Assessment of the Knowledge, Attitude and practices Regarding Antenatal Care amongst Pregnant Women at subcenter Badakharida with a View to Develop BCC Aids for Health Education

India is accounted for 19% (56,000 in numbers) of all global maternal deaths (RMNCH+A, 2013). Though India has made a significant progress in last several years with the Implementation of the RMNCHA+. It describes that “The medical causes can be direct or indirect. The most common direct medical causes of maternal death as per SRS (2001–03) are haemorrhage, mainly postpartum (37%), sepsis because of infection during pregnancy, labour and postpartum period (11%), unsafe abortions (8%), hypertensive disorders (5%) and obstructed labour (5%). These conditions are largely preventable and once detected, they are treatable (RMNCH+A, 2013).  

As its known fact that pregnancy is the most important event in the women’s life. Every woman wishes to have a safe delivery and healthy baby. The quality of the antenatal care, awareness regarding the ANC care and motivation to receive it timely determines the positive outcome of the pregnancy. The health care provider gives health education motivation to the ANC mothers to receive the ANC care at appropriate time so as to enable them to face the adverse events as early diagnosis during the pregnancy can prevent maternal ill-health, injury, maternal mortality, fetal death, infant mortality and morbidity. Promotion of maternal and child health careis keyProgram of the Government of India and the National Population Policy – 2000.                                                             

The Antenatal care refers to pregnancy related health care provided by a doctor or a health worker in medical facility or at home. Antenatal care should monitor a pregnancy for signs of complication detect and treat pre-existing and concurrent problems of pregnancy. It should also provide advice and counselling or preventive care, diet during pregnancy, delivery care, postnatal care and related issues. 

In all these studies, the study from Aligarh conducted by Kushwah et al observed that there is unsatisfactory utilization of AN Care. They observed that there is high dropout rate after registration for AN care (Kushwaha et al., 2016).

Another study from Punjab which was conducted in Amritsar concluded that lack of awareness as an important barrier for utilization of the AN care service (Sharma et al., 2017). The study conducted by Singh et al. (2018) stated that the traditions and customs influence the ANC registration resulting in poor utilization of the AN care service.

Rational for the Study

The health workers at grassroot level such as Sub Centre are primary source of information, motivation and services for the ANC mothers. They play an important role in managing the early registration, delivery of primary care and identification of the complications of the pregnancy. They provide health education to the ANC mothers, but most of the time due to lack of appropriate BCC aids such as flipchart, leaflet, in local language and according the needs of the ANC makes it difficult.

Hence the study aims to assess the knowledge attitude and practices of the ANC mothers attending the ANC clinic at Bada Kharida Subcetre, in Bhatkhumarda Block, Purushottampur with a view to develop BCC material as per the needs of the ANC mothers in local language with available resources. 

Objectives  

The objectives of the study are to: 

1. To assess the knowledge of mothers regarding antenatal care. 

2. To assess the level of utilization of AN care services amongst the AN Mothers

3. To determine the association between the knowledge on antenatal care and selected demographic variables such as age, education, occupation, socio economic status. 

4. To prepare the need-based BCC material in local language on the basis of the finding of the KAP study.  

Methods and Material

The current study is facility based descriptive and descriptive research design was adopted for this study. It was conducted at Sub-Centre Bada Kharida, of Purushottampur block in Odisha during 1st March 2019 to 31st March 2019.   

Sampling:

With the purposive sampling method 40 AN mother who were registered at the time of the study were included in this study. Informed consent was obtained from all respondents prior to participating in the study. Confidentiality was maintained in data collection and compilation. Data was collected using a predesigned and pretested data collection form.

Tool: A Semi structured Interview Schedule was used to assess knowledge of AN care services delivered by the ANM at the Sub-Centre level. Questionnaire included questions on the AN care services available, Information provided by the ANM, time of registration, danger sign during the pregnancy, nutrition during the pregnancy, immunization, Medication, Importance of TT immunization and IFA consumption. 

Procedure: The study was conducted during 1st March 2019 to 31st March 2019 at atSub-Centre Bada Kharida, of Purushottampur block in Odisha. The line listed AN Mothers were identified and face to face interviews were conducted at the Sub Centre by the investigator to fill up the study questioner after obtaining prior consent of the respondent. 

