Awareness of ANC and PNC Care Among Women of Urban Slum in Pune, Maharashtra by A Self -Made Questionnaire

Birth


INTRODUCTION
In India, the maternal mortality ratio has been maintained at a higher level since long.It was reported that the national MMR among Indian women is 130 per 100,000 live births (SRS2014-16) which in itself is very high compared to the international scenario. [1]romotion of maternal and child health must be reflected through Antenatal care and Postnatal care.Lack of care during this period can result in death or disability.The maternal health status of Indian women was noted to be lower as compared to other developed countries.Slums have been recognised as neglected communities characterised by deteriorated housing, overcrowded, poor environmental managements with wide spectrum of adverse health conditions such as under nutrition, delivery related complications, postpartum morbidity, and limited access to health care services. [4]t is estimated that, on an average the slum areas of a city that contain about 20 percent of its population will have about 50 percent of all its disease. [4]here have been limited efforts to study health of individuals especially women living in slums.Study by Hazarika I in 2010 revealed that 74 percent of non-slum women receive 3 or more ANC checkups whereas only 55 percent women of the slums receive check-ups.Similarly, disparity exists in seeking institutional deliveries. [4]hese intra urban disparities are probably the outcome of factors such as employment patterns, literacy levels, availability of health services, traditional customs, gender status, etc.All of this will affect the knowledge which this study opts to assess its influence on reproductive and child health behaviour among the urban slum women. [4]he prevalence of incontinence was 18.6%.Incontinence was reported in 12.5% of primis as compared to 26.4% in multis.The incidence of incontinence rose as age advanced.Sixteen percent developed incontinence following LSCS whenever 19.8% developed incontinence after normal delivery. [1]lums have been recognized as neglected communities characterized by deteriorated housing, overcrowded, poor environmental managements with wide spectrum of adverse health conditions such as under nutrition, delivery-related complications, postpartum morbidity, and limited access to health care services. [4]he World Health Organization (WHO) reported that in 2015 around 830 women died every day from problems in pregnancy and childbirth.Only 5 of the women who died lived-in high-income countries, the rest of the women lived-in low-income countries.The maternal health status of Indian women was noted to be lower as compared to other developed countries.Promotion of maternal and child health has been one of the most important components of the Family Welfare Program of the Government of India.For sustainable growth and development of country, there is a need to improve MCH Care in the country.Safe motherhood by providing good antenatal care (ANC) and postnatal care (PNC) is very important to reduce maternal mortality ratio and infant mortality rate. [4]xercise is safe for both the mother and fetus during pregnancy and recent research support the recommendation to initiate or continue exercise in most pregnancies.The benefits included maintenance of aerobic and musculoskeletal fitness levels, prevention of excessive maternal weight gain, facilitation of labor, help for gestational glucose control and improve psychological adjustment to changes of pregnancy and more rapid postnatal recovery.Risk of caesarean section can be reduced if pregnant woman perform structured physical exercise.There are few barriers like fatigue, lack of time and pregnancy discomforts to physical activity during pregnancy.Aim of the study is to assess the knowledge of antenatal and postnatal exercises among the rural ante natal and postnatal women. [3]ccording to the American College of Obstetricians and Gynecologists (ACOG) and the American College of Sports Medicine (ACSM), a pregnant women without obstetric or medical problems are encouraged to engage in at least 30 minutes of moderate exercise a day (i.e.,) avoiding exercises with risk of abdominal trauma.1,5In the combined CDC-ACSM recommendations for physical activity and health, moderate exercise is defined as exercise of 3-4 METS or any activity that is equivalent in difficulty to brisk walking. [3]xercise during pregnancy is considered to be a havoc among Indian women due to cultural and familial issues.Some women do not feel motivated to exercise despite being aware of the possible benefits that physical exercise could offer to their health and the health of the baby.knowledge about exercise during antenatal and postnatal period is not adequate mainly due to lack of information.Awareness and education must be improved on antenatal & postnatal exercises. [3]ED OF STUDY Antenatal care and postnatal care are a crucial part of a woman's life, it is very important for a woman to have appropriate knowledge about antenatal and postnatal care in order to prevent complications.Hence, this study provides with the information about the level of awareness present among the women of reproductive age and will determine the need of spreading further awareness.It allowed to assess whether the females have a knowledge about regular exercising and maintaining physical fitness in this period.It also allowed us to understand whether there is a need of spreading awareness about antenatal and postnatal care among women of the urban slums.

