RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

“A STUDY TO ASSESS EFEFCTIVENESS OF SELF

INSTRUCTIONAL MODULE ON KNOWLEDGE AND

PRACTICE AMONG ANTENATAL MOTHERS

REGARDING IRON DEFICIENCY ANAEMIA IN

SELECTED HOSPITALS TUMKUR”

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

LATHA.K

IST YEAR M.Sc NURSING

OBSTETRIC AND GYNAECOLOGICAL NURSING

2011-2012

BHARATHI COLLEGE OF NURSING

4TH CROSS, K. R. EXTENSION

TUMKUR1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA FOR THE REGISTRATION OF SUBJECT FOR

DISSERTATION

1 NAME OF THE

CANDIDATE AND

ADDRESS

MISS LATHA K.

1 YEAR M.SC NURSING BHARATHI

COLLEGE OF NURSING , 4TH

CROSS, K.R. EXTENSION , TUMKUR

2 NAME OF THE

INSTITUTION

BHARATHI COLLEGE OF NURSING

4TH CROSS, K.R. EXTENSION ,

TUMKUR

3 COURSE STUDY AND

SUBJECT

1 YEAR M.SC. OBSTETRIC AND

GYNAECOLOGICAL NURSING

4 DATE OF ADMISSION

TO COURSE 22-11-2011

5 TITLE OF THE TOPIC “A STUDY TO ASSESS

EFEFCTIVENESS OF SELF

INSTRUCTIONAL MODULE ON

KNOWLEDGE AND PRACTICE

AMONG ANTENATAL MOTHERS

REGARDING IRON DEFICIENCY

ANAEMIA IN SELECTED

HOSPITALS TUMKUR”

2

INTRODUCITON Cheerfulness is the best promoter of health and is as friendly to the mind as to the

body

Joseph Addision

Cheerfulness during pregnancy makes the child to be healthy “Anemia makes the

mother joyless”

Anemia is defined as low hemoglobin concentration resulting in a

decrease in oxygen carrying capacity or blood according to WHO, Hb level of

11g5 is considered as anemia during pregnancy. Anemia is caused by many factors

such as nutritional deficiency, (iron deficiency topic acid deficiency, protein

efficiency, vit . A deficiency) blood loss, genetic causes, pregnancy, worm

interaction etc.1

Pregnancy causes mainly nutritional anemia, during pregnancy many

physiological changes occur is the cardio vascular system. The plasma volume is

increased and the blood cells are also increased but comparative to the plasma

volume the blood cells are not increased which causes hemodilution. Due to hem

dilution physiological anemia occurs as well as during pregnancy the mother

requires 60mg of iron / day to meet the require on this requirement she develops

iron deficiency anemia. 2

Material iron deficiency anemia is associated with increased weight or size

of the placenta, a condition that may pose a risk for later high blood pressure in the

offspring pregnant women with los hemoglobin levels the iron bearing component

in the blood) have an elevated risk for pre- tern or low birth weight infants

(However, iron , supplement does not appear to have any effect on these

complications) pregnancy is also associated with fluid retention, which in turn

may produce high volumes at plasma (the fluid component of blood) This can

dilute red bloods cells, which may lead to anemia. After delivery, heavy bleeding ,

3

which occurs in 5% to 10% women who have given birth can cause symptoms at

anema.3

The need for bringing down material mortality rate significantly &

improving material health in general has been strongly stress in the national

population policy 2000.. this policy recommends a holistic strategy for bringing

about total interjector co- ordination at the grass root level and involving the

NGOs, civil societal panchayti Raj institutions and women’ Group in bringing

down material mortality ratio and infant mortality rate . 4

In the last decades , the life expectancy of the population in India has

shown remarkable improvement from 41 at birth in 1961 to the present day of 65

years. Yet, over a 100, 000 women in India continue to die of pregnancy related

causes every year, the material mortality Ratio in India is 407 per 1000,000 live

births. The major causes for the these deaths have been identified as hemorrhage

(both ante & post partum), toxemia (Hypertension during pregnancy), anemia,

obstructed lab our, puerperal sepsis ( infections after delivery) and unsafe

abortion. 5

Material mortality is a cause of great concern. However reliable estimates

or maternal mortality are not available. Any interventions to check it will only be