Data Analysis: The data analysis was carried out with the help of SPSS and Excel. 

Results

Table 1 Demographic distribution of the respondents

The total number of AN mothers surveyed 40 out of which Majority 19(47.5%) were below 20 years of age and 14(35%) were in the age group of 20 to 25 years of age. The average age were 22.48 years. Most of the AN mother belong to Other Backward Class category 17(42.5%) whereas 13(32.5%) were of Schedule cast category.Out of 40 AN mother’s 24 (60%) educated up to secondary level. 10(25%) had primary education. All the AN mother’s were housewife.

Table 2 Distribution of the respondents according to knowledge

Table 2 shows that 23(57.5%) AN mother said that one should register Just after she come to know that she is pregnant, where as 16 (40%) said before the completion of the 12 week of pregnancy one should register at the health facility. 1(2.5%) said that during the pregnancy any time registration could be done. Regarding the number of essential visits AN mother 19(47.5%) Respondent said that AN mother should go for check up every month. 20(50%) mothers said that they should go at least 4 times for check-up.1(2.5) said after registration there no need to go for checkup. When asked about the names of the medicine ANM gives 19(47.5%)Mothers said that ANM gives Iron Folic Acid Tablet or Syrup. 18 (45%) said that ANM gives Calcium Tablets. 2 (5%) said ANM gives some tablet but they don’t know the name, whereas 1(2.5) said that ANM don’t give any tables. While answering the open-ended question about why ANM gives the medication 11 (27.5) mothers said don’t know. Out of rest, most of the mother replied that it is to increase blood,few answered that the medication is for healthy mother and baby. Out of 40 AN mother 14 (35%) said High Fever as a danger sign, 23(57.5%) Swelling on hand and foot, 18(70%) pain in abdomen, 21(52.5%) anaemia, 13(32.2%) Fits, 12 (30%) bleeding as danger sign during the pregnancy. The respondents were asked how they identify the danger sign, most of the respondents just replied that when they feel weak, they feel it as danger sign.

About nutrition most of respondent answered that 33 (82.5%) AN mother should take Normal balanced diet with Vitamins and Proteins, 3 (7.5%) said she should take Less diet available at home and 3 (7.5%) knew that she should take Extra Balanced diet with less salt and sugar 3 (7.5%).  Only 1 (2.5%) did not knew about the diet. 

The figure 1 shows that the level of knowledge regarding the services provided by ANM amongst the AN Mothers. It shows that (95%) respondents knew about the blood test, 92.5 know about TT immunization. And IF and Calcium Tablet. 82.5% knew about Height and Weight Measurement and JSY Khadya Scheme Information, 80% Urine test, 77.5% knew about Maa and Shishu Raksha card, 72.5% knew about referral services. But only 47.5 know about the abdominal checkup service of ANM.

Table 3 the attitude of the respondents was positive and all the participants agreed that pregnancy is serious matter of concern. They agree that it is necessary to visit health facility when pregnant. According to all AN mothers IFA and calcium tablets are necessary for them. They also expressed their agreement for the statement that one should report the complication observed to the ASHA/ANM.

Table 4 present the data regarding the practices of the respondents. It shown that, out of the 40 AN mother interviewed 19 (47.5%) came to know about the pregnancy in the 8th week. Most of the AN mother’s 15(37.5%) did the pregnancy test by using the kit available with ASHA. Out of 40 only 3 (7.5%) AN mother’s went for early registration voluntarily. 7(17.5%) AN mother after the advice of Husband or relative. 2 (5%) registered due to advice of ANM. Out of the 40 respondents 37(92.5%) registered Before completion of 12 weeks of pregnancy. Out of 40 respondent 28(70%) said that they visited the ANC clinic whenever they had health issue. 

The ANM checked vajan and ucchata (Height and Weight) of 38 (95%) abdominal examination14 (35%), blood pressure 32(80%) blood test 36 (90%) and urine test 28 (70%) of respondents. 35(87.5%) said that the ANM explained them the danger sign to be observed during the pregnancy whereas 5 (12.5%) respondents said that they have got information. Out of 40 respondents 39(97.5%) received the TT immunization whereas 1(2.5%) have not received it. The 32 (80.0%) respondents consumed all the IFA tablets given to them and 8 (20.0%) did not consumed the IFA tablets. 29(72.5%) AN mother said that they are taking meal when they feel hungry. When asked about extra meal 23(57.5%) said yes, they are taking extra meal. 

