MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES SCHOOL OF NURSING RESEARCH PROPOSAL TITLE

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING

RESEARCH PROPOSAL
TITLE: ASSOCIATION BETWEEN DEMOGRAPHIC CHARACTERISTICS OF MOTHERS AND PREVALENCE OF EXCLUSIVE BREAST FEEDING AT MBAGALA HOSPITAL
NAME: ISAKA HAROUN MLIMBO
REG NO: 20115-04-08723
PROGRAM: BACHELOR OF SCIENCE IN NURSING
SUPERVISOR: JUDITH SHAYO
COURSE COORDINATOR: DR. LILIAN MSELLE

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TABLE OF CONTENTS

TITLE i
CHAPTER ONE: INTRODUCTION iii
1.1. Background iii
1.2. Problem statement iv
1.3. Research goal v
1.4. OBJECTIVES v
1.4.1. Specific objectives v
1.5. Research questions v
1.6. Hypotheses vi
1.7. Conceptual frame work vi
1.7.1. Description of the conceptual framework of the study vii
CHAPTER TWO: LITERATURE REVIEW viii
2.1. Overview of exclusive breastfeeding (EBF). viii
2.1. Relationship between demographic characteristics and the prevalence of EBF viii
CHAPTER THREE: METHODOLOGY x
3.1. Study design x
3.2. Study site x
3.3. Study setting x
3.4. Target population x
3.5. Study population x
3.5.1. Inclusion criteria xi
3.5.2. Exclusion criteria xi

CHAPTER ONE: INTRODUCTION
1.1. Background
Exclusive breastfeeding (EBF) means that the infant receives only breast milk for the first six months of life after birth(Joshi et al., 2014). To ensure successfully EBF for 6months ,WHO and UNICEF recommend initiation of breast feeding within first hour of life ,infant receive only breast milk, whenever a child want day and night and no use of bottles (Sonko & Worku, 2015).

It is one among global known and effective method for preventing infant mortality. Optimum breastfeeding practices can prevent 1.4 million deaths among under five children per year (Mekuria & Edris, 2015). In developing EBF prevent 11.6 % of all under-five deaths (Maonga, Msuya, & Damian, 2016). EBF also have great nutritional and psychological values, breast milk contains antibodies that help protect the baby against many common childhood diseases.

Globally prevalence of EBF is 35% (Maonga et al., 2016).Studies show that it varies from place to place. The prevalence of EBF in Mirzapur 36% was lower than the national figure (Bangladesh) 64% (Joshi et al., 2014).

In Africa the prevalence of EBF also varies from one population to another, a cross-sectional study conducted in Northwest Ethiopia revealed that prevalence of EBF was 68.5% (Mekuria & Edris, 2015),while South-East Nigeria 33.5% despite the fact that the level of knowledge was 82% and awareness of 95.3% .This means that there are other factors that affect EBF. In sub Saharan Africa ranges between 22 and 33 % from population to population and the prevalence of EBF in developing countries is 50% (Maonga et al., 2016).

In East Africa also it varies from one country to another, also varies within a nation. In Tanzania prevalence was found to be lower than the national prevalence in a study conducted in Muheza District Tanga where the prevalence EBF was 24.1% which was lower than the national level which was( 50%) (Maonga et al., 2016)

Despite the efforts that have been done but the prevalence of EBF is below the EBF prevalence of 90% recommended by the WHO. Variation of prevalence in different settings is one of the challenges and also several studies show that women’s have knowledge on practice of EBF ,but the prevalence have not reached to 90%.this implies that in order to reach the target ,more studies should be done so as to know several factors associated with EBF. Programs aimed to promote EBF must not rely on one factor, but rather should consider many factors.

1.2. Problem statement
In spite of the several efforts done to promote exclusive breastfeeding, the practice is not widespread in the world. Globally the prevalence of EBF is35%,in Tanzania 51%of children were breastfed within the first hour of life but (59%) children under six months are exclusively breastfed according to TDHS of 2015-2016.WHO recommended coverage of 90%) has not reached and the national target coverage (80%) (Maonga et al., 2016; Survey, Survey, ; Findings, 2015).

