Development of an Educational Booklet for Women about Self Care During Pregnancy

This study aimed at assessing the knowledge of women about pregnancy changes, self care during it, and development of an educational booklet based on the results of the assessment. The study was conducted at antenatal clinic at El-Shateby University Hospital. From the previous setting, a purposive sample consisting of 200 women was selected. A Structured Questionnaire sheet was developed and used to find out the knowledge and practice of the study sample about pregnancy changes and self care during it. The results found that the majority of women lack basic knowledge about pregnancy changes and self care during pregnancy.


INTRODUCTION
Currently, there is an international concern with women health.This because women are vulnerable group in the society and it has been shown that globally 500,000 women die each year because of reasons related to their reproductive function.Half of this death occurs in developing countries. (1,2) bally every year more than 200 million women become pregnant.Mostof these pregnancies end with the birth of a live baby to a healthy mother, but for others, childbirth is not the joyous event it should be, but it is a time for pain, fear, suffering, and even death.Some of these pregnant women, 15%, are likely to develop complications that need skilled obstetric care to prevent death or serious ill health.
In Egypt, the Maternal Mortality Rate (MMR) was reported to be 174 per 100,000 live births in 1992/1993, (2,3) the figure is considered very high when compared with figures recorded in the Bull High Inst Public Health Vol.38 No. 1 [2008]   developed countries such as: 10 in USA, (4,5) 7 in the UK, (6) and only 4 in Sweden in 1982. (7) recent years, the Egyptian Government conducted several investigations on maternal mortality.
These researches revealed that 69.5% of maternal deaths were due to direct causes such as hemorrhage, eclampsia, and genital tract infection, while 26.9% of maternal deaths were due to indirect causes such as anemia, cardiovascular diseases, and infections.Many underlying factors influence the capacity of women to survive complications emerging during pregnancy and childbirth.) The health of mothers and children is recognized to be closely related to the general health of the community, as they constitute more than two-thirds of any community.The best method for ensuring the health of expectant mother and her infant is proper antenatal care.
Antenatal care has been downplayed in recent years as an intervention for reducing maternal morbidity and mortality. (11,12)reover, during pregnancy and antenatal period, women experience different types of pregnancy discomfort which resulted from normal physiological changes that take place during pregnancy.These discomforts if not anticipated by women and prepared to face it, they can make women anxious, worried, and lead to adverse reaction by women which may hinder their health and development of risk complications such as anemia and infections. (13)ring pregnancy, women may have questions regarding healthy practices and lifestyle for their health and for the health of their babies such as healthy nutrition, rest, sleep, exercise, marital relation, and medications usage during pregnancy. (14)e of the most important functions of antenatal care is to offer the woman advice and information about physiological changes during pregnancy, minor discomfort arises and how to cope with it, danger signs and symptoms and preparation for birth.
Antenatal care helps reduce the numbers and severity of pregnancyrelated complications by careful monitoring and early treatment of diseases aggravated during pregnancy, such as anemia.7) Antenatal period offers maternity nurses and midwives the opportunities for delivering health information and services that can significantly enhance the health of women and their infants.0)

Aim of the study
The aim of this study was to:- • Assess the knowledge of women about pregnancy changes.
• Assess women's knowledge about self care during pregnancy, and • Develop an educational booklet based on the results of the study.

Material
Setting: The study was undertaken in outpatient clinic at El-Shatbey Maternity University Hospital of Alexandria.The hospital provides antenatal care for normal pregnancy as well as for high risk antenatal patients who are usually referred from local primary health care centers.

Subjects:
A purposive sample consisting of 200 women attending the previous setting were randomly selected, and met the following criteria:

•
In early pregnancy, • Without any complication, and Interviewing technique was used to assess the women's knowledge regarding self care during pregnancy.

