RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.Name of the candidate and address

GARIMA MAZUMDARM.Sc NURSING 1 YEARDr. SYAMALA REDDY COLLEGE OF NURSING#111/1 SGR MAIN ROAD,MUNNEKOLALA,MARTHAHALLI,BANGALORE-560037.

2.Name of the InstitutionDr. Syamala Reddy college of Nursing

3.Course of study and subjectM.Sc nursing I year.

Obstetrical & Gynecological Nursing

4. Date of admission to course June 2010

5. Title of the studyA study on effectiveness of planned teaching programme on prevention of Neural tube defect in periconceptional period among female student at selected college in Bangalore.

BRIEF RESUME OF THE INTENDED WORKS

1

“God could not be every where and there fore he made mother”

(Jewish proverb)

6.0. INTRODUCTION

Mother is one who nurtures us in her womb 9 months and bring us to enjoy the

supreme blessing on earth, that is life. A women, pregnancy and motherhood are

developmental milestones that are highly emphasized by our culture. Motherhood

traditionally has been considered almost a sacred state and the only way for women to

fulfill herself. 1

Birth defects are also called "congenital anomalies” or "congenital

abnormalities." The word "congenital" means "present at birth." The words "anomalies"

and "abnormalities" mean that there is a problem present in a baby. 2

World health statistics 2008; about 260,000 national deaths world wide cased by

congenital anomalies. This figure reported about 71 percentage of the neonatal death. 3

Neural tube defects (NTDs) are among the most common birth defects that cause

infant mortality (death) and serious disability. 3

Periconceptional period is the period from first three months before conception

and after three month of conception. Adequate folate intake during the Periconceptional

period, the time just before and just after a women become pregnant, helps to protect

against a number of congenital malformation mainly NTDs. 5

2

The United States public health Service recommended that all women who can

become pregnant consume 400 microgram of folic acid daily for the prevention NTDs

(Centers for Disease Control 2009). Research shows that up to 70 percentage of all cases

of NTD can be prevented by that the Periconceptional maternal consumption of folic

acid. 4

Neural Tube Defects (NTDs) are the second most prevalent group of congenital

anomalies in the world, second only to cardiac malformations and are associated with

substantial morbidity and mortality. NTDs are congenital malformations occurring during

early intrauterine life around 3-4 weeks of gestation by failure of closure of the neural

tube which eventually forms the central nervous system. 4

Annually worldwide an estimated 300,000 or more babies are born with spinal

bifida and anencephaly. In the United States reported birth prevalence rates vary from 4

to 10 per 10,000 live births. Some studies in countries such Ireland, United Kingdom,

China, Hungary, Mexico and India (3.9 to 9 per1000) has reported higher rates. 5

A wide range of frequency has been quoted from different parts of India & it

was 3.9/1000 in Lucknow, 7/1000 in last Delhi and 11.4/1000 birth in

Davangere(Karnataka). 6

There are many factors that cause Neural Tube Defects in newborns. The cause

of NTDs is not known. Scientists believe that there are genetic factors, environmental

factors, and nutritional components. However, according to the March of Dimes, the

parents of about 95% of babies born with NTDs do not have a family history of these

disorders. 3

3

Primary NTDs have multifactorial inheritance maternal risk factors include

alcohol, radiation exposure, insulin dependent diabetes mellitus (IDDM), Valproate and

carbamazepene, zinc, vitamin B, vitaminB12, vitamin C and folate deficiency.

Chromosomal abnormality including Trisomy 13 and 15 has been reported. 7

Maternal malnutrition is an important risk factor for development of Neural tube

defect. lack of Periconceptional folic acid supplementation, folate poor diet , related lack

of education in nutrition , poverty , poor eating habits , prolonged cooking of vegetables

and cultural factors (food-fads) etc. are the important risk factors. 8

Foods that are high in folic acid include kiwi fruits and papaya, vegetables such as

brocolli, brussell sprouts, spinach, cabbage, asparagus and cooked kidney. Be careful not

to overcook your vegetables as this may destroy the folic acid. Other good sources of

folic acid include baked beans, lettuce. Oranges, egg yolks, milk and peas.8

Indian Academy of pediatric (IAP) recommended that all women capable of

becoming pregnant consume 400 microgram of folic acid daily prevent NTDs .Studies

prove that periconceptional folic acid supplementation can prevent 60% or more such as