effective It we know reasonably accurate data on material mortality. An expert

group has been constituted in the department of family welfare, which is working

into the modalities of carrying out a survey for collection of data on maternal

mortality. A pilot survey for this has already been completed.6

Pregnancy and child birth are special events in women lives and indeed ,

in the lives of their families . this can be a time of great hope and joyful

anticipation. It can be a time of tear suffering and even death. Women burdened

with ill health will not be able to function as sole or primary care providers for

the children their basic human right to health and development. 7

Pregnancy makes considerable nutritional demands on the mother , as a

consequence anemia is very common, particularly when consecutive pregnancies

4

are not well spaced. The presence of anemia increases morbidity in pregnant, the

risk of infection, the hazards of post partum hemorrhage, anemia is one of the most

common problems of pregnancy. As estimated 20% to 60% of women will be

anemic at some time during pregnancy. 8

The total requirement for a typical pregnancy with a single fetus is

approximately 1000 mg. unfortunately, most women do not have iron stores that

equal this amount. Material health, nutrition & education are important for the

survival and well being of women and are the key determinates of the health and

well being of the fetus. 9

5

2. Need for the study

In the year 2002 , the world health organization day was observed as

would anemia day” In our country, anemia during pregnancy is one of the major

causes of maternal mortality and morbidity. World health organizations (2002)

study on maternal deaths showed that worldwide 64.4% who died had hemoglobin

less than 5 gm% Anemia was the direct cause of death in 10-15% cases but was an

associated cause in 80-85% cases. Many maternal deaths due to hemorrhage sepsis

and cardiac failure . pregnancy anemia is a major public health problem in many

other developing countries . many women start their pregnancy in an anemic state.

National family health service (1998-99) has shown anemia in 54% of rural

women and 46% of urban women in child bearing age . 10

Desai V.S.Status in India , diets which Are predominantly vegetarian &

lacking in animal proteins, rich in pytates and low in ascorbic acid contents , the

bioavailability of iron is poor this coupled with poor iron absorption contributed

to widespread prevalence at own deficiency anemia”.11

Material health care has been a part of the family welfare programme

since it inception. Intermissions were identified and vertical schemes namely the

national nutritional anemia control programme iron deficiency anemia is a global

public health problem that attects women in all stages of the reproductive cycle.12

In spite of improved M.M.R. and I.M.R. due to advances in medicine and

care, our statistical show high incidence of complications due to anemia . This

could be prevented by providing planning teaching programme early detection

in preventing anemia and its complications.

Adequate teaching on anemia can be provided when the patient visits

ANC O.PD and / or is admitted in the maternity ward by nursing staff specialized

in obstetries nursing or midwife with the help of health education and counseling

seminar by using videos, CDs questionnaire, informative booklets etc.

6

In today’s world , iron deficiency anemia is the most common from at

nutritional deficiency affecting the women, particularly who are subjected to

numerous stress attesting their health and well being. Globally , 48% of the

pregnant and 33.3% of non – pregnant women of reproductive age group suffers

from IDA. 13

Iron deficiency anima during pregnancy is notoriously responsible for

intrauterine growth retardation pre- term labor, intra – uterine death, birth of very

low birth weight internal who die soon after leading to high parental morbidity,

bleeding during delivery it is responsible for 30% of maternal deaths during child

birth . 14

It is also contributory factor to the other major reported causes of

maternal death, such as hemorrhage (24%) and sepsis (8%) (world health

organization/ voluntary health association of India, 2000) according to the world

health organization (2001) According to the world health organization . (2001)

anemia has been implicated as contributing in up to 40% of maternal deaths in

third world countries . 15

During pregnancy the maternal plasma volume gradually expands by

50% or an increase of approximately 1200 ml by them. The total 50% or an

increase of approximately 300 ml. this relative hem dilution produces a fall in Hb

concentration . these changes are considered to represent a physiological

alteration of pregnancy necessary for the development of the tutus. Fetal outcomes

appear with an increased incidence of low birth weight and preterm birth in

mothers have either a very low or very high Hb concentration. 16

Regarding the dietary pattern, the lack of dietary knowledge and the lack

of knowledge about anemia consequences leads to many complications during

pregnancy . Anemia vitamin A and iodine deficiency existed as public health

problems in the adolescent pregnant mothers and 46% of the pregnant mothers out

of 151 selected for the study were found anemic. Abel R.et.al,. (2001), vellore,

reported that among 845 pregnant women understudy, the prevalence of anemia

7

(Hb<gr/dl) was 56,6%, 70.2% and 69.85% respectively among the first trimester

the among the second and third trimester women, which was less than the

recommended value of 11g/ dl. Iron deficiency was significantly more among the

third s trimester women than first.