RESULTS
Table They reported that about three-fourths of their study sample had disturbed sleeping patterns. (24) relation to nutrition during the vast majority of the study sample had wrong answer or don't know the answer related to elements of balanced diet, food rich in iron, and division of main meals and snacks (table 5).This result is in line with the findings of Rashad ( 2001) who had conducted a study about dietary habit of pregnant women in Alexandria.
She reported that her sample lacked both the knowledge as well as the proper practices in choosing their meal components. (25) relation to minor discomforts occurring during pregnancy and how to relive them, the majority of study sample had wrong answer or didn't know as regard morning sickness and vomiting (table 6).This result is in line with the result of Waddell (1995) who stated that occurrence of nausea and vomiting during pregnancy is a common complain (26) .Also the majority of the for crème or antibiotics. (33) regard knowledge about warning signs during pregnancy, less than onethird of the study sample knew absence of fetal movement, less than one-tenth knew increase of the abdominal size as a warning sign during pregnancy, also a less than one-tenth had correct answer about excessive weight gain in short duration, one-fifth had correct answer about severe persistent headache, while less than one-fifth gave correct answer about blurring of vision.Moreover, generalized edema only more than onetenth responded correctly.On the other hand, less than one-fifth had correct answer about bleeding as a warning sign during pregnancy (table 7).This result is in line with El-Zanaty and Way who stated that the women with age 45-49 and with no education were least likely to have heard messages about warning signs of pregnancy. (34)ncerning the knowledge about signs of labor, less than one-third knew the correct answer, also near to three-quarters gave wrong or didn't know the answer about mother and infant clothes (table 8).In relation to the sources of knowledge, the majority of the study sample get their information from last pregnancy experience or from biological mothers or mothers in law.
Radio and TV were reported by more than two-fifths.Also nurses were reported by two-fifths followed by friends were reported by less than one-third, while only the physicians were reported by more than one-quarter.

CONCIUSION
Just read and write The researcher explained the purpose of the research to the study sample and obtained the sample approval to share in the research.The study was undertaken in outpatient clinic at El-Shatbey Maternity University Hospital of Alexandria.Tools: Two tools were developed and used for data collection.Tool (1): A Structured Questionnaire sheet was developed and used for data collection concerning the knowledge of women's about pregnancy changes and their knowledge related to self care during it based on thorough review of current literature.It will be divided into three main parts: Part one: Included questions to identify the socio-demographic and biological characteristics of the sample such as age, education, occupation, gravidity, and parity.Part two: Included questions to assess the study samples' knowledge related to pregnancy changes.Part three: Included questions to assess the study samples' knowledge related to self care during pregnancy.A scoring system for women's knowledge regarding self care during pregnancy was adopted.The correct answers were predetermined according to literature and questions were coded accordingly.Each knowledge was given a score and a total score of knowledge was obtained for each study member.The possible range of score was from 0-10.The score was classified as 7.5 points or more was considered good, 5less than 7.5 was considered fair, and less than 5 was considered poor.Tool (2): Development of an educational booklet based on the result of the Questionnaire sheet.Methods Permission to carry out this study was obtained from the responsible authorities of the selected settings.The researcher explained the purpose of the research to the study member, and obtained the sample approval to share in the research.A structured questionnaire sheet was developed.Data collection was conducted in antenatal clinic of the previously mentioned setting.

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to result of the present study, it can be concluded that there is lack of knowledge regarding importance of antenatal care, physiological and psychological changes during pregnancy, hygiene of pregnancy, nutrition during pregnancy, minor discomfort and warning signs, true signs of labor, and preparation for labor.This may be due to nearly to three-quarters of the study sample just read and write and also nearly to three-fifths of the study sample were housewife, and one-fifth work without income.So there is an important need for an educational booklet about self care during pregnancy.RECOMMENDATIONS Based on the results of the current research, Adequate and variable books and magazine should be available in all services which offer antenatal care.Proper and qualified care should be provided to all aspects, pregnant women including educational counseling.

Table 8 :Table 9 :
Number and percent distribution of the study sample according to their knowledge about labor and what to do during this period.Number and percent distribution of the study sample according to their Sources of information about pregnancy changes and self care during it.The respondents gave more than one answer.

): Distribution of the study subjects according to total score of knowledgeTable 6 : Number and percent distribution of the study sample according to their knowledge about minor discomforts occurring during pregnancy and how to relieve it.
Bull High Inst Public Health Vol.38 No.1 [2008]