AIM
To check for the awareness of antenatal and postnatal care among women of the urban slum in Pune.

REVIEW OF LITERATURE 1.TV Chitra & Seetha Panicker conducted a study on "Child Birth, Pregnancy and Pelvic Floor
Dysfunction" Published on 17 January 2012.The aim of the study was to assess the prevalence of incontinence.Incontinence was reported in 12.5% of primi's as compared to 26.4% in multis.The incidence of incontinence rose as age advanced.Sixteen percent developed incontinence following LSCS whenever 19.8% developed incontinence after normal delivery.This study concluded that pelvic floor dysfunction occurs commonly following childbirth, with increasing parity urinary incontinence particularly stress incontinence was more common.No significant reduction in incidence of incontinence following LSCS was noted in this study.The aim of this study was to assess the knowledge of antenatal females and the practices they follow during pregnancy by the means of a questionnaire.This study concluded that still higher proportion of (41.9%) of pregnant women has inadequate knowledge, and about one-third of study participant have poorly practice ANC care.Their knowledge on certain aspects of ANC were still poor especially regarding the importance of early antenatal check-up, health screening and complications related to diabetes and hypertension in pregnancy.Specific intervention program needs to be planned and conducted to improve their maternal health practices and eventually improve the health status.

EXCLUSION CRITERIA:
1. Women who are not willing for participation.2. Women who don't belong to urban slum.

RESEARCH QUESTION
Are the women of urban slums in Pune aware about Antenatal and Postnatal care?PROCEDURE 1. Permission from ethical committee was taken.2. A Questionnaire was designed and validated with the help of guides, physiotherapists and gynaecologists.3. Consent from participants was taken Participants were selected as per our inclusion criteria.4. Survey was performed using questionnaire, and questions were asked in their comfortable language (Marathi, Hindi).

RESULTS FOR THE ANTENATAL QUESTIONNAIRE:
Result shows that 98% women agreed for regular antenatal checkups.70% agreed that there should be a complete Antenatal checkup done within the first three months itself.100%women agreed that smoking and drinking is harmful for the foetus.Only 15% women agreed that it is important to exercise in pregnancy.36%women disagreed to regular BP checkups and 79% disagreed for regular BSL checkups.7% women didn't opt for institutional delivery and 53% women disagreed for ultrasonography.73%women disagreed to plan for postpartum care.77%disagreed to take extra supplements for nutrition.

RESULTS FOR THE POSTNATAL QUESTIONNAIRE:
Result for the postnatal care questionnaire shows that only 79% women were aware of the changes that have taken place in the body.Only 29% women agreed to keep an 18-34month gap between 2 pregnancies.75%women did not know that they need to avoid sexual activity for some time after delivery.68%womenwere not aware that they need proper supplements and nutrition even after delivery.89%weren't aware of the feeding positions.Only 17% knew about keeping themselves fit.96% women did not know that the vaginal muscles become weak and need to be strengthened.Only 50% women knew about the immunization.