The adverse effect of anemia in maternal and total outcomes are

associated with adverse material outcome such as puerperal sepsis , ante- partum

hemorrhage, postpartum hemorrhage and maternal mortality is common and it is

also responsible for increased incidence or premature births, low birth weight

babies and high prenatal mortality.11

The researcher recommended preventive nutritional supplementation

throughout the reproductive life style which focuses mainly on iron and folic acid.

The researcher round out that supplement of 40 mg. ferrous iron/ day from 18

weeks of gestation appears adequate to prevent iron deficiency in 90% of the

women and iron deficiency in 95% of the woman during pregnancy and post

partum. 19

According to the WHO estimates, the prevalence of nutritional anemia in

Indi is 50-80% in women and 70-90% in pregnant women (Gupta , 2003) Indrani

T.K. (2003) reported the incidence of anemia to be 40 to 80% with HB below 10

gm/% an 10-20% which severe anemia in western parts of the country , National

health programmes in India (2005) reported the prevalence of nutritional anemia

in India 88% for adolescent girls and 85% for pregnant women . Based on the

findings , the authors advocated that optimum dose of iron should be 120 mg.

instead of 60 mg. as is currently being in the national nutrimental anemia

prophylaxis programme. 20

National health programmes in India (2005) reported that national

nutritional Anemia prophylaxis programme which is now a part of RCH- II

program prophylactic treatment for expected and nursing mothers are given one

tablet containing 00 mg elementary iron and 0.5 mg folic acid. Nutrition

education to improve dietary intakes in family for receiving needed macro/ micro

8

nutrients as protein, iron and vitamins like folic acid , B. Complex etc. for

hemoglobin synthesis is important . The Tamil Nadu integrated Nutrition project

was started in 1980 targeting at 6-36 months old children and pregnant and

lactating women. The objective was to reduce anemia from about 55% to about

20% through nutritional services, Health services, communication and monitoring

and evaluation. The projects were assisted by world Bank and with the goal or

universalization of ICDS. All the TINIP blocks were converted into ICDS. 22

Further , it also felt that the compact disc can bemused by anyone and

anywhere it is standardized hence, the investigator was interested in preparing

the CD and testing it for its usefulness in improving the self learning by the

antenatal mothers on prevention of anemia.

9

3. REVIEW OF LITERATURE A literature review is a written summary of the state of existing knowledge on a

research problem. The talk of reviewing research literature involves the

identification, selection , critical analysis and written description of existing

information on a topic. 23 (polit and Hungler, 2003)

Review of literature involves the selection of available documents on the

topic , which contain information, idea data and evidence wirtten from a

particular stand point to fulfill certain aims or express certain views on the

nature of the topic an how it is to be investigated and the effective evaluation of

these documents in relation to the research being proposed . 24 (Hart, 1998)

The review of literature is related to

1) Prevalence of anemia during pregnancy

2) Effects of iron deficiency anemia during pregnancy

Related to mother

Related to fetus

3) Knowledge of mother on prevention of anemia

4) Importance of education in the prevention of iron deficiency anemia

5) Nurses role in prevention and control of anemia.

Incidence of prevalence of anemia during pregnancy.

In today’s world iron deficiency anemia is the most common form of

nutritional deficiency affecting the women, particularly who are subjected to

numerous stress affecting their health and well being globally, 48% of the

pregnant and 33.3% of non pregnant women of reproductive age group

suffers from iron deficiency anemia . 25

A study was conducted on A guide to primary care of iron deficiency

anemia” which stated that iron deficiency.

