A Study to Assess the effectiveness of Fruit laxative on reduction of constipation among Primi antenatal mothers in second trimester in selected rural areas, Babgalore

 

Dineshwori Chanu Paonam

Professor, Obstetric and Gynaecological Nursing, Obstetrics and Gynaecological Nursing,

Goutham College of Nursing, RGUHS, Bangalore, India.

 

ABSTRACT:

Constipation during pregnancy is not usually very serious, but it cause great discomfort and very distressing for the pregnant women. If constipation persists, then hemorrhoids may develop caused by straining at defecation which can subsequently caused difficulties in the birth process. Constipation during pregnancy can be prevented or treated. Fruit have been a natural staple diet, they contain substantial quantities of essential nutrients and serve as medicines and can treat ailments. This study aims to determine the effectiveness of fruit laxative on reduction of constipation. The study was conducted in primi antenatal mothers in second trimester in selected rural areas. A total of 40 primi antenatal mothers were included in the study of which 20 experimental group and 20 control group. Result shows that based on constipation scores of experimental Group. In the pretest majority of the respondents 60% have severe level of constipation, followed by 40% of moderate constipation level and none with mild constipation level. In the posttest all the respondents 100% have moderate constipation level and none of the respondent has severe and mild constipation level. Constipation was reduced after administration of fruit laxative. Hence forth the above study showed that fruit laxative was effective in reduction of constipation among primi antenatal mothers in second trimester.

 

 

INTRODUCTION:

Constipation is one among the minor discomfort and a very common problem during pregnancy. Constipation is defined as the passage of small amount of hard, dry faecal matter fewer than three times per week Constipation during pregnancy is due to reduced motility of large intestine (progesterone effect), increased water reabsorption from large intestine (aldesterone effect), pressure on the pelvic colon by the pregnant uterus, medication and sedentary life.

 

The ailments caused by the intake of unnatural food can be successfully treated by fruits. Fruits contain high source of fiber, moisture mineral, vitamins and roughage. The main physiological action of fruit is laxative effect. The fibrous matter in fruit cellulose, aids in the smooth passage of the food in the digestive tract and easy bowel action. Sugar and organic acids contained in fruit also help to quickly absorb water and softens the stool lead to easier bowel movement and muscle of bowel are regulated and help in proper flow of bile and bladder simulating digestion. Thus regular uses of fruit prevent and cure constipation. According to Indian society of gastroenterology 53% of pregnant women are suffering from constipation. The epidemiology survey explored that in India 30% to 80% of female population had constipation during pregnancy. The current study aims to reduce constipation during pregnancy by determining the effectiveness of fruit laxatives.

 

Constipation is one of the common discomforts experienced by the antenatal mothers so researcher planned to conduct the present study thereby aiming to bring with a cost effective home remedy for the discomfort caused by constipation during pregnancy.

 

STATEMENT OF PROBLEM:

A study to assess the effectiveness of fruit laxative on reduction of constipation among primi antenatal mothers in second trimester in selected rural areas, Bangalore

 

OBJECTIVES OF THE STUDY:

1.     Assess the level of constipation of primi antenatal mothers in second trimester among experimental and control group in terms of pretest.

2.     Evaluate the effectiveness of fruit laxative on reduction of constipation with pretest and posttest scores among experimental and control group.

3.     Find out the association between levels of constipation with selected demographic variable among the primi antenatal mothers in second trimester.

 

REVIEW OF LITERATURE

The review of literature is organized under the following headings:

a)    Study related to constipation during pregnancy

b)    Study related to assessment of constipation

c)     Study related to treatment of constipation

d)    Study related to fruit laxative as management of constipation

 

MATERIAL AND METHODS:

Research Approach:

Evaluative research approach was employed for this study.

 

Research Design:

Quasi experimental research design.

 

Research Setting:

The present study was conducted at rural areas under Taverekerre PHC, Bangalore.

 

Variables under Study:

Dependent Variable:

Dependent variables are primi antenatal mothers with constipation.

