Early marriage & pregnancy.pptxxxxxxxxxx

Early marriage & pregnancy complications

1. DISSERTATION PRESENTATION Mrs. DIVYA GAUTAM M.Sc. Nursing Final Batch 2022-23 Enrolment No.- 2016/10450 Roll No.- 310563

2. STATEMENT OF THE RESEARCH PROBLEM     “A study to assess the effectiveness of information booklet on knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls at selected Sr. Secondary schools of Kota.”

3. OBJECTIVES OF THE STUDY The objective of the Research are- To assess the pre-test knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls of both groups before the implementation of Information Booklet. To assess the post-test knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls of Experimental group after the implementation of Information Booklet. To assess the post-test knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls of control group without the implementation of Information Booklet. To assess the impact of Information Booklet on knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls. To find out the association between pre-test knowledge and attitude score regarding hazards of early marriage and early pregnancy among adolescent girls with their selected socio-demographic variables.

4. HYPOTHESIS At 0.05 level of significance- H 1 : There will be significant difference between pre and posttest knowledge and attitude score regarding hazards of early marriage and early pregnancy among adolescent girls for both groups at selected Sr. Secondary schools of Kota.   H0 1 : There will be no significant difference between pre and posttest knowledge and attitude score regarding hazards of early marriage and early pregnancy among adolescent girls for both groups at selected Sr. Secondary schools of Kota.   H 2 : There will be a significant association between pretest knowledge score regarding hazards of early marriage and early pregnancy among adolescent girls with selected socio-demographic variables.   H0 2 : There will be no significant association between pretest knowledge score regarding hazards of early marriage and early pregnancy among adolescent girls with selected socio-demographic variables.

5. INTRODUCTION AND BACKGROUND OF THE STUDY According to the UN, complications from pregnancy and childbirth are the leading causes of death for girls aged 15- 19 years in the developing countries. Of the 16 million adolescent girls who give birth every year, about 90% are already married. UNICEF estimates some 50,000 die, almost all in low and middle income countries. Stillbirth and newborn deaths are 50% higher among mothers under 20 than in women who get pregnant in their 20s. 6 In India it is estimated that 1/3rd of the total population is under the age group of 20 years, and adolescent are at the risk of sexual and reproductive health problems. More than 15 million girls aged between 15-19 years give birth every year. Adolescent girls who get pregnant before 18 years may be five times more likely to die than a woman aged 20-28 years. 10

6. INTRODUCTION AND BACKGROUND OF THE STUDY Teen pregnancy in India is high with 62 pregnant teens out of every 1,000 women. In comparison, 24 British teens get pregnant before their 19th birthday while the figure is 42 in the US. In India, issues like early marriage and high infant mortality are possible causes for high number of young girls getting pregnant between the ages of 15-19. 11 Adolescence is a transitional stage of physical and mental human development that occurs between childhood and adulthood. This transition involves biological, social and psychological changes, though the biological or physiological ones are the easiest to measure objectively A teenager, or teen, is a young person whose age is between thirteen and nineteen (13-19 yrs). They are called teenagers because their age number ends in "teen" Teenage pregnancy is pregnancy in a female under the age of 20 yrs. A pregnancy can take place as early as two weeks before menarche (the first menstrual period), which signals the possibility of fertility, but usually occurs after menarche. In healthy, well-nourished girls, menarche normally takes place around the ages 12 or 13.

7. NEED FOR THE STUDY Teenage pregnancy causes different medical risks and realities like a) Premature birth, the earlier a baby is born, the more risk there is of respiratory, digestive, vision, cognitive, and other problems. b) Low-birthweight baby: Teens are at higher risk of having low-birth-weight babies only 1,500 to 2,500 grams those needed to be put on a ventilator for help with breathing after birth. c) Sexually Transmitted Diseases: For teens that have sex during pregnancy, STDs such as Chlamydia and HIV are a major concern which can infect the uterus and growing baby. d) Postpartum depression: Pregnant teens may be at higher risk of postpartum depression, which can interfere with taking good care of a newborn. e) Feeling Alone and Isolated: Especially for teens who think they can't tell their parents they're pregnant, feeling scared, isolated, and alone can be a real problem. Without the support of family or other adults, pregnant teens are less likely to eat well, exercise, or get plenty of rest. 18

