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Knowledge and practices regarding management of minor ailments of pregnancy among antenatal mothers: a descriptive study from Rajasthan

Pregnancy is considered as a natural phenomenon; it is a crises situation and a transition phase in every women life towards motherhood which is associated with hormonal and physical changes to prepare women for motherhood. Pregnancy consists of three trimesters marked by specific foetal developments. Whole pregnancy period is associated with number of ailments which are otherwise easily manageable at home. Some of common ailments of pregnancy during 1st trimester includes nausea and vomiting, fatigue, increased micturition. 2 trimester is marked by backache, Leg cramps, constipation, hurt burn while 3 trimester by varicosities, sleep disturbance, haemorrhoids etc. According to WHO in low income settings about 70% of women report signs and symptoms of one or other minor ailments throughout whole period of pregnancy.

despite of this it has been reported in various studies that knowledge among antenatal mothers is inadequate. Vincent S et al observed poor level of knowledge among primigravida antenatal mother regarding selfmanagement of minor discomforts of pregnancy. 7 These minor ailments can be easily manageable at home. Different practices are opted by women such as consumption of herbal medications, use of selfmedications, holding urge to urinate, skipping meals and decreasing their fluid intake in nausea and vomiting, use of paraffin oil as lubricant etc. [8][9][10] Pregnancy is a very important, demanding phase for women and family. The adequate and proper information regarding management of ailments leads to healthy pregnancy outcome and healthy baby. Lack of knowledge can lead to poor pregnancy outcomes. These knowledge and practices are always associated with each other, if knowledge is good practices will also improve. Inherent nature of women further makes the situation more challenging as females feel shy to ask and discuss about these ailments which can be efficiently managed. Research on the minor ailments of pregnancy from western part of Rajasthan remains quite limited and there is paucity of data. With this view in mind the need was felt to undertake a study to assess knowledge and practices regarding management of minor ailments of pregnancy among antenatal mothers at selected hospital of Jodhpur.

METHODS
This cross-sectional study was conducted at Obstetric OPD of All India Institute of Medical Sciences Jodhpur. Data was collected from October 2019 to December 2019. About 368 pregnant females of 3rd trimester who were available at time of data collection and were willing to participate were recruited for study by non-probability (Convenient) sampling technique. Sample size was calculated using Daniels' formula-11 Z 2(1-α/2) P(1-P) d 2 z=level of confidence is 1.96, p=prevalence rate (60%) 12 , d=precision (0.05).
Women with complications in pregnancy such as pregnancy induced hypertension, preeclampsia, eclampsia, gestational diabetes mellitus, heart disease in pregnancy, epilepsy, thyroid dysfunction, infection in pregnancy HIV, malaria, hepatitis. were excluded from study. The study was approved by institutional ethics committee, All India Institute of Medical Sciences, Jodhpur. Informed written consent was taken from the subjects and they were assured of confidentiality with autonomy to withdraw self from the study at any time of data collection. Data was collected through face to face interview method with help of self-structured validated tools. The sociodemographic details were collected using sociodemographic data sheet. Knowledge questionnaire was used to collect knowledge of antenatal women regarding minor ailments of pregnancy. The various subdomains of knowledge questionnaire were introduction, minor ailments, signs and symptoms, prevention and management etc. The knowledge levels were categorized as good (score ≥21), fair (score [14][15][16][17][18][19][20] and poor (score ≤13). Practices regarding management of these ailments were assessed using practice checklist. The tools were pilot tested and found to have good reliability (>0.75). Collected data were analysed using SPSS 16.0 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Descriptive statistics were calculated to summarize demographics and key variables. Inferential statistics was applied (Chi-square) to determine the association of knowledge levels with selected demographic variables. For all associations P < 0.05 was considered statistically significant.

RESULTS
Table1 depicts the demographic profile of the subjects. About 47.6% of subjects were from age group 21-25 years. Nearly 42% of subjects had studied till graduation and above. Nearly half of women (52%) were married for last three years. About 53% of mothers were primigravida. Nearly 43% of antenatal mothers were from 9 months of gestation period. As far as source of information is considered 38% of women gained information regarding minor ailments and management from relatives (Figure1).

