CHAPTER-I
INTRODUCTION
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CHAPTER - I
“Nursing is a practice discipline with
our own theories and research base that
we both generate, use and disseminate
to others.” -Antonia Villarreal
BACKGROUND OF THE STUDY
World Health Organization (WHO) — “WHO recommendations on antenatal
care for a positive pregnancy experience A healthy diet contains adequate
energy, protein, vitamins and minerals, obtained through the consumption of a
variety of foods, including green and orange vegetables, meat, fish, beans, nuts,
whole grains and fruit.” This is part of WHO guidance on antenatal care,
emphasizing that diet in pregnancy needs to be rich, varied and sufficient to
meet maternal and fetal needs.
Nutritional health education to antenatal mother was found to be effective in
reducing the risk of preterm birth and low birth weight, improving head
circumference at birth, and in improving birth weight among infants born to
undernourished women. Balanced energy/ protein supplementation reduces
the risk of still birth and small-for-gestational age, and improve birth rate.
Maintaining a healthy balanced diet is important for maintaining optimal health
throughout life. For women of child bearing age, good nutrition is important for
preparing the body for the demands for pregnancy. During pregnancy, women's
macronutrient (energy) and micronutrients (e.g. vitamins, minerals)
requirement increase, and it is even more important that she consume food
which will give her both the energy and the specific micronutrients which are
essential for maintaining her and her growing baby's health.
United Nations Children’s Fund (UNICEF) — “Program Guidance on Maternal
Nutrition the guidance … aims to support … the designing, implementing and
monitoring of evidence-based programs to improve the nutrition of women
across the life course.” While this statement is broader (covering maternal
nutrition pre-, during and post-pregnancy), it sets the context for antenatal diet:
it emphasizes that ensuring good nutrition in pregnancy is not just about single
nutrients but about a well-planned diet program within health systems.
The United State Department of agriculture (USDA) recommendation that
pregnant women choose food from what they considered to be the five essential
food groups. These five food groups are: vegetables, fruits, dairy, grains, protein.
The USDA has my plate plan for moms that allows mother to calculate how much
of each food group a mother should eat to get the recommendation levels of
vitamins and minerals. During second trimester, it's especially important to eat
foods that are rich in calcium, magnesium and vitamin D these nutrients will help
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baby grow strong bones and teeth.
“Nutrition in pregnancy: basic principles and recommendations” Healthy diet in
pregnancy should guarantee proper fetal growth and development, maintain
(and promote) maternal health and enable lactation. Nutritional counseling and
interventions need to be an integral part of antenatal care and continue during
pregnancy in order to reduce the risk of maternal, fetal and neonatal
complications, as well as the short- and long-term adverse outcomes.
“Prenatal Nutrition; Nutrient Recommendations Before, During & After
Pregnancy” Nutrition before and during pregnancy has a profound effect on the
development of infants. This is a rather critical time for healthy fetal
development as infants rely heavily on maternal stores and nutrient for optimal
growth and health outcome later in life. It is very important that expecting
mothers should change their personal habits like smoking, alcohol, caffeine,
using certain medications and street drugs as soon as they know they are
pregnant or even when they are planning to conceive.
“Maternal nutrition before and during pregnancy” In humans, the link between
the maternal diet and the outcome of pregnancy is best illustrated by the classic
study of wartime famine in Holland. Two micronutrients (iron and folate) have
effects on pregnancy outcome that have been shown with some consistency in
pregnant women.
“Nutrition during Pregnancy and Birth Outcomes” Pregnant women are
recommended to take daily multiple micronutrient supplements. Pre-
conception nutritional status of women has important implications for nutrient
requirements during pregnancy and optimal pregnancy outcomes, independent
of weight gained during pregnancy.
“A Review of the Impact of Dietary Intakes in Human Pregnancy on Infant
Birthweight” Studies assessing maternal dietary intakes and the relationship
with birthweight are inconsistent, thus attempting to draw inferences on the
role of maternal nutrition in determining the fetal growth trajectory is difficult.