8. NEED FOR THE STUDY Adolescents aged less than 16years face four times the risk of maternal death than women aged in their 20s, and the death rate of their neonates is about 50% higher. An estimated 16 million girls aged between 15 and 19give birth every year, with 95% of these births occurring in developing countries. This makes up 11% of all births worldwide. Births to adolescents as a percentage of all births range from about 2% in China to 18% in Latin America and the Caribbean .Worldwide, just seven countries account for half of all adolescent births: Bangladesh, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and the United States of America. About 13 million children are born for teenage mother under the age of 18 years among this the death rate is 143 /1000 per day. 90% of this births and deaths occur in developing countries. In India, 30.9% of teenage girls marry below the age of 15 years. The fertility rate of the population under 15-18 years of age is 73/1000. Between 14 million and 15 million adolescent girls give birth each year. Adolescents aged 15-19 are more likely than older mothers to die in childbirth and very young mothers aged 14 and under are at highest risk. For every young woman who dies in childbirth, 30-50 others are left with an injury, infection or disease. 22

9. NEED FOR THE STUDY According to the Union health ministry's Family Welfare Statistics 2011, compiled by the Registrar General of India, for every woman aged below 18 getting married in urban centers, three women are doing so in rural areas. In percentage-wise decline, Jammu and Kashmir has seen the largest dip in under-aged brides in the recorded five years at 83%, followed by Chhattisgarh (78%), Andhra Pradesh (71%), Haryana (70%) and Madhya Pradesh (69%). Maharashtra has seen a 57% decline in under-aged brides, Odisha (48%), Karnataka (44%) and Punjab (46%). States with lowest percentage of decline in under-aged brides since 2005 include West Bengal (14%), Rajasthan (23%), Jharkhand (27%), Tamil Nadu (29%), Gujarat (33%) and Uttar Pradesh (38%). 24

10. REVIEW OF LITERATURE

11. REVIEW OF LITERATURE The review of literature relevant to present study is classified under following sections:- Section-A: Literature related to general information regarding early marriage and early Pregnancy. Section-B: Literature related to knowledge and attitude regarding early marriage and early pregnancy. Section-C: Literature related to effectiveness of Information booklet regarding early marriage and early pregnancy.

12. R ESEARCH METHODOLOGY

13. RESEARCH METHODOLOGY RESEARCH APPROACH In view of the nature of the problem selected for the study and the objectives to be accomplished, Evaluative approach adopted. Evaluative approach helps to explain the effect of independent variable on the dependent variable. This study includes manipulation, control and no randomization. This approach is considered by the investigator as the most suitable one for this study. RESEARCH DESIGN A quasi-experimental research design with pre and post-test with control group was used to assess the effectiveness of information booklet on knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls at selected Sr. secondary schools of Kota (Raj.).

14. Schematic representation of Research design

15. SETTING OF THE STUDY The setting of the study was selected senior secondary schools of Kota (Raj.). The criterion for selecting this setting was depends upon feasibility for conducting the study, accessibility and availability of the sample and familiarity of the investigator with the settings.

16. P OPULATION Target population for the study were all adolescent girls of senior secondary schools of Kota (Raj.). Accessible population for the study were the selected adolescent girls of selected senior secondary schools of Kota (Raj.).

17. SAMPLE, SAMPLE SIZE AND SAMPLING TECHNIQUE SAMPLE Sample may defined as representative unit of a target population, which is to be worked upon by researches during study. 69 In the present study, adolescent girls who studying in selected senior secondary schools of Kota (Raj.) were selected to participate in this study.   SAMPLE SIZE     The sample size of the study comprised of 100 adolescent girls as 50 for experimental group and 50 for control group . SAMPLING TECHNIQUE In this study Non-probability purposive sampling technique is used for selection of subjects.

18. CRITERIA FOR SAMPLE SELECTION Inclusion criteria Adolescent girls who are: Willing to take an interest in the investigation. Present during the time of information assortment. Who can peruse or compose English or Hindi. Exclusion criteria Adolescent girls who had- Who are absent at the time of the investigation Adolescent girls outside the selected senior secondary schools of Kota (Raj.)