Spina bifida and anencephaly . 9

The studies reported that women periconceptional consuming vitamin supplement

pills containing folic acid an urgently needed to prevent birth defect, compliment to the

folic acid fortification of cereal grains and other studies suggest that substantial

educational campaign could, over a few years period double the number of women

4

consuming folic acid supplement pills and make substantial contribution towards

preventing Spina bifida and Anencephaly. 10

The studies report have been increases in folic acid awareness and knowledge,

since most women of child bearing age still don’t consume the recommended amount of

folic acid daily for prevention of NTDs . Awareness of folic acid among women 18-25

years of age has increase from 52 percentage in 1995 to about 84 percentage in 2005 and

knowledge of folic acid has increased from 4 percentage to 19 percentage in the same

time.10

The Centers for Disease Control and prevention (CDC) estimate that 50

percentage to 70 percentage of all NTDs can be prevented with the maternal

periconceptional consumption of the Vitamin B, folic acid (CDC2001). The Institutes

Medicine CDC recommended the maternal consumption of 400 micrograms of synthetic

folic acid daily 1 month before conception and during the first few months of pregnancy.

Because half of the all pregnancy in the United States are unplanned (Finces and

Henshow 2006) and because NTDs occur often before a women knows she is pregnant.

CDC recommends that all women who can become pregnant consume the recommended

amount of folic acid daily, regardless of their pregnancy intervention. 11

6.1. NEED FOR THE STUDY

5

“A JOURNEY OF A THOUSAND MILES MUST BEGIN WITH A SINGLE STEP”

Joney walker

Congenital malformations have been known and recognized for countries. It is an

estimating problem for research because of the high frequency of their occurrence and the

devastating effect they may have on the individual and his/her family. Central nervous

system anomalies are such anomalies which account for the higher mortality among the

newborn.11

There have been large variations in the incidence of central nervous system

defects in different parts of the World and at different periods. Neural tube defects are

malformations of the developing brain and spinal cord occurring during the third to

fourth week of gestation. 16

Neural tube defects top the list of birth defects in India contributing to both

morbidity and Mortality.12

World health organization (WHO) / United Nations Administrative Committee on

Nutrition stated that Iron and Folic acid deficiency affects more than 3.5 billion people in

developing world. In developed countries the prevalence are about 18 percentage in

pregnant women and 12 percentage in non pregnant women. 19

World literature review on NTD in European countries revealed highest incidence

from Ireland and Wales (6.38-10.92/1000 births). Other parts of the World high

prevalence of NTDs are Northern India and Northern China. 13

6

The incidence of NTDs in Sikhs living in British Columbia, Canada, was reported

to be 2.86/1000 while the overall rate was 1.86/1000 in that area. Michel, et al quoted a

higher incidence of NTDs in Indians living in the North Thames (West) region of UK.21

Neural tube defects occur in about 1 in every 1,000 to 2,000 live births in the

United States, or in about 1,500 to 2,000 babies each year. The vast majority (about 95

percent) of NTDs occur in families with no history of this disorder. 14

The studies reported that a NTDs incidence in India varies from 0.5 to 11/1000

births while the incidence in the USA and Europe is reported below 1/1000, with

progressive decline with periconceptional folate fortification, barring few countries like

Ireland. The incidence tends to vary within various states of India and is reported also

higher in Indians living abroad. The northern states have been consistently reporting a

higher incidence compared to the southern states except for Davangere, (Karnataka). 15

Prevalence of NTDs in the United States has been estimated at 7 per 10,000

Pregnancies (Spina bifida Association America). Approximately 3,000 pregnancies are

affected by NTDs in the United States each year and every women who can become

pregnant is at risk for an NTD affected pregnancy. Epidemiologist reveal the prevalence

data in US are 1 in 1000 births in the US ( not including occulta defects) Anencephaly 3

to 7 in 10,000; Eacencephaly 1.4 in 10,000 ; Spina bifida 5.5 In 10,000; Meningocele 2

to 4 10,000. 16

Prevalence of NTD from different parts of India was reported to vary from 3.9 to

11/1000 births and more so in the northern states (Punjab, Haryana, Delhi, Rajasthan,