DISCUSSION
This study was conducted to assess the awareness towards antenatal and postnatal care services among women of urban slum in Pune.In the slum, the majority of participants belonged to the Hindu religion followed by Islam.Religion brings a gambit of cultures and practices pertaining to pregnancy, nutrition, and diet in pregnancy and child bearing.Along with various myths which are different for different religions. [1]Education is the key factor for improving quality of maternal health care and even access to and utilization of ANC,PNC services.Keeping in mind ,low socioeconomic status doesn't allow these women to gain appropriate information thereby causing lack of knowledge and information. [12]In this study (7%) participants did not prefer delivery at hospitals because of rude hospital staff behavior.In this study, knowledge regarding postnatal care was low as compared to awareness on antenatal care among the slum women.It was found that only 32% women were aware of the fact that they should follow a healthy diet plan along with supplements even after delivery.Majority(71%) of women were unaware about the spacing between pregnancies. [10]The early neonatal period is the most crucial time when effective postnatal care can affect the health of mothers and newborn significantly.Hence it is very important to exclusively breastfeed for 6 months .In this study it was reported that about 94% women didn't choose to exclusively breastfeed for 6 months and chose to feed their baby other commodities as well. [13]In a survey conducted by UNICEF (2009) around three fifths of mothers knew about all the four vaccines that need to be given to the child within the first year of life.In this study 50% women knew about the immunization schedules. [6]In this study only 42% women were aware that there are programmes/schemes for women .On asking them ,the primary source of awareness came from Anganwadi centers , Politicians , NGO's. [1]Only 15-17% women agreed to exercising/walking whereas other women disagreed as there are myths which prevail suggesting that exercise are harmful for the foetus . [9]NCLUSION This study concludes that that there is a lack of awareness about ANC and PNC care among women of urban slum in Pune.Awareness of Postnatal care was less as compared to Antenatal care thereby concluding that women lack awareness of postnatal care as compared to antenatal care.

LIMITATIONS
1.This study was not able to address whether the lack of knowledge was due to age or education level.2. The respondents may not always be completely truthful with their answers, while many respondents may answer how they think society would deem most acceptable.

CLINICAL IMPLICATIONS
1.More awareness should be created about ANC and PNC care among women of Urban slums.2. This study can also be conducted in rural areas in order to understand their level of awareness.

FUTURE SCOPE OF STUDY
1.By understanding the awareness levels , it will be easier to understand which topics need to be covered for spreading awareness.2. A study can be done in order to understand the myths that prevail.

2 .
Barun Bhai Patel, Pranaya Gurmeet, Dattatreya Ramkrishna, Kapil H. Pandya, Ajoy Mahen, Neha Singh conducted "A study on knowledge and practices of antenatal care among pregnant women attending antenatal clinic at a Tertiary Care Hospital of Pune, Maharashtra Departments of Community Medicine and Obstetrics and Gynaecology, AFMC, Pune, Maharashtra, India" published on May-June 2016.
3.S.Rajalakshmi, Dr. Hepzhibah Kirubamani conducted a study on "Awareness about Antenatal and Postnatal Exercises amongst Rural Pregnant Women" published in November -December 2018.The aim of this study was to assess the knowledge of antenatal and postnatal exercises among the rural ante natal and postnatal women, To determine the source of information and how many of the rural antenatal women practice antenatal and postnatal exercise.This study concluded that the results from the current study suggest that knowledge about exercise during antenatal and postnatal period is not adequate mainly due to lack of information.Awareness and education must be improved on antenatal & postnatal exercises.4.Ritika Bharti, Sherin Raj T.P Conducted a study on "Awareness on ANC and PNC Services among Women of Urban Slum in Delhi" published on June 2019.The purpose of this study was to asses awareness towards antenatal and postnatal care services among women (age 15-49) years residing in urban slum of Delhi.The findings reveals that low level of awareness on ANC, PNC and new born care among illiterate women in Delhi slum.The awareness on PNC and new born care was very low compared to awareness on ANC.More than half (60%) of the women had knowledge about danger signs of pregnancy.This study concluded that the emphasis has to be laid on education on postnatal care services and danger signs of new born, so that complications can be detected at early stage to avoid mortality among mothers and children.METHODOLOGY 1. Study Design-Observational study 2. Study setup-From urban slums of Pune. 3. Sampling technique-Convenient sampling.4. Sample size -265 Females.

