INTRODUCTION:

Maternal and child health services (MCH) are promotive, preventive, curative, and rehabilitative health care directed to the mother and children in the form of service programs.¹Maternal and Child Health care is defined as comprehensive care to improve the all-round health of the mother and child.²

In India, women of reproductive age (18-45 years) and children below 5 years of age comprise 60% of the total population. Mothers and children Constitute a more vulnerable section of the population is more in a rural environment. Naturally, they need special health care attention. Hence the health services directed to women and children are given priority by the government of India.³

MCH services provide preventive care for vulnerable groups. The fact that more than 1 lakh women in India are estimated to die every year from pregnancy and childbirth-related causes due to inadequate knowledge of MCH services and illiteracy, poverty, population density, etc. The overall efforts of maternal and child health professionals involve practicing MCH to provide health care service based on the most recent scientific research to assess and identify MCH problems and plan interventions.⁴

In most developing countries such as India, utilization of basic health services has remained poor though there has been an increase in the public and private expenditure on the provision of advanced health care. Appropriate care of the mother is necessary, both before and after the delivery. In India, over 50 percent of the children born are reported to have low birth weight with a low probability of survival in the first year. The poor utilization of MCH services also poses serious threats to maternal and child health. (National Institute of Health and family welfare)⁵

Among the various stages of a woman’s life, the childbearing period represents a period of elevated risk, and the care provided is critical for both the woman’s and child’s health and survival. After independence, the government of India took steps to strengthen maternal and child health services as early as the first and second five-year plans (1951-56 and 1956-61). The promotion of maternal and child health has been central to the objectives of the family welfare program during the fourth five-year plan (1969-74), and since then, there have been several changes and development in the programme⁶.

The proportion of pregnant women who received at least 3 antenatal check-ups was 51% (p>0.05). The coverage of women receiving tetanus toxoid and iron and folic acid was 92%. Out of which the coverage from government hospital was 56%, private hospital was 36% (p<0.05). The coverage of institutional delivery was 54%.The percentage of children immunized with the basic six vaccine preventable diseases was 85%. For contraception, 26% practiced tubectomy, 24% Oral Contraceptive Pills and 28% barrier method and 22% didn’t answer. Only 38% subjects preferred utilization of government hospital facility, 62% had opted private hospital (p<0.05). Self-medication in case of minor ailments was used by 57% of respondents. The study concluded that about half of the total pregnant women had at least 3 antenatal check-ups, 85% of children were immunized, more than 50% deliveries were institutional, 22% people didn’t responded regarding the practice of contraception⁷.

A study was done to assess the knowledge and attitude of women towards MCH services provided by the primary health care centres Results revealed that 57% of the mothers had average knowledge and only 20% had adequate Knowledge on MCH services. Only 3% of the mothers had positive attitude on MCH services, 13% had negative attitude and 53% had neutral attitude on MCH services. It was found that there was a significant association between level of knowledge and education of mothers. The study also revealed that age, education and economic status of the mother influenced their attitude on MCH services. The study concluded that mothers were not having adequate knowledge and positive attitude towards MCH services. It is very important to educate the public about MCH services in order to promote the utilization of these services⁸

The maternal and child health services include the aspects of services such as antenatal, intra-natal, postnatal and contraception. In a study conducted to knowledge attitude and practice of Teenage mothers about contraceptives, 89.47% mothers, at least knew about one or the other method of birth spacing or control. Only 10.53 percent mothers were unaware about contraceptives methods. The source of information about contraceptives was television (T.V.) and peer groups⁹

NEED FOR THE STUDY:

Utilization or underutilization of maternal and child health (MCH) services. For proper program implementation, understanding community knowledge and practices regarding maternal care during pregnancy, delivery, and postnatal period is required. Improving community awareness of maternal and child health (MCH) services is still required.¹⁰

About 65% of the total population in the country consists of women of childbearing age and children under 15 years. About 20% of this group are children. By providing MCH services, almost 2/3rdof the population of India will be served. Mother and child have the highest risk in terms of illness and death. So they need special health care services.¹¹