Suboptimal EBF is responsible for several effects such as malnutrition, increased risk of respiratory infection, and increased infant mortality and morbidity(Ali ; Ayed, 2014; Joshi et al., 2014; Maonga et al., 2016). Due to malnutrition increases a child’s risk of dying from many diseases most prominently measles, pneumonia, and diarrhea which are the highest cause (70%) of neonatal deaths (Onah, Ignatius, Osuorah, Ebenebe, & Ezechukwu, 2014).

Several studies suggested ways of promoting EBF practices which involve antennal care and post natal care education on the benefit of EBF, government must guarantee that workplace is free of harassment and discrimination against women who prefer to breastfeed their babies through appropriate mechanisms and employers, promotion programs must that take into consideration the ecological setting, extending maternity leave to six months for all working mothers could promote exclusive breastfeeding for six months.
Several studies show that mothers have knowledge but knowledge is not translated into practice, leading to sub-optimal breastfeeding practices which implies that there may be other factors that might affect EBF, There is limited information in Tanzania on factors influencing EBF apart from information specific for HIV positive women, so it is very important to conduct this study in Tanzania so as to know the effect demographic factors on the prevalence of EBF practices and to compare the prevalence with the nation prevalence, this will be helpful in promoting EBF.

1.3. Research goal
To promote exclusive breast feeding and reducing infant mortality rate.

1.4. OBJECTIVES
To describe the association between demographic characteristics and the prevalence of exclusive breast feeding before March 2019.

1.4.1. Specific objectives
1. To determine the relationship between maternal age and the prevalence of EBF.
2. To determine the relationship between employment or occupation and the prevalence of EBF.
3. To determine the effect of marital status on the prevalence of EBF.
4. To determine the effect of parity on the prevalence of EBF.

1.5. Research questions
1. Is there any relationship between maternal age and prevalence of EBF?
2. Is there any relationship between prevalence of EBF and employment status or occupation?
3. Is there any relationship between marital status and prevalence of EBF?
4. is there any relationship between parity and prevalence?

1.6. Hypotheses
1. Women who are unemployed are less likely to stop breastfeeding early when compared with women working as administrators and in manual jobs.
2. Single mothers are less likely to breastfeed sufficiently and longer due to absence of partners’ support and confidence compared with married mothers.
3. Primaparous women are more likely to desire or plan to breast feed than multiparous women.

1.7. Conceptual frame work
This conceptual framework has been constructed with reference to different literatures that describe the factors affecting prevalence of EBF practices.

1.7.1. Description of the conceptual framework of the study
The figure above shows both dependent and independent variables of the study.The dependent variable is the prevalence of EBF Practices. The independent variables are Demographic factors such as maternal age, occupation, employment, marital status, parity and level of education. Therefore, the independent variables have a direct influence on the dependent variable, where they can affect the prevalence in negative way or positive way.