7

U.P, Bihar) (3.9-9.0 per /1000 births) compared to eastern, western (5.0/1000 and

southern part (<5.0/1000) of India. (2009). 21

The prevalence of NTDs among consanguineous and non –consanguineous

marriage was 6.3-20.6/1000 and 5.9-8.4/1000 couple respectively. 17

The Centers for Disease Control and Prevention estimates that the birth rates in

2005 for 2 of the most common neural tube defects, Spina bifida and anencephaly, were

17.96 and 11.11 per 100 000 live births, respectively . 18

Reproductive and Child health (RCH) programme stressed importance of folic

acid in periconceptional period for the prevention of Neural tube defect. Dose for the

primary prevention is 0.4 mcg of folic acid per day. 19

Folic acid also known as folate is a B vitamin (B9) found in leafy vegetables like

spinach, kale, orange juice and whole grains. Taking 400 micrograms (0.4milligrams)

daily before or during pregnancy reduces the risk of your baby being born with neural

tube defect (a birth defect which involves the incomplete development of the brain and

spinal cord) by 70%. Most birth defects (the most common being Spina bifida) occurs

during the first 28 days of pregnancy- usually before a woman even knows she is

pregnant. This is why it is so important that any woman of child bearing age or who is

planning to get pregnant should get enough folic acid as more than 50% of pregnancies

are not planned. 20

The studies report that very elevated prevalence of neural tube defects (8.2 per

1,000 live births) in the Ballrampur District, Uttar Pradesh, India. Out of ten cases

8

reported, six were Spina bifida. They also stress the lack of planning for NTD prevention

by periconceptional folate supplementation in India and urge India’s Ministry of Health

to develop a comprehensive strategy to reduce the instances of NTD without delay. 33

An updated guideline from the American College of Obstetrics and Gynecology

recommended periconceptual folic acid supplementation (0.4 mg) in a multivitamin for

most women capable of pregnancy. For a woman planning to become pregnant and

without a history of neural tube defects, the American Academy of Family Physicians

(AAFP) strongly recommends prescribing folic acid supplementation of 0.4 to 0.8 mg/d.

The AAFP also recommends prescribing 0.4 mg of folate supplementation to a woman of

childbearing age if she is not planning a pregnancy. The American College of Obstetrics

and Gynecology, AAFP, and most other organizations recommend 4 mg/d for women

with a history of neural tube defects. 21

The study result that nonpregnant female participants from age 15 to 49 years,

indicate that 8 percentage of women consumed 400 μg/d or more of folic acid from

fortified foods, and 26 percentage of women took 400 μg/d or more of folic acid through

supplements within the previous month. Therefore, 34.3 percentage of women of

reproductive age consumed 400 μg/d or more through a combination of fortified foods

and supplements. 25

The study reported that the success of a 45 minute presentation among female

college student about Periconceptional nutrition and prevention NTD to increasing

knowledge about folic acid and NTD, raising scores on pretest to posttest from 48

percentage correct to 86 percentage correct .One month following the intervention, 9

follow-up posttest score were still higher than the pretest. Education to female student on

prevention of neural tube defect in Periconceptional period will help them to better

understanding of these problems. 22

From above fact the investigator understood that the inadequate intake of folic

acid ,Vitamin B , B12 , Zinc and Calcium etc in periconceptional period lead to neural

tube defects. There fore researcher has chosen this topic to assess the knowledge of the

female student regarding the prevention of Neural tube defect in periconceptional period

to promote awareness among the female student by providing planned teaching

programme.

6.2. REVIEW OF LITERATURE:

Review of literature involve “the selection of available documents on the topic ,

which contain information , ideas and data and evidence written from a particular stand

point to fulfill certain aims or express certain views o the nature of the topic and how is

to be investigated and the effective evaluation on these documents in relation to the

research being proposed”.

The literature review was based on extensive survey of publisher and

unpublished research studies, journal articles and non-research literature related to the

present study.

