Grant Proposal – Peer Reviews

PSY 625: Biological Bases of Behavior

Professor John Cosma

04/01/2018

Adolescent Pregnancy and Maternal Morbidity

Introduction

In the process of migration, the demographic and background characteristics of migrants in Bangladesh play a major role. In this research proposal, it will provide the social demographics of frequency and percent distribution, and economic characteristics of migrants before and after migration in Bangladesh. Background characteristics including age and sex of respondents, family type and size, marital status, and educational attainment of respondents before and after migration are included in social-demographic characteristics. Occupation, income food consumption, and health seeking behaviors are also included in the economic characteristics of Bangladesh.

Background

After marriage, pregnancy is accepted in our country. In many countries, such as Bangladesh, marriage is universal. Typically, in an early marriage there is an early pregnancy. Adolescent marriage can make maternal life troubling in early pregnancy. Early pregnancy can produce maternal and child death. According to the World Health Organization (2012), related to pregnancy and childbirth, approximately 800 women die from preventable causes. Countries such as Bangladesh, 99% of maternal deaths occur. Due to the high rates of early marriage and early pregnancies, countries such as Bangladesh, maternal pregnancy and maternal morbidity is slightly higher than other countries in the world. In Bangladesh, maternal morbidity is increasing due to illnesses and injuries (WHO, 2012). Health practitioners exclaims that adolescent girls are not developed enough to bear a child, which can produce maternal deaths or complications.

Justification

Statement of problem and research issue

In related to childbirth, adolescents' physical development is not fully capable to overcome health complications. For example, a mother who is petite in size and young, is more than likely to deliver a baby that is small, weak, may have possible mental delays, and chances of survival are slim to none. Birth complications, still births, and higher incident rates of low birth weights can happen to children who have adolescent mothers. The percentage of underweight children is about 41.5% of births in Bangladesh. Due to adolescent pregnancy, there is a good number of maternal mortality. According to WHO (2012), women living in Bangladesh, the surrounding rural areas, and poor developing communities, have a higher maternal mortality due to morbidity. It is argued that in young adolescent births, there are higher risks of complications and death than older women who conceive. Maternal mortality is unacceptably high around the world. Around the world, more than 800 women experience death from pregnancy and or child-related birth complications. According to BBS (2007), approximately, 728,000 women died during pregnancy and childbirth and after. In Bangladesh, all deaths occurred due to morbidity and in low-resource settings. In rural areas of Bangladesh, adolescent marriages greatly exist. According to BBS (2007), "adolescent girls age 15 through 19 are twice as likely to die during pregnancy and child births over the age of 20; Girls under the age of 15 are five times likely to die during pregnancy." Infants that have adolescent mothers are at an increased risk for death in maternal mortality. Infants that have adolescent mothers are more likely to die before their first birthday than infants who have older and more developed mothers. Influenced by early pregnancy from an early marriage, maternal morbidity is a crucial topic.

Literature Review

For the objective to be achieved, the comprehensive literature review gives an overview on adolescent pregnancy and its influence on maternal morbidity. The reviews are discussed below.

Ahmed (2003) argued that shat most women had complications in consulted untrained service providers. Consulted village practitioners had a percentage of 41%, homeopaths 11%, and to Kabiraj and other healers 6%, help from medically trained personnel 34%, and those that didn’t seek any care had a percentage of 19%. Positively associated with women's age, education, and many other determining factors, were the use of medical facilities obstetric complications.

Rehaman (2001) argued that in Bangladesh, it is considered unacceptable for maternal morbidity. Than that of male counterparts, in general there is a higher prevalence of morbidity among women. Morbidity can happen because of early age pregnancy. Than that of younger adolescents, older women suffered less from maternal morbidity.

Sarkar (2007) argued that in Bangladesh due to various factors, early marriage is a complex issue. Leading to many children, it was found that early marriage produces an early pregnancy. Women that were not mature or educated, did not prepare for pregnancy and was not aware. As a result of women being uneducated and unaware of the various factors of early pregnancy, women and children's lives can be in danger.

