Indications for caesarean sections at lira regional referral hospital

By
Okello David Livingstone
Reg. Number

Supervisors
Prof. J. Ogwal Okeng
Lira University

Dr. N. Okello
Faculty of Health Sciences Lira University

A Research Proposal Submitted to the Faculty of Health Sciences Lira University in

Partial Fulfilment of the Requirements for the Award of a Bachelor of Science in
Midwifery of Lira University

September, 2015
 CHAPTER ONE: INTRODUCTION
1.1 Background
The background of a research proposal must demonstrate that the student is aware of the
historical evolution and theoretical developments of the study area/topic. The section start by
highlighting the problem under study, Then researcher presents the magnitude/situation/picture
of the problem globally (worldwide), continentally, regionally, nationally and locally/within the
study area (if possible). This section presents the rationale providing evidence and conditions of
the existing situation to make the reader feel the urgency of the problem and the need to study it
in order to solve it or contribute to its solution.

1.2 Statement of the problem

The statement of the problem is the backbone of the research and must indicate the urgency why
the candidate should conduct the study. Four basic qualities of the research problem need to be
emphasised namely: researchable, theoretically or practically significant (should contribute to the
improvement of knowledge), clear and ethical. The statement of the problem must clearly define
the variable(s) and show the relationships / issue(s) that will be investigated. Statistical
information or citations from known authorities should be presented in a brief, specific and
concise manner. Such facts may be used to highlight the magnitude or extent of the problem.
Major previous researches undertaken on the subject should be cited (where applicable in case of
theoretical problems). This will enable the candidate to indicate the gaps in the knowledge and
justify the need for the proposed study.

In summary the statement of the problem has four major parts:

i. What is the problem?
ii. What is the magnitude of the problem?
iii. What have others done in an attempt to solve the problem?
iv. The existing gap (s)?
v. What the current study is going to do to address the gap (s)?
1.3 Objectives,
1.3.1 General/main objective:
The main objective or purpose of the study spells out what the researcher intends to do. This is
usually related to the title of the study (title reframed).
For example: to describe, to determine, to examine, to assess, to explore and others.
1.3.2 Specific objectives:
The specific objectives are a breakdown of the general objective or purpose of the study,
respectively. Specific objectives should spell out the relationship between variables to be
investigated. (2 TO 4 SPECIFIC OBJECTIVES)
MUST BE SMART (SPECIFIC, MEASUREABLE, ACHIEVABLE, REALISTIC AND
TIME BOUND)

1.4 Research questions OR hypothesis

NB: THE SPECIFIC OBJECTIVES SHOULD BE CONVERTED INTO EITHER
HYPOTHESES OR RESEARCH QUESTIONS
1.4.1 Research Questions: refer to questions which a researcher would like to be answered by
undertaking the study.

1.4.2 Hypothesis: A hypothesis is a statement of the predicted outcome. As a guide, qualitative

studies shall not be required to state the hypotheses.
NB. There are usually null (H0) & alternative hypotheses (Ha).
Example: H0 =Smoking does not cause lung cancer
Ha = Smoking causes lung cancer
1.5 Scope of the study (geographical, time and content scope)
The scope provides for the boundary or limits of the research in terms of geographical area and
time span and content (i.e. independent and dependent variables to be investigated).
1.6 Significance of the study
The significance of the study states the relevance/contribution/benefits of the study in terms of
academic contributions and practical use that might be made of the findings to the
organization/sector in which the researcher is based and to the public at large. The researcher
must inform the reader the reasons why and how s/he thinks the findings might change policies,
 theory or practice. In short, s/he should indicate who will benefit from the findings of the study
and how.
1.8 Theoretical/conceptual framework
A conceptual framework is diagrammatic representation of the researcher’s own position on the
problem and gives direction to the study. It may be an adaptation of a model used in a previous
study, with modifications to suit the inquiry. It shows the relationships among the different
variables that s/he wants to investigate. Arrows are used to show the linkages, which can be one
way or two ways. The student must clearly operationalise all the study variables. Take the
example below:

A CONCEPTUAL FRAME WORK SHOWING INDICATIONS FOR CEASAREAN

SECTION
Obstetric factors
- Referral status
- Parity
- ANC booking status
-Use of Oxytocin
- IV fluid administration
- Prolonged labour

Maternal factors during

Demographic factors
labour
Age
Baby size
Marital status
Prolonged starvation
Education level
Ingestion of herbal CAESAREAN SECTION
medicine
Fevers

Figure 1. Conceptual framework

C
1.9 Operational definitions.
The key concepts to be used in the study have to be clearly defined. The definitions shall be
operational and not dictionary definitions.
 CHAPTER TWO: LITERATURE REVIEW