The review of literature is presented in the following order:

10

1 Studies related to Meaning of neural tube defect.

2 Studies related to types of neural tube defect.

3 Studies related to Incidence and prevalence of neural tube defect.

4 Studies related to etiology of neural tube defect

5 Studies related to prevention of neural tube defect in periconceptional period.

6 Studies related to the awareness among female college student regarding prevention

of neural tube defect in periconceptional period.

1. Studies related to meaning of neural tube defect:

NTDs are serious birth defects of the brain and spine. There are two common

forms of NTDs, anencephaly and spinal bifida, which account for 90 percentage of all

cases (Centers for Disease Control 2000), NTDs occur very early in pregnancy, between

18 and 28 days post ovulation, often before a women knows that she is pregnant. 24

The defect occurs when the Neural tube, which later becomes the brain and

spine, does not form or close completely. Anencephaly the condition that results when

the upper end of the Neural tube does not close completely and the brain and the skull are

missing or under developed is a fatal birth defect. (Seilet 2006) .The Spina bifida

Association of America estimates that there are 70,000 people currently living with Spina

bifida is the United State .24

2. Studies related to types of neural tube defect

11

There are two types of NTDs. The most common are called open type NTDs,

Open NTDs are occur when the brain and / or Spinal cord are exposed at birth through a

defect in the skull or vertebrae (back bone). E.g. of the open NTDs are Spina bifida

(myelomeningocele), Anencephaly and Enencephalocele. 25

Rare type of NTDs is called closed NTDs. Closed NTDs occur when the Spinal

bifida is covered by skin. Common examples of closed NTDs are Lipomyelo-

meningocele and lipomeningocele. Spina bifida occulta (SBO) in potentially another

from of a NTDs in which there is a typically benign (non symptom causing) bony change

in one or more Vertebrae, but not involving the nervous within the Spinal column. About

80% of those affected will have normal intelligence, according to the Spina Bifida

Association, but some will have learning disabilities. 25

3. Studies related to incidence and prevalence of Neural tube defect

In US and World Wide an incidence of 0.9 –0.6 per 1000 live birth is reported.

Kulkarni reported in a prospective births from November1985-1987 at three hospital

from Davngere, Karnataka), a total of 40 babies born with NTDs. the study classified the

defect with respect to the religion, where thirty three of the babies were born to the group

of 2684 Hindu mothers and seven to the 815 Muslim mother (incidence 11.5 /1000

births) with respect to the social class, the study was found to be significant and Seasonal

variations were found. 26

12

A study reported that the risk after having one male affected was 0.058 and after

having one female affected, it was 0.051. He also reported that after and affected sibs, the

risk for a third two affected female to 0.16 for female birth after two affected male. The

frequency of neural tube malformations among all births , live or still births ,was found to

be higher among female than the male. 27

A study reported that the highest frequency of NTD was observed in North India,

in Amritsar, Chandigarh, Delhi, Japer, Udaipur and Ajmer. The combined rate for

anencephaly and Spina bifida was greater than 0.5 per/1000 births. The high frequency

was compared to the rate observed among the high risk communities in the world like the

Irish and Egyptains, and the author reported that these defect are low among Negros and

Mongolians .In USA and Japan showed that the incidence of NTD was 9.6 and 9.0 per

1000 among spontaneous abortions and therapeutic abortion respectively as against to 2.0

per 1000 at births .the rate was less than this for all the Centers in south India except for

Davangere, Hyderabad and Pandichery. 28

3. Studies related to etiology of neural tube defect:

The studies show etiology as multifactorial / polygenic trait. Where NTDs could

be caused by one or more genes interacting with environmental factors , which include

multiparty , chemicals and drugs materials illness (Diabetes mellitus) , temperature,

obesity , leads to drinking water ,occupational hazard, poor nutrient content diet

etc .among the environmental factors , folic acid deficiency has proved. 29

13

A prospective study was conducted over a period of one year in the city of Al –

Madinah in Saudi Arabia detected 18 cases of Spina Bifida. The incidence was 1.09 per

1000 live births, the male to female ratio 2:1 and the increase in the incidence is

attributed to cansanguinity which was found to be in 89% of the Spina Bifida parents as

compared with the 67% of the control. 30

A study reported 25% of the 64 mother were on folate supplementing during

affected pregnancy, to prove that the NTD is closely related to folic acid defiency.