 

Independent Variable:

Independent variable are fruit laxative

 

Target population:

The population of the study was primi antenatal mothers in second trimester at selected rural areas, Bangalore.

 

Sample and Sampling Technique:

A non probability purposive sampling technique was used to select sample for the study.

 

Sample Size:

The sample size for the present study was 40 (20 sample experimental group and 20 sample control group) primi antenatal mothers in second trimester.

 

Criteria for Sample Selection:

Sampling criteria is that which specifies the characteristics that the sample in the population must possess.

 

Inclusion Criteria:

1.   Primi antenatal mothers who are having constipation for 2 days

2.   Primi antenatal mothers of all age group.

3.   Primi antenatal mothers who are in second trimester only.

4.   Primi antenatal mothers who are willing to participate.

 

Exclusion Criteria:

1.   Primi antenatal mothers who are not available during data collection.

2. Primi antenatal mothers who are having other associated problem with constipation such as DM, oligohydramnious, polyhydramnious etc.

 

Data Collection Tool:

The written permission was obtained from the Medical Officer PHC Taverekerre, Bangalore, prior to the data collection. Survey was conducted in Taverekerre, Yellechakuppe, Joganahally, Naganahally, Honoganahally and Vartur village prior to the data collection. Data collection was done in month of November. The purpose of the study was explained and an informal consent was obtained from the subjects.

 

A pretest done by using modified constipation assessment scale among the primi antenatal mothers in second trimester on the first day for both experimental and control group. Experimental group consist 20 subjects and control group consist 20 subjects. Fruit laxative was administered to the experimental group twice daily from day 1 to day 3, total of 3 consecutive days. Same procedure was repeated for all groups each day. Fruit was not administered to the control group and restricted fruits for the purpose of control. (Schedule on fruit laxative - 100 kcal of grape (seedless) 200gm, 45 kcal of guava 85gm and 214 kcal in two medium banana (Chiquita) i,e 359 kcal as two serving.

Posttest was administered by using the same scale on 4^th day for both experimental and control group. The data collection process was terminated by thanking the respondents for their co-operation.

 

Ethical Consideration:

·       Permission was obtained from the research committee of Goutham College of Nursing, Bangalore and the Medical Officer of Taverekerre PHC, Bangalore.

·       Informed consent was obtained from primi antenatal mothers in second trimester who were willing to participate in the study. Anonymity and confidentiality of the participants was maintained

 

RESULTS:

Table -1: Indicates majority of the respondents 35% belongs to age group between 24-26 years and 22-23 years and 25% belong to 20-21 years. 60% belongs to Hindu family and 40% belongs to Muslim family. 55% belongs to nuclear family and 45% belong to joint family, 40% were in middle school and minimum 10% were in PUC, 50% were housewife and 15% were in private and business, education of spouse majority of respondents 30% were in high school and 20% were in middle school, 45% earned between Rs3, 001-5,000 and 15% earned between Rs.8, 001-10,000, Regarding personal habit 100% were having others. 85% of respondents were having mixed diet and 15% were vegetarian. 90% of respondents used to walk and 10% were jogging. Regarding exposure to source of information 45% of respondent received information from health personnel and 25% received information from family members respectively among experimental group.

 

Regarding control group, majority of respondents 40% belongs to age group 24-26 years and 25% belong to 20-21 years respectively. 90% were Hindu and 10% were Muslim, 70% belongs to joint family and 30% belongs to nuclear family, 80% were in primary school and 5% were in PUC, 80% were housewife and 5% were in private, majority of respondents 45% were in high school and 10% were in PUC respectively. 40% earned between Rs.5, 001- 8,000, 25% earned between Rs.3, 001-5,000, 20% earned between Rs.8, 001-10,000 respectively. Regarding personal habit 100% were having others. 90% of respondents were having mixed diet and 10% were vegetarian. Regarding personal activity 100% of respondents were walking. 45% of the respondents received information from the health personnel and 20% of the respondents received information from the friends/neighbors respectively.

