A Study to Assess the Knowledge on Constipation among the Mothers of Infants Attending S.V.R.R.G.G.H, Tirupati, with a View to Develop an Information Booklet

 

Ms. Ruth Grace Mallela

Lecturer, Sree Narayana Nursing College, Nellore.

 

ABSTRACT:

A descriptive design was conducted to assess the knowledge and knowledge on practice regarding constipation of infants among the selected mothers at S.V.R.R.G.G.H, Tirupati. Quantitative approach with non experimental research design was adopted for the study. 100 mothers of infants were selected by using non probability convenient sampling technique and assessed their knowledge by using structured questionnaire. Information booklet was provided regarding prevention of constipation among infants.

 

The results shows that out of 100 mothers of the infants, 28% (28) have inadequate, 70% (70) have moderate and 2% (2) have adequate level of knowledge on constipation. There was a statistically significant association exists between the levels of knowledge on constipation with the age of the infant, age of the mother, education of the mother and the father, occupation of the father, family income per month, diet of the mother, diet of the infant and the type of stool passed by the infant at p<0.01 level, and  knowledge on practices regarding prevention of constipation among mothers with the age of the infant, age of the mother, religion, education of the mother and the father, occupation of the mother and father, caretaker of the infant, family income per month, place of residence, diet of the infant and the type of stool passed by the infant at p<0.01 level, gender of the infant, type of the family and diet of the mother at p<0.05 level.

 

 

 

INTRODUCTION:

The wealth of the nation is in the health of its population. Children constitute of 40% of the total population of the world.¹ Infants (the age group between 0-1 years) constitute 2.92% of the total population in India. Infants need appropriate care for survival and healthy development. Infant mortality rate according to the 2012 estimate is 46.07/1000 live births. The major concern in the infancy, apart from the communicable diseases is feeding related problems.²

 

Constipation is defined as the difficulty in passing stool for longer than a normal time between the bowel movements. Joseph.M.Croffe in 2006 stated the constipation is a common problem throughout the world. It occurs about 0.3% to 28% of children worldwide.³

 

Infants have a mean of 4 stools per day during the first week of life. This frequency gradually declines to a mean average of 1.7 stools per day at 2 years of age and 1.2 stools per day at 4 years of age. Some normal breast-fed babies do not have stools for several days or longer. After 4 years, the frequency of bowel movements remains unchanged.⁴

 

S.No	Age	Bowel move-ments per week	Bowel movements per day
1	0-3 Months Breast-fed Formula fed	5-40 5-28	2.9 2.0
2	6-12 Months	5-28	1.8
3	1-3Years	4-21	1.4
4	More than 3 Years	3-14	1.0

Adopted from Fontana M Bianch C, Cataldo F, et al. Bowel frequency in healthy children. Acts  Paediatr Scand 1987;78:682-84

 

In the first two or three days of life, it would be typical for a baby to pass feces two or three times and wet the diapers oddly. As the mother’s milk increases, his urine output increases. The bowel movements within the six months are more in the breast fed infants than in the artificial fed infants.⁵ Most childhood constipation results from intentional withholding of stool following a painful experience with defecation.³

 

Constipation in a breast fed baby is a very rare condition. Human milk is the best option for infant nutrition upto 1 year of age. Breast milk consists of a number of micronutrients, that are available in quantities and qualities that make them easily digestible by the new born’s intestines and observed for energy and growth. Human milk also contains two proteins, whey (lactalbumin) and casein (curd), in a ratio of approximately 60:40 (80:20 in most cow-milk based formula). This ratio in human milk makes it more digestible and produces soft stools seen in breast-fed infants. Thus human milk has laxative effect and constipation is uncommon. Here the mother has to be aware that, less than two bowel movements with painful staining indicates constipation.⁶

 

Constipation of infants often begins with the transition from the breast milk to formula, transition in to the solid foods after 4 to 6 months. Once the solid foods are introduced to the breast fed babies, there will be many changes in the elimination pattern. Here the mother can notice the food intolerance with either constipation or diarrhea.⁷

 