5 .
Study duration-6 months OUTCOME MEASURE: Self -made structured questionnaire approved and validated by guides and experts.MATERIALS REQUIRED: 1. Pen/Pencil 2. Paper(questionnaire) INCLUSION CRITERIA: 1. 1.Pregnant Women of reproductive age (18-45) 2. Women who have recently delivered 3. Women who belong to urban slum.4. Women who are planning for a baby.
SUBJECTS FILLING THE QUESTIONNAIRE DATA ANALYSIS AND INTERPRETATION ANTENATAL CARE QUESTIONNAIRE Q1.DO PREGNANT WOMEN NEED TO GO FOR ANTENATAL CHECK UP REGULARLY?Q1 DO PREGNANT WOMEN NEED TO GO FOR ANTENATAL CHECK UP REGULARLY?FIRST ANC CHECK UP SHOULD BE DONE WITHIN THE FIRST 3 MONTHS?Q2 THE FIRST ANC CHECKUP SHOULD BE DONE WITHIN THE FIRST THREE MONTHS?SMOKING AND DRINKING HARMFUL FOR THE FOETUS?Q3 IS SMOKING AND DRINKING HARMFUL FOR THE FOETUS?IT IMPORTANT TO EXERCISE REGULARLY DURING PREGNANCY?Q4 IS IT IMPORTANT TO EXERCISE REGULRLY DURING PREGNANCY?IT IMPORTANT TO GET YOUR BLOOD PRESSURE CHECKED REGULARLY?Q5 IS IT IMPORTANT TO GET YOUR BP CHECKED REGULARLY (No.of responses) IT IMPORTANT TO GET YOUR BLOOD SUGAR LEVEL CHECKED REGULARLY?Q6 IS IT IMPORTANT TO GET YOUR BLOOD SUGAR LEVEL CHECKED REGULARLY?IT NECESSARY TO DO AN ULTRASOUND SCAN IN PREGNANCY?Q8 IS IT NECESSARY TO DO AN ULTRASOUND SCAN IN PREGNANCY?YOU THINK IT IS IMPORTANT TO TAKE EXTRA SUPPLEMENTS FOR NUTRITION?Q10 DO YOU THINK IT IS IMPORTANT TO TAKE EXTRA SUPPLEMENTSFOR NUTRITION?YOU AWARE ABOUT THE SCHEMES AVAILABLE FOR YOU AND YOUR BABY?Q11 ARE YOU AWARE ABOUT THE SCHEMES AVAILABLE BY THE GOVERNMENT FOR YOU AND YOUR BABY?
POSTNATAL CARE QUESTIONNAIRE Q1.ARE YOU AWARE THAT VARIOUS BODY CHANGES HAVE TAKEN PLACE AND NEED TO BE ACKNOWLEDGED?Pie chart no:12 Q2.ARE YOU AWARE THAT THERE SHOULD BE AT LEAST AN 18-34 MONTH GAP BETWEEN 2 PREGNANCIES?AWARE THAT VARIOUS BODY CHANGES HAVE TAKEN PLACE AND NEED TO BE ACKNOWLEDGED?YOU AWARE THAT YOU HAVE TO AVOID SEXUAL ACTIVITY FOR ATLEAST 4-6 WEEKS AFTER DELIVERY?Pie chart no:14 Q4.ARE YOU AWARE OF THE SUPPLEMENTS NEEDED FOR NUTRITION AFTER DELIVERY?YOU AWARE OF PROPER FEEDING POSITIONS?Q5 ARE YOU AWARE OF THE PROPER FEEDING POSITIONS?YOU AWARE OF THE FITNESS REGIMES THAT MUST BE FOLLOWED AFTER PREGNANCY?Q6 ARE YOU AWARE ABOUT THE FITNESS REGIMES WHICH MUST BE FOLLOWED AFTER PREGNANCY?YOU AWARE THAT YOU NEED TO STRENGHTEN YOUR VAGINAL MUSCLES AFTER DELIVERY?Q7 ARE YOU AWARE THAT YOU NEED TO STRENGTHEN YOUR VAGINAL MUSCLES AFTER DELIVERY?YOU AWARE THAT ABDOMINAL MUSCLES BECOME LOOSE AND WEAK AND IT IS VERY IMPORTANT TO STRENGTHEN THEM?Q8 ARE YOU AWARE THAT ABDOMINAL MUSCLES BECOME LOOSE AND WEAK AND IT IS VERY IMPORTANT TO STRENGTHEN THEM?YOU AWARE THAT IT IS IMPORTANT TO EXCLUSIVELY BREASTFEED FOR 6 MONTHS?Q9 ARE YOU AWARE THAT IT IS IMPORTANT TO EXCLUSIVELY BREASTFEED FOR YOU AWARE ABOUT THE IMMUNISATION SCHEDULES FOR THE BABY?Q10 ARE YOU AWARE ABOUT THE IMMUNIZATION SCHEDULES FOR THE BABY? (No.of responses) YOU AWARE ABOUT THE SCHEMES AVAILABLE FOR YOU AND YOUR BABY?Q11 ARE YOU AWARE OF THE SCHEMES AVAILABLE FOR YOU AND YOUR BABY?

