INTRODUCTION:

The act of giving birth is the only moment when both pain and pleasure converge at a moment of time. This experience of transformation from womanhood or wifehood into motherhood is a privilege reserved exclusively for women. Hence this transformation phase that is pregnancy and following childbirth has been contributed to have a great impact on both maternal and infant health.

In any community, mother and children constitute a priority group; they comprise approximately 71.14% of the population of the developing countries. In India women of the child bearing age constitute 22.2% and children under 15 years of age about 35.3% of the total population together they constitute nearly 57.5% of the total population. Mother and children not only constitute a large group but they are also a vulnerable or special risk group. The risk is connected with child bearing in the case of women and survival in case of children.

Global observation shows that in developed regions MMR averages at 13/100,000 live births, in developing regions the figure is 440 for the same number of live births. From commonly accepted indices, it is evident that infant, child and MMR are high in many developing countries. Further much of the sickness and deaths among mother and children is largely preventable by improving the health of the mother and children. India contributes around 20 percent of global births. Each year in India, roughly 30 million women experience pregnancy and 27 million have a live birth. Of these, an estimated 1, 36,000 maternal deaths and one million new born deaths occur each year, thus pregnancy-relatedmortality and morbidity continues to take a huge toll on the lives of Indian women and their new born. These considerations have led to the formulation of specific health services for mother and child in India.

An evaluatery study done at Maharashtra by P. P. Doke & team concludes that 56% of eligible women had heard about PMMVY scheme. The awareness was 60.30% among eligible women in tribal area & 50.34 % in non-tribal area. (11) Study done by K Singh at Achrol PHC, Rajasthan shows that only 64.55% of women were aware about PMMVY. Study done at rural Karnataka also shows very low that is only 18.6% awareness about PMMVY. Study done by Vinaya Kumary T and Shantha Kumari K at Mangalore also shows that the majority of the antenatal mothers (61%) moderate knowledge, 36% had poor knowledge, 2.5% had very good knowledge and no mothers had good knowledge. Above all studies are related to government schemes which provide cash benefit to antenatal and postnatal mothers show that there is a lack of knowledge causing less utilization of schemes among beneficiaries.²

NEED FOR THE STUDY:

Every pregnant woman hopes for a healthy baby and an uncomplicated pregnancy. However, every day, about 1,500 women and adolescent girls die from problems related to pregnancy and childbirth. Every year, some 10 million women and adolescent girls experience complications during pregnancy, many of which leave them and/or their children with infections and severe disabilities.

According to WHO, globally estimating the maternal mortality rate, over 5,00,000 die every year and in those 1,500 women in a day because of complications of pregnancy and childbirth. Each year, approximately eight million women suffer pregnancy-related complications and over half a million die. Some 99 percent of all maternal deaths occur in developing countries. Two thirds of maternal deaths in 2000 occurred in 13 of the world's poorest countries. During the same year, India alone accounted for one quarter of all maternal deaths.³

According to Statistical Report, Registrar General of India, Maternal Mortality Rate (MMR) of India in 2001-2003 was 301 per lakh live births. The state of maternal, new born and child health in India is of global importance; in 2005, more than 78,000 (20%) of 387 200 maternal deaths, and more than 1 million (31%) of 3•4 million neonatal deaths occurred in India. The maternal mortality ratio declined from about 520 per 100,000 live births in 1,990 to nearly 290 per 1,00,000 in 2005 and the neonatal mortality rate decreased from 54 per 1000 live births in 1990 to 38 per 1000 in 2005. Despite this progress, the numbers of maternal and neonatal deaths remained high in south East Asia.

According to 2007 statistics the infant mortality rate in India was 34.6 deaths per 1000 live births. The national average maternal mortality rate lies between 420- 540/1 lakh live births. It isrecognized that Rajasthan is the state, which has highest MMR in India, i. e., 670/one lakh live births Pregnant women die in India due to a combination of important factors like, poverty, ineffective or unaffordable health services, lack of political, managerial and administrative will. All this culminates in a high proportion of home deliveries by unskilled relatives and delays in seeking care and this in turn adds to the maternal mortality ratios. The institutional delivery or delivery by skilled personal plays major role in reducing MMR and IMR. In India, while 77% of pregnant women receive some form of antenatal check-up, only 41% deliver in an institution. Even though all services are free only 13% of the lowest income quintile delivers in a hospital.