 

Table 1: Frequency and percentage distribution of socio demographic variables N = 40

Characteristics		Category	Respondents
			Control (n=20)		Experimental (n=20)		Combined (n=40)
			N	%	N	%	N	%
Age Group (years)		20-21	5	25.0	6	30.0	11	27.5
		22-23	7	35.0	7	35.0	14	35.0
		24-26	8	40.0	7	35.0	15	37.5
Religion		Hindu	18	90.0	12	60.0	30	75.0
		Christian	0	0.0	0	0.0	0	0.0
		Muslim	2	10.0	8	40.0	10	25.0
		Others	0	0.0	0	0.0	0	0.0
Type of Family		Nuclear	6	30.0	11	55.0	17	42.5
		Joint	14	70.0	9	45.0	21	52.5
		Extended	0	0.0	0	0.0	0	0.0
Educational status		Primary	8	80.0	6	30.0	14	35.0
		Middle	5	25.0	8	40.0	13	32.5
		High school	6	30.0	4	20.0	10	25.0
		PUC	1	5.0	2	10.0	3	7.5
		Degree/ above	0	0.0	0	0.0	0	0.0
Occupational status		Agriculture	0	0.0	4	20.0	4	10.0
		Private	1	5.0	3	15.0	4	10.0
		House wife	16	80.0	10	50.0	26	65.0
		Business	3	15.0	3	15.0	6	15.0
		Degree/ above	0	0.0	0	0.0	0	0.0
Education of spouse	Primary		3	15.0	5	25.0	8	20.0
	Middle		6	30.0	4	20.0	10	25.0
	High school		9	45.0	6	30.0	15	37.5
	PUC		2	10.0	5	25.0	7	17.5
	Degree/ above		0	0.0	0	0.0	0	0.0
Family income/month	Rs.3,001-5,000		5	25.0	9	45.0	14	35.0
	Rs.5,001-8,000		10	40.0	8	40.0	18	45.0
	Rs.8,001-10,000		5	20.0	3	15.0	8	20.0
Personal habit	Smoking		0	0.0	0	0.0	0	0.0
	Tobacco chewing		0	0.0	0	0.0	0	0.0
	Alcohol		0	0.0	0	0.0	0	0.0
	Others		20	100.0	20	100.0	40	100.0
Dietary pattern	Vegetarian		2	10.0	3	15.0	5	12.5
	Non –vegetarian		0	0.0	0	0.0	0	0.0
	Mixed		18	90.0	17	85.0	35	87.5
Personal activity	Walking		20	100.0	18	90.0	38	95.0
	Jogging		0	0.0	2	10.0	2	5.0
	Yoga		0	0.0	0	0.0	0	0.0
	Meditation		0	0.0	0	0.0	0	0.0
	Others		0	0.0	0	0.0	0	0.0
Exposure to Source of Information	Family members		7	35.0	5	25.0	12	30.0
	Friends/Neighbors		4	20.0	6	30.0	10	25.0
	Health personnel		9	45.0	9	45.0	18	45.0
	Self-learning		0	0.0	0	0.0	0	0.0
	TV/Radio		0	0.0	0	0.0	0	0.0

 

 

Table 2 Aspect wise Pretest Mean Constipation Scores of Experimental group N = 20

No.	Aspects	Statements	Max. Score	Constipation Scores
				Mean	Mean (%)	SD (%)
I	Abdominal distention	1	3	2.30	76.7	15.7
II	Change in amount of gas passed rectally	1	3	1.50	50.0	17.1
III	Less frequent bowel moments	1	3	2.20	73.3	13.7
IV	Rectal fullness or pressure	1	3	2.30	76.7	15.7
V	Rectal pain with bowel moments	1	3	1.75	58.3	18.3
VI	Small stool size	1	3	2.25	75.0	14.8
VII	Urge but inability to pass stool	1	3	2.50	83.3	17.1
VIII	Excess straining	1	3	2.20	73.3	13.7
IX	Hard, dry stool	1	3	2.20	73.3	13.7
	Combined	9	27	19.20	71.1	8.6

