INTRODUCTION:

World Health Organization defines “Teenage Pregnancy as any pregnancy of a girl aged 10 to 19 years. Adolescent Pregnancy means pregnancy in a woman aged 10-19 years”(Adolescent Pregnancy-WHO-2004). This is the period when structural, functional and psychological development occur in a girl to prepare her for assuming the responsibility of motherhood.¹

Adolescent pregnancy is a natural consequence of sexual activity unprotected through contraception; teen pregnancy is socially and economically a social problem because of the implications deriving from the mother’s status: psychologically immature, having no consistent skills nor the ability to ensure a steady income, so unable to raise and educate her own child, the pregnant teenager faces multiple medical risks and complications at birth or affecting the child’s constitution and health.²

Pregnant teenagers face many obstetrics issues as women in their 20s and 30s. However, there are additional medical concerns for younger mothers, particularly those under fifteen and those living in developing countries. A report by ‘save the children’ found that, annually, 13 million children are born to women under age 20 worldwide, more than 90% in developing countries. Complications of pregnancy and childbirth are the leading cause of mortality among women between the ages of 15 and 19.³

In the Indian subcontinent, early marriage sometimes results in adolescent pregnancy, particularly in rural regions where the rate is much higher than it is in urbanized areas. Latest data suggests that teen pregnancy in India is high with 62 pregnant teens out of every 1,000 women. Approximately 1 million teenagers become pregnant each year, and the estimates of pregnancies include the sum of live births, induced abortions, and spontaneous losses. Because of the various outcomes of pregnancies, precise pregnancy rates are difficult to determine in addition, reports a nation data reporting are delayed because of the time required to analyze large data sets. The demographics of adolescent pregnancy have changed dramatically in the past 25 years.⁴

According to UNICEF, worldwide every 5th child is born to teenage mother. Worldwide 13 million births each year occur to girls younger than 19 years. Approximately 90% of the teenage births occur in developing countries. Teenage pregnancy is an important public health problem in both developed and developing country, as it is a ‘high-risk’ or ‘at-risk’ pregnancy due to its association with various adverse maternal and fetal outcomes which results in increased mortality and morbidity of the mother and the child.⁵

According to the United Nations Population Fund (UNFPA), “Pregnancies among girls less than 18 years of age have irreparable consequences. It violates the rights of girls, with life threatening consequences in terms of sexual and reproductive health, and poses high development costs for communities, particularly in perpetuating the cycle of poverty”.⁶

In Karnataka 21 per cent of women in rural areas begin child-bearing at an early age. Early marriage of women continued to be high, 42 per cent of those in the age group of 20-24 were married before the legal minimum age (18 years), while 15 per cent of men in the age group of 25-29 got married before the minimum marriageable age (21). Teenage pregnancies among those aged between 15-17 years are higher in Karnataka (17%) against the national average (16%).⁷

In India it is estimated that 1/3rd of the total population is under the age group of 20 years, and adolescent are at the risk of sexual and reproductive health problems. More than 15 million girls aged between 15-19 years give birth every year. Adolescent girls who get pregnant before 18 years may be five times more likely to die than a woman aged 20-28 years.⁸

With modernization, teenage pregnancy rate is rapidly declining in developed countries, but it is still high in developing countries like India. The scenario of teenage pregnancy in developed countries is quite different from that of the developing countries and has distinctly different rates of pregnancy as well.⁹

Teenage pregnancy is a fairly common occurrence in India, due to many factors such as early marriage, girls reaching puberty at younger ages and high specific fertility rate in the adolescent age group. In India teenage pregnancy varies from 8 to 14%. The pregnant teenager may not be quite fit to bear the burden of pregnancy and labour at a tender age, the obstetric outcome of teenage pregnancy is influenced by many socio- medical factors, maternal and prenatal morbidity mortality in teenagers.¹⁰

According to 2011 statistics, every minute in the world, 380 women become pregnant, 190 faces unplanned pregnancy, 110 experiences a pregnancy related complication, and 40 have an unsafe abortion. Adolescent girls dying from pregnancy related causes accounts for 13% of all maternal deaths. The risk of maternal mortality is twice as high for women aged 15–19 years and five times higher for girls aged 10–14 years compared to women aged 20–29 years.¹¹