CHAPTER TWO: LITERATURE REVIEW
2.1. Overview of exclusive breastfeeding (EBF).
EBF relates with demographic characteristics such maternal age, occupation, employment, marital status and parity, this results to variation of the prevalence of EBF from one setting to another. Awareness among health workers regarding to variations is helpful in planning better health promotion intervention.
2.1. Relationship between demographic characteristics and the prevalence of EBF
In Tanzania, a study a conducted in Muheza Tanga which involved total of 316 women with infants aged 6–12 months, participants were interviewed using a questionnaire and 12 key informants using in-depth interview guide. It was found that prevalence of EBF was 24.1% which was lower compared to the prevalence of Tanzania which was 50%.The association between advanced maternal age was statistically significant with the EBF practices (Maonga et al., 2016).
A cross sectional study which included total of 600 mothers, who have a child aged 6-12 months, attending primary health care centers within the Abha city. Their age ranged between 18 and 47 years. It was found that governmental workers had significant double probability of not practicing exclusive breast feeding as opposed to house wives. Work related problems (46.2%) is one among of the barriers for EBF.This study depicted the association between demographic characteristics such as employment status, occupation and prevalence EBF practices(Ali ; Ayed, 2014).but another study conducted among 121 mothers of infants aged 0–6 months in rural Bangladesh( Mirzapur Upazill) revealed that there is no statistical significant association between demographic characteristics of the mother and prevalence of EBF practices(Joshi et al., 2014).
A study conducted among 400 mother-infant pairs attending the infant welfare clinic of the Nnamdi Azikiwe University teaching hospital (NAUTH) in South East Nigeria data on breastfeeding were based on infant feeding practice in the previous 24 hour. It was found that Practice of EBF was ( 33.5%).Increased likelihood of EBF practice was seen in mothers who gave their infants breast milk as their first feed, while decreased likelihood of EBF practice was found among mothers of lower educational level, and higher social economic status (Onah et al., 2014).
A community based cross sectional study among 422 women with infants aged less than 6 months aimed at assessing the prevalence and predictors of exclusive breastfeeding with in the first six months of life among women in Halaby special woreda in Ethiopia. It was found that EBF prevalence was ( 70.5%),awareness about antenatal care follow up was (94.2%) ,also it was found that mothers who attended formal school showed statistically significant association with the EBF practices (Sonko ; Worku, 2015). This statistics suggest that strategies of increasing EBF practices should not only focus on improving awareness but also considering demographic characteristics especially the level of education and other factors such as employment, occupation, maternal age, parity, marital status and type of delivery.

A cross-sectional study conducted among 1000 profession professional working mothers, aged 40 or younger, who were in full-time employment and working in Kumasi metropolis of Ghana. It was found that the prevalence of EBF among professional workers was 42%, while 58% of professional women could not practice EBF according to WHO recommendations of EBF (Danso, 2014).Extending maternity leave to six months for all working mothers could promote exclusive breastfeeding for six months in professional working mothers.

CHAPTER THREE: METHODOLOGY
3.1. Study design
Study design is an overall plan for addressing a research question and for handling various challenges to the worth of the study evidence (Polit, D.,;Beck, 2014). This study will employ a descriptive cross-sectional study design involving the use of quantitative approach of data collection. This study design is suitable for this study mainly because the researcher seeks to know the relationship between demographic characteristics of mothers and prevalence o f EBF Practice at a particular point in time.

3.2. Study site
Is the overall location for research (Polit ; Beck, 2013).This study will be conducted at Mbagala hospital found in Dar es Salaam, Tanzania. The study site is selected for the study because of easiness on accessing the study participants.
3.3. Study setting
The specific location where data will be obtained (Polit, D.,;Beck, 2014).The study will be conducted at Mbagala postnatal clinic. This setting is chosen because the sample for study will be obtained from mothers with infants under 24 months who attend to that clinic.
3.4. Target population
Target population is the entire population in which the researcher is interested and to which he or she would like to generalize the results of a study (Polit, D.,;Beck, 2014). The target population of this study is all lactating women attending at Mbagala postnatal clinic.

3.5. Study population
Study population is the population from which the sample for the study is chosen (Polit ; Beck, 2013). This study will involve lactating women with children aged 0 to 24months who will be attending at Mbagala postpartum clinic. This is because under this period the maternal recall of
EBF practice is expected to be reliable and valid.

3.5.1. Inclusion criteria
These are specific characteristics that participants/subjects need to possess so as they can be qualify to be included in the research study. The population under this study will involve all lactating mothers with infants aged 0to 24months who are mentally and or physically capable and who will be attending at Mbagala postnatal clinic.
3.5.2. Exclusion criteria
These are criteria that specify characteristics that disqualify the subject to participate in the study. Participants that will be excluded from the study are: those having contraindication for breast feeding, not willing to participate and lactating mothers who will not be available at the day of data collection.