The most common cause of anemia is prevalent in 10% to 30% of the

world’s population inadequate intake of iron may be an important causative

factor particularly when the body requires more iron than usual . The popular

10

increase of fiber in diets may increase incidence of iron deficiency anemia

because too much fiber in the diet renders available iron unabsorbable. 26

WHO expert group recommended that pregnant women hemoglobin level

below 11 gm% (per 33%) should be considered anemic in practice , in India a

level of 10-%gm may be more realistic. Anemia is a clinical feature and not a

disease . it is a major public health hazard in India were nearly 40- 90% of

pregnant women are considered anemic . It contributed directly to 20% of

maternal deaths and indirectly to a further 20%.27

A study conducted on “Nutritional anemia and its control” in IGNOU,

New Delhi which revealed that prevalence of nutritional anemia in India shows

that 85% pregnant women (9.9% having severe anemia) were anemic . Nutrition

education to improve dietary intake in family for receiving needed macro/

micro nutrients as proteins, iron and vitamins like folic acid, B12 , A and C, for

hemoglobin synthesis is important . 28

The researcher stated that iron deficiency anemia is the most common clinical

problem in all parts of the word and an enormous public health problem in a

developing country like India. As many as 4-5 million people , 66-80% of the

world’ population , may be iron deficient, 2 billion mainly due to iron deficiency

and in developing countries., frequently exacerbated in malaria and worm

infestations..29

Knowledge of mothers on prevention of anemia

A study was conducted to determine the effectiveness of self instructional

module regarding high risk factors for the antenatal mothers. So pregnant

women were selected based on their attendance in antenatal clinic the findings

of the study showed that these women had inadequate knowledge regarding iron

deficiency anemia .28

A study was conducted to evaluate the level of knowledge about the

influence of diet during pregnancy in relation to their eating habits stated that

the majority of women does have knowledge on the influence of diet and the

11

influence of her nourishment before pregnancy on the development of fetus,

however, it hardly results in the charge of their eating habits.29

A study was conducted on prevention and control of anemia in pregnant

women in rural areas of Haryana, India. It included 360 pregnant women.

Knowledge, attitude and practice survey was carried out. The findings of the study

revealed that all of them lack knowledge regarding iron rich diet specially the

jiggery and pulses.30

Importance of education on prevention of iron deficiency anemia

The study was conducted on developing an anemia management protocol state

that anemia is best manages with an effective protocol that provides

standardized guidance for clinical interventions while maintaining the flexibility

to respond to the needs of individual patients. An anemia management protocol is

very helpful for the nurses for prevention and control of anemia. 31

A study was conducted on nursing care to pregnant women with iron

deficiency anemia stated that nurses role in setting up a protocol of data survey

and to screen out the anemia cases by proper planning can be a useful measure

for the prevention and control of iron deficiency anemia . 32

A study was conducted on health education to prevent anemia among

women of reproductive age in southern India concluded that those women who

received health education where they lived, from health workers they knew, and

together with participants familiar to them learned more about anemia

prevention than others. 33

Nurses role in prevention and control of anemia.

A study was conducted the optimum dose of supplemental iron for

prophylaxis against authors advocated that based on the findings, the authors

advocated that based on the findings , the authors advocated that based on the

findings , the authors advocated that optimum dose of iron should be 120 mg

instead of 600 mg as is currently being used in the national nutritional Anemia

prophylaxis programme. 34

12

The researcher quoted that every women needs iron supplementation

during pregnancy. Government of India has evolved National Anemia

prophylaxis programme which is operational since 1972 and it is aimed at

distribution of iron tables containing 60 mg of elemental iron and 500 mg. of

topic acid daily during last 100 days of pregnancy. 35

13

4. STATEMENT OF THE PROBLEM “A study to assess effectiveness of self instructional module on knowledge and

practice among antenatal mothers regarding iron deficiency anemia in selected

hospitals , Tumkur.”

5. OBJECTIVES OF THE STUDY To assess the knowledge of the antenatal mothers regarding iron

deficiency anemia before and after implementation of self instructional module.

To assess hemoglobin level of the antenatal mother s before and after

implementation programme to assess the effectiveness of self instructional

module.

To find out the association between level of knowledge and

demographic variables.

To find out the association between hemoglobin level in pre and post

test with the various demographic variables.

6. OPERATIONAL DEFINITIONS Assess: Statistical measurement of the level of hemoglobin among antenatal

mother as observed from the scores based on sahli method of blood test.

Effectiveness : It is the significant improvement of knowledge and practices

on antenatal mothers with regard to iron deficiency anemia after the

implementation of the self instructional module as evidenced by the differences in

the pre test and post test scores.

Self instructional module: It j refers to systematically organized definition.

Etiology, signs and symptoms management and prevention of iron deficiency

anemia.

14

Anemia : The condition having less than the normal number of red blood cells or

less than the normal quantity of hemoglobin in the blood. The oxygen carrying

capacity of the blood is therefore decreased.