Garner J. Alexander et al (2018) conducted a cross sectional study on Adolescent perinatal outcomes at Campbelltown and Liverpool hospitals within South West Sydney, Australia. Researcher selected 103 adolescents compared with 2291 women aged 20 to 34 years. Data was collected by using questionnaires. The result of the study was adolescents were more likely to be primiparous, had longer average gestations, and had lower pre-pregnancy body mass index. Adolescents had lower rates of cesarean section delivery and gestational diabetes mellitus. There was no significant difference in smoking rates, perinatal mortality rate, and small for gestational age, intrauterine growth restriction, apgar score of less than 7 at 5 minutes, admission to special care nursery, or hypertensive disorder of pregnancy rates. Adolescents had lower booking systolic and diastolic blood pressures, and their highest antenatal systolic blood pressures were lower. The study concluded that Adolescents have birth outcomes to similar to those of their older counterparts. Adolescents had lower booking blood pressures. This may have implications for the screening and diagnosis of hypertensive disorders of pregnancy in adolescents.¹²

Mrs. P. Vadivukkarasi Ramanadin conducted a descriptive study on teenage pregnancy and its prevention among the teenage girl residing in selected areas of Dadra and Nagar Haveli. Researcher selected Teenage girls by Non Probability, Convenient Sampling Technique and Sample size was 32. Data was collected by using Interview schedule with structured knowledge questionnaire. The finding of the study shows that maximum number (37.5%) of teenage girls have very poor and 15.625% of them have good knowledge on teenage pregnancy. Study shows that majority of the teenage girls are not having adequate knowledge regarding teenage pregnancy.¹³

Koteswaramma D. (2016) conducted a pre experimental study on Effectiveness of Structured Teaching Programme on Hazards of Teenage Pregnancy in Adolescent Girls in Tirupati, India. Researcher selected 50 teenage girls by using simple random sampling technique. Data was collected by using structured knowledge questionnaire. The Findings revealed that adolescents (66%) are receiving information from mass media,28 % stated teachers have given knowledge about teenage pregnancy. Students have not received any information about teenage pregnancy from parents and health team members. Awareness on hazards of teenage pregnancy is inadequate (Pretest mean knowledge is 16.98), which was improved after imparting education (post test knowledge 57.84). Which is significant at 0.01 level (The paired t value - 23.37). The result suggested that imparting the structured teaching programme to teenage girls could enlighten their knowledge on hazards of teenage pregnancy that may result in best practices such as delay in early marriage and pregnancy. Therefore Nursing personnel can organize counseling and educational sessions at colleges to prevent teenage pregnancies.¹⁴

OBJECTIVE OF THE STUDY:

(1) To assess the existing knowledge of adolescent girls on complications of teenage pregnancy before the administration of Structured Teaching Programme.

(2) To assess the effectiveness of Structured Teaching Programme on knowledge regarding complications of teenage pregnancy among adolescent girls.

(3) To associate the pre-test knowledge scores with their selected demographic variables.

RESEARCH HYPOTHESES:

The hypotheses will be tested at the 0.05 level of significance.

H₁: The mean post-test knowledge scores will be significantly higher than the mean pre-test knowledge scores.

H₂: There will be significant association between pre-test knowledge scores with their selected demographic variables.

MATERIAL AND METHODS:

Research Design:

The pre- experimental (one group pre test post test) research design without randomization.

Setting:

The study was conducted in Adarsh India Montessory Inter College Lucknow.

Population:

Accessible population for this study includes adolescent girls of Adarsh India Montessory Inter College Lucknow.

Sample:

Selected 100 (adolescent girls) samples.

Sampling Technique:

The samples were selected for this study by non-probability purposive sampling technique.

Data analysis:

The demographic variables were organized by using descriptive measures (frequency and percentage). The data from the structured knowledge questionnaire before and after administration of structured teaching programme will be analyzed using mean, standard deviation (SD) and paired “t” test. The association between the level of knowledge and the selected demographic variables were assessed by Chi-square test.

RESULT:

Section-I: Distribution of sample subjects according to their demographic variables. Demographic variables were age in years, religion, type of family, family income, accommodation, Residential area, and previous knowledge regarding teenage pregnancy.

Section- II: Knowledge of adolescent girls regarding complications of teenage pregnancy.

Section-III: Effectiveness of Structured Teaching Programme on knowledge regarding complications of teenage pregnancy.