English questionnaire

1. Age_______________
2. Age of a child_______________

3. Level of education:
a) None ( )
b) Primary ( )
c) Secondary ( )
d) College ( )

4. Marital status;
a) Married.
b) Single.
c) Divorced.
d) Cohabiting.
e) Widowed.

5. Occupation;
a) Employed ( )
b) Self-employed ( )
c) Peasant ( )
d) House wife ( )
e) Student ( )
f) Others ( )

6. Type of delivery
a) SVD ( )
b) CS ( )

7. Do you breast feed your baby?
A) Yes ( )
(b) No ( )

8. Do you started to breast feed in the first hour of life?
a) Yes ( )
b) No ( )

9 Are you doing EBF?
a) Yes ( )
b) No ( )
Dodoso la Kiswahili

1. Umri wako ………….
2. Umri wa motto …………..
3. Kiwango chako cha elimu
a) Hujasoma ( )
b) Shule ya msingi ( )
c) Shule ya sekondari ( )
d) Chuo ( )

4. Hali yako ya ndoa

b )Umeolewa ( )
b) Hujaolewa ( )
c) Mmetengana ( )
d) Umefiwa ( )
e)Munaishi bila ndo

5. Kazi unayofanya
a) Umeajiriwa ( )
b) Umejiajiri ( )
c) Mkulima mdogo mdogo ( )
d) Mama wa nyumbani ( )
e) Mwanafunzi ( )
f) kazi nyingine ( )
6. Ulijifungua kwa njia gani
a) Kawaida.
b) Upasuaji.
7. Unanyonyesha mtoto wako?
a) Ndiyo ( )
b) Hapana( )
8. je uliweza kumnyonyesha mtoto ndani ya muda wa saa moja baada ya kujifungua ?
a) Ndiyo ( )
b) Hapana ( )

9.Unafanya unyonyeshaji wa maziwa ya mama pekee ?
a) Ndiyo ( )
b) Hapana ( )

REFERENCE
Ali, A., ; Ayed, N. (2014). Knowledge, attitude and practice regarding exclusive breastfeeding among mothers attending primary health care centers in Abha city, 3(11), 1355–1363. https://doi.org/10.5455/ijmsph.2014.140820141
Danso, J. (2014). Examining the Practice of Exclusive Breastfeeding among Professional Working Mothers in Kumasi Metropolis of Ghana. International Journal of Nursing, 1(1), 11–24. Retrieved from www.aripd.org/ijn
Joshi, P. C., Angdembe, M. R., Das, S. K., Ahmed, S., Syed, A., Faruque, G., ; Ahmed, T. (2014). Prevalence of exclusive breastfeeding and associated factors among mothers in rural Bangladesh?: a cross-sectional study, 9(1), 1–8. https://doi.org/10.1186/1746-4358-9-7
Maonga, A. R., Msuya, S. E., ; Damian, D. J. (2016). Factors Affecting Exclusive Breastfeeding among Women in Muheza District Tanga Northeastern Tanzania?: A Mixed Method Community Based Study. Maternal and Child Health Journal, 20(1), 77–87. https://doi.org/10.1007/s10995-015-1805-z
Mekuria, G., ; Edris, M. (2015). Exclusive breastfeeding and associated factors among mothers in Debre Markos , Northwest Ethiopia?: a cross-sectional study, 1–7. https://doi.org/10.1186/s13006-014-0027-0
Onah, S., Ignatius, D., Osuorah, C., Ebenebe, J., ; Ezechukwu, C. (2014). Infant feeding practices and maternal socio-demographic factors that Ali, A., ; Ayed, N. (2014). Knowledge, attitude and practice regarding exclusive breastfeeding among mothers attending primary health care centers in Abha city, 3(11), 1355–1363. https://doi.org/10.5455/ijmsph.2014.140820141
Danso, J. (2014). Examining the Practice of Exclusive Breastfeeding among Professional Working Mothers in Kumasi Metropolis of Ghana. International Journal of Nursing, 1(1), 11–24. Retrieved from www.aripd.org/ijn
Joshi, P. C., Angdembe, M. R., Das, S. K., Ahmed, S., Syed, A., Faruque, G., ; Ahmed, T. (2014). Prevalence of exclusive breastfeeding and associated factors among mothers in rural Bangladesh?: a cross-sectional study, 9(1), 1–8. https://doi.org/10.1186/1746-4358-9-7
Maonga, A. R., Msuya, S. E., ; Damian, D. J. (2016). Factors Affecting Exclusive Breastfeeding among Women in Muheza District Tanga Northeastern Tanzania?: A Mixed Method Community Based Study. Maternal and Child Health Journal, 20(1), 77–87. https://doi.org/10.1007/s10995-015-1805-z
Mekuria, G., ; Edris, M. (2015). Exclusive breastfeeding and associated factors among mothers in Debre Markos , Northwest Ethiopia?: a cross-sectional study, 1–7. https://doi.org/10.1186/s13006-014-0027-0
Onah, S., Ignatius, D., Osuorah, C., Ebenebe, J., ; Ezechukwu, C. (2014). Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria?: a cross-sectional and analytical study, 9(1), 1–10.
Polit, D.,;Beck, C. . . (2014). Essentials of Nursing Research seventh edition:Appraising evidence for nursing practice. Lippincott Williams ; Wilkins.
Polit, D. F., ; Beck, C. T. (2013). Nursing Research principles and method. Nursing Research Principles and Method, 310.
Sonko, A., ; Worku, A. (2015). APrevalence and predictors of exclusive breastfeeding for the first six months of life among women in Halaba special woreda , Southern Nations , Nationalities and Peoples ‘ Region / SNNPR /, AEthiopia?: a community based cross-sectional study. Archives of Public Health, 73(1), 1–11. https://doi.org/10.1186/s13690-015-0098-4
Survey, H., Survey, M. I., & Findings, K. (2015). Tanzania. Tanzania 2015-16 Demographic and Health Survey and Malaria Indicator Survey.