Mass Media
Relatives Health Personals All Above

Knowledge status among mothers regarding minor ailments of pregnancy
Almost 61% of antenatal mothers had fair knowledge followed by 37% had poor knowledge and only 2.4% women reported to have good knowledge ( Figure 3). Mean knowledge score was 14.6±3.6 which means that overall women had fair level of knowledge regarding management of minor ailments of pregnancy at home.  Table 2 illustrates the various practices being performed by antenatal mothers regarding management of minor ailments of pregnancy at home. Majority (86%) of mothers ate frequent meals followed by 74% of women avoided strong odours and smell in order to manage nausea and vomiting. Almost 80% of women opted for small frequent meals and 71% of women preferred cold milk or water to relieve hurt burn whereas 1/3 rd of sample ignored this ailment and did not do anything to relieve it. Constipation being another minor ailment faced by women during pregnancy was also managed at home by women. About 94% of women ate fruits and vegetables followed by 76% of women take plenty of water (8 glasses/day). Leg massage (63%), rest and elevating foot with pillow (58%) were practiced by women to relieve discomfort of leg cramps respectively. Backache was managed by taking rest (95%). Around 80% of women complained of disturbed sleep less than 6 hours and nearly 85% women reported to have rest in afternoon for fulfilment of sleep. Table 3 depicts that knowledge regarding management of minor ailments of pregnancy was found to have significant association with age (p=0.00), occupation (p=0.00), Education (p=0.00), type of family (p=0.00) and Source of information (p value=0.00).   Based on the results of study findings, a booklet in Hindi on management of minor ailments of pregnancy: healthy and happy motherhood was prepared by the authors. This booklet was validated for content by Nursing, Public health and OBG health professionals. The booklet was also validated for its language by Hindi experts. This information booklet was be circulated in hospital and community health settings to spread awareness regarding minor ailments of pregnancy and their management.

DISCUSSION
Each pregnancy is a new and different experience to mother providing a bridge to future generation. Throughout the period of pregnancy women experience number of minor health problems which result from numerous physiological, biochemical changes to provide environment for foetus growth. These ailments if not managed properly can affect the pregnancy outcome. The current study was conducted to assess knowledge and practices regarding management of minor ailments of pregnancy among antenatal mothers at selected hospital of Jodhpur The results of present study shows that nearly half of women were from age group 21-25 years. About 42% of women were graduate. Nearly half of the women were multigravida. This nearly agrees with the findings of a study conducted by Algeswari et al where 50% of female under study were from age group 20-25 years, 48% were graduate and 42% of females were multigravida. 13 Minor ailments of pregnancy are results of various ongoing physiological and hormonal changes to prepare women body for motherhood. In current study increased urine frequency, fatigue, nausea vomiting, backache, leg cramps were some of the most common minor ailments whereas minor ailments like constipation and increased vaginal secretions were least reported. Similar findings were reported by Kaur et al where in about 60% of antenatal women reported to have constipation. 12 Results of present study also nearly agrees with the findings of the study conducted by Agampodi where 77% subjects reported increased nausea and vomiting. 8  As far as practices are concerned antenatal mothers were performing wide range of home practices to manage different minor ailments of pregnancy such as eating small and frequent meals, avoiding strong odours to manage nausea and vomiting, Void when urge is felt and drinking plenty of liquids for frequent urination. Whereas in case of constipation eating fruits and vegetables followed by drinking plenty of water and walking were evidently performed by women. For backache and sleep disturbance, rest was the most common practice. Consistent results were found from study conducted by Aldossary et al where results revealed that avoiding odours, eating small several meals are preferred choices for nausea and vomiting, void when urge is felt and increase fluid intake during day are practiced by women for increase urine frequency. Planning a time for nap or rest period daily were also chosen for fatigue. Increase intake of foods high in fibre, drinking more water for constipation were some preferred choices. 17 The results are also in agreement with the results of a study conducted by Hassan EH and researchers where study subjects used to eat more fresh vegetables, fruits, increased fluid intake and took yogurt respectively for relieving constipation. 10 Knowledge about minor ailments can vary with changing socio demographic profile. In present study knowledge levels were found to be significantly associated with age, education, occupation, monthly income and source of information which is similar to the study conducted by Vincet et al where knowledge had significant association with age and education. 7 Consistent results were found from study conducted by Aziz et al where knowledge was found to be associated with age and education. 18 Several limitations should be considered. The results may not be generalized as the study was conducted at a single setting among sample chosen by convenient sampling technique.

CONCLUSION
It is shown from study findings that antenatal mothers had fair knowledge regarding minor ailments and based on their knowledge they performed varied practices to manage their ailments. Since minor ailments are common during pregnancy and most of these ailments can be simply managed by home remedies only. A due consideration should be given to minor ailments because these are quite bothersome to women and affects quality of life which later affects outcomes of pregnancy. There is need to plan and implement aggressive awareness program for the mothers and family so as to provide them healthy pregnancy experience.