RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.

NAME OF THE CANDIDATE

Mrs. BLESSY VARGHESE

AND ADDRESS

GOUTHAM COLLEGE OF NURSING,

MANJUNATHANAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE-10.

2.

NAME OF THE INSTITUTION

GOUTHAM COLLEGE OF NURSING,

MANJUNATHANAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE-10.

3.

COURSE OF THE STUDY AND

M.Sc. NURSING I YEAR

SUBJECT

OBSTETRICS AND GYNAECOLOGICAL

4.

DATE OF ADMISSION TO THE

NURSING
05.06.2008

5.

COURSE
TITLE OF THE TOPIC

A STUDY TO ASSESS THE

EFFECTIVENESS OF GINGER TEA ON
REDUCTION OF MORNING SICKNESS
AMONG FIRST TRIMESTER PRIMI
ANTENATAL MOTHERS IN SELECTED
AREAS,BANGALORE.

6
6.1

BRIEF RESUME OF THE INTENDED WORK:

NEED FOR THE STUDY:

Pregnancy is a long and very special journey for a women .Its a wonderful
experience yet it is associated with some minor disorders as nausea and vomiting,
heart burn , constipation , cramps, back ache, varicose veins , ankle edema.1
According to WHO, in World the total fertility rate was 2.7 and total fertility
rate in India was 3.1 in the year 2000-2005.2 According to UNICEF data ,in India the
antenatal care coverage percentage in the year 2005-2006 was 74% and 47% of birth
attended by skilled health personnel.3 According to Census of India, in Karnataka
female population constitutes 49.11% of total population and the total fertility rate is
2.2.4
Among all the minor discomforts associated with pregnancy a very common
experience shared by pregnant women all over the world is morning sickness, a
normal psychological phenomenon not an illness but a part of being healthy. 5
Nausea and vomiting specially in the morning, soon after getting out of bed are
usually common in primigravida. They usually appear following first and second
missed period and subside by the end of first trimester.6
Hyperemesis gravidarum is the severe type of vomiting of pregnancy which
has got deleterious effect on the health of the mother and/or incapacitates her in day
to day activities. It affects 1 in 1000 pregnancies or 0.5-2%.7 70-80% of pregnant
women will endure nausea symptoms and 40-50% will experience vomiting.
Although 20% of women will experience morning sickness for a longer period of
time and 2% of these will suffer until baby is finally born. 5 The incidence seems to
higher among teenagers, women over age 35,women who are obese, non smokers or
women with multiple pregnancies.8

Some researchers consider morning sickness to be normal because growing

placenta produce estrogen which can heighten a womans sense of smell and cause
nausea. If a placenta is not producing estrogen it means that there may be a problem
with pregnancy. Others suggested morning sickness may also be exerting a
protective mechanism by making a pregnant women shy away from foods that may

be unhealthy for her fetus.9

A cross sectional comparative study was done to examine perceived stress,
social support, maternal psychological adaptation among 150 pregnant women with
different severities as mild, moderate, severe of nausea and vomiting of pregnancy.
The findings revealed that pregnant women with mild nausea vomiting had
significantly lower stress than did pregnant women with severe nausea and
vomiting. Social support and maternal adaptation were not different but the severity
was associated with fear of helplessness and loss of control.10
A study was conducted among 160 women who provided daily recordings of
pregnancy duration, severity of nausea and vomiting. The findings were that 74% of
women reported nausea lasting a mean of 36.4 days. Morning sickness occurred in
only 1.8% of women whereas 80% reported nausea lasting for all day. Only 50% of
women were relieved by 14 weeks of gestation and 90% had relief by week
22.Researcher suggested a larger study is needed in clinical trial.11
A study was conducted to assess nausea vomiting of pregnancy among 363
pregnant women. Results were that 28% experience nausea only while 52% nausea
and vomiting. The mean number of days from last menstrual period to onset and
cessation was 39 and 84 respectively. The mean total number of hours of nausea per
pregnancy in those 292 women experiencing symptoms was 56 with peak symptom
occurring in 9th week. Researcher concluded a detailed study is needed to know the
etiology of nausea.12

