵ ਹ੅ਣ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ
b) ਫੱ ਚ੃ ਦੀ ਹਯਓਤ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ
c) ਕਯੱ ਬਸਥ ਸ਼ੀਸ਼ੂ ਦੀ ਉਭਯ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ
d) ਫੱ ਚ੃ ਦ੃ ਔੂਨ ਦੀ ਭਾਤਯਾ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ

Q.15 ਭਾਂ ਦੁਆਯਾ ਭਖਹਸੂਸ ਓੀਤੀ ਩ਖਹਰੀ ਬਯੂਣ ਦੀ ਹਯਓਤ ਹ੄

a) ਤ੃ਜ਼ ਓਯਨਾ
b) ਸਾਹ ਦੀ ਦਯ ਵਧੀ ਹ੅ਈ ਆਵਾਜ਼
c) ਫਹੁਤ ਖਜ਼ਆਦਾ ਅੰ ਤੜੀਆਂ ਦੀ ਆਵਾਜ਼
d) ਉ਩ਯ੅ਓਤ ਖਵੱ ਚੋਂ ਓ੅ਈ ਨਹੀਂ

Q.16 ਫਰੱ ਡ ਕਰੂਓ੅ਜ਼ ਦ੃ ਧਯ ਦੀ ਜਾਂਚ ਓਯਨ ਦਾ ਓੀ ਭਓਸਦ ਹ੄

a) ਫੱ ਚ੃ ਦ੃ ਰਾਈਵ ਹ੅ਣ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ
b) ਫੱ ਚ੃ ਦੀ ਹਯਓਤ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ
c) ਕਯੱ ਬਸਥ ਸ਼ੀਸ਼ੂ ਦੀ ਉਭਯ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ
d) ਫੱਚ੃ ਦ੃ ਔੂਨ ਦੀ ਭਾਤਯਾ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ

Q.17 ਕਰੂਓ੅ਜ਼ ਸਖਹਣਸ਼ੀਰਤਾ ਟ੄ਸਟ (GTT) ਕਯਬ ਅਵਸਥਾ ਦੀ ਖਤਭਾਹੀ ਖਵੱ ਚ ਓੀਤਾ ਜਾਂਦਾ ਹ੄
a) ਩ਖਹਰੀ ਖਤਭਾਹੀ
b) ਦੂਜਾ ਖਤਭਾਹੀ
c) IIIrd ਖਤਭਾਹੀ
d) ਓਦ੃ ਨਹੀਂ

Q.18 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਖਨ਼ੈੱਜੀ ਸਪਾਈ ਫਣਾਈ ਯੱ ਔਣ ਦਾ ਓੀ ਭਓਸਦ ਹ੄

a) ਰਾਕ ਤੋਂ ਫਚਣ ਰਈ
b) ਚੰ ਕੀ ਖਸਹਤ ਫਣਾਈ ਯੱ ਔਣ ਰਈ
c) ਫੱ ਚ੃ ਦ੃ ਖਵਓਾਸ ਨੰ ੂ ਖਫਹਤਯ ਫਣਾਉਣ ਰਈ
d) ਫੱ ਚ੃ ਦਾ ਬਾਯ ਵਧਾਉਣਾ

99
Q.19 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਛਾਤੀ ਦੀ ਦ੃ਔਬਾਰ ਖਓਉਂ ਜ਼ਯੂਯੀ ਹ੄?
a) ਛਾਤੀ ਦ੃ ਖਡਸਚਾਯਜ ਦੀ ਜਾਂਚ ਓਯਨ ਰਈ
b) ਅਸਧਾਯਨਤਾਵਾਂ ਦਾ ਩ਤਾ ਰਕਾਉਣ ਰਈ
c) ਒ਯਤ ਦੀ ਖਸਹਤ ਫਣਾਈ ਯੱ ਔਣ ਰਈ
d) ਉ਩ਯ੅ਓਤ ਖਵੱ ਚੋਂ ਓ੅ਈ ਨਹੀਂ

Q.20 ਅਸੀਂ ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਤੰ ਕ ਓੱ ਩ੜ੃ ਾਉਣ ਤੋਂ ਩ਯਹ੃ਜ਼ ਖਓਉਂ ਓਯਦ੃ ਹਾਂ?
a) ਸਾਹ ਖੱ ੁਟਣ ਤੋਂ ਯਾਹਤ ਾਉਣ ਰਈ
b) ਫੱ ਚ੃ਦਾਨੀ ਦਾ ਸਭਯਥਨ ਓਯਨ ਰਈ
c) ਬਯੂਣ ਦ੃ ਖਵਓਾਸ ਨੰ ੂ ਉਤਸ਼ਾਖਹਤ ਓਯਨ ਰਈ
d) ਰਾਕ ਦੀ ਸੰ ਬਾਵਨਾ ਨੰ ੂ ਖਟਾਉਣ ਰਈ