A community-based cross-sectional, observational study was undertaken in a UHC of Kolkata to assess the level of IEC regarding pregnancy and child care, received by the women at an MCH clinic. The study subjects comprised 400 antenatal and postnatal mothers and mothers of children under five years. The result of the study shows that warning signs of danger was explained to only 10% of the Antenatal and Postnatal women. Advice regarding family planning appeared to be the most frequently covered, though that too was explained to less than half of the subjects. About 1/3^rd of the women were advised on breastfeeding. Only 8% of the mothers had been told about all issues regarding pregnancy and child care. Breastfeeding and weaning were properly explained to 85.7% and 81.1% of the total mothers of U5 children. Advice regarding subsequent nutrition was given to 60.9% of mothers. About only a quarter of the total mothers were advised on home management of diarrhoea and acute respiratory infections. Very few mothers were counselled about the growth pattern of their children and none were shown the growth chart. Only 12.9% of the mothers were informed about all issues. The conclusion of the study was that IEC regarding maternal and child care other than feeding practices is a neglected service in the health facility where the study was conducted¹².

The results of a study, done to assess the knowledge of essential new-born care in antenatal mothers, which is an important component of MCH services, showed that about 25% of mothers had good knowledge, 64% of mothers had moderate knowledge and 11% of mothers had poor knowledge related to essential newborn care. The study concluded the need to bring awareness in antenatal mothers regarding the MCH services and to improve their knowledge about essential new-born care¹³

A pre-experimental research design was used to assess the knowledge of prenatal diagnostic tests for maternal and fetal well-being in high-risk antenatal mothers, revealing that, education on prenatal diagnostic tests was effective in all areas. There was no significant association found between the knowledge scores of the high-risk antenatal mothers with their selected demographic variables (P>0.05). Whereas a highly significant difference was found between the area-wise score values of pre-test, post-test, and overall score¹⁴

In an analysis of childbirth fear and associated factors in primigravida mothers, the highest percentage (98%) of the third-trimester primigravida mothers had ‘extreme fear’ of childbirth, and (2%) of them had ‘moderate fear’. The majority (95%) of the sample had an ‘unfavourable influence’ of associated factors and (5%) had a ‘favorable influence’. There was a positive correlation (0.30) found between childbirth-related fear level and associated factors among third-trimester primigravida mothers at 0.05 level of significance. A significant association was found between childbirth-related fear level and following demographic variables such as religion (χ2 8.25), employment status (χ2 5.69), and monthly income (χ2 14.58). There was a significant association between associated factors and following demographic variables such as age (χ2 5.11), a supportive person during pregnant (χ2 1.31), and information regarding the childbirth process (χ2 3.84)¹⁵

The postnatal component of MCH services also focuses on the improving the knowledge of postnatal mothers regarding the management of common breast disorders during postnatal period. An educational intervention was given to antenatal women in third trimester regarding the management of common breast disorders during postnatal period in the form of self-instructional module. The analysis of the pre-test knowledge revealed that in the pre-test scores, majority (84%) of the sample had average knowledge, 12% had good knowledge and 4% of them had poor knowledge on breast disorders where as in the post test scores, majority (66%) of the sample had average knowledge and 34% of the sample had good knowledge and none of them had poor knowledge on breast disorders¹⁶

Currently, the main health problems affecting the health of the mother and child in India are the triad of malnutrition, infection, and unregulated fertility. The most advanced countries are concerned with problems such as perinatal problems, congenital malformation, and genetic and behavioural problems. India continues to contribute about a quarter of all global maternal deaths from complications of pregnancy and childbirth, which are mostly preventable. Every year, 30 million women become pregnant, and out of these, 265,000 mothers die of causes related to pregnancy and childbirth in Andhra Pradesh. More than half of all married women are anaemic, and one-third of them are malnourished. Only 49 percent of women receive iron and folic acid for at least 100 days during pregnancy, as recommended. Perinatal mortality, which includes stillbirths and very early infant deaths, is estimated at 28 deaths per 1000 pregnancies in Andhra Pradesh and Telangana.