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING

RESEARCH PROPOSAL
TITLE: KNOWLEDGE ON DRUG ADMINISTRATION AND DOSAGE CALCULATION AMONG UNDERGRADUATE NURSING STUDENTS AT MUHAS.
NAME: ISAKA HAROUN MLIMBO
REG NO: 20115-04-08723
PROGRAM: BACHELOR OF SCIENCE IN NURSING
SUPERVISOR: DR TECLA
COURSE COORDINATOR: DR. LILIAN MSELLE

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18 JUNE 2018

TABLE OF CONTENTS
TITLE—————————————————————————————————- —-i
CHAPTER ONE: INTRODUCTION ——————————————————————–1
1.1.Background———————————————————————————————–1
1.2. Problem statement————————————————————————————–2
1.5. Objectives—————————————————————————————— —–3
1.5.1. Broad objectives——————————————————————————– —–3
1.5.2. Specific objectives—————————————————————————– —-3
1.6. Research question————————————————————————————-4
1.7. Research hypothesis———————————————————————————–4
1.8. Conceptual framework of the study—— ———————————————————–5
1.7.1. Description of the conceptual framework of the study——————————————6
1.7.2. Independent and dependent variables———————————— ———————–6
CHAPTER TWO: LITERATURE REVIEW———————————————————-7
REFERENCES———————————————————————————————10

CHAPTER ONE: INTRODUCTION
1.1. Background
The administration of medication or drugs is a complex process that consists of participation of three professionals: physician, nurse and pharmacist (Abdullah, Mohammed, & Ismail, 2014) . Safety considerations are paramount in drug administration (Savage, 2015). Nurses common notion has been that the nurses’ involvement in medication management is quite simple: giving the Right patient the Right drug in the Right dose and Right administration form at the Right time (Feleke, Mulatu, ; Yesmaw, 2015).