Antenatal Mothers:

Women who are in the period between conception and birth are called as antenatal

mothers.

Knowledge ; knowledge is defined variously as (1) expertise, and skills acquired

by a person through experience or education ., the theoretical or practical

understanding of a subject (ii) what is known in a particular field or in total; facts

and information or (iii) awareness or familiarity gained by experience of a fact or

situation. The sum of what is known regarding anemia

Practice: refers to the actual activities by the antenatal mothers to prevent anemia.

In the present study the practices are measured by two wages. One is by collecting

the verbal response of the antenatal mothers in the following areas.

Diet : regular course of dating and drinking adopted by a person or animal this

does not include diet therapy, a specific diet prescribed in the treatment of a

disease.

7. ASSUMPTION :

Antenatal mothers may have inadequate knowledge regarding iron

deficiency anemia.

Self instructional module may have effect on knowledge of mothers

regarding iron deficiency anemia.

15

8. HYPOTHESIS H1. : There is no significant difference between pretest and posttest knowledge

and hemoglobin level of antenatal mothers,

H2 : There is no significant association between the post test knowledge and

hemoglobin level o f the antenatal mothers and selected demographic variables.

9. MATERIALS AND METHODS

9.1 Sources of Data

Data will be collected from mothers in selected hospitals Tumkur .

Research approach : Pre- experimental approach

Research Design : One group pretest and post test research design

Setting of the study : Study will be conducted at selected hospitals ,

Tumkur

Sample Technique : Simple random sampling technique

Sample Size : 70

Selected variables :

Independent variables : Self instructional module

Dependant variables : Knowledge of mothers regarding iron

deficiency anemia

Demographic variables : Age, education, religion, and monthly income

Population : Antenatal mothers who were visiting

maternity centre for antenatal check- up during

the period of data collection.

16

Sample Criteria

Inclusion criteria : Antenatal mothers who are

1. primigravida and multigravida

2. willing to participle in the study .

3. Age group of 18 – 30 years

4. who are able to understand and speak

kannada/ English

Exclusion criteria : Antenatal mothers who are

1. Not willing to participate in the study

2. Not available at the time of data collection .

9.2 Methods of data collection

A written permission will be obtained from the administrative authority prior to

the onset of the study the purpose of the study and the method of data collection

will be explained to the participants and informed consent will be taken

Confidentiality will be assured to all subjects to get their co- operation . Data

will be collected from 70 months s per the inclusion criteria of the study. At the

end of the post- test subjects will be thanked for their co- operation.

Tool for data collection : The tool consists of following sections.

Section A : Demographic Performa of mothers like age, educational status,

religion and monthly income.

Section : B structured self administered questionnaire to assess the knowledge of

mothers regarding iron deficiency anemia.

Section C : self instructional module on iron deficiency anemia.

Method of data analysis and interpretation

The data collected will be analyzed by using descriptive and inferential statistics,

17

Descriptive statistics

Number, percentage ,mean and standard deviation to describe the demographic

variable. To assess the knowledge of pre test and post test.

Inferential statics

Paired ‘t’ test analyzing the effectiveness between the pre and post test. Chi

square test analyzing the association between demographic characteristics with

the knowledge about iron deficiency anemia and hemoglobin level in pre and post

test.

Duration of the study: Six week

9.3 Does the study require any investigation or intervention to be conducted on

the patient or other human beings or animal? Yes, informed consent will be

obtained from the mothers.

9.4 Has ethical clearance has been obtained from your institution ?

Yes, permission will be obtained from ethical committee’s report.

18

10.BIBLIOGRAPHIC REFERENCES :

1. Mudaliar and menon’s clinical obstetrics , 10th ed. Orient longerman pvt. Ltd.

Publication : 2005

2. Ruth benette, V myles text book for midwives, 13th ed., Churchill living stone. :

2003

3. Varneys Text book of midwifery. 4th ed. USA jones and Brannett publishers :

2005

4. Mahajan B.K. Gupta M.C. Text book of preventive and social medicine, 2nd ed.

Jaypee publishers; New Delhi: 1995

5. Padubidir, principles and practice of obstetrics, 2nd ed. Published by

mannzarkhan : 1999

6. Sunar Rao Kasthuri. An introduction to community health nursing , 4 th ed . B.I

Publications: New Delhi :2004.