A cross-sectional study was conducted to determine the performance of institutional and non- institutional deliveries among 400 households in the slums of Delhi. The results revealed that non-institutional deliveries were found to be about 46 percent. Factors such as ―economic status‖ were identified as the ones for preference for non-institutional deliveries. The researcher further concluded that improvement in the economic condition of the people may promote- institutional deliveries. Hence researcher felt that there was a need to assess the knowledge of mothers regarding Pradhan Mantri Matru Vandana Yojana as it provides financial assistance to the mothers.

In Karnataka the maternal mortality rate is 195/one lakh live births and ranks third among states. According to the SRS 1997, IMR in Karnataka is 52/1000 live births. In Gulbarga district, the maternal mortality rate is 195 for every 1000 deliveries and the infant mortality is 55 for every 1000 deliveries. The infant mortality rate in Udupi District is eight/1000 whereas maternal mortality rate is 65/one lakh. In Mangalore the IMR is 65.5 deaths/1000 live births with MMRof 1-10/2500 live births.

The poor health of the mother, including diseases that were not adequately treated before or during pregnancy, is often a factor contributing to new born deaths or to babies born too early and/or with low birth weight, which can cause future complications. Governments have aresponsibility to ensure that every woman has access to quality maternity care, including prenatal and post-natal services.

In April, 2005, in response to the slow and varied progress in improvement of maternal and neonatal health, the Government of India launched Pradhan Mantri Matru Vandana Yojana an additional conditional cash transfer scheme to incentivize women of low socioeconomic status to give birth in a health facility. The ultimate goal of the programme is to reduce the number of maternal and neonatal deaths. PMMVY had a great impact in reducing maternal and newborn health morbidities and mortalities. Since the launch of PMMVY, the numbers of institutional deliveries have started increasing. Against the 27.61 Lakh beneficiaries in 2006- 07, the number of beneficiaries jumped to 53.13 Lakh in 2007.⁴

Many women, including adolescents, have difficulty accessing quality health care due to poverty, distance, lack of information, inadequate services or cultural practices. A community based cross-sectional study Conducted from Jan 2009 to Dec 2009 among 3212 women to explore the reasons of Missed opportunities of Pradhan Mantri Matru Vandana Yojana benefits among the beneficiaries of Solapur slum area Out of 3,212 women 360 (11.20%) were eligible for getting the benefit of Pradhan Mantri Matru Vandana Yojana.

Among the 360 only 118 (32.78%) women got the benefit of PMMVY while, 242 (67.22%) missed the opportunity of getting PMMVY benefit due to Lack of information of PMMVY in 37.19% women followed by difficulty in getting the documents and card was not-filled in time by ANM were the common causes in 25.62% and 15.29% women respectively. finding shows the poor IEC efforts in the implementation of PMMVY, divulging most of the poor eligible women from their rights of PMMVY benefits. Hence, continuous IEC activity with active involvement of health service provider like ANM, MPW is needed. So, there is a need to assess the knowledge of antenatal-mothers regarding Pradhan Mantri Matru Vandana Yojana and thereby imparting the knowledge about the healthcare facilities provided by the government.⁵

OBJECTIVES:

· To assess the pre-test Score of knowledge regarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers.

· To assess the post-test Score of knowledge regarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers.

· To Evaluate the effectiveness of structured teaching programme on knowledgeregarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers.

· To find out the association between pre-test knowledge score regarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers with their socio demographic variables

HYPOTHESIS:

H1: There will be significant difference between pre test and post test knowledge regarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers

H2: There will be significant association between pre test knowledge score regarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers with their socio demographic variables.

CONCEPTUAL FRAMEWORK:

Conceptualization is the process of forming ideas, design, and plans. A conceptual framework deals with concepts assembled together by virtue of their relevance to the research problem, which provides a certain frame of reference for clinical practices, research and education. It gives direction for planning research, design, data collection and interpretation of findings.

According to Polit and Hungler a conceptual framework is a set of broad ideas and principles taken from relevant field of inquiry and used to structure a subsequent presentation. It carries potential usefulness as a tool to scaffold research and assist researcher to make meaning of subsequent findings.

The conceptual framework represents less formal attempt at organizing a phenomenon. Conceptual models with abstractions concepts that are used as building blocks and provide a conceptual perspective regarding interrelated phenomena, which are closely structured.⁶

Theoretical framework provides of variables, suggesting ways or methods to conduct study and guiding the interpretation, evaluation and integration of significant findings.

The present study aims at determining the effectiveness of structured teaching programme on knowledge of antenatal mothers regarding Pradhan Mantri Matru Vandana Yojana. The theoretical framework for the present study is developed from King‟s theory of goal attainment (ImogeneM King). The model is modified to suit to the present study. The model comprises of 2 primary components that include

1. Perception

2. Judgment

· Action

· Reaction

· Interaction

· Transaction

SAMPLING TECHNIQUE:

The participants of the present study are selected by using stratified non probability purposive sampling technique in which the research will select the participant.