The knowledge of postnatal mothers regarding the common neonatal disorders was elicited in a study and the results showed that the majority of postnatal mothers had average pre-test scores that is 29(99%) and 1(1%) of postnatal mothers had poor knowledge regarding common minor neonatal problems. The mean knowledge scores in pre-test was 1.32 and SD was 0.469 and in post-test mean was 1.52and SD was 0.499. So, it is evident that mean post-test knowledge score of postnatal mothers was significantly greater than their mean pre-test knowledge score. t’ {1199} = 10.572 at P < .005 level of significance¹⁷

A study was done to assess maternal and neonatal health services in 49 developing countries. Maternal health program effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially in the treatment of emergency obstetrics conditions¹⁸.

The mean pre-test knowledge score was 14.64 and the mean post-test knowledge score was 23.7, in as study to assess the effectiveness of an educational intervention on the knowledge and attitude of antenatal women in managing the complications during pregnancy. The mean pre-test attitude score was 51.24 and the mean post-test attitude score was 75.82. The significance of the difference between pre-test and post-test knowledge was statistically tested using paired ‘t-test and it was found significant at a 0.05 level.¹⁹

During the field experiences, the investigator found that most of the women in the reproductive age group are not having adequate knowledge regarding the MCH services and the utilization of those services. Hence the investigator felt that there is a need to impart knowledge to the women regarding the utilization of MCH services which are beneficial to maintain the health of mothers and children. The investigator plans to assess and compare the knowledge of women in both the selected urban and rural areas and to impart and distribute an information booklet on knowledge of MCH services to the women. The purpose of this study was to compare the knowledge and attitudes of urban and rural women regarding MCH services.

STATEMENT OF THE PROBLEM:

A study to assess the knowledge and attitude of women regarding MCH services in selected urban and rural areas, Rajahmundry.

OBJECTIVES:

The study was aimed to

1. Assess the knowledge of women in urban and rural areas regarding MCH services

2. Assess the attitude of women in urban and rural areas regarding MCH services

3. Determine the relationship between the knowledge and attitude of women in urban areas regarding MCH services

4. Determine the relationship between the knowledge and attitude of women in rural areas regarding MCH services

5. Compare the knowledge and attitude of women in urban and rural areas regarding MCH services

6. Find out the association of knowledge and attitude with selected demographic variables of urban women

7. Find out the association of knowledge and attitude with selected demographic variables of rural women.

HYPOTHESIS:

H_1
-There will be a significant correlation between the knowledge and attitude of urban and rural women regarding MCH services

H₂- There will be a significant difference in knowledge and attitude between women of urban and rural areas regarding MCH services

H_3
-There will be a significant association of knowledge and attitude with selected demographic variables of urban women

H₄- There will be a significant association of knowledge and attitude with selected demographic variables of rural women.

MATERIALS AND METHODS:

Research approach and design:

The research approach for the present was the quantitative approach and the research design selected for the study was a comparative descriptive cross-sectional research design.

Setting:

The setting for the present study was Ambedkar Nagar in the urban area and the rural area was Rajanagaram. The setting was selected on the basis of the availability of an adequate sample, familiarity with the area, and the cooperation of the study participants.

Sample size:

The study was conducted on 60 women of reproductive age group, 30 each from urban and rural areas respectively.

Sampling technique:

The sampling technique adopted for the inclusion of samples into the present study was the non-probability convenient sampling technique.

Data collection tools and techniques:

The data was collected using a pre-validated structured questionnaire which consisted of items relating to the knowledge aspects of MCH services and items to ascertain the demographic characteristics of the subjects. The attitude towards MCH services was elicited by a 3-point Likert scale that measured the scores as disagree, uncertain, and agree.