Management includes reassurance, dietary modifications, pharmacological

therapy for patient with persistent symptoms and complementary alternative
treatment as psychotherapy , herbal remedies, acupressure .13
Ginger is used in more ways than any other spices . The derived products are
such as ginger powder, syrup ginger, volatile oil. The chemistry of component which
contributes aroma and pungency that characterize ginger is reviewed. Areas where

more research is needed are functional ,physiological ,toxicological properties in use

of ginger.14
A clinical trial study conducted among 70 antenatal women who were
experiencing severe nausea and vomiting during pregnancy were randomly assigned
to take capsules 250mg of ginger four times a day or a placebo. Compared to
controls women who took ginger for 4 days reported significant improvement in
nausea at the level of p<0.014and fewer episodes of vomiting at the level of
p<0.021.Although results were good but researcher suggest a larger study is needed
to determine safety of ginger during pregnancy.15
The researcher has observed during her clinical posting that morning
sickness is one of the main health problems which affect all pregnant women. As
conventional antiemetics are burdened with potential of teratogenic effects during
embryogenesis period of pregnancy. Researchers felt that there is a need of
intervention in this field in order to support pregnant mother so that she can enjoy
her pregnancy. Ginger tea is one of the herbal remedy used in the treatment of
nausea and vomiting but as there is need for further study in that area, the
investigator is interested to conduct an experimental study by using ginger tea with
an aim to reduce nausea and vomiting.

6.2

REVIEW OF LITERATURE:
Review of literature is an integral component of research process. It
enhances the depth of knowledge and inspires a clear insight into crux of problem. It
help the researcher to know what data are available to narrow the problem itself as
well as the technique that might be used.16
Review of literature for this study is divided under following headings:
A) Studies related to morning sickness
4

B) Studies related to management of morning sickness

C) Studies related to use of ginger in reducing nausea and vomiting
A) Studies related to morning sickness
A study was conducted using questionnaire was administered to 102
pregnant women in the first 12 weeks of pregnancy in an effort to see which factor is
co-related with nausea and vomiting. Findings showed that nausea ,vomiting
correlated with unsuitable diet with big and rare meals, poor communication with
husband, poor communication with obstetrician, stress doubts and inadequate
information about pregnancy and childbirth.17
A study was conducted to find out aversive stimuli that are related to nausea
vomiting in pregnancy among 273 women in an antenatal setting. Data was collected
by using nausea and vomiting in pregnancy instrument: General Health
Questionnaire (GHQ).Results stated that total of 5% women reported that an
aversive stimulus was olfaction, with 72% reported food smells. A number of
women were affected by the odour of drinks 26% and other products
31%.Researcher concluded odour appears to be an important stimulus related to
pregnancy nausea vomiting.18

A study was conducted to investigate association between depression and

anxiety early in pregnancy and nausea and vomiting. Anxiety and depression scores
of 230 women were investigated by using Hospital Anxiety And Depression Scale.
Nausea and vomiting of pregnancy were scored by using Rhodes System. Results
shown a significant correlation between Rhodes score and anxiety at the level of
r=0.388,p<0.001 and depression score at the level of r=0.331,p<0.001was found
Gestational age showed inverse correlation with anxiety score at the level of
p=0.019.The conclusion was that there is an association