 

Table 2: Aspect wise Pretest mean constipation Scores of Experimental Group. Regarding abdominal distention the mean constipation scores was 76.7%, in the aspect of change in amount of gas passed rectally the mean constipation scores was 50.0%, less frequent bowel movement mean constipation scores 73.3%, rectal fullness or pressure mean constipation scores was 76.7%, rectal pain with bowel movement mean constipation scores was 58.3%, small stool size mean constipation scores was 75.0%, urge but inability to pass stool mean constipation scores was 83.3%, excess straining mean constipation scores was 73.3% and hard, dry stool mean constipation scores was 73.3%. The total means constipation Score was 71.1%

 

Table 3 Over all Pretest Mean Constipation scores among Control and Experimental group N = 40

Aspects	Sample	Constipation Scores (%)			Student ‘t’ Test
		Mean	Mean (%)	SD (%)
Control	20	20.05	74.3	7.5	1.25 NS
Experimental	20	19.20	71.1	8.6

NS: Non-Signifiant t (0.05, 38df) = 1.96

 

Table 3: Indicates over all Pretest Mean constipation scores among Experimental and Control Group. Overall pretests mean constipation scores of Experimental and Control Group was 74.3% and 71.1%. The obtained‘t’ value is 1.25 and is statistically non-significant at p > 0.05 level.

 

Hence, there is no significant difference in the pretest constipation scores of primi antenatal mothers in second trimester children among Experimental and Control Group.

 

Table 4 Indicates over all Posttest Mean constipation scores among Experimental and Control Group. Overall posttests mean constipation scores of Experimental and Control Group was 75.4% and 48.1%%. The obtained‘t’ value was 15.69 and was statistically significant at p > 0.05 level.

 

Hence, there was significant difference in reduction of constipation among primi antenatal mothers in second trimester receiving fruit laxative among Experimental group. Hence research hypothesis H₃ is accepted.

 

Table 4 Over all Posttest Mean Constipation scores among Control and Experimental group N = 40

Aspects	Sample	Constipation Scores (%)			Student ‘t’ Test
		Mean	Mean (%)	SD (%)
Control	20	20.35	75.4	6.2	15.69 *
Experimental	20	13.00	48.1	4.7

* Significant at 5% level, t (0.05, 38df) = 1.96

 

Table 5: Indicates classification of respondents based on constipation scores of experimental Group. In the pretest majority of the respondents 60% have severe level of constipation, followed by 40% of moderate constipation level and none with mild constipation level. In the posttest all the respondents 100% have moderate constipation level and none of the respondent has severe and mild constipation level.

 

Further the statistical χ2 value was 17.14, which was significant at 5% level. There exists a significant association between constipation scores of the respondents in pretest and posttest of experimental group. So this indicates fruit laxative was effective in reduction of constipation among primi antenatal mothers in second trimester.

 

Table 5: Classification of Respondents on Constipation scores of pretest and posttest-Experimental group       N = 20

Constipation levels	Category	Classification of Respondents
		Pre test		Post test
		Number	%	Number	%
Mild	1- 9 Score	0	0.0	0	0.0
Moderate	10-18 Score	8	40.0	20	100.0
Severe	19-27 Score	12	60.0	0	0.0
Total		20	100.0	20	100.0
χ 2 Value		17.14 *

Significant at 5% level χ ² (0.05, 1df) = 3.841

 

 

Fig. 1 Classification of Respondents on constipation scores of Pretest and posttest Experimental group

 

Table 6: Indicates the classification of respondents on constipation scores of pretest and posttest of control group. In the pretest majority of the respondents 70% have severe constipation level followed by 30% with moderate constipation level and none with mild constipation level. In the posttest majority of the respondents 85% have severe constipation level followed by 15% having moderate constipation level with none having mild constipation level.