RESULTS:

Statistical analysis was done using the software SPSS-16. Descriptive and inferential statistics were used to find the frequency, percentage, mean and standard deviation. Karl Pearson’s coefficient correlation was used to find out the correlation between the knowledge and attitude of urban and rural women.To compare the knowledge and attitude of urban and rural women, two sample unpaired t-testwas used. Chi-square test was used to find the association of knowledge and attitude with selected demographic variables of women in urban and rural area.

Rural knowledge level reveals that out of 30 samples, 9 samples (30%) had adequate knowledge, 18 samples (60%) had moderately adequate knowledge and 3 samples (10%) had inadequate knowledge. Urban knowledge level reveals that out of 30 samples, 9 samples (30%) had adequate knowledge, 20 samples (66.7%) has moderately adequate knowledge and 1 sample (3.3%) had inadequate knowledge (Table-1).

Rural Women attitude revealed that out of 30 samples, 27 samples (90%) had positive attitude and 3 samples (10%) had negative attitude. Urban Women attitude level revealed that out of 30 samples, 29 samples (96.7%) had positive attitude and 1 sample (3.3%) had negative attitude (Table-2).

Table-3: Distribution of correlation coefficient between knowledge and attitude of urban women (n=30)

Urban women

Rural women

Knowledge and attitude

(Pearson’s correlation)

0.53

0.4

There is a strong positive correlation between knowledge and attitude of urban women. There is a moderate positive correlation between knowledge and attitude of rural women (Table-3).

Table-4: Mean, standard deviation, ‘t’ test values of knowledge scores.

Areas

Mean

‘t’ calculated value

‘t’ table value

Significance

Rural

(n=30)

17.76

4.64

1.2

2.00

N.S

Urban

(n=30)

19.1

4.01

SD: Standard deviation

Table-5: Mean, Standard deviation, ‘t’ test values of attitude scores.

Areas

Mean

‘t’ calculated value

‘t’ table value

Significance

Rural

(n=30)

47.2

8.94

1.3

2.00

N.S

Urban

(n=30)

50.2

8.44

SD: Standard deviation

The mean of the rural and urban knowledge are 17.76 and 19.1, standard deviation are 4.64 and 4.01 respectively. ‘t’ test cal. Value 1.2, ‘t’ test table value 2.00(P<0.05). There is no significant difference in knowledge score between rural and urban women regarding MCH services. The mean of the rural and urban attitude are 47.2 and 50.2, standard deviation are 8.94 and 8.44 respectively. ‘t’ test cal. Value 1.3, ‘t’ test table value 2.00(P<0.05). There is no significant difference in attitude score between rural and urban women regarding MCH services (Table-4 and 5).

DISCUSSION:

The present study was aimed to assess the knowledge and attitude regarding MCH services among women in selected urban and rural areas, in Rajahmundry. The result showed that, with regard to the knowledge of the women in rural areas, the majority 60% had moderately adequate knowledge, 30% had adequate knowledge and 10% had inadequate knowledge. In urban areas, the majority, 66.7% had moderately adequate knowledge, 30% had adequate knowledge and 3.3% had inadequate knowledge. With regard to the attitude of the women in rural areas, the majority 90% had positive attitudes and 10% had negative attitudes. In urban areas, the majority 96.7% had a positive attitude and 3.3% had a negative attitude. The results were consistent with the study conducted by Rajiv Kumar Gupta, et.al. (2015).

There was a moderate positive correlation (0.4) between the knowledge and attitude of rural women regarding MCH services and there is a strong positive correlation (0.53) between the knowledge and attitude of urban women regarding MCH services.

The knowledge mean score was 17.76 in rural women and 19.1 in urban women. The mean attitude score was 47,2 and 50.2 respectively in rural and urban women regarding MCH services, which elicited that there was no significant difference in knowledge and attitudes of urban and rural women regarding MCH services.

The result showed that the mean score was 17.76, in rural knowledge and 19.1, in urban knowledge was not significant at 0.05 levels as the t-value is 1.2. The mean score of 47.2 in rural attitude and 50.2 in urban attitude was not significant as the t-value is 1.3.