between anxiety and

depression early in pregnancy and severity of NVP.19

B) Studies related to management of morning sickness
A study was done to assess obstetrician-gynecologists treatment of nausea
and vomiting of pregnancy and to compare it with recommendations in American
College Of Obstetrician and Gynecologists (ACOG) bulletin. A questionnaire was
mailed to 1075 ACOG fellows who constitute Collaboratory Ambulatory Research
Network. The result was most frequently recommended treatment for patient with
moderate to severe nausea were eat frequent, small meals 93%,snack on soda
crackers 68.5%and take vitamin B6 plus doxylamine 67.18%.Respondents who read
the bulletin were more likely to prescribe vitamin B6 84% vs.73.8%,p=0.005 and
vitamin B6 plus doxylamine 70.9% vs.59.3%,p=0.009.The conclusion was that
obstetrician gynecologist treatment and prescribing practices generally follow
ACOG recommendations.20
A study was conducted to examine the use of Complementary and
Alternative Medicine (CAM) among 70 women suffering from nausea vomiting
during pregnancy. Samples were asked to fill a questionnaire which includes
demographic data as well as use of CAM. Results were 61% reported using
acupressure,21% of those reported using CAM, 8% their physician or pharmacist
and 71% discussed the usage with family, friends other health professionals.21
A study was conducted to evaluate the effectiveness of low level nerve
stimulation therapy over the volar aspect of wrist at the P6 point to treat nausea and
vomiting in early pregnancy. Pregnant volunteers n=230 with mild to severe nausea
vomiting between 6 and 12 weeks gestation participated in a 21 days trial. The
outcome was measured by Rhodes Index of Nausea, Vomiting, and Retching.
Pretreatment Rhodes index scores for entire population demonstrated no significant
difference between study and control group. The time averaged change in Rhodes
index total experience of 6.48 for the study group was better than control value of

4.6 at the level of p=.02.Researcher concluded that nerve stimulation therapy is

effective in reducing nausea vomiting in the first trimester of pregnancy.22
C) Studies related to use of ginger in reduction of nausea and vomiting
A study was conducted to evaluate the effectiveness of ginger extract on
symptoms of morning sickness among 120 women who were less than 20 weeks
pregnant in a double blind randomized placebo controlled trial. They received
125mg of ginger extract or placebo four times per day for four days. The result was
that the nausea experience score was significantly less for ginger extract group
relative to placebo after the first day of treatment and this difference was observed
for every treatment.23
A study to examine the effect of 1.05g of ginger or 75mg of vitamin B6 per
day were compared using randomized double blind design among 291 South
Australian women less than 16 weeks pregnant. Women took either treatment daily
for 3 weeks. Results shown ginger was equivalent to vitamin B6 in reducing nausea
at the level of mean difference 0.2; 90% confidence interval CI-0.3,0.8,retching at
the level of mean difference=0.3, 90% CI-0.0,0.6 and vomiting at the level of mean
difference 0.5, 90% CI=0.0.0.9.Researchers concluded that ginger is as effective as
vitamin B6 in controlling nausea vomiting and dry retching in early pregnancy.24

A study was done to assess the effectiveness of ginger as an antiemetic in

nausea vomiting induced by chemotherapy. Patients were randomly assigned to
receive one of the three antiemetics; ginger, metaclopromide and ondasterone.
Results were complete control of nausea was achieved in 62% of patients on ginger,
58%with metaclopromide and 86% with ondasterone. Researchers concluded that
powdered ginger root was effective in reducing nausea and vomiting and the
antiemetic property of ginger was found to be equal of metaclopromide.25

A study was conducted to evaluate the efficacy of powdered ginger root in

the treatment of hyperemesis gravidarum among 30 women. Each women
swallowed capsules containing either 250mg ginger or lactose q.i.d during first four
days of treatment. The severity of symptoms before and after each period was
evaluated.19 women 70.4% stated preference to the period in ginger had been given
at the level of p=0.003.More objectively assessed by relief scores a significantly
greater relief of the symptoms was found after ginger treatment compared to placebo
at the level of p=0.035 ,suggesting that powdered ginger in daily dose of 1g for four
days is best in eliminating symptoms of hyperemesis gravidarum.26
6.3

STATEMENT OF THE PROBLEM :

A study to assess the effectiveness of ginger tea on reduction of morning
sickness among first trimester primi antenatal mothers in selected areas in
Bangalore.

6.4

OBJECTIVES OF THE STUDY:

1. Assess the level of morning sickness experienced by first trimester primi
antenatal mothers in pre-test scores.
2. Assess the effectiveness of ginger tea in reduction of morning sickness
among first trimester primi antenatal mothers in pre-test and post-test scores.
3. Explore the association between level of morning sickness and selected

6.5

demographic variables among first trimester primi antenatal mothers.