7. Wong and perry . Maternal and child nursing care library of congredd

cataloging in publications data 2006

8. Indian nursing jounal year book. The Trained Nurses association of India .

1996-97

9. Sharon, Mily foundations of materials new born nursing , 4 th Ed jett Patterson

publications 2006

10. Guindi. W . et al severe maternal anemia and pregnancy out come journal

gynecology obsterics biology reproduction. 2004. oct available from : URL : http /

www. Google. Com.

11. Desai V.S Anaemia in pregnancy – A medical problem of the under

developed world. International journal of gynecology and obstetrics . India : 200

12. Hyder S.M. etal . An Anaemia and Iron deficiency during pregnancy in Rural

Bangladesh. Journal of Public health nutrition . Dec 2004. Available from : URL :

http / www. Google.com

19

13. Administrative committee on co- oridinational / sub committee on nutrition –

Nutrition through out of the life cycle . 4th report on the world nutrition situation :

2000.

14. D.C. Dutta Text book of obstetrics . 5th ed published by new central book

agency: 2003

15. world health organizational / voluntary health association of India

reproductive health National protile on women’n health and development India .

New Delhi : 2000

16. Rammonson K. Physiological changes during pregnancy . Journal of

obsterics and gynecology. October . 2006. available from URL : http/ www.

Google.com

17. Kazlowska et.al. Dietary knowledge nd practice in pregnant women 2002.

18. Indian journal of community medicine . 2002.

19. Fernandez – Ballart. J. Murphy. M.M. 2001 . Preventive nutritional

supplementation throughout the reproductive life cycle – public health nutrition,

2004 Dec- Jan Available from: URL : http/ / www google.com

20 Gupta Neeru. Maternal motality, magnitude causes and concerns. Journal of

obstetrics and gynecology . sep. 2006. available from URL : http/ /

www.google.com

21. Park. K essential of community helath nursing . 14th ed. Banarsidas Banot

Publishers : Jabalpur; 2004.

22. Kishore . J National Health programmes in India ., 5 th ed century

publications : New Delhi: 2005.

23. Polit and Hungler. Nursing research. 1st ed. 2003

24. Hart. Textbook of research methodology , 2nd ed.

25. Administration committee on co- ordination/ subcommittee on Nutrition .

2000. Available from : URL : http // www.google .com

26. Bushneel F.K. A guide to primary care of iron deticiency anemia. 3rd ed. 2003.

20

Velpandian. T Potential impact of carbonyl iron supplementation during

pregnancy and iron deficiency anemia. International Journal of Gynecology and

obstetrics India Aug. 2003 . Available from : URL : http/ www. Google. Com

28. Devi Lakshmi, effectiveness of self instructional module for antenatal mother

regarding selected high risk factor during pregnancy in a a selected primary

health centre, unpublished master thesis ; 2000

29. Kalowska et. Al., Dietary knowledge and practice in pregnant women 2002

30. Raina N. Gupta A sharma prevention and contra of Anemia in pregnant women

and adolesunt girls in rural areas of Haryana – India reproductive health focus :

survival for Women and children foundation . Report of mother care project India

1999.

31. Amgen Inc. developing an anemia management protocol case study of the

anaemic patient. Anna journal . Dec 1997. Available from : URL : http / / www.

Google .com

32. Barros. S.M. Costa C.A Nursing care to pregnant women with iron deficiency

anaemai. Americal Journal of Nursing Nov. 2005. Available from : URL : http/ /

www. Google.com

33. NYP , Dejiin- Karlsson et. Al Health education to prevent anaemi a among

women of reproductive age in southern India . Sweden, Health care women’s

2006. Feb available from: URL ; http// www. Google. Com

34. Reddaiah . V.P supplementary iron dose in pregnancy anaemia prophylaxiz.

Indian journal of pediatrics. 1999 Jan – Feb

35. Shirish. N. Dattary, Sudip. Manual of obstetrics. 16th ed. NOIDA Elseview p 9

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9.Signature of the candidate :

10. Remark of the guide :

11. Name and designation of

11.1 Guide : Prof:A. Mercy Rani

.

11.2. Signature :

11.3. Co-guide :

11.4. Signature :

11.5. Head of the department : Prof: A.Mercy Rani

11.6. Signature :

12.1. Remarks of the principal :

12.2. Signature :

22