 

Further the statistical χ2 value was 1.29, which was non-significant at 5% level. There exists no significant association between constipation scores of the respondents in pretest and posttest of control group.

 

Table 6: Classification of Respondents on Constipation scores of pretest and posttest- Control group

N = 20

Constipation levels	Category	Classification of Respondents
		Pre test		Post test
		Number	%	Number	%
Mild	1- 9 Score	0	0.0	0	0.0
Moderate	10- 18 Score	6	30.0	3	15.0
Severe	19-27 Score	14	70.0	17	85.0
Total		20	100.0	20	100.0
χ 2 Value		1.29 NS

NS: Non - Signifiant χ ² (0.05, 1df) = 3.841

 

 

Fig. 2: Classification of respondents on constipation scores of Pretest and Posttest Control group

 

Table 7: indicates association between Demographic variables and Pretest constipation scores of Experimental Group. Age group and type of family exists significant association with the pretest constipation scores of experimental group (P<0.05). Hence the research hypothesis H₄ is accepted.

 

And there exists a non-significant association between pretest constipation scores of primi antenatal mothers in second trimester among experimental group with other selected demographic variables such as religion, educational status, educational status of spouse, occupational status, monthly income, dietary pattern and exposure to source of information. Hence the research H₄ is rejected and H₀₂ is accepted.

Further, the constipation scores of experimental group in the posttest was found to be moderate (100%) with respect to all the samples. Hence, the association between demographic variables with constipation scores was not tabulated.

 

Table 7: Association between Demographic variables and Pretest Constipation scores of Experimental Group                 N = 20

Demographic Variables	Category	Sample	Respondents constipation scores				χ 2 Value	P Value
			Moderate		Severe
			N	%	N	%
Age Group (years)	20-21	6	0	0.0	6	100	10.47*	< 0.05
	22-23	7	2	28.6	5	71.4
	24-26	7	6	85.7	1	14.3
Religion	Hindu	12	4	33.3	8	66.7	0.56	> 0.05
	Muslim	8	4	50.0	4	50.0
Type of Family	Nuclear	11	7	63.6	4	36.4	5.69*	< 0.05
	Joint	9	1	11.1	8	88.9
Educational Status	Primary	6	1	16.7	5	83.3	3.51 NS	> 0.05
	Middle	8	5	62.5	3	37.5
	High school	4	1	25.0	3	75.0
	PUC	2	1	50.0	1	50.0
Educational status of Spouse	Primary	5	0	0.0	5	100	5.28 NS	> 0.05
	Middle	4	2	50.0	2	50.0
	High school	6	4	66.7	2	33.3
	PUC	5	2	40.0	3	60.0
Occupational status	Agriculture	4	1	25.0	3	75.0	5.35 NS	> 0.05
	Private	3	1	33.3	2	66.7
	House wife	10	3	30.0	7	70.0
	Business	3	3	100	0	0.0
Monthly Income	Rs.3,001-5,000	9	4	44.4	5	55.6	1.71 NS	> 0.05
	Rs.5,001-8,000	8	2	25.0	6	75.0
	Rs.8,001-10,000	3	2	66.7	1	33.3
Dietary pattern	Vegetarian	3	2	66.7	1	33.3	1.05 NS	> 0.05
	Non-vegetarian	17	6	35.3	11	64.7
Source of information	Family member	5	2	40.0	3	60.0	0.19 NS	> 0.05
	Friends/Relatives	6	2	33.3	4	66.7
	Health personal	9	4	44.4	5	55.6
Total		20	8	40.0	12	60.0

* Significant at 5% Level,                                                         NS: Non-significant

 

 

CONCLUSION:

The present study concludes that all primi antenatal mothers in second trimester (100%) have moderate constipation level and none of the respondent has severe and mild constipation level. It was concluded that fruit laxative was effective in reducing constipation among primi antenatal mothers.

 

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Received on 06.07.2020          Modified on 20.08.2020

Accepted on 21.09.2020     © AandV Publications all right reserved