OPERATIONAL DEFINITION:
1. Effectiveness: In this study it refers to the extent to which ginger tea has
achieved the desired effects as measured by reduction in number of vomiting
and feeling of nausea.
2. Morning sickness: It refers to the nausea and vomiting which occurs during
first three months of pregnancy.
3. Ginger tea: Ginger tea is prepared by mixing 500mg of ginger root in a cup
of water, boil, simmer and add sugar for taste and giving it in 2 servings per
day for four days.
4. First trimester: Refers to the first three months of pregnancy i.e. period

between 1-12 weeks of pregnancy.

5. Primi antenatal mothers: Refers to all pregnant women before childbirth
and who are pregnant for the first time.
6.6

HYPOTHESIS:
H1-There will be significant reduction in the level of morning sickness in pre-test
and post-test scores among first trimester primi antenatal mothers at a level of
p<0.05.
H2-There will be significant association between level of morning sickness and
selected demographic variable among first trimester primi antenatal mothers.

6.7

DELIMITATION:
1. The study is limited to the area which is selected for the data collection.
2. The primi antenatal mothers who are in first trimester.
3. Primi antenatal mothers who are not in high risk of pregnancy.
4. The intervention is limited for 4 days only per sample.

6.8

PROJECTED OUTCOME:
1. The study may determine the effectiveness of ginger tea among first
trimester primi antenatal mothers.
2. The study would motivate and guide primi antenatal mothers in coping up

7.

with morning sickness.

MATERIALS AND METHODS:

7.1

SOURCE OF DATA

First trimester primi antenatal mothers from

selected areas, Bangalore.

7.2.1

INCLUSION AND EXCLUSION CRITERIA:

INCLUSION CRITERIA

1. Primi antenatal mothers who are in first

trimester.
2. Primi antenatal mothers who have
nausea and vomiting.
3. Primi antenatal mothers who are willing
to participate in the study.

EXCLUSION CRITERIA

1. Primi antenatal mothers who are not

available during data collection
2. Primi antenatal mothers who are having
other obstetric problems.

7.2.2

RESEARCH DESIGN:

One group Pre-test Post-test design, PreExperimental

design

to

measure

the

effectiveness of Ginger tea.

7.2.3

VARIABLE:
DEPENDENT VARIABLE

Morning sickness among first trimester

primi antenatal mothers.

7.2.4

INDEPENDENT VARIABLE

Ginger tea

ATTRIBUTE VARIABLE

Age, socioeconomic status ,education, etc

SETTING

Study will be conducted in selected areas in

Bangalore.

7.2.5

SAMPLING TECHNIQUE:

The

investigator

will

use

purposive

sampling technique for the study.

7.2.6

SAMPLE SIZE:

A total of 30 primi antenatal mothers in the

10

7.2.7

first trimester.
1. Demographic Performa of primi first

TOOL FOR THE RESEARCH :

trimester antenatal mothers

2. Rhodes Index of Nausea, Vomiting And
Retching.
Its a standardized self administered tool
which contain 8 items and is a total
symptom experience scale.
7.2.8

COLLECTION OF DATA:

A prior formal permission will be obtained

from the concerned authority. The purpose
of the study will be explained and an
informed consent will be obtained from the
subject. The researcher will administer the
questionnaire to assess the demographic
variables and Rhodes index of nausea
vomiting and retching questionnaire to
assess the degree of morning sickness in the
pre- test. Then ginger tea prepared by using
500mg of ginger root will be given two
times a day for four days and then post test
score will be assessed using the same tool.
Proposed study duration is 30 days.

7.2.9

METHOD OF DATA ANALYSIS The investigator will analyze the data

AND PRESENTATION:

obtained by using descriptive and inferential

statistics. The plan of data analysis will be
as follows:
1. Organize the data in a master sheet and
computer
2. Frequencies and percentages for the
analysis of background data.