Section- IV: Association between the level of pre-test knowledge scores with their selected demographic variables.

SECTION I-Description of sample subject according to their demographic variables

Table No. 1: Frequency and Percentage distribution of adolescent girls according to their demographic variables. n=100

S. No.	Demographic Variables		Frequency	Percentage
S. No.	Demographic Variables		f	%
1	Age in Years	a. 12-13 years	13	13.00
		b. 14-15 years	38	38.00
		c. 16-17 years	45	45.00
		d. 18-19 years	4	04.00
2	Religion	a. Hindu	100	100.00
		b. Muslim	00	00.00
		c. Christian	00	00.00
		d. Sikh	00	00.00
		e. Others	00	00.00
3	Type of family	a. Nuclear family	43	43.00
		b. Joint family	55	55.00
		c. Extended family	02	02.00
4	Monthly income	a. Rs.10,000- 15,000	18	18.00
		b. Rs.16,000- 20,000	49	49.00
		c. Rs.21,000- 25,000	21	21.00
		d. Rs.26,000- 30,000	06	06.00
		e. Rs.31,000 and above	06	06.00
5	Accommodation	a. Day Scholar/ Home	100	100.00
		b. Hosteller	00	00.00
		c. Paying Guest	00	00.00
		d. Local Guardian	00	00.00
6	Residential area	a. Urban area	96	96.00
6	Residential area	b. Rural area	04	04.00
7	Previous knowledge regarding teenage pregnancy	a. Yes	11	11.00
7	Previous knowledge regarding teenage pregnancy	b. No	89	89.00
8	Source of information	a. Family members	05	05.00
		b.Teachers	06	06.00
		c.Peer group or seniors	00	00.00
		d.Attended any Health exhibition or Seminars	00	00.00
		e.Newspaper, magazines, journals, articles, mass media.	00	00.00

SECTION II

KNOWLEDGE OF ADOLESCENT GIRLS REGARDING COMPLICATIONS OF TEENAGE PREGNANCY IN PRE-TEST AND POST- TEST.

This section describes the frequency and percentage distribution of sample subjects according to the pre-test and post test knowledge regarding complications of teenage pregnancy.

TABLE NO. 2

Pre- test frequency and percentage distribution of sample subjects.

Pre Knowledge Score

S. No.	Level of Existing Knowledge	Frequency (f)	Percentage (%)
1	Inadequate (≤50%)	97	97.0
2	Moderate (51-75%)	3	3.0
3	Adequate (≤76%)	0	00.0

Figure: Bar diagram showing percentage distribution of sample subjects according to their pre-test knowledge regarding complications of teenage pregnancy

TABLE NO. 3: Post- test frequency and percentage distribution of sample subjects.

Post Knowledge Score

S. No.	Level of Existing Knowledge	Frequency (f)	Percentage (%)
1	Inadequate (≤50%)	0	0.0
2	Moderate (51-75%)	23	23.0
3	Adequate (≥76%)	77	77.0

Figure: Split pie graph showing percentage distribution of sample subjects according to their Post-Test knowledge regarding complications of teenage pregnancy

COMPARISON OF PRE-TEST AND POST-TEST KNOWLEDGE SCORES

The data presented in the table no. 4, shows that the mean post test knowledge scores of sample subjects were 32.66 and mean pre-test knowledge scores were 14.47. The ‘t’ value was computed and found to be 34.835, which is more than the tabulated value i.e. 1.98, at <0.05 level of significance.

This shows that the difference between pre-test and post-test of sample subjects was a true difference and not by chance. Hence, null hypothesis H0₁rejected, thus research hypothesis was accepted.

TABLE NO. 4: Testing of hypothesis n=100

Knowledge scores

Mean and SD

Std. Error Mean

t- Value

p- Value

Pre-test

14.47 ±2.90

0.522

34.835

<0.001

Post-test

32.66 ± 4.03

t (99) =1.98 and p<0.05 S*

TABLE NO. 5: SECTION III- Association between pre-test level of knowledge scores regarding complications of teenage pregnancy with their selected demographic variables among adolescent girls. n=100