19. DESCRIPTION OF THE TOOLS FOR DATA COLLECTION   Data collection tool comprises of three Sections – Section- A SOCIO-DEMOGRAPHIC PERFORMA Section- B STRUCTURED SELF ADMINISTERED QUESTIONNAIRE Section- C LIKERT ATTITUDE SCALE

20. SECTION A: SOCIO-DEMOGRAPHIC PERFORMA Socio demographic variables consists of 07 items as Age, E ducational status, R eligion of adolescent girls, T ype of family, M onthly family income, O ccupational status of father and P revious sources of knowledge regarding early marriage and early pregnancy.

21. SECTION B: STRUCTURED SELF ADMINISTERED QUESTIONNAIRE   Structured Interview questionnaire consists of 24 items and is divided into area wise like: Section A- Q uestion related to General Information Regarding Nutritional Deficiency Anemia Section B- Question related to Common Causes and Symptoms of Nutritional Deficiency Anemia Section C- Question related to Diagnosis, Treatment and management of Nutritional Deficiency Anemia Section D- Question related to Prevention and complication of Nutritional Deficiency Anemia

22. SCORING INTERPRETATION SCORE LEVEL OF KNOWLEDGE LEVEL OF ATTITUDE 0-50% Inadequate Unfavorable attitude 51-75% Moderately Adequate Moderate Favorable attitude above 75% Adequate favorable attitude

23. PREPARATION OF THE FINAL DRAFT OF INFORMATION BOOKLET Organization of the Content   The selected content was composed under after primary headings:   INTRODUCTION Reasons of early child marriage and pregnancy Trigger factors of adolescent marriage in india Adverse effects of adolescent girl marriage SIDE EFFECTS OF ADOLESCENT PREGNANCY KEY FACTORS FOR PREVENTING ADOLESCENT PREGNANCY CONSEQUENCES OF CHILD MARRIAGE ROLE OF STAKEHOLDERS

24. PILOT STUDY   Pilot study was conducted from 12/11/2024 to 20/11/2024 in Govt. Sr. Secondary school, Aawasan Mandal, Keshavpura , Kota to find out the effectiveness of the tool and study in terms of enhancement of knowledge and attitude regarding early marriage and early pregnancy among adolescent girls . The topic was explained and confidentiality was assured and investigator collected data from 10 samples, 5 control group and 5 experimental groups who fulfilled inclusive criteria other than the sample area. An informed consent was obtained from the sample. Assurance was given to them that the anonymity of each individual was maintained. Pre-test Structured interview questionnaire was given to 10 samples (5 control group and 5 experimental group). On the same day, Information booklet was given and after 3 days post test was conducted with the same structured questionnaire.

25. R eliability co-efficient “r” value The reliability of the final tool was established by testing the internal consistency using split-half method was used. The tool was administered to 10 samples (5 control group and 5 experimental group) and the reliability of the tool was established under Spearman Brown’s prophecy formulate method. The reliability of the structured interview questionnaire was 0.818 . Since the score is positive; the instrument was seen as higher, measurably reliable for the current investigation.

26. MAIN STUDY DATA COLLECTION PROCEDURE Permission was obtained from the concerned authority. The investigator conducted the main study from 03/12/2024 to 17/12/2024 in New Public Sr. Secondary school, Vigyan nagar , Kota . Authorization was gotten from Principal of the school. In the wake of acquiring the consent examiner met the subjects and builds up the affinity. 100 adolescent girls (50 for experimental group and 50 for control group) were selected by convenient sampling technique. A written informed consent was taken separately from each subject. Appropriate orientation direction was given to the respondent about the point of the examination, length, nature of the poll and sufficient consideration was taken for shielding the respondent from the potential dangers including look after privacy, security and identity.  

27. MAIN STUDY DATA COLLECTION PROCEDURE   The demographical tool and structured Interview questionnaire was administered for both experimental and control group by using close ended questionnaire to assess the knowledge and attitude regarding early marriage and early pregnancy among adolescent girls. Data was collected and observed for 100 adolescent girls , out of which 50 adolescent girls were in the experimental group and 50 adolescent girls were in control group. Immediately after pre-test, information booklet on knowledge and attitude regarding early marriage and early pregnancy was given only for sample in the experimental group. Evaluation of the information booklet was be done by conducting post-test, 7 days after the implementation of information booklet.