1 . 2 . 3 . 7 . 8 . 9 .
15. Agarwal P, Singh MM, Garg S. "Maternal health-care utilization among women in an urban slum in Delhi, Indian Journal of Community Medicine.2007.Vol.32, issue 3, Pp203-205.16.Sharma P, Kishore S, Semwal J & Kandpal S.D. Awareness of Janani Suraksha Yojana amongst married women (15-49 years) in our field practice area of Dehradun.Souvenir IAPSMCON 2010; O-32.17. Fotso JC, Ezeh A, Oronje R. Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do?J Urban Health.2008;85(3):428-442.doi: 10.1007/s11524-008-9263-1 18. Shekhar C, Ram F. National report on evaluation of functioning of urban health posts/urban family centers in India.International institute of population sciences (IIPS), Mumbai; 2005.19.MadhiwallaN.Healthcare in urban slums in India.2008;20(3):113-114 20.Aggarwal P, Singh MM, Garg S. Maternal Health Care utilization among women in an urban slum in Delhi Indian journal communitymed 2007;32:203-205.doi: 10.4103/0970-0218.36829.ANNEXURE 1:-सं मतीचे पत्र मी ___________________ "पु णे शहर च्या झोपडपट्टीतील महहला मध्ये , गर्भ पन आनी प्रसु ती नं तर काळजी बद्दल जागरूकता" या प्रबं धाचा हिषय म्हणू न स्िे च्छे ने सहर्ागी होण्यास तयार आहे .सिे क्षणाचे स्िरूप आहण कालािधी याबाबत मला माहहती दे ण्यात आली आहे .अभ्यासाशी सं बं हधत आिश्यक सिे क्षण करण्यास माझा कोणत्याही आक्षे प नाही.Do pregnant women need to go for antenatal check-up regularly?YES NO Should the first ANC check-up be done within first 3 months?YES NO Is smoking and drinking harmful for foetus?YES NO 4. Is it important to exercise regularly during pregnancy?YES NO 5. Is it important to get your BP checked regularly?YES NO 6.Is it important to get your blood sugar level checked regularly?YES NO Should women deliver babies in the hospital?YES NO Is it necessary to do an ultrasound scan in pregnancy?YES NO Do you think planning for postpartum care is important?YES NO 10.Do you think it is important to take extra supplements for nutrition?YES NO 11.Are you aware about the schemes available by the government for you and your baby?YES NO 12.Are you aware about the schemes available by the government for you and your baby?YES NO Postnatal care questionnaire: -1.Are you aware that various body changes have taken place and need to be acknowledged?YES NO 2.Are you aware that there should be at least an 18-34month gap between 2 pregnancies?YES NO 3.Are you aware that you have to avoid sexual activity for at least 4-6 weeks after delivery?YES NO 4.Are you aware of the supplements needed for nutrition after delivery?YES NO 5.Are you aware of proper feeding positions?YES NO 6.Are you aware about the fitness regimes which must be followed after pregnancy?YES NO 7. Are you aware that you need to strengthen your vaginal muscles after delivery?YES NO 8. Are you aware that abdominal muscles become loose and weak and it is very important to strengthen them?YES NO 9. Are you aware that it is important to exclusively breast feed for 6 months?YES NO 10.Are you aware about the immunization schedules of the baby YES NO