S. No	Variables	Level of Knowledge				Statistical Significance
		Inadequate (n=97)		Moderate (n=03)		Chi- Square	df	p – Value
		No.	%	No.	%	Chi- Square	df	p – Value
1-	Age (Years)
	12-13 years	12	12.04	01	33.30	2.605	3	0.453
	14-15 years	38	39.20	00	00.00
	16-17 years	43	44.30	02	66.70
	18-19 years	04	04.00	00	00.00
2-	Religion
	Hindu	97	100.00	03	100.00	-	-	-
	Muslim	00	00.00	00	00.00
	Sikh	00	00.00	00	00.00
	Christian	00	00.00	00	00.00
	Others
3-	Type of Family
	Nuclear Family	42	43.40	01	33.33	0.206	2	0.902
	Joint Family	53	54.60	02	67.70
	Extended Family	02	02.10	00	00.00
4-	Monthly income
	Rs.10,000- 15,000	16	16.50	02	66.70	5.245	4	0.263
	Rs.15,000- 20,000	48	49.50	01	33.30
	Rs.20,000- 25, 000	21	21.60	00	00.00
	Rs.25,000- 305,000	06	06.20	00	00.00
	Rs.30,000 and above	06	06.20	00	00.00
5-	Accommodation
	Day Scholar/Home	100	100.0	00	100.00	-	-	-
	Hosteller	00	00.00	00	00.00
	Paying Guest	00	00.00	00	00.00
	Local Guardian	00	00.00	00	00.00
6-	Residential area
	Urban area	94	96.90	02	66.70	6.930	1	0.008*
	Rural area	03	03.10	01	33.30	6.930	1	0.008*
7-	Previous knowledge regarding teenage pregnancy
	Yes	10	10.30	01	33.30
	No	87	89.70	02	66.70
8-	Source of information
	Family members	04	04.10	01	33.30	1.576	1	0.209
	Teachers	06	06.20	00	00.00
	Peer group or seniors	00	00.00	00	00.00
	Attended any Health exhibition or Seminars	00	00.00	00	00.00
	Newspaper, magazines, journals, articles, mass media	00	00.00	00	00.00

The findings of the research study also shows that there is a significant association between knowledge level and “residential area” (p=0.008). There is a significant association at p=0.05 level of significance.

Thus it can be concluded that the research hypothesis accepted and null hypothesis rejected, which means there is an association between one variable.:

The pre test knowledge scores shows that the majority of sample subjects (97.0%) had inadequate level of knowledge but after Structured Teaching Programme as an intervention, post-test knowledge scores depicts that majority of sample subjects (77%) had adequate level of knowledge and (23.0%) had moderate level of knowledge and none of the sample had inadequate level of knowledge. The calculated ‘t’- value was found to be (34.835) which was more than the tabulated value of (1.98) at 0.05 level of significance. This indicates that Structured Teaching Programme was proved to be very effective method of transforming information and also helps to enhance the level of knowledge regarding complications of teenage pregnancy. There was a significant association between the pre-test knowledge scores and other demographic variable like residential area of adolescent girls (χ²=6.930).

DISCUSSION:

The discussion of the study is based on the objectives of the study.

The first objective of the study was to assess the existing knowledge of adolescent girls on complications of teenage pregnancy before the administration of Structured Teaching Programme:

In the present study the level of existing knowledge was categorized into inadequate, moderate and adequate knowledge level. Pre-test knowledge scores among adolescent girls depicts that majority of samples (97.0%) had inadequate level of knowledge, (3%) had moderate level of knowledge and none of the sample had adequate knowledge regarding complications of teenage pregnancy.

The present study findings is in accordance with findings of Krishnan Gayatri G (2016), It revealed that in pre-test 25 (83.30%) adolescent girls were having inadequate level of knowledge, 5(16.70%) adolescent girls were having moderate level of knowledge and no one was having adequate level of knowledge. So this indicated that before giving the structured teaching programme the existing level of knowledge regarding adolescent pregnancy in adolescent was low level of knowledge.¹⁵

The second objective of the study was to assess the effectiveness of Structured Teaching Programme on knowledge regarding complications of teenage pregnancy:

The result of the present study showed that the post–test mean knowledge scores was found higher, mean (32.66) and Standard Deviation (4.03) when compared with pre-test mean knowledge scores, mean (14.47) and SD (2.90), calculated ‘t’ value was 34.835 which was more than tabulated value 1.98 at <0.05 level of significance. Hence this indicates that Structured Teaching Programme was effective in providing knowledge regarding complications of teenage pregnancy among adolescent girls.