28. DATA ANALYSIS & INTERPRETATION

29. ORGANISATION OF FINDINGS The analyzed data has been organized and presented in the following sections- Section I Description of socio demographic variables of the adolescent girls for both Experimental and control group   Section II Analysis and interpretation of pre -test and post- test level of knowledge and attitude score for both Experimental and control group Section III Association of mean Pre-Test Knowledge and attitude score with selected socio- demographic variables  

30. Frequency and percentage distribution of Samples as per baseline characteristics

31. Frequency and percentage distribution of Samples as per baseline characteristics

32. SECTION- II SECTION II: EFFECTIVENESS OF INFORMATION BOOKLET IN TERMS OF GAIN IN KNOWLEDGE SCORE

33. EFFECTIVENESS OF INFORMATION BOOKLET IN TERMS OF GAIN IN KNOWLEDGE SCORE

34. Mean and Percentage Pre and Post-test attitude score regarding hazards of early marriage and early pregnancy

35. Mean and Percentage Pre and Post-test attitude score regarding hazards of early marriage and early pregnancy

36. SECTION- III Chi-square test showing the association between pre-test knowledge scores and selected socio-demographic variables   FOR EXPERIMENTAL GROUP (KNOWLEDGE VARIABLE) The smaller the p-value, the stronger the evidence that you should reject the null hypothesis. A p-value less than 0.05 (typically ≤ 0.05) is statistically significant. A p-value higher than 0.05 (> 0.05) is not statistically significant and indicates strong evidence for the null hypothesis.   From table 4.10 and 4.11 it is evident that the demographic variables such as age in years, educational status, monthly family income and previous sources of information the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis.

37. SECTION- III Chi-square test showing the association between pre-test knowledge scores and selected socio-demographic variables   FOR CONTROL GROUP (KNOWLEDGE VARIABLE) The smaller the p-value, the stronger the evidence that you should reject the null hypothesis. A p-value less than 0.05 (typically ≤ 0.05) is statistically significant. A p-value higher than 0.05 (> 0.05) is not statistically significant and indicates strong evidence for the null hypothesis.   From table 4.12 and 4.13 it is evident that the demographic variable of previous sources of information, the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis.

38. SECTION- III Chi-square test showing the association between pre-test Attitude scores and selected socio-demographic variables   FOR EXPERIMENTAL GROUP (KNOWLEDGE VARIABLE) The smaller the p-value, the stronger the evidence that you should reject the null hypothesis. A p-value less than 0.05 (typically ≤ 0.05) is statistically significant. A p-value higher than 0.05 (> 0.05) is not statistically significant and indicates strong evidence for the null hypothesis.   From table 4.13 and 4.14 it is evident that the demographic variables such as age in years, educational status, monthly family income and previous sources of information the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis.

39. SECTION- III Chi-square test showing the association between pre-test Attitude scores and selected socio-demographic variables   FOR CONTROL GROUP (KNOWLEDGE VARIABLE) The smaller the p-value, the stronger the evidence that you should reject the null hypothesis. A p-value less than 0.05 (typically ≤ 0.05) is statistically significant. A p-value higher than 0.05 (> 0.05) is not statistically significant and indicates strong evidence for the null hypothesis.   From table 4.15 and 4.16 it is evident that the demographic variable of previous sources of information, the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis.

40. SUMMARY In view of the nature of the problem selected for the study and the objectives to be accomplished, Evaluative approach adopted. Evaluative approach helps to explain the effect of independent variable on the dependent variable. This study includes manipulation, control and no randomization.   A quasi-experimental research design with pre and post-test with control group was used to assess the effectiveness of information booklet on knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls at selected Sr. Sec. Schools of Kota (Raj).   As a framework for assessing the knowledge and attitude regarding early marriage and early pregnancy among adolescent girls at selected Sr. Sec. schools of Kota, J.W. Kenny’s open system model is adopted. The system’s theory is concerned with changes due to interrelation between various factors in a situation. All living systems are open, in which there is a continual exchange of matter, energy and information. Open system have varying degrees input and gives back output in form of matter, energy and information.