It is becoming increasingly difficult to fully maintain patients’ safety during the process of drug administration (Alemu, Belachew, & Yimam, 2017).This is due drug administration errors which are caused by several factors. Drug administration errors are caused poor dosage calculation skills, administration of wrong drug, wrong route, wrong patient, inappropriate speed of administration of drugs, and wrong documentation (Feleke et al., 2015; Savage, 2015)

A systematic review on medication errors in Middle Eastern countries report revealed that incidence rates were between 11% to 90% (B. et al., 2016). Similarly in South East Asian countries revealed that the error rates were between 15.2% to 88.6% (Salmasi, Khan, Hong, Ming, & Wong, 2015) .In Indonesia incidence of medication errors were 20.4% ,Drug administration error were most frequent medication errors identified 59% where errors in documentation were the most common form of drug administra¬tion errors (Ernawati, Lee, & Hughes, 2014).this statistics prove that knowledge on drug administration is inadequate.

In Africa drug administration error have been reported in Ethiopia on a study conducted on 2014 where the incidence was 56.4 %, The majority of errors (87.5 %) was due to documentation error, (Feleke et al., 2015).

In a study conducted in Durban South Africa revealed that 24% of staff members were unable to complete all medical calculations correctly, while 44% were unable to answer three or more questions correctly (Gokhul, Jeena, & Gray, 2016). This statistics shows low knowledge on dosage calculation among staff members.

In East Africa, a study conducted in Kisii hospital showed that medication errors rate was 75.8 % (Nanyama & Pharm, 2014) the most frequent type of drug administration errors were due documentation errors 73.9 which support the finding obtained in the studies conducted in Indonesia and Ethiopia (Ernawati et al., 2014; Feleke et al., 2015; Nanyama & Pharm, 2014), This statistics suggest that knowledge drug administration is low and nurses to do not follow 10 Rights of drug administration.

In Tanzania, little is known about the level of knowledge on drug administration and dosage calculation among nurses and students because few studies were conducted .a study conducted in St.john University revealed that dose-calculation skills were inadequate in nursing staff who participated in a dosage calculation test. In an educational audit, Tanzanian nurses and nursing students also experienced difficulties with mathematically calculating medication dosages (Savage, 2015).

1.2. Problem statement
Knowledge on the administration of IV medications was average was over 50% of the nurses did not understand that the rate of slow bolus IV medication administration should be longer than one minute, and specific to the types of medications ( Shamsuddin & Shafie, 2012).

Inadequate knowledge on drug administration results to drug administration errors which are the most prevalent cause of Medication errors which is the worldwide problem. Drug administration errors accounts about 56.4 % where majority of errors 87.5 % was due to documentation error, followed by technique error 73.1 % and time error 53.6 % .Drug administration involves administering drug at the wrong time (24.0%), dosage errors (16.8%), and administering drug to the wrong patient (13.8%). (Fathi et al., 2017; Feleke et al., 2015)

Drug administration errors are among the top common causes of injuries to the hospitalized patients (Alemu et al., 2017).The significant impact of medication administration errors affect patients in terms of morbidity, mortality, adverse drug events, and increased length of hospital stay (Feleke et al., 2015).

Nurse educators should be active in identifying issues that affect patient safety, involved in monitoring and developing policies and guidelines, and be conversant with the clinical realities so that relevant issues are addressed, comprehensive total quality management programmes must and to ensure that all students who qualify to become practicing nurses are competent in drug administration and dosage calculation (Savage, 2015). Mathematical competency and dosage calculation skills play an important role in safe drug administration ,should be acquired during the school years (Özyaz?c?o?lu et al., 2018)

It is very important to conduct this study in Tanzania so as to identify the factors associated with the knowledge on drug administration and dosage calculation, and to compare them with the factors mentioned in the literature. Also many studies conducted based on the knowledge on drug calculations and few studies have been conducted in Tanzania so little is known about the knowledge of drug administration and dosage calculations.

1.4. Research goal
To reduce drug or medication administration errors and promoting patient safety.

1.5. Objectives
1.5.1. Broad objectives
The objective of this study is to determine the knowledge on drug administration and dosage calculations among undergraduate nursing students at MUHAS before March 2019.