While comparing the study findings of the other published researches, findings of this study is akin to the findings of Koteswaramma D. (2015) the knowledge of awareness on hazards of teenage pregnancy is inadequate (Pre-test mean knowledge is 16.98),which was improved after imparting education (post test knowledge 57.84). This is significant at 0.01 level of significance (paired t value 23.37). Hence this indicated that Structured Teaching Programme was effective in providing knowledge regarding complications of adolescent pregnancy among adolescent girls.¹⁶

Third objective of the study was to associate the pre-test knowledge scores with their selected demographic variables:

In the present study association found between the pre-test knowledge score and other demographic variables like residential area of adolescent girls in which most of adolescent girls that is 96% were from urban area. Majority of the samples (100%) were Hindu. Majority of sample subject (89%) samples had no previous knowledge and only (11%) had previous knowledge regarding complications of teenage pregnancy. Among (11%) of sample subjects with previous knowledge (6%) belongs to teachers and (5%) through family members, as a source of information. Association of pre test knowledge score was found only with residential area of adolescent girls i.e. more than the table value (χ²=6.930).

This result is contradicted by a similar study of Shaikh Fouzia et al (2015), in this study most of the women belonged to urban areas (62.39%), which shows that association found with pre test knowledge score with their residential area.¹⁷ The finding were supported by study of Doddihal R. Chandrika a prospective study of adolescent pregnancy complications in a rural area, in this study the (88.2%) were Hindus which indicates that the association found between pre-existing knowledge with their demographic area.¹⁸

IMPLICATIONS OF THE STUDY:

After analyzing the gathered information, the researcher came to know that there was inadequate knowledge regarding complications of teenage pregnancy among adolescent girls and Structured Teaching Programme had a significant role in improving their knowledge. Thus findings of the study have implications for Nursing Education, Nursing Practice, Nursing Research and Nursing administration.

NURSING EDUCATION:

· The study proved that the Structured Teaching Programme regarding the complications of teenage pregnancy is effective in gaining the knowledge. So this will enhance the students to appreciate the importance of knowledge regarding complications of teenage pregnancy.

· The study will be helpful for the students to realize their role in primary prevention of complications of teenage pregnancy among adolescent girls.

· During basic education courses, students may get education regarding teenage pregnancy and its outcome.

· The health care providers are the key personnel in imparting education to the adolescent girls regarding complications of teenage pregnancy.

NURSING PRACTICE:

This study stresses that there is a need of involvement of nursing staff in planning and conducting education programs and also there is need of student nurses to involve in the educational programs.

· Nurses play a major role in the health care system, they can provide supportive education services will help individuals, families and communities to obtain restore or recover optimal health.

· The study revealed that, there is a need of educational program for the reproductive health, early marriage and complications of teenage pregnancy among teenagers and women in community and health care system.

· There is a need of nurses to involve in the educational program for the awareness of reproductive health, sexuality and early marriage.

· Nurses working in the hospital setting will be able to find out the high risk population and provide comprehensive health education about teenage pregnancy, sexuality, and reproductive health.

NURSING RESEARCH:

In India very few studies are conducted among adolescent girls regarding knowledge on complications of teenage pregnancy.

· The study will be valuable reference and pathway for further research.

· Studies revealed that complications of teenage pregnancy are more prevalent in girls less than 19 years.

· The present study reveals that there is a lack of adequate knowledge about complications of teenage pregnancy among adolescent girls.

· This study enlightens that there is a need for educational programmes in the schools or community to improve the knowledge regarding complications of teenage pregnancy among adolescent girls.

NURSING ADMINISTRATION:

The main focus of nursing administration is to organize seminars and workshop and other educational programmes for adolescent girls as a part of in-service education programme by which they can gain the knowledge on the complications of teenage pregnancy among adolescent girls and can provide schools or community based education programmes to the target population effectively.

Nursing administrator should take part in the health policy making and developing protocols.

The nurse administrator should make proper recommendation to train effectively the nurses in care of teenage mothers.

Nurse educator should provide adequate knowledge regarding complications of teenage pregnancy to the nurse’s students.

LIMITATIONS:

· The study was limited to the Adarsh India Montessori Inter College at Lucknow.