The study results revealed that there was a significant association between attitude and selected demographic variables of rural and urban areas such as occupation at 0.05 level of significance. There was no significant association found between attitude and selected demographic variables of rural and urban areas such as age, religion, place of residence, educational status, and income of the family per month at 0.05 level of significance.

CONCLUSION:

The following conclusions were drawn based on the findings of the study

· The knowledge of the women in rural areas, the majority 60% had moderately adequate knowledge, 30% had adequate knowledge and 10% had inadequate knowledge. In urban areas, the majority, 66.7% had moderately adequate knowledge, 30% had adequate knowledge and 3.3% had inadequate knowledge. With regard to the attitude of the women in rural areas, the majority 90% had positive attitudes and 10% had negative attitudes. In urban areas, the majority 96.7% had a positive attitude and 3.3% had a negative attitude.

· There is a moderate positive correlation between the knowledge and attitude of rural women regarding MCH services and there is a strong positive correlation between the knowledge and attitude of urban women regarding MCH services

· There is no significant difference between the knowledge and attitude of urban and rural women regarding MCH services.

· There was no significant association found between knowledge and selected demographic variables of rural and urban areas like age, religion, place of residence, educational status, occupation, and income of the family per month.

· There was a significant association between attitude and selected demographic variables of rural and urban areas such as occupation. There was no significant association found between attitude and selected demographic variables of rural and urban areas such as age, religion, place of residence, educational status, and income of the family per month.

STUDY IMPLICATIONS:

The findings of the study have the following implications for Nursing Practice, Nursing Education, Nursing Administration, and Nursing Research.

Nursing Practice:

· Health education should be made an integral component of nursing practice.

· Nursing personnel should conduct planned teaching programmes for women in hospital and community settings.

· Need to develop strategies for educating the women regarding MCH services.

Nursing Education:

· Teaching modules should be introduced into the curriculum at primary levels of nursing education.

· The students should be trained in putting their efforts to reduce the occurrence of morbidity and mortality by improving the knowledge and attitude of women on MCH services.

· Nursing personnel working in MCH clinics, community health departments, PHC, and sub-centers should be given in-service education to update and improve their activities in terms of knowledge, skills, and attributes in identifying the needs of women and also to plan, implement and educate by health education programme to women.

Nursing Research:

The researcher should focus attention on the knowledge and attitude acquired by the women on the effectiveness of health education programme on MCH services.

Nursing Administration:

· There should be an increase in the proportion of healthcare organizations providing health education to all women regarding MCH services.

· The nurse administrator should take an interest in providing information regarding the need for organizing the health education programme on MCH services.

LIMITATIONS:

1. Small number of subjects and convenient sampling technique limit the generalization of the study findings.

2. The study did not include perceptions and barriers of women towards utilization of MCH services.

RECOMMENDATIONS:

Based on the findings of the study the following recommendations were made

1. A similar study can be replicated with a larger sample to generalize the findings

2. Future qualitative studies can be undertaken regarding the perception of women and the possible impediments tothe utilization of maternal and child health services

3. Manuals, Information booklets, and self-instructional modules can be developed including all aspects of maternal and child health services.

ACKNOWLEDGMENT:

The authors wish to thank the institutional authorities and the participants of the study.

CONFLICT OF INTEREST:

The authors have no conflict of interest.

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Received on 24.07.2023 Modified on 02.08.2023

Asian J. Nursing Education and Research. 2023; 13(4):305-311.

DOI: 10.52711/2349-2996.2023.00063

Sl. No	Level of Knowledge	Rural (n=30)		Urban (n=30)
Sl. No	Level of Knowledge	Frequency	Percentage	Frequency	Percentage
1	Adequate	9	30%	9	30%
2	Moderately Adequate	18	60%	20	66.7%
3	Inadequate	3	10%	1	3.3%

S. No	Attitude	Rural (n=30)		Urban (n=30)
S. No	Attitude	Frequency	Percentage	Frequency	Percentage
1	Positive attitude	27	90%	29	96.7%
2	Negative attitude	3	10%	1	3.3%