Q.21 ਤੁਸੀਂ ਟੀਟਨਸ ਦੀ ਩ਖਹਰੀ ਔੁਯਾਓ ਖਓਸ ਭਹੀਨੇ ਰੈਂਦ੃ ਹ੅

a) ਩ਖਹਰਾ ਭਹੀਨਾ
b) ਦੂਜਾ ਭਹੀਨਾ
c) ਤੀਜਾ ਭਹੀਨਾ
d) ਚ੆ਥਾ ਭਹੀਨਾ

Q.22 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਡਾਓਟਯ ਟ੄ਟਨਸ ਟ੆ਓਸਾਇਡ ਦੀ ਖਓੰ ਨੀ ਔੁਯਾਓ ਰ੄ਣ ਦੀ ਸਰਾਹ ਖਦੰ ਦਾ ਹ੄
a) 1 ਸਭਾਂ
b) 2 ਸਭਾਂ
c) 3 ਸਭਾਂ
d) 4 ਸਭਾਂ

Q.23 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਵ੄ਓਸੀਨ ਰ੄ਣ ਦਾ ਓੀ ਭਓਸਦ ਹ੄?

a) ਵੱ ਧ ਤੋਂ ਵੱ ਧ ਵਾਧ੃ ਰਈ o
b) ਫੱ ਚ੃ ਨੰ ੂ ਓਯਾਸ ਇਨਪ੄ਓਸ਼ਨ ਨੰ ੂ ਯ੅ਓਣ ਰਈ
c) ਫੱ ਚ੃ ਦਾ ਬਾਯ ਵਧਣਾ
d) ਬਾਯ ਵਧਾਉਣ ਰਈ

Q.24 ਤੁਸੀਂ ਜਣ੃਩੃ ਤੋਂ ਫਾਅਦ ਛਾਤੀ ਦਾ ਦੱ ਧ

ੁ ਚੰ ਖਾ
ੁ ਉਣਾ ਓਦੋਂ ਸ਼ੁਯੂ ਓਯ੅ਕ੃
a) ਅੱ ਧ੃ ਇੱ ਓ ਖੰ ਟ੃ ਦ੃ ਅੰ ਦਯ
b) 2 ਖੰ ਖਟਆਂ ਦ੃ ਅੰ ਦਯ
c) 1 ਖਦਨ ਦ੃ ਅੰ ਦਯ
d) 4 ਖਦਨਾਂ ਦ੃ ਅੰ ਦਯ

10
0
Q.25 ਖਵਸ਼੃ਸ਼ ਛਾਤੀ ਦਾ ਦੱ ਧ
ੁ ਚੰ ਖਾ
ੁ ਉਣ ਦ੃ ਓੀ ਪਾਇਦ੃ ਹਨ?
a) ਫੱ ਚ੃ ਦਾ ਬਾਯ ਵਧਾਉਣ ਰਈ
b) ਫੱ ਚ੃ ਦੀ ਚੰ ਕੀ ਖਸਹਤ ਨੰ ੂ ਉਤਸ਼ਾਖਹਤ ਓਯਨ ਰਈ
c) ਭਾਂ ਦ੃ ਜੀਵਨ ਨੰ ੂ ਉਤਸ਼ਾਖਹਤ ਓਯਨ ਰਈ
d) ਫੱ ਚ੃ ਨੰ ੂ ਿਤੀਯ੅ਧਓ ਸ਼ਓਤੀ ਿਦਾਨ ਓਯਨ ਰਈ

Q.26 ਤੁਸੀਂ ਨਵਜੰ ਭ੃ ਫੱ ਚ੃ ਨੰ ੂ BCG ਵ੄ਓਸੀਨ ਓਦੋਂ ਰਕਾ਑ਕ੃

a) ਜਨਭ ਸਭੇਂ
b) 1 ਹਫ਼ਤ੃
c) 1 ਭਹੀਨਾ
d) 3 ਖਦਨ

Q.27 ਕਯਬ ਅਵਸਥਾ ਦ੆ਯਾਨ ਓਸਯਤ ਓਯਨ ਦ੃ ਓੀ ਪਾਇਦ੃ ਹਨ?