11

3. Paired t values to determine the

significance
4. Chi-square

test

to

determine

the

association
7.3

DOES THESTUDY REQUIRE ANY INVESTIGATION OR INTERVENTION

TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR
ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY?
Yes, the study will be conducted to assess the effectiveness of ginger tea among first
trimester primi antenatal mothers in selected areas Bangalore.

7.4

HAS

ETHICAL

CLEARANCE

BEEN

OBTAINED

FROM

YOUR

INSTITUTION IN CASE OF 7.3?

Yes, informed consent will be obtained from the institution authorities and subject.
Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the
8.

study will be maintained with honesty and impartiality.

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livingstone:2000.p-13,203-5
2. Reproductive and health indicator database; Monitoring and evaluation:
Family planning and fertility
http://www.who.int/reproductive_indicators/countrydata.asp?page=106
3. Statistics by country/India
http://www.unicef.org/infobycountry/india_statistics.html
4. Demographic data http://en.wikipedia.org/wiki/karnataka#demographics
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Available from www.solresource.com
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agency.2006. p-102-156
7. Pilliteri Adele. Maternal and child health nursing care of childbearing and
childrearing family.3rd ed. Lipincott Williams and Wikins; 1992. p-233
8. Baby

centre

medical

advisory

12

board.2005;

Available

from

www.babypartners.com
9. Mary Ann Lie Bert. Alternative and Complementary Therapies, leading
publisher in biotechnology, June 2001;7(3):125-8
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health .2007Jan-feb;52(1):e1-7
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prospective study of its frequency, intensity and patterns of change. Amj
.Obset. Gynecol 2000 Apr;182(4):131-7
12. Gadsby R, Barnie-Adsherd AM, Jaqqer C.A prospective study of nausea and
vomiting during pregnancy.Br.J.Gen.Pract.1993 Jun;43(371):245-8
13. Quinla JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician
2003Jul;68(1):121-8
14. Govindrajan V S. Ginger chemistry, technology and quality evaluation part2.Crit.Rev.Food.Soci.Nutr.1982;17(3):189-258
15. T Vutyavanich, T Kraisarian, R Ruangsri. Ginger for nausea and vomiting in
pregnancy. Obset Gynecol 2001;(97):577-82
16. Polit D F, Hungler B P..Nursing Research: Principles and methods.6 th
ed.Philadelphia:Lippincott1999; p.79
17. Iatrakin S M,G G Sakellaropopular. Vomiting and nausea in first 12 weeks of
pregnancy. First department of obg. 1988;49:22-24
18. Swallow B L S, Lindon ,Murray D. Journal of obstetrics & gynecology .vol
25:p-544-49
19. Koken G, Yilmarker M, Cosar E Sahin. J.psychom obset gynecol 2008
Jun;29(2):91-95
20. Millingan, Power M.L, Schulkin J. Managing nausea and vomiting of
pregnancy. American College of ObstetricGynecologists.J. Reprod. med.
2007 Oct ;5:2(10):922-28
21. Georgousis A, Smith M ,Boon H. Use of CAM by women suffering from
nausea and vomiting during pregnancy.2002 May;17;2:5
22. Rosen T, DE Veriana, Miller H.S, Steward L, Rebarber A, Soltnick RN.A

13

randomized controlled trial of nerve stimulation on relief of nausea and

vomiting in pregnancy. Obset Gynecol 2003 Jul;102(1):p-129-135
23. Willets, Ekangi K E, Eden J A .Effect of ginger extract on pregnancy induced
nausea. Obset Gynaec 2003;43:139-144
24. Smith C, Crowther C, Wilson K et .A randomized controlled trial of ginger
to treat nausea vomiting in pregnancy Obset Gynecol 2004;103:639-45
25. Sontakke S, ThawaniV, Naik M S .Ginger as an antiemetics in nausea and
vomiting by chemotherapy: A randomized cross over ,double blind study
.Indian journal of pharmacology .2003;35: 32-36
26. Fischer Rasmussen, Kager S K, Dahi C, Asping U. Ginger: hyperemesis
gravidarum .Eur J.Obset Gynecol Repro.Biol 1991 Jan;38(1):19-24

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