Double blind randomized trial of Medical Research Council, Great Britain shows that

supplementation of 5mg per day for at least one month prior to conception to 3 months

post conception reduce the risk of reoccurrence of NTD by 70% .31

4. Studies related to prevention of neural tube defect in periconceptional period.

A case control study on neural tube defect of neonate and folic acid awareness

.and conducted in teaching hospital in Sri Lanka, during the study period 14,580 live

births took place at GH Kandy and twenty of them had NTDs. The number of babies with

NTDs transferred from other hospitals was 30. The control group comprised 150 mothers

with normal babies. Fourteen (28%) of the affected group were able to idenyify folic acid

tablet as a vitamin taken during pregnancy, in comparison to 87 (58%) of the control

group. One (2%) from the affected group and 70 (46%) from the control group knew

about the value of pre-conceptional FA .None of the affected mothers had used FA pre-

14

conceptionaly where as 54 (26%) of the control group mother believed that folic acid

helped in preventing birth defects. 31

A prospective study, conducted at M G H Medical College and My Hospital,

Indore M P between October 2008- 2009. Total 52 cases of Spina bifida admitted in the

hospital were evaluated about maternal antenatal history, folic acid intake, birth order,

family history & socio-economic status. Out of the total 52 cases, 20 belong to 2nd birth

order, 16 belong to 1st birth order, 10 belong to 3rd birth order, 5 belong to 4th birth

order & 1 belong to 5th birth order. Maternal folic acid intake was not found in all cases

during preconception & 1st month of gestation. Two mothers gave history of viral fever

during 2nd month of gestation. Family history was not found in any case. All except 2

cases belong to low socio-economic status. 32

A retrospective study, suggest that the association of folic acid supplementation

with twinning is the result of confounding by infertility treatment and by differential

reporting of folic acid use. This study examined the association between risk for twinning

in 176 042 women and exposure to a multivitamin or folic acid supplementation before or

during pregnancy. After adjustment for age and parity, the authors reported an OR of

1.59 for twin delivery after periconceptional folic acid supplementation. After accounting

for the under reporting of folic acid use and in vitro fertilization, the or for twin delivery

after preconceptional supplementation decreased to 1.02 and was no longer statistically

significantly greater than the risk for women who did not take folic acid. 34

A cohort study shows that women who were considering pregnancy and gave

them multivitamins containing 0.8 mg (800 μg) of folic acid 1 month before planned

15

conception. The authors reported a protective effect of folic acid against neural tube

defects: 1 neural tube defect occurred in 3056 women who took folic acid supplements

and 9 occurred in 3056 women who did not. The difference between the supplemented

and unsupplemented groups was statistically significant after adjustment for birth order,

chronic maternal disorders, and history of fetal death or congenital abnormality.34

The U.S. Public Health Service recommended the daily consumption of 0.4 mg

(400 μg) of folic acid in women of childbearing age (15 to 44 years). In 1996, the

USPSTF made a similar recommendation on the basis of several studies, including large

randomized, controlled trial (RCT) that demonstrated a statistically significant reduction

in incidence of neural tube defects in women who took a multivitamin with 0.8 mg (800

μg) of folic acid in the periconceptional period. The USPSTF recommended that all

women planning pregnancy take a daily multivitamin containing folic acid at a dose of

0.4 to 0.8 mg beginning at least 1 month before conception and continuing through the

first trimester, to reduce the risk for neural tube defect. 35

5. Studies related to the awareness among female college student regarding

prevention of neural tube defect in periconceptional period

A questionnaire-based study conducted a study on the level of awareness among

female college students on the importance of preconception folic acid supplementation in

preventing neural tube defects (NTDs). Five hundreds questionnaires were distributed to

the female students of the 3 colleges, namely, Humanities, Sciences, and Health in

Jeddah, Kingdom of Saudi Arabia in April 2008. Two hundred and seventeen

questionnaires were filled, and returned (43.4%). Mean age +/- SD was 20.96 +/- 2.25

16

years. Almost 88% were not aware of the importance of folic acid in preventing NTDs.