Sample Size:

In the present study the sample size consists of 60 anti natal mother of selected hospital of durg district (C.G).

Variables:

According to POLIT AND HUNGLER, variable is an attribute of a person or an object that varies, that it takes an different values. Two type of variable are identified in the study. They are dependent variable and independent variables.

Dependent Variable:

In the present study to assess the effectiveness of structured teaching programme on knowledge regarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers at Selected hospital of Durg C.G.

Independent Variables:

In the present study to assess the knowledge regarding Pradhan Mantri Matru Vandana Yojana among antenatal mothers at Selected hospital of Durg C.G.

Sampling Criteria:

Inclusion Criteria:

1. Antenatal Mother living in hospital area.

2. Antenatal Mother who are willing to participate in the study.

3. Antenatal Mother who can understand Hindi language.

4. Antenatal Mother who were present at the time of study.

Exclusion Criteria:

1. Antenatal Mother

2. Antenatal Mother who are not willing to participate in the study.

3. Antenatal Mother who cannot understand Hindi language.

4. Antenatal Mother who were not present at the time of study.

Description of the Tools:

The self structured questionnaires were organised in two sections-

Criterion Measures:

The question prepared for assessment of knowledge on food adulteration and food adulterant detection. The score categorized as:

· Good - 21 to 30

· Average – 11 to 20

· Poor – 1 to10

Method of Data Collection:

The data collection was done for 4 weeks period. After obtaining informed and willing from the study participants the study was conducted at the Mekhara hospital district durg (C.G.) total of 60 samples data were collected.

According to Kerlinger F. N. (2003):

Defines analysis as the “categorizing, ordering, manipulating and summarizing the data to obtain answer to the research questions.”

The purpose of analysis is to reduce data to enligle intelligible and in interpretable from, so that the relation of research problem can be studied and tested Analysis is a process which entering in the one form on the other in the very beginning. To avoid making conclusion or interpretation from insufficient or invalid data, the final analysis must be anticipated in details, when plan begins making for information. This chapter presentsthe analysis and interpretation of data collection to assess the effectiveness of structured teaching programme on knowledge regarding Pradhan Mantri Matru Vandana Yojana among antenatalmothers at selected hospital of Durg C.G.

The data analysis is carried out based on the objective set by the researcher. The collected data were organized, tabulated, analyzed and interpreted by the statistical table and graphs.

Section 1: Distribution of subject according to socio demographic variable by frequency and percentage.

Table 1: Percentage Distribution of Subjects According to Age

N=60

S. N.	Age (in Years)	Frequency (f)	Percentage (%)
1.	19-23	18	30
2.	24-28	22	36.6
3.	29-33	20	33.4
4.	Above 34	0	0
	Total	60	100

Table 2: Percentage Distribution Of Subjects According To Religion

N=60

S. No.	Religion	Frequency(f)	Percentage (%)
1.	Hindu	44	73.3
2.	Muslim	8	13.3
3.	Christian	5	8.3
4.	Sikh	3	5
	Total	60	100

Table 3: Distribution of Subjects According to Type of Family.

N= 60

S. No	Type of family	Frequency (f)	Percentage (%)
1.	Joint	40	66.7
2.	Nuclear	20	33.3
	Total	60	100

Table 4: Distribution of subjects according to Gravida

S. No	Gravida	Frequency (f)	Percentage (%)
1.	Gravida 1	40	66.7
2.	Gravida 2	20	33.3
	Total	60	100

Table 5: Distribution of Subjects According to Educational Qualification of Mother. N= 60

S. No	Educational Qualification of mother	Frequency (f)	Percentage (%)
1.	Primary	19	26.6
2.	Secondary	21	30
3.	Higher secondary	10	21.7
4	Graduate and above	10	21.7
	Total	60	100

Table 6: Distribution of subjects according to occupation of mother. N= 60

S.No	Occupation of Mother	Frequency (f)	Percentage (%)
1.	Housewife	24	40
2.	Daily wage earner	18	30
3.	Private job	8	13.33
4.	Govt. Job	10	16.66
	Total	60	100

Table 7: Distribution of Subjects According to Family Monthly Income. N= 60

S. No	Family monthly Income	Frequency (f)	Percentage (%)
1.	Below 5,000	9	15
2.	5,001-10,000	13	21.7
3.	10,001-15,000	25	41.6
4.	More than 15,000	13	21.7
	Total	60	100