The symptoms may be painful passage of stools and hard faeces. Constipation in the infants arise due to the artificial feeding, food allergy, transition in to the solid diet, inadequate toilet training and certain illness like mega colon. The remedies to relieve the constipation are the fruit juices and high fiber diet with potatoes, peas, and squashed apple after 6 month of age, proper toilet training from 8^th month onwards, breast feeding and stopping the artificial milk feeding. Constipation can be a chronic condition which causes significant pain and discomfort. Chronic constipation can also lead to complications such as fecal impaction, anal fissure and fecal incontinence.⁸

 

Constipation is very common among the feeding problems. Every person has suffered with this at some time amidst our rapidly changing living standards. In children, constipation is a not only special but, a common problem also. Thus, an extensive evaluation is often not necessary in a child presenting with constipation.  Evacuation of the rectum with oral or rectal laxatives if an impaction is present, laxatives to ensure soft stools and behavior modification will relieve the constipation.⁵

 

At present, in child health care more emphasis is given to preventive approach than curative approach. So, it is better that constipation can be prevented by proper breast feeding and by proper education of mothers regarding prevention of constipation.⁹ Prevention is the most helpful aspect in relation to constipation because, faulty habits practiced by mothers of infants in different areas according to their cultures can cause unwanted health problems to the infants.¹⁰

 

OBJECTIVES:

·        Assess the knowledge and knowledge on practice regarding constipation of infants among the selected mothers.

·        Associate the level of Knowledge of mothers regarding constipation of infants with selected socio demographic variables.  

·        Associate the level of Knowledge on practices related to the prevention of constipation among infants with selected socio demographic variables. 

 

OPERATIONAL DEFINITIONS:

·        Knowledge: The information regarding the constipation of infants and the information regarding the practices related to prevention of constipation among infants.    

·        Mothers: Mothers with infant.

·        Infant: A baby upto one year.

·        Constipation: Constipation according to the Bristol stool scale used in the study, refers to type 1(separate hard lumps like nuts which are hard to pass) and type 2 (sausage shaped but lumpy stools) forms of the stool.

 

ASSUMPTION:

The mothers have insufficient knowledge regarding constipation among infants and its prevention.

 

RESEARCH METHODOLOGY:

The study was descriptive in nature and was conducted in Pediatric hospital, S.V.R.R.G.G.H, Tirupati, Chittoor district, Andhra Pradesh. Non-probability Convenient Sampling Technique was adopted for selecting the samples. The population selected for the study was mothers of infants. The sample size was 100. Structured interview schedule was administered to assess the level of knowledge.

 

Criteria for sample selection:

Inclusion Criteria:

1.      The mothers of infants of those who are attending S.V.R.R.G.G.H, Tirupathi.

2.      Those who can understand Telugu. 

3.      Those who are willing to participate in the study.

 

Exclusion criteria:  

1.      Mothers of infants with congenital gastro-intestinal anomalies like,

·        Anal agenesis, jejunoileal and large-bowel obstruction, esophageal atresia, diaphragmatic hernia, duodenal stenosis, choledochal cyst and annular pancreas.

2.      Mothers of infants with organic causes of constipation like,

·        Hirschsprung’s disease, pseudo obstruction, spinal cord abnormality, hypothyroidism, diabetes insipidus, cystic fibrosis and  gluten enteropathy.

 

Tool description and scoring:

        It consists of 3 sections,

Section-I: It consists of socio-demographic data such as age of the infant, age of the mother, gender of the child, religion, education, occupation of mother and father, type of family, acre-taker of the infant, family income, residence, diet of the mother, diet if the infant and type of the stool passed.

 

Section-II: It consists of 10 multiple choice questions regarding knowledge on constipation among the mothers of the infants. It includes meaning, risk factors, causes, signs and symptoms, diagnostic evaluation, management and complications.

 

Section-III: It consists of 15 dichotomous questions on the knowledge among mothers of infants regarding prevention of constipation.

 

Scoring:

< 50% inadequate knowledge, 50-70% moderately adequate knowledge and >75% adequate knowledge.

 

Method of Data collection:

A formal written permission was obtained from the medical superintendent of S.V.R.R.G.G.H, Tirupati to conduct the study. Investigator introduced herself to the mothers of the infants and explained the significance of the study. Written consent was obtained from them after explaining the purpose of the study. Per day 10 mothers were interviewed. The interview session for parents is approximately for about 10-15 mts.