1.5.2. Specific objectives
1. To assess the level of knowledge regarding drug administration among undergraduate nursing students at MUHAS.
2. To assess the level of knowledge regarding dosage calculations among undergraduate nursing students at MUHAS.
3. To find out the association between the year of study and the level of knowledge regarding drug administration and drug dosage calculation among undergraduate nursing student at MUHAS.

1.6. Research question
1. What do the undergraduate student nurses know about Drug administration and dosage calculations?
2. Is the any relationship between the year of study and the level of knowledge on Drug administration and Dosage calculations?

1.7. Research hypothesis
1. Undergraduate nursing students with good clinical attendance are more likely to have more knowledge on Drug administration and dosage calculation than those with poor attendance.
2. Undergraduate nursing students with more clinical experience are more likely to have more knowledge on Drug administration and dosage calculation.

1.8. Conceptual framework of the study
This conceptual framework has been constructed with reference to different literatures that describe the factors affection the knowledge on drug administration and dosage calculations.

Social demographic data

1.7.1. Description of the conceptual framework of the study
The figure above shows both dependent and independent variables of the study. The dependent variable is knowledge on drug administration and dosage calculation. The independent variables are social demographic factors and university curriculum, special training attendance, year of study, mathematical skills, and experience. Therefore, the independent variables have a direct influence on the dependent variable, whenever the social economic factors and university curriculum, special training attendance, year of study, mathematical skills, and experience are stable the level of knowledge on drug administration and dosage calculation increases. Hence Drug administration errors are reduced and patient safety is increased.

1.7.2. Independent and dependent variables
The independent variables of this study are social-economic factors such as Age, sex, marital status and other factors such as university curriculum, clinical attendance, class attendance, year of study, special training , mathematical skills, student to staff interactions, and working experience(In-service). The dependent variable of this study is the knowledge on drug administration and dosage calculations.

CHAPTER TWO: LITERATURE REVIEW
Overview
An audit educational in study of St.john University aimed at conducting an educational audit on drug dose calculation learning in a Tanzanian school of nursing. A total of 268 registered nurses and nursing students in two year groups of a nursing degree programme were the subjects for the audit; they were given a pretest, then four hours of teaching, a post-test after two weeks and a second post-test after eight weeks .it was found that there was significant improvement in the first pretest. A study revealed that dose calculations skills were in adequate among staff nurses (Savage, 2015). This suggests that knowledge on drug administration and dosage calculation is in adequate.

Knowledge on medication administration
According to a study conducted on 4 head nurses and 242 staff nurses (246 totals) in Universiti Kebangsaan Malaysia Medical Centre to determine knowledge levels of nurses with regards to preparation and administration of IV medications. It was found that Mean correct scores for knowledge among head nurses and staff nurses were 12.5 ± SD 2.1 and 10.3 ± SD 2.6 respectively ,Less than 50% of respondents obtained correct answers for calculation and dosing of IV medications (Shamsuddin & Shafie, 2012) .Indicating average knowledge drug administration.

A descriptive research study conducted at the different Critical and Intensive Care Units at El-Manila Specialty Hospitals affiliated to Cairo University , Sample consists of sixty bedside male and female nurses who are working in the different Critical and Intensive Care Units. Study aimed to assess the nurses’ knowledge and practices about administration of medications via nasogastric tube (NGT) among critically ill patients at Cairo University Hospitals. Majority of the studied sample were females, married and having diploma qualification as well, more than two third of them their age ranged between 26 – 45 years. More than half of them had more than 10 years of experience. It was found that all of them scored less than 75% which mean were having an unsatisfactory level of knowledge and practices (Abdullah et al., 2014).

Knowledge on dosage calculation
Study aimed at compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses. Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2) Underwent a multiple choice test in pharmacology, drug management and drug dose calculations. It was found that the knowledge among the nurses was found to be superior to that of the students: 68.9% and 61.5% correct answers, respectively, (p

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