Possible Findings

Results of the Research include:

· Poorness of individuals who live in rural areas can cause adolescent marriage. Being poor can cause early pregnancy.

· Adolescent marriage and early pregnancy can make a young girls' life unsafe and insecure.

· Due to adolescent pregnancy, a vast majority of mothers and daughters in Bangladesh suffer.

· Children's health is poor due to the impact of pregnancy.

· By early pregnancy, mothers and children died.

· Development is a great problem; however, it increases the population.

Possible Impacts of Findings

The problem of assessing causes and impacts of adolescent marriages and adolescent pregnancy, can be resolved by the implications of new policies that can be helpful to the development of children. Policy makers and the government, can make decisions that will affect adolescent pregnancy on maternal morbidity. By the government helping to create new decisions on this matter, it can help the country of Bangladesh develop.

Study Goals

Views of increasing and accelerating the understanding of maternal health of adolescent mothers will be conducting in the study. Complications due to early pregnancy from early marriage, increases the chances of maternal and child morbidity. Adolescent mothers who fall into this health-related complication will also increase maternal and child mortality. The impact of adolescent marriage on maternal morbidity, strongly correlates between adolescent pregnancy and maternal morbidity.

Objectives

· In rural areas, knowing the causes of adolescent marriages.

· Identifying maternal child morbidity and child mortality due to the impact of adolescent pregnancy.

Research Questions

· What are the causes of young adolescent girls in rural areas to get married?

· What are the effects of maternal morbidity and mortality in adolescent pregnancy?

Research Gap

Using cross-sectional data, a vast number of valuable studies of adolescent pregnancy have been done in the outside of Bangladesh. The studies that have been done based on adolescent pregnancy and maternal morbidity presents evidence on trends and relationships. However, the impact on adolescent pregnancy on maternal health have produced studies on the comprehensive picture. None of the studies have identify causes of early marriage. The research of the study will identify the issues.

Limitations of the Research

Given the research, the study will be conducted by a cross-sectional study. The important limitations of the research include: Outcomes on the self-reporting of respondents, social desirability, and recall biases.

Concept Variables and Levels of Measurement

Methodology

Study Design: After reviewing literature, a cross-sectional study design was constructed to collect data based on conceptual framework.

Study Area and Population: The selection of a study area can be difficult. Of any study, the accomplishment depends upon the selection of the area of study. In Sylhet district's sadar pourashava, the area of study was selected as number 3, 5, 6, and 8 because.....

· In Bangladesh, it represents activities of adolescent marriage prevalence.

· High maternal morbidity and death rate.

· All the research requirements can be fulfilled.

· Easy access to collected information.

Conceptualization and Conceptual Framework

Types of research and research strategies: Quantitative Strategy is used for the research problems associated in the study. Testing the existing theory in the epistemological and ontological positions is the use of quantitative strategy. However, the study rejects interpretivism and objectivism. For example, from the proposed research question listed "What are the causes of young adolescent girls in rural areas to get married?" Indicates the interpretive issues that social reality is influenced by social action.

Research Design: Experimental Design is fitting of the research problem. There are limited resources in the design in which two groups cannot be selected in the experiment. Time and money are the essentials needed for the experimental design of the cross-sectional experiment.

Sampling Strategy : Probability sampling used for young adolescent girls are not possible. The Bangladesh country is very conservative. People in Bangladesh would prefer not to share personal information or personal issues. Given the information about Bangladesh and its residence, a non-probability sampling strategy and specifically convivence sampling would be used. From the randomly assigned population, it can be difficult to gain information. However, an available person's interview could be more convenient. This process could be easier because it can save time and money.

Sample Size

Data Collection: For this research, primary and secondary data were collected. Simultaneously, data collection and analysis will occur. Systematic actions were taken to carry out the research. The actions included: Collection of the information, and data analysis and interpretation. Primary and secondary data have different steps, which are included below.

Primary Data Source- With the structured questionnaire, primary data will be collected from the field survey.

Data Type- Quantitative

Instrument- Intruments such as a recorder, pen, pencil, questionnaire, and camera will be used.