Discussion

The study done by Gupta et al. (2015) in rural area of North India shown that knowledge about ANC services, 86.2% respondents knew about early registration where as in present study 57.5% respondent said AN mother said should register just after she come to know about pregnancy and 40% said that she should register before completion of 16th week of pregnancy. Regarding the knowledge about the medication given by the ANM 47.5% women could tell that she gives Iron and Folic Acid tablet or Syrup, in the study of Gupta et al. (2015) 57.5% women had knowledge about iron folic acid (IFA) tablet supplementation, this study 94.3% and 61.6% had adequate knowledge about the increase in food intake and the importance of TT injection during pregnancy. Whereas in present study the all the respondents were aware of TT Immunization and 82.5% knew that the AN mother should take Normal balanced diet with vitamins ad proteins. 7.5 had misconception that she should take less diet. 7.5 believed that extra balanced diet with less salt and sugar should be taken during pregnancy. Regarding the frequency of diet 35% said as and when a AN mother feelshungry, she should eat, while 62.5% said that three to four time one should take meal daily. Whereas 2.5% said AN mother should eat twice only. 

In present study regarding the ANC visit, 47.5% said every month AN mother should go for checkup, while 50% said that at least 4 times AN mother should go for checkup after registration, which was less in the study conducted by Gupta et al. (2015) which was only 10.9%.

In the present study 92.5% AN mother registered in first trimester and 7.5 registered in second trimester. Compared to other studies conducted by Gupta et al. (2015) 89.6% of the mothers had registered for ANC, out of whom 64.5% registered in second trimester and 9.9% in 1st trimester. In the study of Bhimani et al. (2016) 24.38% AN registered in first trimester and 54.25%. Registered their pregnancy during 2nd trimester where as in the study of Kushwaha et al. (2016) 62% AN mother was registered during first trimester of pregnancy. The study of Sharma et al. (2017) shown that 64.4% of women had their first antenatal visit in 2nd trimester. In study of Mumbare and Rege (2011) 63.81% pregnant women were registered in the first trimester.

In present study the 70% (28) AN mother visited for AN check-up when they had health issue whereas in Surendranagar study showed that 59.18% (216) women had availed three or more than three antenatal visits and 27.94% (102) had availed less than three antenatal visits (Rahman and Medhi, 2017). In present study the 97.5%(39) AN mother received the TT immunization, only 2.5%(1) was left out comparatively in the study of Bhimani et al. (2016) 81.92% (299)  received both the doses of TT Immunization. In the study conducted by Kushwaha et al. (2016) 85.5% women received required doses of tetanus toxoid (TT) vaccine. The other study of Sharma et al. (2017) 65.6% respondent received TT immunization fully. The study at Jorhat conducted by Rahman and Medhi (2017) shown that only 25.8% had complete TT immunization whereas 74.2% received one dose only. 

The Consumption of IFA tables were 80% in present study, compared to other studies like in Surendranagar study it was 47% Consumed complete course of iron and folic acid tablets. Most of 95.5% women received IFA. While the study of Sharma et al. (2017) in urban slum of Amritsar city, 64.4% of women had their first antenatal visit in 2nd trimester.  In the study of Sharma et al. (2017), it was seen that 57.1% of women consumed IFA tablets during pregnancy. The Mumbare and Rege (2011) study shown that consumption of IFA was 68.57%. 

In other studies, the comparative data was not observed on knowledge about the importance of IFA, In the present study while answering open ended question 27.5 mothers were not knowing the reasons to take IFA.  Out of rest most of the mother replied that it is to increase blood i.g. anaemia. Few answered that the medication is for healthy mother and baby. The level of knowledge about the danger sign to be observed was, 35% said High Fever as a danger sign, 57.5% Swelling on hand and foot, 70% pain in abdomen, 52.5% anaemia, 32.2% Fits, 12 30% bleeding as danger sign during the pregnancy. The respondents were asked how they identify the danger sign, most of the respondents just replied that when they feel weak, they feel it as danger sign. The analysis shown that the level of knowledge regarding the services provided by ANM amongst the AN Mothers shows that 95% respondents know about the blood test, 92.5 know about TT immunization. And IF and Calcium Tablet. 82.5% know about Height and Weight Measurement and JSY Khadya Scheme Information, 80% Urine test, 77.5% know about Maa and Shishu Raksha card, 72.5% know about referral services. But only 47.5 know about the abdominal checkup service of ANM.