41. SUMMARY The reliability of the final tool was established by testing the internal consistency using split-half method was used. The tool was administered to 10 samples (5 control group and 5 experimental group) and the reliability of the tool was established under Spearman Brown’s prophecy formulate method.   The reliability of the structured interview questionnaire was 0.81. After the validation of tool and pilot study, the investigator conducted the main study after obtaining written permission from the concerned authority. The investigator conducted the main study from 03/12/2024 to 17/12/2024 in New public Sr. sec. school, Vigyan nagar , Kota

42. SUMMARY 100 adolescent girls (50 for experimental group and 50 for control group) were selected by convenient sampling technique. A written informed consent was taken separately from each subject. The demographical tool and structured Interview questionnaire was administered for both experimental and control group by using close ended questionnaire to assess the knowledge and attitude regarding hazards of early marriage and early pregnancy among adolescent girls. Data was collected and observed for 100 adolescent girls , out of which 50 adolescent girls were in the experimental group and 50 adolescent girls were in control group.   Immediately after pre-test, information booklet on knowledge and attitude regarding early marriage and early pregnancy was given only for sample in the experimental group. Evaluation of the information booklet was be done by conducting post-test, 7 days after the implementation of information booklet.

43. MAJOR FINDINGS & CONCLUSION In the Experimental group, the pretest subjects scored 31.6% of knowledge score and after implementation of Information booklet they scored 76.84%. The difference is 45.24%. This 45.24% difference in knowledge is the effectiveness of Information booklet. Adolescent girls gained 45.24% of more knowledge due to Information booklet. In the Control group, the pretest subjects scored 32.23% of knowledge score and in the post-test they scored 32.46%. The difference between pre-test and post-test score is 0.23%. Mean and Percentage Pre-test and Post-test attitude score regarding early marriage and early pregnancy between Experimental and control group. In pre-test, experimental group scored 32.0% whereas control group scored 33.0%. It shows that attitude is unfavorable in both groups after pre-test. In post-test, experimental group scored 81.0% whereas control group scored 34.0%. It shows after post-test for experimental group attitude is favorable while for control group it is unfavorable.

44. MAJOR FINDINGS & CONCLUSION The pretest and posttest knowledge score of adolescent girls on early marriage and early pregnancy. In the Experimental group, the pretest subjects scored 31.6% of knowledge score and after implementation of Information booklet they scored 76.84%. The difference is 45.24%. This 45.24% difference in knowledge is the effectiveness of Information booklet. Adolescent girls gained 45.24% of more knowledge due to Information booklet.   The Mean and Percentage Pre-test and Post-test attitude score regarding early marriage and early pregnancy between Experimental and control group. In pre-test, experimental group scored 32.0% whereas control group scored 33.0%. It shows that attitude is unfavorable in both groups after pre-test. In post-test, experimental group scored 81.0% whereas control group scored 34.0%. It shows after post-test for experimental group attitude is favorable while for control group it is unfavorable.

45. MAJOR FINDINGS & CONCLUSION It is evident that the demographic variables such as age in years, educational status, monthly family income and previous sources of information the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis. It is evident that the demographic variable of previous sources of information, the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis. It is evident that the demographic variables such as age in years, educational status, monthly family income and previous sources of information the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis. It is evident that the demographic variable of previous sources of information, the calculated p-value is less than 0.05 (typically ≤ 0.05) at p<0.05 level of significance. It indicates strong evidence for the research hypothesis.

46. LIMITATIONS OF THE STUDY Study sample were limited to the adolescent girls at selected rural areas of Kota hence globalization is limited. Using a purposive sampling which restricted the generalization of the result on whole population. The study was limited to the subjects who were willing to participate and present at the time of study. The size of the sample is limited i.e. 100 adolescent girls (50 experimental & 50 control group) in selected Sr. Sec. schools of Kota (Raj). The study did not assess the skill and practice of adolescent girls residing in selected Sr. Sec. schools of Kota (Raj).

47. RECOMMENDATIONS On the ground of the findings of the study following recommendations has been made: A similar study may be replicated on a larger sample; there by findings can be generalized for a larger population. A comparative study can be carried out among adolescent girls of rural areas and urban areas. Individual case study can be done on early marriage and early pregnancy. A longitudinal study can be done on the same adolescent girls in different setting.

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