KEY DIETARY RECOMMENDATIONS :-
Balanced intake: Consume a varied diet that includes whole grains, lean
proteins, healthy fats, and a wide variety of fruits and vegetables.
Increased nutrients: During pregnancy, protein needs increase, and it's crucial
to consume adequate iron, folic acid, calcium, and iodine.
Prenatal supplements: Take prenatal supplements, such as folic acid and iron,
as advised by a health professional to ensure adequate nutrient intake.
Hydration: Drink plenty of fluids, especially water, to stay hydrated and support
the body's increased needs during pregnancy.
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Adequate calories: Aim for approximately 300 extra calories per day, from
nutrient-rich sources, to support both the mother and developing baby.
FOODS TO INCLUDE :-
Vegetables: Green and orange vegetables like spinach, carrots, sweet potatoes,
and tomatoes are excellent sources of vitamins and minerals.
Proteins: Choose lean meats, poultry, fish (low-mercury options), beans, and
nuts to meet increased protein requirements.
Whole grains: Opt for whole grains to get enough fiber, which aids digestion.
Fruits: A wide variety of fruits provide essential vitamins and nutrients.
Dairy: Include pasteurized dairy products to get necessary calcium and other
nutrients.
FOODS TO LIMIT OR AVOID :-
High-mercury fish: Limit or avoid fish known to be high in mercury, as it can be
harmful to fetal development.
Processed foods: Minimize processed foods, which are often high in unhealthy
fats, added sugars, and sodium.
Excess caffeine: Limit caffeine consumption.
Alcohol: Avoid all forms of alcohol.
Unpasteurized products: Avoid unpasteurized milk and cheeses to prevent
foodborne illness.
FOOD SAFETY :-
Thorough cooking: Ensure all meats, poultry, and eggs are cooked thoroughly
until they are steaming hot all the way through.
Proper storage: Store raw and ready-to-eat foods separately to prevent cross-
contamination.
Check dates: Make sure to check "use-by" dates and avoid food past its expiry.
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NEEDS OF THE STUDY :-
To assess the knowledge of antenatal mother regarding antenatal diet during
pregnancy.
Maintaining a healthy diet before and during pregnancy helps to protect both the
pregnant and her developing baby from immediate and long-term health risk. Nutrition
education and counseling is a widely used strategy to improve the nutritional status of
women during pregnancy.
The strategy focuses primarily on:
1. Promoting a healthy diet by increasing the diversity and amount of
food consume
2. Promoting adequate weight gain through sufficient and balanced
protein and energy intake.
3. Promoting consistence and continued use of micronutrient
supplements, food supplements or fortified foods.
4. Available evidence suggests that nutrition education and counselling
may support optimal gestational weight gain (i.e. neither insufficient
nor excessive), reduce the risk of anemia in the late pregnancy,
increase birth weight, lower the risk of preterm delivery. Counselling
may be more effective in undernourished population when women are
also provided with nutrition support such as food or micronutrient
supplements.
American dietetic Association (ADA) recommended the following
components of a healthy life style at antenatal period appropriate
weight gain, eating of variety of food according to pyramid of food
guide and timely supplementation of vitamin and mineral fluid intake
is an important role of healthy nutrition at antenatal period.
5. Barker’s hypothesis- influences of birth weight health in later life
states that condition during pregnancy will have long term effects on
adult health. Associated risk of life long disease includes cardio-
vascular disease, type2 diabetes, obesity and hypertension. Babies
born lighter in weight appear to have an increased weight of mortality
then babies born at a heavier weight. This doesn't mean that heavy
babies are less of concern. Death rate would rise as birth weight
increases beyond normal birth weight range. Therefore, it is important
to maintain in healthy gestational weight gain throughout pregnancy
for achieving the optimal infant birth weight.
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PROBLEM STATEMENT :-
A descriptive study to assess the existing knowledge regarding antenatal diet
among antenatal mother In selected village of Community Health Center
Dharshiwa Raipur C.G.