a) ਭਾਂ ਅਤ੃ ਕਯੱ ਬਸਥ ਸ਼ੀਸ਼ੂ ਰਈ ਔੂਨ ਸੰ ਚਾਯ ਨੰ ੂ ਵਧਾ਑
b) ਬੱ ਔ
ੁ ਵਧਾਉਣਾ
c) ਭਾਂ ਦਾ ਬਾਯ ਖਟਣਾ
d) ਭਾਂ ਦਾ ਬਾਯ ਵਧਾ਑

Q.28 ਩੃ਟ ਦੀ ਚੰ ਕੀ ਸੁਯ ਫਣਾਈ ਯੱ ਔਣ ਰਈ ਖਓਸ ਖਓਸਭ ਦੀ ਓਸਯਤ ਦੀ ਸਰਾਹ ਖਦੱ ਤੀ ਜਾਂਦੀ ਹ੄
a) ਸਾਹ ਰ੄ਣ ਦੀ ਓਸਯਤ
b) ਩੃ਟ ਨੰ ੂ ਭਜ਼ਫੂਤ ਓਯਨ ਵਾਰੀ ਓਸਯਤ
c) ਬਾਯ ਚੱ ਓ
ੁ ਣ ਦੀ ਓਸਯਤ
d) ਯਖਸੰ ਕ
Q.29 ਕਯਬ ਅਵਸਥਾ ਖਵੱ ਚ ਜਣ੃਩੃ ਦੀ ਸੰ ਬਾਖਵਤ ਖਭਤੀ ਨੰ ੂ ਖਓਵੇਂ ਖਕਖਣਆ ਜਾਵ੃ਕਾ
a.) 9 ਭਹੀਨੇ +7 ਖਦਨ
b.) ਕਯਬ ਅਵਸਥਾ ਦਾ 10 ਭਹੀਨਾ
c.) ਭਾਹਵਾਯੀ ਦੀ ਆਔਯੀ ਖਭਤੀ + 9 ਭਹੀਨੇ + 7 ਖਦਨ
d.) 10 ਭਹੀਨੇ +7 ਖਦਨ

Q.30 ਵ੄ਨਯਰ ਖਡਜ਼ੀਜ਼ ਖਯਸਯਚ ਰ੄ਫਾਯਟਯੀ (VDRL) ਦੀ ਸਓਿੀਖਨੰ ਕ ਰਈ ਵਯਤੀ ਜਾਂਦੀ ਹ੄

a.) ਅਨੀਭੀਆ
b) ਐ਼ੈੱਚ.ਆਈ.ਵੀ
c.) ਡਾਇਫੀਟੀਜ਼ ਭਰ੃ਟਸ
d.) ਖਸਖਪਖਰਸ

10
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 15-20, 2017: Abstracts", Annals of Nutrition
and Metabolism, 2017
Publication

7 www.sciencegate.app
Internet Source 1%
8 ejmcm.com
Internet Source 1%
9 ijone.org
Internet Source 1%
10 pt.scribd.com
Internet Source 1%
11 snehaleducation.files.wordpress.com
Internet Source 1%
12 www.scribd.com
Internet Source <1%
13 journalcra.com
Internet Source <1%
14 irjmst.com
Internet Source <1%
15 www.ijres.org
Internet Source <1%
16 www.ijtsrd.com
Internet Source <1%
 ANNEXURE - XIII
PRE
PART-A (Knowledge/ Attitude/ Practice/ Depression etc……tools score
In case of (Knowledge enter 1=corret 0 =Incorrect response) (Practice enter 1=Yes 0=No) (Attitude enter likert scale value 1,2.3….) or Enter answer according to your tool (Leave extra column blank)