After listening to the lecture, 82.9% thought that they will surely use folic acid

preconception, and 98.6% will relay the important message about the importance of folic

acid to others. Similar educating programme are required, in order to decrease the high

rate. 36

A study was conducted to assess the knowledge of neural tube defect (NTD)

prevention by folic acid and periconceptional practices in young women. Young minority

women were enrolled in a folic acid program at 3 urban Houston, Texas, reproductive

health clinics and assessed for NTD knowledge and preventive practices. A 3-month

supply of multivitamins was also dispensed at enrollment. A 3-month program follow-up

survey of a randomly selected sample at 2 sites was conducted. Of 387 women (mean

age: 18 ± 1.9 years), 72% were black and 28% were Hispanic. At enrollment, clinics

were a major source of information of NTD prevention (44%); 52% had heard of folic

acid, 45% had heard of NTDs, and 50% had heard of birth defects prevention by

multivitamins. Significantly more Hispanic than black young women had heard of NTDs

(59% vs. 39%). Pregnancy history, regular birth control use, and education level for age

were independently associated with knowledge. In young women with low education

level for age, regular birth control use was significantly associated with knowledge. At

enrollment, daily multivitamin intake was very low (9%) and folate-rich foods were

consumed in inadequate amounts. Adequate folate diet was not associated with

knowledge. The program follow-up survey indicated that 88% to 92% had knowledge of

NTDs and folic acid, and 67% reported taking a daily multivitamin. Preliminary evidence

17

suggests that a promotion program improves knowledge, and dispensing of multivitamins

increases multivitamin use. 37

A study was conducted to ascertain knowledge of periconceptional folate for

prevention of neural tube defect (NTD) and to estimate folate intake in young women.

Three hundred young women were questioned about their knowledge of folate for

prevention of NTD. Their folate intake was assessed by food frequency questionnaire.

Fourteen per cent of 16–19 year olds and 41% of undergraduates were aware of the need

to increase folate intake before conception. Median folate intake was estimated to be 235

μg/day in 16–19 year olds and 248.5 μg/day in undergraduates. More than a quarter of

women in both groups had folate intakes less than the reference nutrient intake (RNI)

(200 μg/d) below which prevalence of NTD rises dramatically and these women would

therefore be at increased risk of having a child with NTD should they have an unplanned

pregnancy. Strategies are required to increase folate intake among young women and

inform them of the benefit of periconceptional folate supplementation. 38

STATEMENT OF THE PROBLEM:

A study on effectiveness of planned teaching programme on prevention of

Neural tube defect in periconceptional period among female student at selected college in

Bangalore.

18

6.3. OBJECTIVES OF THE STUDY:

1. To assess the knowledge of female student regarding prevention of Neural tube defect

in periconceptional period before planned teaching programme.

2. To evaluate the effectiveness of planned teaching programme on prevention of Neural

tube defect in periconceptional period among female student.

3. To determine the relationship between the socio-demographic variables and

knowledge of the female student.

HYPOTHESIS:

H 1: There is a significant relationship between planned teaching programme and level of

knowledge among female student regarding prevention of Neural tube defect in

periconceptional period.

H 2: There is a significant association between the levels of knowledge among female

student regarding prevention of Neural tube defect in periconceptional period and

selected demographic variable

OPERATIONAL DEFINITIONS:

Knowledge: Information possessed by final year student about the prevention of Neural

tube defect.

19

Effectiveness: Improvement in the level of knowledge of female student after planned

teaching programme on prevention of neural tube defect in periconceptional period

measured by self administered questionnaire.

Planned teaching programme: It refers to organized group teaching for 30-45 min,

through lecture cum discussion method using flash card to impart knowledge for the final

year female student regarding prevention of neural tube defect in periconceptional period.

Neural tube defect: Neural tube defects are the most structural congenital anomalies

and imply a failure of proper closure of neural tube and covering mesoderm and

ectoderm.

Periconceptional period: Periconceptional period is period start from first three month

before conception and after three month of conception.