· The sample size was limited to 100 only.

· The study was limited only to the adolescent girls in Adarsh India Montessori Inter College at Lucknow.

· The tools used were not standardized tools.

· The study was limited to only knowledge aspect. The study could be conducted to evaluate the attitude and practice too.

RECOMMENDATIONS:

· The study can be repeated by taking a large sample in other parts of the state.

· A similar study on a large and wider sample will be more pertinent in making broad generalizations.

· A study can be done to assess knowledge and attitude of adolescent girls regarding complications of teenage pregnancy.

· An experimental study can be carried out to find out the effectiveness of video assisted programme on complications of teenage pregnancy.

· A similar study can be replicated with control group.

· Longitudinal studies to determine the constant effectiveness of structured teaching programme over a period of time may be conducted.

CONCLUSIONS:

This study has clearly brought out the need for a structured teaching programme for adolescent girls regarding complications of teenage pregnancy. The study findings showed the effectiveness of Structured Teaching Programme on knowledge regarding complications of teenage pregnancy.

REFERENCES:

1. Adolescent Pregnancy; “Issues in adolescent health and development”; WHO Discussion Papers on Adolescence; WHO 2004; PP 86.

2. Simigiu Aurora; “Teen Pregnancy, Factors, Options, Consequences”; published in International Conference of Scientific Paper; 24-26 May 2012

3. Report on “save the children”2016-17; available on www.savethechildren.in

4. Daflapurkar Bangale Shruti; “high risk case in obstetrics”; teenage pregnancy; published by jaypee brothers publications; page no. 340

5. UNICEF; “A league table of teenage births in rich nations”; Innocenti Research Centre Florence; Italy. 2001.

6. UNFPA;"Adolescent Pregnancy"; UNFPA; 2013; PP 1-60.

7. Teenage pregnancies higher than national average in Karnataka; India’s national news paper the Hindu; 2008 Nov 5; Available on: URL: http;//www.hindu.Com.

8. Youth and health issues; World youth report; 2003; 2008 Aug 20; PP 1-32. Available on http; // www.un.org

9. Anandalakshmi, P N; “ Teenage pregnancy & its effects on maternal & Child health - A hospital experience”; published in Indian Journal of Medical Sciences; vol 43; 1993; PP 8-11.

10. Sharma AK, Chhabra P, Aggarwel QP.; “Pregnancy in adolescents: A community based study”; Indian journal of preventive and social medicine; 2003; 34(1);182

11. WHO; Adolescent girls pregnancy census; 2011; available on https://www.google.co.in/2011+census+on+adolescent+girls&aqs

12. Garner J. Alexander et al, (2018); “Adolescent Perinatal Outcomes”; Published in Mayo Foundation for Medical Education and Research Elsevier; available on http//creativecommon.org/licences.

13. Ramanadin Vadivukkarasi P. et al, (2017); “A descriptive study to assess the knowledge on teenage pregnancy and its prevention among the teenage girl residing in selected areas of Dadra and Nagar Haveli”; published in International Journal of Nursing Education and Research 5(3): July- September 2017; www.anvpublication.org

14. Koteswaramma D. (2016); “Effectiveness of Structured Teaching Programme on Hazards of Teenage Pregnancy in Adolescent Girls”; published in Asian J. Nur. Edu. And Research; www.anvpublication.org

15. Krishnan Gayatri G (2016); “effect of structured teaching program on knowledge and attitude regarding preconception care among adolescent girls” published in International Journal of Applied Research; vol. 2; page no.435-439; available on www.allresearchjournal.com

16. Koteswaramma D. (2015); “hazards teenage pregnancy in adolescent girls”; published in Asian J. Nur. Edu. And Research; vol.6; www.anvpublication.org

17. Shaikh F, Abbas S, et al (2016); “Adverse Outcome of a Teenage Pregnancy”; J Liaquat Uni Med Health Sci; volume-04; page no.179-82.

18. Doddihal R. Chandrika (2017); “A prospective study of adolescent pregnancy complications in a rural area of South India; vol-9; published in International Journal of Research in Medical Sciences; available on www.msjonline.org

Received on 15.10.2018 Modified on 18.11.2018

Int. J. Nur. Edu. and Research. 2019; 7(2): 157-164.

DOI: 10.5958/2454-2660.2019.00032.2