Qno.10

Qno.11

Qno.12

Qno.13

Qno.14

Qno.15

Qno.16

Qno.17

Qno.18

Qno.19

Qno.20

Qno.21

Qno.22

Qno.23

Qno.24

Qno.25

Qno.26

Qno.27

Qno.28

Qno.29

Qno.30
Qno.1

Qno.2

Qno.3

Qno.4

Qno.5

Qno.6

Qno.7

Qno.8

Qno.9
1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 1 1 1 0 1 1 0 1 0 0 1 0 1
0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0 1 0 1 0 1 1 1 1 0 0 1 0 1
0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0
1 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 1 0 1 1 1 1 1 1 0 0 1 1 1
0 1 1 0 1 0 0 0 0 1 1 1 0 0 1 0 1 1 0 1 0 1 1 1 0 1 0 0 0 0
0 0 0 1 0 1 1 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 0 1 0 0 1 0 1 0
0 1 0 1 0 1 0 0 0 1 1 0 0 0 0 1 1 0 1 1 0 1 0 1 0 0 1 0 0 0
0 0 1 0 0 1 0 0 1 1 0 0 1 1 0 0 1 0 1 1 0 1 0 1 1 0 1 1 0 1
0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 1 1 0 1 0 1 1 0 0 1 0 1
1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1 0 1 0 0 1 1 0 1 0 0 0 0 1
0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 1 1 0 1 1 1 1 0 0 0 1
0 1 0 0 0 0 0 0 1 0 1 0 1 0 1 0 1 0 1 1 1 1 1 1 1 1 0 0 0 1
1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0
1 1 1 1 0 0 0 0 1 0 0 1 0 1 0 0 1 1 1 0 0 1 1 1 1 0 1 1 0 1
0 0 0 0 1 0 0 0 1 1 1 0 0 1 0 0 1 1 1 1 1 1 0 1 0 0 0 1 0 0
1 0 0 1 0 1 0 1 0 1 1 0 0 0 1 1 1 1 0 1 0 1 0 1 0 0 0 0 0 0
0 0 0 1 0 0 0 0 1 0 1 0 1 0 1 0 1 1 0 1 0 1 0 1 0 0 1 1 0 0
0 1 0 0 1 0 0 0 1 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 1 0 1 0
0 0 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 1 0 1 0 0 1 0 1 0 0 1
1 0 0 1 0 0 0 0 0 1 0 0 1 0 1 1 1 1 0 1 0 1 1 0 1 0 1 0 1 1
0 0 0 1 0 0 1 0 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 0
0 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 1
0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 1
1 1 0 1 0 1 0 0 1 1 0 1 0 0 1 1 1 0 0 1 1 1 0 1 1 0 1 0 1 1
0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 1 1 1 1 1 1 1 1 1 0 1
0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 1 1 0 0
0 0 1 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 1 0 1 1 0 1
1 0 0 1 0 0 1 1 1 0 0 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0
0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0
0 0 0 0 1 1 1 0 1 0 1 1 0 1 1 1 0 0 0 1 0 1 0 1 0 0 0 0 0 0
0 0 0 1 0 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 1
1 1 0 0 0 1 0 0 1 0 1 1 0 1 1 1 0 0 0 1 0 1 1 1 1 0 0 1 0 1
0 1 0 1 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 0 1
0 0 0 1 1 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 1 0 1
0 0 1 1 0 0 1 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0
1 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 1 1 1
0 0 1 0 1 1 0 1 0 0 1 0 1 0 1 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0
0 0 1 1 0 1 0 1 1 0 1 0 0 1 1 0 0 1 0 1 0 1 0 0 1 0 0 0 0 1
0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 1 0 1 0 1 0 1 1 0
1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 1 0 0 1 0 1 0 0 0 1 0 0
1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 1 0 0 0
0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 0 1 0 0 0
0 0 0 1 0 0 1 0 1 0 1 1 0 0 1 0 1 0 1 0 0 1 1 0 0 0 0 1 1 0
1 1 0 1 0 1 0 0 1 0 0 1 1 0 1 0 1 1 0 1 1 1 0 0 1 1 0 0 1 1
1 1 0 1 1 0 0 1 1 0 1 0 1 1 1 0 0 0 1 1 0 1 0 0 1 0 0 1 1 1
1 1 1 1 0 0 1 0 0 0 0 0 0 1 1 1 0 1 0 1 0 0 0 0 1 1 1 0 1 1
1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0
0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 1 0 0 1 0
0 0 0 0 0 1 0 1 1 1 1 1 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0
0 0 0 0 1 0 0 1 1 1 1 1 0 0 1 0 1 1 0 0 0 1 0 0 1 0 0 1 1 1
1 1 1 0 0 1 1 0 0 1 1 0 0 1 1 1 0 0 0 1 1 0 1 1 1 0 0 1 0 1
1 1 0 1 1 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 0 1 0 0 0 0 0 0 0 0
1 1 0 1 1 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 0 1 0 0 0 0 0 0 0 0
1 0 0 1 0 0 0 1 1 0 1 0 0 0 1 0 1 0 0 1 0 1 0 1 1 0 1 1 0 1
1 1 0 1 1 0 0 1 0 1 0 0 1 0 0 1 1 0 1 1 0 1 0 0 1 0 0 0 0 1
0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 1
0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 1 1 0
1 0 1 0 1 0 0 0 1 0 0 0 1 0 1 0 1 0 0 0 0 1 0 1 1 0 0 0 0 1
 POST
PART-B (Knowledge/ Attitude/ Practice/ Depression etc……tools score
In case of (Knowledge enter 1=corret 0 =Incorrect response) (Practice enter 1=Yes 0=No) (Attitude enter likert scale value 1,2.3….) or Enter answer according to your tool (Leave extra column blank)
In case of (Knowledge enter 1=corret 0 =Incorrect response) (Practice enter 1=Yes 0=No) (Attitude enter likert scale value 1,2.3….) or Enter answer according to your tool (Leave extra column blank)