Tools and Techniques- The instruments listed above will be used for collecting data. For this research, a structural questionnaire will be used. The exploratory inquiry involved with the research topic will be used during the interview and the tools will be used to collect data in the study.

Secondary Data Source

Secondary data will include: The Bangladesh Bureau of Statistics, Bangladesh demographic health survey, official reports, and books, newspaper, national and international journals.

Data Entry, Data analysis plan and preparation for analysis

Using SPSS database, the completion of editing and recording data are entered. To prepare the data for final analysis, rearranging the data, collapsing the data, creating variables, scaling of variables, merging categories with their frequency are conducted. The analysis was done in three ways by using the statistical software SPSS and MS Excel. These three ways include:

· Univariate Analysis- In both tabular and graphical form, frequency of distribution percentage of both dependent and independent variables was represented. Background, socio-economic status, and social contacts of respondents, were shown in the univariate analysis.

· Bivariate Analysis- Independent and dependent variables were observed in the bivariate analysis. In the study, the variables used were categorical. With chi-square test, cross tabulation is conducted.

· Multivariate Analysis- To find out the impact of forces for migration, logistic models were fitted for dependent variables and multiple cross tabulations.

Hypothesis

· In the place of origin and Dhaka, there is a difference between incomes.

· In the place of origin and Dhaka, there is a difference between employment facilities.

· In the place of origin and Dhaka, there is a difference between educational facilities.

· Before and after migration, there is a difference between the family size of migrants.

· There are relationships between migration and possession of assets.

· Before and after migration, there is a difference between food consumption by the migrants.

· There is an association between the levels of education and income.

· There is an association between income and the wealth of the family.

· There is an association between income and food consumption.

· There is an association between family size and the wealth of the family

Budget

Appendix A: Budget

SUMMARY PROPOSAL BUDGET FOR INSTITUTION USE ONLY

ORGANIZATION

      PROPOSAL NO. DURATION (MONTHS)

PRINCIPAL INVESTIGATOR (PI)/PROJECT DIRECTOR

Instructor B. Jones, PhD AWARD NO.

A. PERSONNEL: PI/PD, Co-PIs, Faculty, Graduate Assistants, etc. Funds

List each separately with name and title. Requested By

Proposer

1. Instructor B. Jones, PhD ($50,000/year) - 10% effort for 12 months $5,000

2. Research Assistant (RA) - 50% effort for 12 months $60,000

TOTAL SALARIES $65,000

B. EQUIPMENT (LIST ITEM AND DOLLAR AMOUNT FOR EACH ITEM EXCEEDING $5,000.)

None

TOTAL EQUIPMENT $5,000

C. TRAVEL 1. DOMESTIC - PI attendance at national meeting $2,000

2. OTHER - Travel for RA to participants home $4,000

TOTALTRAVEL $4,000

D. PARTICIPANT SUPPORT $1,000

1. STIPENDS $ 75

2. TRAVEL $ 2,000

3. SUBSISTENCE      

4. OTHER      

TOTAL NUMBER OF PARTICIPANTS (25) TOTAL PARTICIPANT COSTS $3,075

E. OTHER DIRECT COSTS

1. MATERIALS AND SUPPLIES- Computer for patient training, data collection and analysis $4000

2. OTHER Quality of Life scale $2000

3 OTHER Office supplies $533

4. OTHER            

TOTAL OTHER DIRECT COSTS $6533

F. TOTAL DIRECT COSTS (A THROUGH E) $83608

G. TOTAL INDIRECT COSTS (F&A) (Rate = 37.5%) $2229.55

H. TOTAL DIRECT AND INDIRECT COSTS (F + G) $85837.55

References

· Ahmed, M.S. 2003. Intimate partner violence against women: Experience from a woman-focused development programme in Matlab, Bangladesh. Journal of Health, Population and Nutrition 23(1): 95- 101.

· Bangladesh Bureau of Statistics (BBS) and UNICEF. 2007. Multiple Indicators Cluster Survey Bangladesh 2006, Key findings. Dhaka, Bangladesh: BBS and UNICEF.