OBJECTIVE :-
1. To count the existing knowledge regarding balanced diet among the
antenatal mother during. the antenatal period.
2. To find out the association between knowledge regarding of balanced diet
among antenatal mother during the antenatal diet with selected socio
demographic variables.
3. To develop a pamphlet and create awareness regarding antenatal diet
among antenatal mother residing in village Baroda, Raipur district.
4. To assess the level of knowledge of antenatal mother regarding components
of an antenatal diet.
5. To identify the sources of information regarding antenatal nutrition among
antenatal mothers.
ASSUMPTION :–
1. Antenatal mother may have varying of knowledge regarding antenatal diet.
2. knowledge about an adequate antenatal diet influences maternal and fetal
health outcomes.
3. Demographic factors such as education and socioeconomic status may
influence the knowledge of antenatal diet.
4. Structured questionnaires can effectively measure the level of knowledge
among antenatal mother.
HYPOTHESIS :–
A descriptive study, it usually focuses on assessing or describing the current state of
knowledge rather than testing a relationship between variables. In descriptive studies,
hypotheses are often non-directional. However, if you want a hypothesis, it can be
stated as:
o Hypothesis (H1): - “Antenatal mothers in the selected village of Baroda,
Raipur, Chhattisgarh have inadequate knowledge regarding antenatal diet.”
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o Null Hypothesis (H0): - “There is no significant inadequacy in the knowledge
of antenatal mothers regarding antenatal diet in the selected village of
Baroda, Raipur, Chhattisgarh.”
OPERATIONAL DEFINITION :-
1. Antenatal Mothers: - Pregnant women residing in the selected village of
Baroda, Raipur, Chhattisgarh, who are in any trimester of pregnancy and
willing to participate in the study.
2. Knowledge Regarding Antenatal Diet: - The awareness and understanding of
pregnant women about the types of food, nutrients, frequency of meals, and
dietary practices necessary for maternal and fetal health during pregnancy.
Knowledge will be measured using a structured questionnaire with multiple-
choice or close-ended questions.
3. Selected Village: - The specific village chosen in Baroda, Raipur,
Chhattisgarh, for data collection where the study population resides.
a. Adequate Knowledge: - If the respondent scores ≥75% on the
knowledge questionnaire.
b. Inadequate Knowledge: - If the respondent scores <75% on the
knowledge questionnaire.
DELIMITATION :–
1. The study is limited to antenatal mothers residing in a Community Health
Center Dharshiwa Raipur, Chhattisgarh.
2. The study includes only antenatal mother who are available and willing to
participate during the period of data collection.
3. The study is limited to assessing knowledge regarding antenatal diet and does
not include practices or attitudes.
4. The study is restricted to data collected through a structured knowledge
questionnaire developed by the researcher.
5. The study findings are delimited to sample size and setting and therefore may
not be generalized to all antenatal mother in other areas.
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PROJECTED OUTCOMES :-
The study is expected to reveal the existing level of knowledge of antenatal mothers
regarding the importance, components, and benefits of a balanced antenatal diet.
Assess - descriptive research study designed to assess the existing knowledge regarding
antenatal diet among antenatal mothers in a selected village of Baroda, Raipur,
Chhattisgarh the study aims to evaluate how well antenatal mothers understand the
importance, components, and benefits of a balanced diet during pregnancy and to
identify the factors influencing their knowledge levels.
This assessment is significant because adequate maternal nutrition plays a crucial role
in ensuring healthy pregnancy outcomes and fetal development. By identifying existing
gaps in knowledge, the study provides valuable insights that can guide health
professionals, particularly nurses and community health workers, in planning effective
health education and nutrition programs for antenatal mothers.
Knowledge -The present study focuses on assessing the knowledge of antenatal
mothers regarding antenatal diet, which is a crucial aspect of maternal and fetal health.
Knowledge in this context refers to the understanding and awareness of pregnant
women about:
1. The importance of a balanced diet during pregnancy.
2. The nutritional components required during pregnancy, including
carbohydrates, proteins, fats, vitamins, minerals, and fluids.