ASSUMPTIONS:

1. Female student have inadequate knowledge on prevention of neural tube defect in

periconceptional period.

2. Socio demographic variables influence the level of knowledge of the female

student regarding prevention of Neural tube defect in periconceptional period.

3. Mass media influences the level of female student regarding prevention of neural

tube defect in periconceptional period.

7.0. MATERIALS AND METHOD:

20

7.1. SOURCES OF DATA: Data will be collected from female student from selected

college, Bangalore.

7.2. METHOD OF DATA COLLECTION PROCEDURE:

RESEARCH APPROACH: Non- experimental approach.

RESEARCH DESIGN: Quasi experimental design.

SAMPLING TECHNIQUE: Convenience sampling technique will be used.

SAMPLE SIZE: Sample size – 60

SETTING OF THE STUDY: The study will be conducted in selected College at Bangalore.

VARIABLE UNDER STUDY:

In this study three are two variables such as dependent variable and independent

variable.

DEPENDENT VARIABLE:

In present study dependent variable is the knowledge regarding prevention of

Neural tube defect.

INDEPENDENT VARIABLE:

In this independent variable considered as planned teaching programme.

21

SAMPLING CRITERIA:

Inclusion criteria:

1. Female student who are in the final year.

2. Female student who are willing to participate in the study.

3. Female student who are able to read & write English and Hindi.

4. Female student who are in age between 20 -25 years.

Exclusion criteria:

1. Final year female student with history of mental illness.

DATA COLLECTION TOOL

Tool:

A self administered questionnaire will be prepared to assess the knowledge of

final year student regarding prevention of neural tube defect in periconceptional period at

selected college in Bangalore.

Questionnaire will consist of two sections:

Section A: Items on socio demographic variables such as age, sex, education,

occupation, type of family, etc.

22

Section B: Items on assessment of level of knowledge among female college student

regarding prevention of Neural tube defect.

VALIDITY :

The validity of the tool will be ascertained in consultation with guide and other

expert from various fields like nursing, gynecologists, nutritionist and biostatisticians.

DATA ANALYSIS METHODS:

Data analysis will be done by descriptive and inferential statistics.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN

OR ANIMALS?

No. Only self administered questionnaire will be used for data collection. No

other invasive or laboratory procedures will be conducted on the samples.

7.4. HAS ETHICAL CLEARENCE BEEN OBTAINED?

The ethical clearance will be obtained. Confidentiality & anonymity of subjects

will be maintained. Consent will be taken from female student before conducting the

study.

23

8.0. LIST OF REFERENCES:

1. Marlow R. Dorothy, Barbara E. Reddling, Textbook of Pediatric Nursing, 6th edition,

Mosby publishers, 1998, page no. 33-35.

2. http://www.day for mother.com/what it mean.html.

3. http://www.online library .ifglobal.org/en/prevention of neu.

4. Kulkarni ML, Mathew MA Ramchandran B. High incidence of neural tube defect in

south India.2007, page no .49-52.

5. Slevnsen, Folate intake during periconceptional period. Journal of Maternal and Child

Health Nursing, 2008, Volume 11, Issue 4, page no.21-27.

6. Lawrence et.al, Psychology social factors association with use of multivitamin by

women of child bearing age, Journal of Community Health. Volume 32, Issue 1,

2008, page no. 57-69.

7. Agarwal SS et al. Neural tube defect: a preventable congenital malformation, India

pediar1999 ,page no 36.

8. O.P Ghai, Piyush Gupta, V.K Paul. Text book of pediatrics. 6th edition Revised and

Enlarged CBS publishers and Distributors New Delhi, page no.531-532.

9. http//www.recog.org.UK/women-health/clinical.

10. http//www.suite101.com/content/folic-acid.

24

11. Oakley .fortification of food with folic acid how much is enough? American Journal

of pediatrics, Volume 99, Issue 7, page no.81-87.

12. Centers for Disease Control and Prevention (CDC) Spinal incidence at birth United

States,2004, MMWER Morb Wkly Rep 2006, page no .441-446.

13. Green- Raleigh ,Trends in Folic Acid awareness and Behaviour in the United

States.2006.