A literature review is an account of what has been published on a topic by accredited scholars
and researchers. It presents a survey and discussion of the literature in a given area of study. It is
a concise overview of what has been studied, argued and established about a topic, and it is
usually organized either chronologically or thematically. This section should enable participants
demonstrate skills in two areas namely (1) information seeking: the ability to scan the literature
efficiently, using manual or computerized methods, to identify a set of useful articles and books
and (2) critical appraisal: the ability to apply principles of analyses and value judgement to
identify unbiased and valid studies on a problem under investigation, and be able to detect and
present the research gaps in a scholarly way.
A literature review must:
1. be organized around objectives, themes or concepts related to the study.
2. synthesize results into a summary of what is and is not known.
3. identify areas of controversy and gaps in the literature.
4. formulate questions that need further research.
Summary of the literature review
The candidate should identify the key lessons learnt from the literature review. The major trends,
and most importantly the gaps that have been identified in the literature which the study intends
to address have to be highlighted.
 CHAPTER THREE: METHODOLOGY
3.1 Study design
This subsection describes the plan/pattern, which the research intends to follow e.g. whether it is
longitudinal or cross-sectional, descriptive, explanatory or experimental, case study, cohort
(retrospective or prospective), etc. The choice can be either qualitative or quantitative or a mixed
methods approach and whatever choice is made must be explained and justified.

3.2 Study site & setting

Here the researcher mentions the place (s) /study area(s) / study site (s) and equally indicate the
direction/location with a known nearby reference point/location, activities in the place,
population, etc (study setting). Example: this study will be conducted at Amach Health centre
sIV (site), Erute Health Sub-district. This health centre is 16 kilometres south of Lira town,
serving a population of about 100,000 people (majorly the Langi), having, an average of 50
inpatients and 200 out-patients daily, etc (setting).

3.3 Study populations

This is the description of the participants/objects/elements from which samples will be
drawn. The target population is the entire population in which the researcher is interested
and to which s/he would like to generalise the results of the study. Whereas the accessible
population is the population of participants/subjects/elements available for a particular
study: often a non-random subset of the target population. The study participants/subjects
are part of the accessible population that have been selected and consented to participate
in the study. All categories of the likely population to be studied must be presented and
their numbers appropriately given. Example of a study population can be pregnant
mothers accessing delivery services at lira hospital.
3.4 Study procedure
This requires the researcher give a detail description on the procedures that will be followed in
the data collection exercise. This involves stating clearly how the research assistant(s) is/are
going to be recruited and trained, and interviews will be conducted. How samples are going to be
collected, transported and how the laboratory experiment are going to be performed, etc. Where
applicable, you need to state how you are going to conduct the pilot study or pretesting the study
tool (e.g. the questionnaire)

3.5 Sample size determination

This is the description of how the number of participants/elements to be studied will be
computed. The sample size determination will be dictated by the nature of the study-(qualitative
and/or quantitative study), and the degree of generalisation expected. As a guide, the sample size
of 30 or less is appropriate for qualitative studies. However, for quantitative studies, the sample
size should exceed 30 participants.
NB: i. There are different approaches recommended for sample size determination and students
must justifiably select the most appropriate approaches without reproducing approaches that
other students have previously used.
ii. The sample size is usually determined mathematically/using a formula.
Example: 1. Estimating a population proportion (p): Suppose we want to conduct a survey to
determine the prevalence (p) of a relatively common disease in a community

Where: n = is the estimated sample size, z 1-α is the appropriate cut-off point on the standard
normal distribution. (For example, for 95% confidence, z1-a = 1.96.), p = the anticipated
prevalence or proportion, δ = the percentage precision (e.g. 5% precision = 10% width of
interval)
3.6 Sampling techniques
This sub-section describes in detail the sampling techniques that will be used in selecting the
sample to be studied e.g. probability or non-probability based sampling.
Probability based sampling includes simple random, systematic random, stratified, random,
cluster, etc, Non-probability sampling includes purposive, maximum variation, homogenous,
snow ball, quota, convenient or accidental, etc.
The choice of which sampling strategy to use is influenced by the approach (qualitative or
quantitative) pointed out under the research design. If the approach is qualitative, the non-
random sampling strategies are used. If the approach is quantitative, the sampling strategies are
random sampling techniques. If the approach is a mixed methods approach, both random and
non-random sampling strategies are used.

