FACTORS CONTRIBUTING TO LOW BIRTH WEIGHT AMONG MOTHERS OF REPRODUCTIVE AGE IN MATHARE SLUMS, NAIROBI; KENYA A PROPOSAL SUBMITTED IN PART FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF BACHELOR OF SCIENCE IN NURSING OF THE UNIVERSITY OF NAIROBI BY: GEOFREY MUNENE MW AI H32/2600/2003 SUPERVISOR; MR. JAMES MWAURA, BSC, MSC LECTURER, SCHOOL OF NURSING SCIENCES UNIVERSITY OF NAIROBI 4 TH, SEPTEMBER 2006
DECLARATION I declare that this research proposal is my original work and has not, by all means been submitted to any learning Institution for award of a degree or diploma. Signature: Date: [(4Cv,j/~-IJ:- 0 'tlo'l) Or Mwai Geoffrey M. H3212600/2003 11
CERTIFICATE OF APPROVAL This research proposal has been submitted for examinations in the degree of Bachelors of Science in nursing with my approval as a University supervisor. Signature _ Date ------- Mr. James Mwaura, BSC, MSC, Lecturer, School of Nursing Sciences. University of Nairobi. 111
DEDICATION My humble dedication goes to my family members for their endless unconditional love and support. Truly you have inspired me throughout my school life, may the almighty Lord bless you abundantly. IV
ACKNOWLEDGEMENTS: I would like to acknowledge the support from the Lecturers and non-teaching (support staff) of the school of nursing Sciences, University of Nairobi throughout my course. I acknowledge my supervisor Mr. James Mwaura for being resourceful, instrumental and supportive in my efforts to develop this research proposal. My special thanks goes to all my friends especially Miss Ruth Wainaina who helped me in typing and editing this work. May the almighty God bless you all. v
TABLE OF CONTENTS: Declaration -------------------------------------------------------------------------------- 11 Certificate of approval------------------------------------------------------------------ III Dedication ------------------------------------------------------------------------------ IV Operational definitions ----------------------------------------------------------------- v Abbreviations---------------------------------------------------------------------------- IX Executive summary--------------------------------------------------------------------- X CHAPTER ONE: 1.0 Introduction----------------------------------------------------------------- 1 CHAPTER TWO: LITERATURE REVIEW: 2.0 Definition of low birth weight------------------------------------- 3 2.1 Prevalence oflow birth weight------------------------------------ 3 2.2 Risk factors for low birth weight----------------------------------- 5 2.3 Medical conditions and complications of low birth weight----- 6 2.4 Prevention of low birth weight-------------------------------------- 8 2.5 Conclusions------------------------------------------------------------- 8 CHAPTER THREE 3.0 Problem statement---------------------------------------------------- 9 3.1 Background information--------------------------------------------- 10 3.2 Studyjustification ---------------------------------------------------- 11 3.3 Conceptual framework----------------------------------------------- 12 3.4 Hypotheses------------------------------------------------------------- 13 3.5 Main objectives-------------------------------------------------------- 13 3.6 Specific objectives----------------------------------------------------- 13 3.7 Study questions-------------------------------------------------------- 14 3.8 Expected benefits----------------------------------------------------- 14 CHAPTER FOUR; RESEARCH METHODOLOGY: 4.0 Study design------------------------------------------------------------- 15 4.1 Study variables---------------------------------------------------------- 15 4.2 Study area---------------------------------------------------------------- 16 4.3 Study population-------------------------------------------------------- 16 4.4 Sampling----------------------------------------------------------------- 16 4.40 Sample size determination--------------------------------------------- 16 4.41 Inclusion and exclusion criteria -------------------------------------- 18 4.5 Data collection tools--------------------------------------------------- 19 4.60 Pretesting of study tools----------------------------------------------- 19 4.61 Tool implementation--------------------------------------------------- 19 4.7 Data cleaning ----------------------------------------------------------- 19 4.8 Data entry and analysis------------------------------------------------ 19 4.9 Presentation of results-------------------------------------------------- 20 4.10 Control of biases and errors------------------------------------------- 20 4.11 Ethical considerations-------------------------------------------------- 20 4.12 Limitation of study---------------------------------------------------- 20 Vi
Time plan------------------------------------------------------------------- 21 Budget----------------------------------------------------------------------- 22 References ----------------------------------------------------------------- 23 APPENDICES; Appendix I; Letter seeking authority to conduct research. ------------- 25 Appendix II; Consent form--------------------------------------------------- 26 Appendix III; Questionnaire-------------------------------------------------- 27 Appendix IV; Letter to ethical committee---------------------------------- 37 Vll
OPERATION DEFINITION Developing world - Countries which haven't advanced much in terms of industries and machine power and have low gross domestic per capita. Lifestyle - This refers to the way people live either as a community or as an individual in terms of personal or community hygiene, habits, behaviour, social values, attitudes and activities or practices. The way that people live has significant impact on health. Risky lifestyle therefore would include for example excessive drug use and abuse during pregnancy. Preterm labor - This is labor which occurs before 36 weeks of gestation are over either spontaneously or induced. Small for Gestation Age - This refers to an infant who is born after the due date (36 weeks) but height and weight are below expected range. Vlll
LIST OF ABBREVIATIONS C.B D - Central Business District H.I.V- Human Immuno deficiency Virus I.Q - Intellectual Quotient I.U.G.R - Intra Uterine Growth retardation L.B.W - Low Birth Weight N.G.O - Non Governmental Organization S.G. A -Small for Gestation Age S.P.S.S - Statistical Package for Social Sciences S.T.I - Sexually Transmitted Diseases TORCHESA - Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex, Syphilis and Aids UN - United Nations UNICEF - United Nations Children's Fund. WHO - World Health Organization IX
EXECUTIVE SUMMARY Low birth weight (L.B.W) continues to be a major public health concern. This is because L.B.W children are placed at risk for neuro-sensory, developmental, physical and psychological problem. Much of the L.B.W infants are due to preterm labor or Intra Uterine Growth Retardation! Restriction (I.UG.R) or a combination of both. This study therefore aims at establishing the factors contributing to L.B. W In women of reproductive age in Mathare slums, and to secondarily offer recommendations on how to reduce the prevalence of L.B.W. The study area is Mathare slums, located to the North Western side, about 10km from the Central Business District (C.B.D) Nairobi. Mathare has a population of about 500,000 Inhabitants. The study subjects will be mothers with infants (0-2 yrs) who were born with L.B.W. A total of 198 subjects will be selected using purposive sampling method. This is a casual comparative study where data will be collected by use of Self-administered questionnaire. Five Batchelor of science in nursing students (BScN) will be used as research assistants who will be trained on implementation of the tool. The BScN will be guided by six Mathare slum residents. Bar graphs, pie charts, chi-squares T-Test will be used during data analysis and presentation. Pre-testing of the study tool will be done in Mukuru Kwa Njenga slums to ensure the clarity of the questions. The study will take an average of six months with a projected total budget of Kshs. 277,343.00. x