In this study it is revealed that all the AN mother has registered either in first of second trimester. Out of which only 7.5 % AN mother registered voluntarily, whereas most of the mothers did it on the advice of the ASHA and Anganwadi Workers. This may be because of the incentive scheme under JSY, NRHM in which ASHA and AWW are paid for early registration Rs. 150/- for registration, Rs. 50/- for each follow up visit of ANC, Rs. 300/- for institutional delivery and Rs. 250/- Homebased new born care. (Operational Guidelines for implementation of JSY).

The knowledgelevel of the AN mother about the AN care services is increased as they are attending the AN clinic due to the efforts of the ASHA and AWW. But when they were asked why all these investigation like height weight measurement, Blood Testing, TT immunization is carried out the responses were don’t know. It also shown that though they have knowledge about the nutrition many of them are not taking extra meal.

Conclusion

The study concluded that 

1. The voluntary registration practices are very less. 

2. The Monetary assistance scheme for AN mother, ASHA and AWW has boosted the early registration and utilization of Antenatal care services. But there is need to increase voluntary registration of the AN mother as the behavioural change occurred out of concern and knowledge regarding the importance of the care for safe and positive delivery outcome. 

3. There is need to increase knowledge regarding the importance of the AN services is amongst the AN mother and women in reproductive age group.

4. Though the ANM was explaining the AN mothers about the danger signs but the retention of the information is observed less. 

This shows that there is need of appropriate BCC aids such as Flip charts to be used in the ANC clinic for counselling of the mothers. It should be in local language and easy to understand. The flip chart should have content explaining the importance of the AN care service. The Study was approved by Ethical Committee of National Institute of Public Health Training & Research, Mumbai (Formerly Known as Family Welfare Training & Research Centre, Mumbai)

References 

Bhimani, N.R., Vachhani, P.V., & Kartha, G.P. (2016). Utilization pattern of antenatal health care services among married women of reproductive age group in the rural area of Surendranagar district, Gujarat, India: a community based cross-sectional study. International Journal of Research in Medical Science, 4, 252-61.

Gupta, R.K., Shora, T.N., Verma, A.K., & Jain, R. (2015). Knowledge regarding antenatal care services, its utilization, and delivery practices in mothers (aged 15-49 years) in a rural area of North India. Tropical Journal of Medical Research, 18, 89-94.

Kushwaha, P., Mehnaz, S., Ansari, M.A., & Khalil, S. (2016). Utilization of antenatal care services in peri urban area of Aligarh. International Journal of Medical Science and  Public Health, 5, 2004-2008.

Mumbare, S.S., & Rege, R. (2011). Ante natal care services utilization, delivery practices and factors affecting them in tribal area of North Maharashtra. Indian Jornal of  Community Medicine, 36, 287-290. 

Rahman, S.J., & Medhi, A.H. (2017). Utilization of antenatal services in urban slums of Jorhat municipality, Assam, India and the socio – demographic factors affecting it. International Jounral of  Community Medicine and Public Health, 4, 129-33.

RMNCH+A (2013). A Strategic Approach to Reproductive, Maternal, Newborn, Child and Adolescent Health in India. Ministry of Health & Family Welfare Government of India.

Sharma, N., Kumar, H.V.K., & Devgan, S. (2017). A study on utilization of antenatal care services in urban slums of Amritsar city, Punjab, India. International Jounral of  Community Medicine and Public Health, 4, 698-703.

Singh, P., Gupta, R.K., Kumari, R., Langer, B., Gupta, C., & Gupta, R. (2018). Antenatal care utilization in  recently delivered rural females: A hospital-based crosssectional study. nternational Jounral of  Community Medicine and Public Health, 7.

Conflict of interest: None
Role of funding source: None