14. Anthony. "Folic Acid and Neural Tube Defects.” Maternal and Child Health Bureau,

Health Resources and Services Administration, May 2008 ;page no. 22- 45.

15. NN Dissanayak, folic acid awareness at Hospital in Sri Lanka. Sri Lanka Journal of

Child Health, Volume 39, Issue 4, 2010, page no. 11-16.

16. Indian Academy of Pediatrics. Folic acid for prevention of Neural tube

defect .pediatrics 2007; page no .325-327.

17. .http://www.anencephalie-info.org/prevention.

18. .http://www.nbdpn.org/current/resources/ntd.

19. htpp://www.nejm.ntd org/doi/full/10.1055/NEJM199.

20. The Gallup Organization for the March of Dimes Foundation Survey, Maternal and

Child Health Journal.2006, Volume 10, page 77-82.

25

21. 20. Centers for Disease Control .Economic burden of Spina bifida –United States,

Morbidity and Mortality Weekly report. 2004, Volume 35, Issue 8, page no. 64-

70.

22. Dipietro NA and Kier et al, An Educational intervention about folic acid and healthy

pregnancies targeted at college age women. Journal of the American Pharmacists

Association, Volume 41, Issue2, page no.3-5.

23. Wind bam GC, Edmonds LD Current trends in the incidence of Neural tube defects.

Pediatrics, 1998, Volume 7, Issue 3, page no. 19- 23.

24. Geisel Janel, Folic acid and Neural tube defect s in pregnancy .The Journal of

Perinatal Nursing, Volume 17, Issue 4, page no. 68-79.

25. http//www. ibis-birth defect.org/start ntd.info.

26. Wind bam GC, Edmonds L D. Currents Trends in the incidence of Neural tube

defects in. pediatrics, Volume 70, Issue 33, page no 58-61.

27. httt//www.dev preg.com/folic acid supplem.

28. Vermal IC, High incidence of Neural tube defects in North India .2001. page no .8-

11.

29. Dr Ygitha. Multifactorial cause of NTDs, Nightingale Nursing times, 2005, Volume

5, Issue 32, page no. 32-35.

26

30. Anil Chanarin I, Deacon R, Cobalamin and Folate: Recent developments

J .2005,Page no 7-13.

31. Murshid WR, Spina bifida in Saudi Arabia ,Consanguinity among the parents a risk

factors , pediatr Neurosurg 2000; page no. 10-12 .

32. American College of Obstetrics and Gynecology, Neural tube defect. Washing ton

(DC) 2001, page no 66-74.

33. Asindi, Amer AL Shehri, Neural tube defects in Asik Region of Saudi Arabia. Journal

of Saudi Medicine, 2001, Volume 21, Issue 2, Page no. 1-2.

34. Nasib C Digra, Prevention of neural tube defect, 2009 May, Volume 6, no.1, page no.

5-8.

35. Journal of Obstetrics & Gynecology, Volume 28, 2006, page no. 220-250.

http://www.ncbi.nim.nih.gov/pubmed/16650361

36. Czeizel and Dudas ID. Prevention of the first occurrence of Neural tube defect by

periconceptional vitamin supplementation. N.Eng J Med, 2004, page no 1832-1835.

37. Kari J,A Bbandari ES, Baitalmal Folic Acid Awareness among female student NTDs

prevention. 2009 May, page no. 123-144.

38. Marian R Chacko, Knowledge and periconceptional prevention practices in Minority

young women. The Journal of Pediatrics Nursing.2005, Volume 12, Issue 3, page no.

36-42.

27

39. Jennifer Wild at .al , Folate intake in young Women and their knowledge of pre-

conceptional folate supplementation to prevent Neural tube defect , European Journal

of obstetrics and Gynecology and Reproductive Biology . Volume87, 2000, Page

no.9-12.

9. Signature of Candidate

10.Remarks of the Guide

28

11.Name and Designation

11.1 Guide

11.2 Signature

11.3 Co-guide

11.4 Signature

11.5 Head of the Department

11.6 Signature

1212.1 Remarks of the

Chairman and Principal

12.2 Signature

29