 

Data analysis:

Statistical method used for analysis were descriptive statistics that include Frequency, Percentage, mean distribution and standard deviation are used to analyze the study variables, the knowledge of the mothers of infants on constipation and its prevention. Inferential statistics namely Chi-square was used to analyze the association of demographic variables with knowledge scores.

 

RESULTS: Section-I Distribution of demographic variables among mothers of infants

 

Table-1: Frequency and percentage Distribution of demographic variables among selected mothers of infants

 

 

Table 1 continued

 

 

 

Table-1 shows that out of 100 mothers of infants attending S.V.R.R G.G.H, 22% (22) were aged between 15-20 years, 27% (27) were aged between 21-25 years and 9% (9) were aged between 31-35 years. Regarding the age of the infants, 38% (38) were between 1-3 months and 25% (25) between 7-12 months. Regarding the gender of the infant, 58% (58) were male babies and 42% (42) are female babies. In relation to religion 69% (69) were Hindu mothers, 15% (15) were Muslim and 16% (16) belonged to Christian category. Regarding education of the mother 51% (51) are illiterate, 10% (10) are collegiate. Pertaining to the education of the father 10% (10) were illiterate and 31% (31) are collegiate. Regarding the occupation of the mother 86% (86) were home makers and only 7% (7) were labourers. In relation to occupation of the father 37% (37) were employees and 10% (10) were farmers. Pertaining to the type of family 24% (24) belonged to joint family and 9% (9) were from extended family. In relation to the care taker of the infant, 65% (65) were parents and 35% (35) were grandmothers. Regarding the monthly income of the family, 60% (60) were in between 5,000 to 10,000 rupees and 7% (7) were above 20,000 rupees in relation to place of residence, 31% (31) were from urban and 5% (5) were from urban slums. Pertaining to the diet of the mother, 10% (10) were vegetarians and 85% (85) were having mixed diet. Regarding the diet of the infant, 26% (26) were having exclusive breast feeding and 16% (16) were fed with commercially available complementary feeds. Pertaining to the type of the stool passed by the infant, 11% (11) were passing type1 stool and 36% (36) were passing type 5 stool.

 

SECTION –II

Table 2: Distribution of the level of knowledge and knowledge on practices related to prevention of constipation in infants among the mothers of infants.                                                          n=100

 

Fig: 1 Distribution of knowledge among mothers of Infant

 

Table-2: indicates that out of 100 mothers of the infants, 62% (62) have inadequate, 36% (36) have moderate and 2% (2) have adequate level of knowledge on constipation. Out of 100 mothers of the infants, 35% (35) have inadequate, 55% (55) have moderate and 10% (10) have adequate level of knowledge on practices regarding the prevention on constipation. Out of 100 mothers of the infants, 28% (28) have inadequate, 70% (70) have moderate and 2% (2) have adequate level of total knowledge on constipation.

 

SECTION – III Association between demographic variables with the level of knowledge on constipation.

The association between level of knowledge on constipation and age of the infant, age of the mother, education of the mother and the father, occupation of the father, family income per month, diet of the mother, diet of the infant and the type of stool passed by the infant are significant at p<0.01 level.

 

Association between demographic variables with the level of knowledge on practices related to prevention of constipation among infants.  

The association between level of knowledge on practices regarding prevention of constipation among infants and age of the infant, age of the mother, religion, education of the mother and the father, occupation of the mother and father, caretaker of the infant, family income per month, place of residence, diet of the infant and the type of stool passed by the infant are significant at p<0.01 level and gender of the infant, type of the family and diet of the mother are significant at p<0.05 level.

 

DISCUSSION: 

The study revealed that out of 100 mothers of the infants, 62% (62) have inadequate, 36% (36) have moderate and 2% (2) have adequate level of knowledge on constipation. Out of 100 mothers of the infants, 35% (35) have inadequate, 55% (55) have moderate and 10% (10) have adequate level of knowledge on practices regarding the prevention on constipation. Out of 100 mothers of the infants, 28% (28) have inadequate, 70% (70) have moderate and 2% (2) have adequate level of total knowledge on constipation. The association between level of knowledge on constipation and age of the infant, age of the mother, education of the mother and the father, occupation of the father, family income per month, diet of the mother, diet of the infant and the type of stool passed by the infant are significant at p<0.01 level. The association between level of knowledge on practices regarding prevention of constipation among infants and age of the infant, age of the mother, religion, education of the mother and the father, occupation of the mother and father, caretaker of the infant, family income per month, place of residence, diet of the infant and the type of stool passed by the infant are significant at p<0.01 level and gender of the infant, type of the family and diet of the mother are significant at p<0.05 level.