Table 8: Distribution of Subjects According to History of Still Birth in Family N= 60

S. No	History of still Birth in family	Frequency (f)	Percentage (%)
1.	Absent	55	91.66
2.	Present	5	8.33
	Total	60	100

Table 9: Distribution of Subjects According to Previous Knowledge

N= 60

S. No	Previous knowledge	Frequency (f)	Percentage (%)
1.	Yes	21	35
2.	No	39	65
	Total	60	100

Table 10: Distribution of Subjects According to Source of Information. N= 60

S. No	Source of Information	Frequency (f)	Percentage (%)
1.	Relative	9	15
2.	Friends	12	20
3.	Health worker	13	21.66
4.	Media	25	41.66
	Total	60	100

SECTION- IV:

Table-13: Chi square analysis to find out the association between knowledge score with their selected socio-demographic variables. N= 60

S. N	Sample characteristics	Level of pre test
		Very good				Good						Average									chi squa re test		df		Tabl e valu e		Inference
		f	%			f			%			f			%			N
1.	Age (In years)
	19 to 23 year	13	21.6 %			3			5%			2			3.33%			18			2.31		4		12.59		Not Significant
	24 to 28 year	13	21.6%			6			10%			3			5%			22
	29 to 3 year	12	20%			7			11.6%			1			1.66%			20
	34 and above	0	0			0			0			0						0
2	Religion
	Hindu	32	53%			10			16.66%			2			3.33%			44			13.13		6		12.59		Significant
	Muslim	2	3.33%			3			5 %			3			5%			8
	Christian	3	5%			2			3.99%			0			0%			5
	Shikh	1	1.6%			1			1.6%			1			1.6%			33

3	Type of family
	Joint	24	40%			12			20%			4			6.66%			40			0.22		2		5.99		Not Significant
	Nuclear	14	23.33			4			6.66%			2			3.33%			20
	Gravida
	Gravida 1	24	40%			11			18.33%			5			8.33%			40			0.98		2		5.99		Not Significant
	Gravida 2	14	23.33%			5			8.33%			1			1.6%			20
5.	Educational qualification of Antenatal mother
	Primary	15	25%			3			5				1			1.66%			19			6.04		6		12.59	Significant
	Secondary- school	13	21.666%			5			8.33%				3			5%			21
	Higher secondary	15	8.33%			3			5%				2			3.3%			10
	Graduate	5	8.33%			5			8.33%				0			0			10
6.	Occupation of mother
	Housewife	13		21.66%			8			13.3%			3			5%			12			1.69		6		12.59	Not significant
	Daily wage earner	13		21.66%			4			6.66%			1			1.66%			18
	Govt. job	5		8.33%			2			3.33%			1			1.66%			8
	Privet Job	7		11.66%			2			3.33%			1			1.66%			10
7	Family monthly income
	Below 5,000	5		8.33%			3			5%			1			1.66%			9			3.81		6		12.59	Not significant
	5,001-10,000	10		16.66%			2			3.33%			1			1.66%			13
	10,001-15,000	17		28.33			6			10%			2			3.33%			25
	More than 15,000	6		10			5			8.33%			2			3.33%			13
8	History of still birth in family
	Absent	37			61.66%			13			21.66%		5			8.33%			50			4.54		2		5.99	Not significant
	Present	1			1.6%			3			5%		1			1.66%			5
9	Previous knowledge
	Yes	13			21.66%			7			11.66%			1			1.66%			21		1.41		2		5.99	Not Significant
	No	25			14.66%			9			15%			5			8.33%			39
10	Source of information
	Relative	6			10%			2			3.33			1			1.6%			9		0.44		6		12.59	Not Significant
	Friends	8			13.33%			3			5%			1			1.6%			12
	H. W	9			15. %			4			6.66%			1			1.6%
	Media	15			25%			7			11.6%			3			5%			25

S. No	Category	Pre-test				Post test
		(f)	(%)	Mean	Mean score %	(f)	(%)	Mean	Mean score %
1.	Poor (0-10)	38	63.33	5.18	17.26%	0	0	0	0
2.	Average (11-20)	16	26.66	4.35	14.5%	32	53.33	8.18	27.26%
3.	Good (21-30)	6	10	2.23	7.36%	28	46.66	10.4	34.66%
	Total	60	100	11.76	39.42%	60	100	18.58	61.92%

Knowledge	Mean	SD	D f	Paired t test	P value	Table value	Inferences
Pretest	11.76	5.30	9	11.41	0.001	3.46	Significance
Posttest	18.58	4.43	9	11.41	0.001	3.46	Significance