3. The benefits of proper nutrition for maternal well-being and fetal
development.
4. Dietary practices to prevent complications, such as anemia, gestational
diabetes, low birth weight, and preterm delivery.
5. Sources of information and guidance related to antenatal nutrition, such as
family, healthcare providers, media, or community programs.
Antenatal diet -In a research study, the antenatal diet can be studied in several ways:
1. Knowledge Assessment: Evaluating pregnant women’s awareness about the
components and importance of a balanced diet.
2. Dietary Practices: Studying actual food intake patterns and adherence to
dietary recommendations.
3. Impact Studies: Assessing how antenatal nutrition affects maternal outcomes
(e.g., anemia, gestational weight gain) and neonatal outcomes (e.g., birth
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weight, gestational age).
4. Intervention Studies: Implementing nutrition counseling or supplementation
and measuring improvements in knowledge, practices, and health outcomes.
Antenatal mother - In this research study, the term “antenatal mother” refers to a
pregnant woman who is receiving or eligible to receive antenatal care during any
trimester of her pregnancy. Antenatal care involves regular health check-ups,
monitoring of maternal and fetal well-being, and receiving guidance on nutrition,
exercise, and preventive measures to ensure a healthy pregnancy and delivery.
CONCEPTUAL FRAMEWORK
INTRODUCTION: -
It presents logically constructed concepts to provide general explanations of the
relationship among the concepts of the research study, without using a single
existing theory.
Concept is a word picture or mental idea of a phenomenon or is an image or
symbolic representation of an abstract idea.
Conceptual framework represents the researcher's synthesis of literature on
how to explain a phenomenon it maps out the actions required in the course of
the study "A descriptive study to assess the knowledge regarding antenatal diet
among antenatal mother.
DEFINITION: -
‘According to polit and back’
Polit & Beck define a conceptual framework (or conceptual model) as
“interrelated concepts or abstractions assembled together in a rational scheme
by virtue of their relevance to a common theme.”
In simpler terms, it is a structure of key concepts relevant to your study and how
they link to each other around the phenomenon you are investigating (in your
case: knowledge of antenatal diet).Thus, in your study the conceptual
framework would illustrate how factors (e.g., education, socioeconomic status,
parity) relate to antenatal mothers’ knowledge of diet, and perhaps how that
knowledge influences outcomes (or at least knowledge gaps).
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According to B T Basavanthappa
B.T. Basavanthappa discusses frameworks in the context of nursing research
saying that a theoretical framework presents the reasoning on which the study
is based, clarifies the concepts, states the assumptions and specifies
relationships among concepts.
Although his focus is “theoretical framework,” this definition can be adapted
for a conceptual framework in your descriptive research: you define key
concepts (knowledge, antenatal diet, demographic factors), their assumed
relationships, and clearly state assumptions underlying your investigation.
The conceptual framework chosen for this study is based on Health Belief Model.
It is one of the most widely used models to explain why people do or do not take
preventive health action. The model was first developed in 1950 by Godfrey
Hoch Baum, Irwin Rosenstock and Stephen Kegels and was later modified to
include the influence of health motivation.
The model comprised of three primary components, including
1. Individual perception
2. Modifying factors
3. Factors affecting the likelihood of initiating or engaging in action.
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CONCEPTUAL FRAMEWORK
Maintenance of maternal
and fetal health
Antenatal mother
judgements capability
to perform particular
health behaviour
Antenatal mothers
positive & Negative Plan and
feelings regarding develop self-
antenatal care & diet
instructional
module
inadequate knowledge
and attitude regarding Acceptance of self-
antenatal care & diet instructional module
on antenatal care
on antenatal mother.
Conduction of test
Family, peers, norms,
support system
Lack of interest family
And peer member
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SUMMARY
This chapters deals with the Needs of study, Problem statement, Assumption,
Hypothesis, Operational definition, Delimitation, Projected Outcome,
Conceptual Framework.
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