Qno.10

Qno.11

Qno.12

Qno.13

Qno.14

Qno.15

Qno.16

Qno.17

Qno.18

Qno.19

Qno.20

Qno.21

Qno.22

Qno.23

Qno.24

Qno.25

Qno.26

Qno.27

Qno.28

Qno.29

Qno.30
Qno.1

Qno.2

Qno.3

Qno.4

Qno.5

Qno.6

Qno.7

Qno.8

Qno.9
1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 1 1 1 0 1 1 0 1 0 0 1 0 1
0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0 1 0 1 0 1 1 1 1 0 0 1 0 1
0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0
1 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 1 0 1 1 1 1 1 1 0 0 1 1 1
0 1 1 0 1 0 0 0 0 1 1 1 0 0 1 0 1 1 0 1 0 1 1 1 0 1 0 0 0 0
0 0 0 1 0 1 1 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 0 1 0 0 1 0 1 0
0 1 0 1 0 1 0 0 0 1 1 0 0 0 0 1 1 0 1 1 0 1 0 1 0 0 1 0 0 0
0 0 1 0 0 1 0 0 1 1 0 0 1 1 0 0 1 0 1 1 0 1 0 1 1 0 1 1 0 1
0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 1 1 0 1 0 1 1 0 0 1 0 1
1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1 0 1 0 0 1 1 0 1 0 0 0 0 1
0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 1 1 0 1 1 1 1 0 0 0 1
0 1 0 0 0 0 0 0 1 0 1 0 1 0 1 0 1 0 1 1 1 1 1 1 1 1 0 0 0 1
1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0
1 1 1 1 0 0 0 0 1 0 0 1 0 1 0 0 1 1 1 0 0 1 1 1 1 0 1 1 0 1
0 0 0 0 1 0 0 0 1 1 1 0 0 1 0 0 1 1 1 1 1 1 0 1 0 0 0 1 0 0
1 0 0 1 0 1 0 1 0 1 1 0 0 0 1 1 1 1 0 1 0 1 0 1 0 0 0 0 0 0
0 0 0 1 0 0 0 0 1 0 1 0 1 0 1 0 1 1 0 1 0 1 0 1 0 0 1 1 0 0
0 1 0 0 1 0 0 0 1 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 1 0 1 0
0 0 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 1 0 1 0 0 1 0 1 0 0 1
1 0 0 1 0 0 0 0 0 1 0 0 1 0 1 1 1 1 0 1 0 1 1 0 1 0 1 0 1 1
0 0 0 1 0 0 1 0 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 0
0 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 1
0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 1
1 1 0 1 0 1 0 0 1 1 0 1 0 0 1 1 1 0 0 1 1 1 0 1 1 0 1 0 1 1
0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 1 1 1 1 1 1 1 1 1 0 1
0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 1 1 0 0
0 0 1 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 1 0 1 1 0 1
1 0 0 1 0 0 1 1 1 0 0 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0
0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0
0 0 0 0 1 1 1 0 1 0 1 1 0 1 1 1 0 0 0 1 0 1 0 1 0 0 0 0 0 0
0 0 0 1 0 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 1
1 1 0 0 0 1 0 0 1 0 1 1 0 1 1 1 0 0 0 1 0 1 1 1 1 0 0 1 0 1
0 1 0 1 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 0 1
0 0 0 1 1 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 1 0 1
0 0 1 1 0 0 1 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0
1 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 1 1 1
0 0 1 0 1 1 0 1 0 0 1 0 1 0 1 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0
0 0 1 1 0 1 0 1 1 0 1 0 0 1 1 0 0 1 0 1 0 1 0 0 1 0 0 0 0 1
0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 1 0 1 0 1 0 1 1 0
1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 1 0 0 1 0 1 0 0 0 1 0 0
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0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 0 1 0 0 0
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