3.7 Eligibility criteria (inclusion & exclusion)

3.7.1 Inclusion criteria: All individuals who are within the target population and meet the
selection/inclusion condition (s) for the study. They should be able to give informed consent (by
the parent if is below 18 years/minor)
3.7.2 Exclusion criteria: All individuals who meet the inclusion criteria but because of one
reason or another cannot participate in the study. Example failure to consent, too sick,
communication barrier, etc.
3.8 Data management
3.8.1 Data collection method and instrument
This includes the specific techniques to be used in the collection of data. Methods could include
face-to-face interview, key informants interview, focus group discussion (FGD), survey,
observation, documentary review, etc. It also describes the instrumentation to be used e.g.
interview guide, questionnaire, key informants’ guides, group discussion topics, observation
checklists, etc.
3.8.2 Data entry & cleaning
State the statistical software on which the researcher is going to use to enter/capture and clean
the data collected/generated from the laboratory. The cleaning involves checking for correctness
of entered data (spellings, incomplete information, etc). This may include EpiInfo, SPSS, Stata,
Microsoft Office Excel*, OpenEpi, Epidata.
NB: *Excel cannot be used for cleaning the data on it own.
3.8.3. a Data analysis
It indicates statistical tests that will be carried out and how the resulting information will be used
for the research report. Where both qualitative and quantitative data is expected, the student
should describe in a detailed way how both qualitative and quantitative data will be analysed.
3.8.3. b Measurement of variables (quantitative studies)
Measurements, which refer to the formulae or scales to be used in the study, have to be described
by the students.
3.9 Quality control (validity & reliability)
Data quality control, which refers to reliability and validity of instruments have to be precisely
described. Reliability refers to the degree of consistency or accuracy with which an instrument
measures the attributes it is designed to measure while validity the degree to which an
instruments measures what is intended to measure. These will reinforce the findings and ensure
that the wider scientific community will accept the hypothesis.
For example, there must have been randomization of the sample groups and appropriate care and
diligence shown in the allocation of controls. Internal validity dictates how an experimental
design is structured and encompasses all of the steps of the scientific research method. Even if
your results are great, a sloppy and inconsistent design will compromise your integrity in the
eyes of the scientific community. Internal validity and reliability are at the core of any
experimental design. Internal validity and reliability are ensured through piloting before the
actual data collection. Piloting is encouraged as the pilot findings may enable the
researcher/student to re-design the research instruments to improve the reliability and the validity
of data.

3.10 Ethical considerations

3.10.1 Approval: state which Institutional Review Committee, IRB (Research Ethic Committee,
REC) that is going to review and approve the research proposal
3.10.2 Consent: state how and from who, the informed consent will be obtained
3.10.3 Privacy protection: state how the researcher is going to ensure the privacy of the study
participants during and after the study period.
2.10.4 Confidentiality: state how the researcher is going to protect the information provided by
the study participants from being accessed by an unauthorised person (s) during and after the
study period.
3.11 Study limitations
These are anticipated hindrance (s) to the research process which is (are) may affect it
negatively.

REFERENCES
This is a list of all works cited in the proposal and should be written according to the Vancouver
format (for medicine/medical courses). Software such as EndNotes, Zetero, etc, is usually used
to ease this process.

APPENDICES
Appendix 1: Questionnaire (Mandatory where applicable).
Appendix 2: Interview Schedule (Mandatory where applicable)
Appendix 3: Focus-group Guide (Mandatory where applicable)
Appendix 4: Observation checklist (Mandatory where applicable)
Appendix 5: Documentary Analysis Guide (Mandatory where applicable)
Appendix 6: Work plan and Timeframe (Optional)
This is the schedule or timetable of activities and the period in which the research is to be
conducted with due regard to budgetary limitations. It could be presented in a tabular form
indicating activity, duration and dates. However, it is preferably presented state how the
researcher is going to ensure the privacy of the study participants during and after the study
period. on a Gantt Chart.

Activity Duration Dates

(days/weeks/months
)

Appendix 7: Budget (Optional)

A budget for conducting the study should be included at the end of the proposal. The budget
consists of the amount of activities and items that are necessary to carry out the research. This is
optional for the Masters proposal because UMI does not fund student research. However, where
a student is to indicate it, it shows the financial plan and financial resources needed for the
implementation of the research. It should be clear and reasonable (affordable) and preferably
activity-based. It should be itemized according to an acceptable format (e.g. of the funder). For
the Masters proposal the following format is acceptable.

Item Quantity Unit Cost Total Cost

Subsistence Allowance
Honorarium
Travel (Vehicle Hire)
Data Analysis (use of analytical computer software
e.g. SPSS)
Secretarial Services (Processing the research
instruments and reports)
Photocopying
Report Production (Printing and Binding)
Other Expenses (Specify)