 

CONCLUSION:

Among 100 mothers of the infants, 62% (62) have inadequate, 36% (36) have moderate and 2% (2) have adequate level of knowledge on constipation. Among 100 mothers of the infants, 35% (35) have inadequate, 55% (55) have moderate and 10% (10) have adequate level of knowledge on practices regarding the prevention on constipation. At present, in child health care more emphasis is given on preventive approach rather than curative approach. So, it is better that constipation can be prevented by the proper breast feeding and by proper education of mothers regarding prevention of constipation.

 

NURSING IMPLICATIONS:

Nursing practice:

·        Nurses, as competent professionals, have responsibility to identify the symptoms of constipation among infants. The knowledge and understanding about infant constipation, can act as reference for nurses in planning appropriate interventions to prevent it.

·        Nurses need to help the parents to manage the constipation of infants. Such information should include orientation of parents, about the condition of child on their visit to the hospital.

·        Nursing staff need to be educated on identifying the minor symptoms of constipation in infants who attending hospital. Also they need to learn to use some exercises for the relieving of the constipation in infants.

 

Nursing education:

·        In nursing schools and colleges, students should be trained in planning and implementing health education programmes based upon the needs.

·        As a nurse educator one need to contribute to the existing body of nursing knowledge about the infant constipation and its prevention.

·        In-service education programme can be conducted to upgrade the knowledge of nurses about factors causing constipation and the measures for its management.

·        In pediatric hospitals education programmes can be planned and imparted through projector, skit, and puppet shows etc.

 

Nursing administrations:

·        Adequate nursing staff can be posted in pediatric hospitals.

·        Nurse should develop proper knowledge on constipation.

·        Nursing personnel can do focused group discussion and teaching where ever it is necessary.

·        In service education programme has to be conducted for staff nurses, working in pediatric hospitals.

 

Nursing research:

·        The researches in nursing profession should focus the attention towards to identifying the causes leading to infant constipation.

·        There should be more scope for research in this area to identify the remedy measures for infant constipation.

 

RECOMMENDATIONS:

·        Experimental study can be conducted with the help of planned health education programme on constipation of infants among mothers of infants.

·        A comparative study can be conducted to find out the relationship between demographic variables and the levels of knowledge on constipation of infants.

·        The study can be replicated with a larger population.

·        Similar studies can be conducted on large scale.

 

REFERENCES:

1.       Park K. Textbook of Preventive and Social Medicine: Banarsidas Banot publishers; 20^nd edition, 2012, P 446-5, 72-74.

2.       http://www.cia.gov/library/publications/the-world-factbook/fields/2091.html.

3.       Joseph M. Croffie. Constipation in children. Indian Journal of pediatrics. 2006Aug; 73(8).

4.       Nyhan WE. Stool frequency of normal infants in the first weeks of life. Pediatrics.1952;10:414-25.

5.       Baker. S.S et.al. Constipation in infants and children evaluation and treatment. Journal of Gastroenterology Nutrition 1999;29:612.

6.       Marlin J.Hockberry, Wongs Essentials of Pediatric Nursing, 7^th edition, Elsevier publications, Pp.840

7.       Johnson E. Childhood. Journal of American board of family practioner 2003;16:13.

8.       Loaning-Baucke. V. Prevalence, symptoms and outcome of the constipation in infants and toddlers. Journal pediatrics 2005; 146:359.

9.       Potts M.J and Sensey. J. Infant Constipation: Maternal knowledge and beliefs.2006.Pubmed.com.

10.     Ruth Grace. M. Transcultural Nursing Theory. Narayana Nursing Journal. 2015Mar; 4(1):43-6

 

 

 

Received on 21.05.2015           Modified on 03.07.2015

Accepted on 22.07.2015           © A&V Publication all right reserved